Post-traumatic stress disorder has jettisoned its way to the forefront of firefighter health and wellness in recent years. It is a problem that hits home for a substantial populous of the United States Fire Service, and for good reason. According to the Firefighter Behavioral Health Alliance (2016), PTSD and its underlying consequences have taken the lives of at least 131 firefighters and EMS workers in 2016 alone (Dill, 2016), and that’s only in the United States. This figure sadly includes my senior man and partner of the last 5 years.
The fire service as a whole has done an exceptional job of identifying and educating its membership of the problem, but the time has come to look inward. We must ask ourselves an even more taxing question. Are we responsible for creating and perpetuating the growing epidemic of PTSD and suicide in the fire service?
This question takes its’ roots in the ever developing process of fire service recruitment. Nationwide we dangle before aspiring professionals the bounty of solid pay, great benefits, and an overall culture of camaraderie and family. We sell the position of firefighter from the same platform as white collar business and industry, and we veil our sales pitch behind the shroud of our pop culture image, one that perpetually emphasizes the miracle save and the happy ending, the affluent and beautiful world of the Hollywood fire service where everyone goes home safe and suffering only last for 30-90 minutes (with commercials). Are we selling our future recruits a lie?
The truth is the members of the fire service live in a dark and complex world, one tucked away beneath the surface, where the majority of society will never venture to look. It’s not just the gore and the death; but the abuse, the poverty, and the barrage of sickness, pain, and suffering that will span nearly a lifetime; or at the very least a 20-30 year career.
We Are The Sin Eaters
We as firefighters are the ‘Sin-Eaters,’ tasked with stepping beyond the light of the world into the dark corners where few people choose (or even know) to look. We do this by choice, each and every one of us, and we bear the responsibility of what we see, hear, and smell. We do this, willingly, because as firefighters the public has entrusted us to be strong, calculated, and decisive where others can not because in doing so we ever so often have the opportunity to do something truly remarkable…save a life.
The most important takeaway of this concept is that we do this by choice. We expose ourselves by choice. However, in failing to paint an adequate picture of what we do for our future recruits, we have taken away from them the opportunity to look inward, and to truly ask themselves if they are prepared for what we are tasked with doing. How can we expect to mitigate the problem of PTSD and suicide in the fire service if we first fail to prepare those we recruit for the realities of what we do in the first place?
The first step in combating PTSD in the fire service is to ensure we take on the responsibility of recruiting those who are mentally prepared and discouraging those who are not. If we continue to fail in this respect, the responsibility of their disease or their death rests squarely at our feet, because we are the ones who brought them in under false pretense. The dark side of the fire service should be no less transparent in fire department recruitment, than the fact that we run into burning buildings.
After The Pitch
It is critical that the recruitment process be retooled in order for PTSD in the fire service to truly be mitigated, but it must also extend beyond recruiting, and into employment. The fire service as a whole is exemplar in educating its membership as to the existence of, and subsequent consequences of PTSD and psychological disorders. However, dissemination without resolution can manifest into a dangerous and detrimental environment.
In the age of digital information and social media, it is nearly impossible as a firefighter to log onto a
computer or smartphone without finding an email, memo, or social media post highlighting the prevalence of psychological distress within the fire service. Often these posts showcase a growing list of our brothers and sisters who have committed suicide or fallen victim to the grips of depression, anxiety, and substance abuse.
True to our nature as servicemen, we are quick to spread the word of this growing epidemic in our field. We are even quicker to honor those who have fallen. However, we are failing as an organization to reach beyond education, awareness, and mitigation to the real solution, prevention. Quite the opposite, we are (in fact) promoting the growth of the very problem we are trying so desperately to prevent.
We hire new members to carry on our profession and craft, and we have a responsibility to correct the massive misconceptions we have allowed to infiltrate the hiring and training process. Members are recruited under a false pretense of the mental stamina required of our position and subsequently saturated with education and information pertaining to PTSD, substance abuse, and suicide. Consequently, future generations of firefighters are taught to believe that the behaviors exhibited by those suffering from mental distress are the expected behaviors of persons in their position. This may very well be contributing to the 63% increase in reported firefighter suicides in the United States since 2012.
By over saturating our membership with information pertaining to this grave problem we are forcing them to ask the question “Is this how I’m supposed to feel?” Inevitably a portion of our members will manifest the ‘expected’ response. They will begin to believe that they are expected to be haunted by the things we do, see, hear, and experience because we as an organization have conditioned them to believe this response is ‘the norm”.
One of the greatest points of pride for firemen is the ability to handle an infinite number of situations that the general public could never even begin to imagine. We take great pride in the responsibility of being asked to mitigate any situation that our crews are tasked with resolving, and doing so in a manner that is calm, calculated, and professional. This is one of the greatest traditions carried on the backs of firefighters for centuries, the ability to show up and help where no one else can. It is the very essence of why firefighters have been held in such high regard since the inception of the fire service. However, we have an obligation to maintain this image in the public eye, and we have an obligation to staff our departments and apparatus with members who are prepared to be mentally strong when others can not. We as firefighters hold greater respect and dignity in the public eye than nearly any profession on earth, and the reason is simple, we are there when you need us. It is time for the fire service to move beyond education of PTSD and psychological wellness in the fire service, and to shift its focus towards preventative measures that begin at the recruitment process and build from a foundation of personnel who are prepared for the task that lies before them, who are prepared to show up and perform, fully aware that no one else is coming if we fail.
In 2014 while speaking to the concept of post-traumatic stress growth General James Norman Mattis stated that “while victimhood in America is exalted, I do not think that our veterans should join those ranks” (Mattis, 2014). I think the same should be true of nations firefighters. If we continue to tell our members that they are somehow damaged by what we do, it is only a matter of time before they come to believe this is true. However if we empower them with a sense of pride to be strong and courageous when others cannot, we will bread future generations of firefighters whom will rise to the call to serve their fellow man selflessly and without question, who will wear their battle scars with pride, as they tell a story of a life dedicated to the service of others.
This is our call to action for the fire service. We are not damaged, but rather forged in the fires of our craft to be stronger and more resilient than ever before, because we as firemen are called upon to exhibit this strength unwaveringly.
Mattis, James N. General “General Mattis on PTG.” YouTube. YouTube, 06 Jan. 2017. Web. 06 Feb. 2017.
Dill, Jeff, Captain. “What Are These Numbers? « Firefighter Behavioral Health Alliance.” What Are These
February 4, 2017
Numbers? « Firefighter Behavioral Health Alliance. Firefighter Behavioral Health Alliance, 01 Jan. 2017. Web.
06 Feb. 2017.
Post Traumatic Stress Disorder (PTSD) in Firefighters is becoming a hot topic in the fire service. It’s not a difficult idea to wrap your head around, we all know it’s a constant struggle for some of our brothers and sisters. Managing the raw mortality of the general public is not for the faint of heart. Our experiences with risk, death, trauma, and merely bearing witness to the personal tragedies of others is just another Wednesday at the office. The first responder (Police, Fire, EMS) job experience cannot be matched in procedure, process, or practice in any other profession.
Firefighting began with neighbors helping neighbors, entire communities banding together for collective survival in bucket brigades and it has morphed into a massive complex industrial entity, quilted together in inconsistencies. The idea of neighbors helping neighbors remains the same, but the process has changed dramatically. Instead of entire communities standing up to shoulder the load, a select few are standing up, swearing-in, and accepting the life of experiencing all the tragedies and miracles for the sake of others. “So others may live.”
For the last ten years, there has been extensive research into military combat-related PTSD; it’s the majority of research that currently exists with PTSD. What doesn’t exist is extensive research into the propensity and prevalence of PTSD in Firefighters. In every instance of trying to understand firefighter PTSD the only example that can be referenced is combat and war, however, the comparison is not apples to apples. Firefighter PTSD can not and should not be compared to what soldiers experience in combat.
Combat-related PTSD occurs because of what soldiers experience and the tasks that he/she performs while they are deployed. The symptoms of combat-related PTSD generally surface when the soldier attempts to reintegrate into society. In short, a soldier leaves the safety of home, inserts into a combat zone; experiences and/or does awful things for a defined term of time (deployment); the soldier returns home and tries to carry on as if nothing happened. No other profession can compare or match the reality of taking another person’s life in combat while accepting the feeling of being hunted or targeted for death.
In a differing experience, Firefighters are nearly always and fairly consistently on the verge of experiencing, if not in the middle of mitigating, a traumatic event (whether there own or witnessing others). Firefighters live in society, and there is no reintegration unless you attempt to measure it after every shift. The exposure to traumatic incidents is spread across years and even decades, over one’s career.
For the first responder, the consistent exposure to traumatic events becomes a way of life. It’s that reality that begs the question; are firefighters ever “post” trauma?
Sure, there is a moment when the traumatic incident ends, followed by an inconsistent amount of unmeasurable time until there is another traumatic experience which will have its own “post” block of time. The repeated exposure to traumatic events creates layers of exposure like an onion, one layer on top of another. You may remember one specific traumatic incident for the rest of or life; it may be an awful memory, but it doesn’t always give you PTSD symptoms. It’s not fully known WHY some people get PTSD and others don’t. Again, PTSD isn’t about what’s wrong with you; it’s about what happened to you and how you’re able to process it. Clearly, we’re all different.
To complicate matters, after a while, all the traumatic experiences start to become relative to one another. The worst call you’ve ever experienced will always stick out until it is matched or topped by another call, leaving lesser, moderately traumatic situations to feel not so bad, because you’ve had worse. If you took the average resident of your community and had them bear witness to a traumatic car accident, that event is likely to be more traumatizing to them, because you’ve been exposed to worse or similar incidents.
As you can probably conclude, it’s not entirely simple to break down the prevalence of PTSD in Firefighters. There are several types of firefighters. Career, volunteer, wildland, airport, industrial, federal, shipboard, and more. Each segment of our profession has vastly differing experiences related to trauma. The airport firefighter could work his entire career without experiencing a traumatic event, while the career firefighter in a metropolitan environment could experience multiple traumatic experiences per week for an entire career.
To make things even more complex, volunteer firefighters in rural areas may experience a fair amount of traumatic experiences related to people they know personally, as opposed strangers, which adds another barrier to research. To further complicate the volunteer research challenge, volunteers lack the PTSD protective factors (social support, kitchen table discussions, access to EAP) available to career firefighters. Volunteers who respond to a traumatic event and then return home to their family brings it’s own dynamic that has the potential for marriage and family implications.
If you’ve made it this far, you might be feeling that you’re completely fine, as if nothing could possibly affect you, and you could be right. However, desensitization is the key theme here. Desensitization is the diminished emotional responsiveness to a negative or aversive stimulus after repeated exposure. This has long-term implications which could affect your social relationships outside of the fire department, including your family.
More research is needed in this area so we can begin to understand the bigger picture. With more research, we’re able to create better solutions for firefighters, their families, and the industry. Please take this short survey to help Station Pride gather the data needed to realize a global picture of the greater fire service. The more firefighters that take the survey, the clearer the picture. Please be as honest as possible.
Firefighters have been around since bucket brigades started in the 1600s, so after 400 plus years it might be a good idea to focus on how we as a society can help protect from and possibly prevent PTSD from even happening in the first place. So until that happens, I might not let this subject rest.
Why has so little research been done to gain an understanding of trauma and firefighting?
I am going to venture to think that one challenge to research could be engaging such a large population in research that will actually convey a general understanding. How can you compare volunteers to career firefighters or career firefighters to contract firefighters overseas in terms of what you see and what you deal with, you simply can’t. After that, there is a whole other layer to compare in regards to the environment the station is in, the frequency of calls and intensity of calls. We just aren’t comparing apples to apples.
I combed through articles and research where scholars are attempting to study and figure this out, but the research is extremely limited and very few studies have actually been done. Some studies lead to dead ends. However, some of the research leads to actual evidence that makes some sense and is worth investigating further.
What does the research say that is helpful?
One very interesting point stands out as I rifle through the limited research; gallows humor plays a large role in a firefighter’s ability to manage and overcome trauma. Having witnessed interactions of firefighters in day rooms, humor is intertwined into almost all conversations. There is more banter, friendly interrogations, sarcastic comments and jokes involving everyone and their mother heard between firefighters than in almost any other workplace I have stepped foot in. This banter back and forth encourages and fosters positive relationships with one another. This all relates back to one of my original proposals that protective factors are built into fire departments to protect you all from the negative effects of trauma.
To gain a better understanding of trauma in firefighters, a study was conducted on 128 firefighters in an urban environment. The research ranked coping mechanisms identified by all the firefighters in the study and “found most useful among the sample were the use of humor followed by support from coworkers, family support, exercise, and kitchen table discussion at the firehouse.” (1).
The form of humor that has been most effective in coping with trauma is gallows humor. Gallows humor can be best defined as “dark humor or crass joking. It is humor that treats serious, frightening, or painful subject matter in a light or satirical way, and is used in response to incidents that elicit an emotional response from firefighters or would elicit an emotional response from the average bystander” (1). This is where you find ways to use humor when dealing with an intense or horrible situation because it helps to do three things: offset the stress that you feel, distance yourself from the reality of a traumatic call and it increases camaraderie in the station.
What role does the fire department play?
Not all negative responses to trauma can be avoided through humor and other protective factors. The fact is, you all are dealing with some of the most critical and gruesome moments in a person’s life. Your response can be the difference between a person living and dying. Whether or not you did all you could, there will be times that you don’t immediately bounce back from an incident.
Before assuming a horrifying incident is to blame for experiencing symptoms of PTSD, there are other aspects to also consider. It would be important for leadership within fire departments to first look at the organizational structure of the department to determine if it is playing a negative role. Increased work tension or stress within the organizational makeup of a fire station can be detrimental to firefighters and other emergency service personnel. In a research study published in 2015 by Josh Rinker (2), it was identified that “the day-to-day functioning of fire and EMS companies can contribute to poor mental health functioning if the resources available do not correspond with the needs of their staff.” (2) If the day-to-day is not functioning efficiently or effectively, it could increase the risk for mental health issues to arise for firefighters.
It would be interesting if Rinker’s 2015 conclusions lead to new studies that were conducted in well-functioning fire departments compared to those where firefighters are overworked, underpaid and had lower morale. Would we see that stations with better morale and more team camaraderie have fewer issues related to mental health than those that have poor morale and where firefighters or working in less than ideal conditions?
So where do we go from here?
Station Pride wouldn’t be Station Pride if we didn’t find a way to tackle an issue head-on. So we turn to you for feedback in a survey. Participating in this easy and confidential survey will help us begin to lay some groundwork to figuring out how we can move forward.
Alvarado, G. E. (2013). Gallows Humor as a Resiliency Factor Among Urban Firefighters with Specific Implications on Prevalence Rates of PTSD. Azusa: Azusa Pacific University.
Rinker, J. (2015). The relationship between emotional intelligence and Firefighters and Emergency Medical Personnel. Chicago: ProQuest Dissertations & Theses Global.
You’ve likely seen the compelling artwork, created by Artist and Firefighter Paramedic (FF/P) Daniel Sundahl, popping up in your Facebook newsfeed, Instagram, and relevant articles over the last year or more. Sundahl’s images convey a strong visual message highlighting the individual conflicts faced by emergency responders as they serve the needs of humanity. When the chaos of a bloody scene has settled or when the fire has been extinguished, responders are often left to wrestle with their own thoughts and feelings in
private moments of deep reflection. Every minute of every day, emergency responders around the world respond to and mitigate emergency situations based in the intense reality of raw mortality.
In his new book, Portraits of an Emergency, FF/P Daniel Sundahl has found an artistic way of depicting these powerful moments of reflection allowing other responders to connect and communicate their mental and emotion challenges, as well as providing outsiders the opportunity to begin to understand the inner struggle of their public servants.
While making your way through the book, you immediately begin to feel the soul of the artist, and if you’re a responder, you suddenly find yourself identifying with the images and their accompanying stories. The artistic renderings of photos taken by Sundahl shine a bright ghostly light onto the moment’s that create Post Traumatic Stress Disorder in emergency responders, putting this important issue on Front Street.
In the last year or two, there has been a meaningful conversation within the fire service regarding suicide and the propensity and effects of post-traumatic stress disorder (PTSD) in first responders. Daniel Sundahl puts himself out on the forefront of creating PTSD awareness industry-wide by capturing his own struggles and confidently breaking macho stereotypes. Portraits of an Emergency is a powerful walk through Sundahl’s own difficult realization of PTSD and his answer for how to face it and heal.
By sharing his artwork with the emergency service community, Sundahl is giving himself an outlet that helps him reconcile his internal conflicts with PTSD while providing thought-provoking images for emergency responders to reflect on their own mental and emotional well-being.
Portraits of an Emergency is a must have for every firehouse dayroom, EMS station break room, 911 dispatch center restroom, or police station ready room. Aside from raising the level of awareness concerning PTSD among first responders, the book provides emergency service leaders, company officers, and chiefs a casual, edgy, ice-breaker to approaching the topic of PTSD with their workforce.
We all know firefighters, and first responders don’t enjoy discussing their possible weaknesses. PTSD can be a scary and uncertain disorder. Firefighters and emergency workers will often hide their symptoms fearing for their career or harbor the idea of becoming an outcast among their peers for being weak or unstable. It’s imperative for first responders to realize that PTSD isn’t about what’s wrong with them, it’s about what happened to them, Sundahl’s images highlight that sentiment exactly. The photo renderings in Portraits of an Emergency helps to start the conversation and allow Chief’s and leaders to provide avenues for assistance. Part of Sundahl’s purpose for this book, which is a first of it’s kind, is to help prevent firefighter and emergency responder suicides. It’s an important issue in our career field and often addressed passively.
As first responders, we often live our lives wondering if we’ve made enough of an impact or if we’ve made a difference. Firefighter Paramedic Daniel Sundahl doesn’t have this problem. By placing his talent and his personal struggles in the forefront of his new book, Sundahl is providing PTSD awareness with the goal of first responder suicide prevention for the benefit of us all. Daniel Sundahl with DanSun Photo Art and his first book Portraits of an Emergency is leaving his mark on the fire and emergency services. Sundahl’s photo art will likely become a powerfully poignant staple of the emergency service industry worldwide.
Order your station a copy of Portraits of an Emergency (Here)
We recently published an article that identified some of the protective factors that help reduce the risk of Post-Traumatic Stress Disorder (PTSD) in career firefighters (here) but what about the risk of PTSD with those of you that are volunteer firefighters?
The National Fire Protection Association reported that there were “approximately 1,140,750 firefighters in the U.S. in 2013. Of the total number of firefighters 354,600 (31%) were career firefighters and 786,150 (69%) were volunteer firefighters.” (NFPA, 2014).
That is a huge number of you that volunteer day in and day out to interrupt your normal life at work or home at a moment’s notice and jump at the call to help your community. How do you go from responding to a call one minute and then immediately go back to whatever it was you were doing before you raced to the fire station? Unless you found this magic on/off switch on your body somewhere, (if you did, you should patent that right away), you can’t just shut it all off and go back to your life as it was right before a difficult call.
Many small town America fire departments can sometimes barely afford the equipment you need just to function let alone fund the support you would need following a horrific call.
This one hits home for me because I can remember like it was yesterday hearing my father’s pager go off in the next room, alerting not only him but the entire family that there was a crisis in our small town that needing rescuing. I can still hear the front door slam shut and hear his footsteps pound the sidewalk as he started to run the block down the hill to the volunteer fire station. Each time that pager went off, the men that volunteered for our small town quickly tossed off their hat of being a construction worker, farmer, banker, and ran to put on a helmet and gear. You always knew that our volunteer fire department was out there saving the day when you saw all the haphazardly parked cars and trucks belonging to our firefighters scattered along the street downtown. They got to the station as fast as possibly, never knowing what crisis was awaiting them, never knowing if they were rushing to help a neighbor, a friend or even a family member.
So, you put your life on the line as a volunteer, and your community would feel your absence if you weren’t there, right? Why is there such limited information out there on how this drastically impacts your mental well-being?
It appears that there has been a total of two, that’s right two studies on the effects of trauma on volunteer firefighters. It took a grad student in Ontario, Canada to publish one of them in 2010. Brad Campbell, a Seguin Township resident, a graduate of the School of Social Work at Laurentian University, conducted a two-year study of nine volunteer firefighters to help figure out how big of a problem this really is. His thesis can’t even be found online to see what this 95-page book says because it is probably tucked away on some dusty library shelf in Ontario. The big take away from his two-year study was this: volunteer firefighting psychological trauma remains overlooked.
I don’t think that comes as a surprise to most of you. If you are interested in reading the super short article about that, you can find it here.
Sometimes it doesn’t just stop at PTSD either.
The effects of PTSD can lead to even bigger and more permanent problems, such as taking your own life.
The Firefighter Behavioral Health Alliance (FBHA) is currently tracking the number of suicides each year for all firefighters, both volunteer, and career. Last year alone there were 112 suicides. Since the FBHA started tracking this information in 2012, there has been a total of 754 suicides.
We are talking about 754 avoidable firefighter deaths. Many of these suicides could have been prevented if there was help readily available, easily accessible, and perhaps even required. You can find more of this research at FBHA.
The reality here?
A volunteer firefighter has an increased chance of struggling with PTSD. It could be assumed that the volunteer has an even greater chance than that of a career firefighter because the protective factors are not in place as they are with career firefighters.
Now imagine responding to call where a teenager has been ejected from a vehicle, you are first one scene, and the teen is a mangled corpse. You place her human remains into a body bag, finish the call, and return home to wash the blood off your clothes just in time to enjoy dinner with your family and the 6:00 news.
This scenario, which is common among volunteer firefighters, highlights the need for intervention. Encourage your volunteer fire department to take the initiative for all their members. PTSD support should be a priority for every department.
PTSD isn’t about what’s wrong with you, it’s about what happened to you.
There are resources out there for volunteers. The National Volunteer Fire Council (NVFC) has teamed up with the American Addictions Center (AAC) to offer you and your family a free and confidential helpline. You can call 1-888-731-FIRE 24 hours a day, seven days a week and 365 days a year. The person that answers the phone knows what you are going through, has been there, and has the resources to help you. You can also access more help, training, and resources for not only you but your entire department by visiting http://www.nvfc.org/.
There are a lot of you out there. Each and every one of you deserves to be taken care of just as you take care of your friends, your neighbors, members of your community, and complete strangers.
At the end of the day, this isn’t a new problem. PTSD is an issue that has existed since the dawn of firefighting and other traumatic events. The psychological impacts just haven’t been fully considered until recently. It seems; however, there is a stronger focus on career firefighters while less of an open and verbal concern for volunteers.
You answer the call to help others at a moment’s notice, and many of you may believe that since you are there to help others, you can’t reach out for help yourself. You don’t have to be a statistic; you can get the help you need. Talk to someone, talk to anyone, your life is just as valuable as the person you are rescuing when the alarm goes off.
PTSD is real, and it needs everyone’s attention.
Just mentioning the words Post Traumatic Stress Disorder or PTSD probably has you running for the hills right now but trust me, it doesn’t have to be a scary subject. Every firefighter in this world is willing to take on any risk to save another person’s life. Sometimes that risk means witnessing or engaging in a crisis that would be unthinkable for the average Joe on the street to handle. You jump in on someone’s worst day of his or her life and at times risk your life for the sake of theirs. With that said, sad to say it, but that means you have witnessed a traumatic event. When you witness a traumatic event, it puts you at risk for developing PTSD. It puts you at greater risk to develop PTSD when you continuously witness traumatic events. It probably sounds a lot like your day-to-day life as a firefighter, endlessly witnessing trauma.
There is such limited information out there to let you know what the stats say about PTSD amongst firefighters. The most consistent, predicted number out there says that about 37% of firefighters show signs or symptoms of PTSD. You would think that number would be higher since it is pretty safe to say that 100% of you witness at least one traumatic event throughout the course of your career. You’re probably laughing right now because that number is probably way higher than one.
Whether it was by choice or by chance, the way that a firehouse is set up, and the way that your schedule works is a protective factor that reduces your risk to develop PTSD. Protective factors are a fancy way of saying that there is something in place that helps you reduce the risk of developing PTSD. Psychologists, actually let’s call them head docs; they had to develop a fancy way to say it that sounded smart. It looks better in our field when we sound smart.
So let’s look at what these protective factors are and how you can rely on them to process through any traumatic event that you might come across. Because let’s face it, the next alarm that goes off could lead you right into someone’s worst day and your next call might be the one that is hard to forget. Your next call might be the one that plays over and over in your mind. Your next call might be the one that wakes you up at night in a pool of sweat. You never know what the next call is.
So what about these protective factors makes the risk of PTSD lower for firefighters? The fact that you live in the firehouse with the same people that are going through the same trauma with you, that in itself allows you to process events in a healthy way. You are side by side with the same people day in and day out, and they are someone with whom you can relate. You eat, sleep, shower, and who knows what else goes on in there but regardless, you do this with one another. If you were to experience an incident and then immediately return home to your family, it would make it harder to process it fully and effectively because they didn’t live the incident with you. The other protective factor is your schedule, as much as your wife, girlfriend, partner, might hate your schedule, it is a protective factor. When you work these long hours, it means that your support system is right there with you and that helps.
I know many of you think that you are invincible but even though you aren’t the average Joe, you still breathe and bleed just as they do. So just because these protective factors are in place, doesn’t mean you are invincible to developing PTSD. You should know the warning signs and talk to someone about it. Really quick. Here are some down and dirty signs to look for: If you are experiencing panic attacks, feeling numb towards emotions, difficulty concentrating, frequent nightmares, feeling extra stress or anxiousness, flashbacks to the event that feel real, or even memory loss, you might need to find someone to talk to about it. These are just some quick signs that should trigger you to dig a little deeper and see if everything is alright.
So turning to someone for help doesn’t mean you are weak, it means you are human. If you think things don’t feel right, you should listen to your body and talk to someone. At the end of the day, the world needs you and needs you to take care of yourself.
Who do I want to be? A question we have all asked ourselves at one point in our lives. At a very young age, I focused on playing baseball and being a firefighter like my dad. I loved baseball with a passion and grew up watching the New York Yankees with my dad as a little kid. I grew up wanting the best of both worlds, being able to play baseball for the Yankees and be a firefighter for the FDNY at the same time. I soon realized as I got older that I couldn’t have the best of both worlds. I had to come to a point in my life where I had to choose what I wanted to do with my life. At 18 years old and about to graduate high school, it’s not easy figuring out what you want to do. I was fortunate enough to have amazing parents who raised me right and taught me how to be a man of God.
I spent my whole life going to church every Sunday and even going to youth group every Wednesday night. I know in the fire service religion is a touchy subject and can cause controversy among a lot of the guys and gals at the station. Everyone has their opinion in life, and that’s what makes the power of decision-making so great, we get to choose what we want to believe in and do with our lives. Many people believe there is a God, and many people don’t. I believe there is a God, and I believe he sent his son Jesus Christ on this earth to die on the cross for our sins so that we may be forgiven. I also believe God has a plan for each of our lives and opens doors of opportunity for us each and every day. It’s up to me to have faith and trust in Him to guide me through my journey in life.
When I graduated high school, I had the choice of going to college and playing baseball, or start my career in the fire service and follow in the footsteps of my father. It wasn’t an easy choice for me; I spent many days praying and asking God what He would want me to do. That summer, I spent a lot of my time doing ride time with my father as an Explorer. One of the last fires I ran with my dad that summer was a fully involved office building that was next an abandoned warehouse. Even though it was a “surround and drown” type scenario, I knew from that moment that this is what I had a love for in my life. It’s like God set a fire in my heart, a burning passion to serve and help others in my community. From that moment on, I made it a commitment to strive and be the best firefighter/paramedic God would want me to be.
Fast forward four years later and I’m now a Firefighter/Paramedic with a great fire department, went to college to get my Associates Degree and now I’m working on earning my Bachelor’s Degree. God has provided for me in my life, and I will always be grateful for the many opportunities He has given me. At 22 years old, I am still very young and have a lot to learn and experience. There came a low point in my life, where I was angry and frustrated with how my life was turning out and I stopped putting my faith and trust in God. I started questioning myself and even wondered if this career was right for me, or if this was even the path God wanted me to go down. I lost all hope and at one point gave up. Then all of sudden God always finds a way to to give you reassurance and to tell you that He is with you and has never left you. Through friends, family, church and my amazing girlfriend, I was able to see and realize how great God is and how He had made me stronger. He restored my hope and confidence and gave me life again. I felt like a new man, and I felt a new fire restored in my heart.
Being 22 and still young, I don’t have a lot of advice or experience to give. If there’s one piece of advice I have, it’s don’t give up finding what your calling is in life. I don’t know exactly what God has planned for the rest of my future, but I do know He wants me to be the best firefighter/paramedic that I can be. He would want me to show His love to others in their time of need. For those that are still unsure what the future holds for their lives, don’t give up on searching for an answer. Even if you believe or don’t believe in God, there is a plan for your life. Someone is looking after you all the time. He loves you and cares about you, even when it seems like the rest of world is crumbling around you. He will show you the plans for your life, and He will lead you down the path that will bring joy and great success for your life.
The fire service is a very special field. Those of us that work in it know this, and those aspiring to enter the field hope to find out. I don’t think I have ever talked with a firefighter who didn’t love this job. Now, that’s not to say that there aren’t those of us who experience burnout, depression, or just a general lack of zeal from time to time. But I believe most would say they LOVED being a firefighter. I wonder how it is that we love a job so much. Especially one that can expose us to such sorrow and destruction. Since 2001, I have had that type of love for this job. I have volunteered and understand the daily struggle of those departments. And now, I am fortunate enough to make my living riding the officers seat in a fire truck. I think I know why most of us love what we do amidst all the pain, and I also believe there are ways to make it an even better profession.
If you have been in the emergency services for any length of time, you know what you can see. Make sure you are no stranger to the programs and help offered for responders who may be “at the end of their rope” or battling the numerous demons that may creep up. We are given the numbers to chaplains, peer counselors, suicide hotlines, and employee assistance programs, and yet we still find emergency services professionals coping with things like alcoholism, depression, drug use and suicide. Why?
PTSD seems to be the buzzword/acronym of the moment. According to the Mayo Clinic, Post-Traumatic Stress Disorder (PTSD) is a mental health condition that’s triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares, and severe anxiety, as well as uncontrollable thoughts about the event. To me, this definition may not fit the problem that responders are experiencing. After much reading and research, I think that responders are more than likely suffering from another condition called Combat Operational Stress (COS).
The reading list for a promotional exam I was studying included a book by Christopher Brennan called The Combat Position. This is an excellent book. I highly recommend it for any rank firefighter. This book was the first time I had seen any reference to COS, and the points the author makes seem very valid. The United States Marine Corps defines Combat stress as: sometimes called combat and operational stress or combat and operational stress reaction, is a common response to the mental and emotional effort active duty personnel exercise when facing tough and dangerous situations. In other words, PTSD is better used to describe the mental stress created by one event, where COS seems to reflect the cumulative type of stressors that first responders encounter.
The Marines go on to list some of the risk factors as:
– Sleeping less than 6-8 hours per day on average
– Witnessing death close up
– Losing a close friend or valued leader in combat or other operations
– Being physically injured, especially if seriously
– Close brushes with death, especially if the individual believed they were going to die
– Handling remains
– Being impacted by family, relationship, or other home front stressors
– Being young and inexperienced
I am in no way comparing the fire service to the Marine Corps, but I do find the risk factors for COS to be strikingly similar to the types of stressors that firefighters around the country may encounter. And we need to be aware of the dangers of these common stressors.
It seems clear that the fire service is made up of mostly “type A” personalities. We don’t show weakness or ask for help easily. I believe that could be the reason for the following statistic.
“Firefighter Suicides by year.”
And these numbers continue to climb as we move past 2012. One hundred and four firefighters committed suicide in 2014. We as a service should be truly shocked at these numbers. We are losing almost, and sometimes more, firefighters to suicide than we are Line of Duty Deaths. All of these “type A’s” who have dedicated their lives, and well being to making sure the people they serve stay alive, are not taking care of themselves. We don’t reach out; we bury our feelings and continue to go fix other people’s problems. WHY?
Recently my “area” has experienced the suicides of four members of the emergency services community. These have included firefighters, fire officers, and paramedics working for three different services. Receiving the news always has the same effect on my mind. It is a crushing feeling, and my thoughts seem to progress like this. Why? But he/she had so much going for them. They always seemed ok. Is there anything I could have done for them to change what they did? And it is in these times that we tend to focus on those around us. We ask members of our crew “Are you doing OK?”, “Do you need to talk about anything?”, and a genuine sense of caring arises out of such tragedy.
In the opening paragraph of this article, I spoke about the love of the job, even through the bad things we see. We love this job because we find an enormous sense of pride knowing that we have an “extended family” that will be there for us whenever we are in need. We love this job because it gives us the opportunity to be a part of something much bigger than ourselves. We love this job because we build relationships that are closer than some siblings; we always call it “Brotherhood.” We love this job because we love each other. We don’t hesitate to ask for help to fix a roof, pour concrete, work on a car, or build something. But we need to make this “Brotherhood” stronger. We have to find ways to combat our people feeling like they have nowhere to turn. Let’s put down macho-ism. Let’s put away the fear of being mocked. Let’s be the family that we can be. Talk to each other, and truly get to know each other. All of us should have at least that one person that we can talk to; at least one person that understands you. The only hurdle to jump is to trust these “brothers” and “sisters” and be willing to talk to them.
Station-Pride author James Cook wrote an article titled “Ghosts”. If you haven’t read it, please do. I have provided a link for your viewing enjoyment at the bottom. This article is one that most of us can relate to, and may be a source of comfort for some.
I would like to share a personal experience in closing that relates to my “ghosts” and those brothers of mine that helped me through my rough time.
Sleep wasn’t coming easily. A recurring dream was keeping me awake. A vivid dream that seemed to be set on repeat, and I was getting fed up with it. My family could tell that I was distant, but it comes with the territory sometimes, right? I had been to all the classes. I was up to date on how to recognize if the guys I was working with were “too stressed out” and I was willing to help should they need me. I knew that I needed more sleep, and I knew that recurring dreams could be a symptom of stress, but I was way too tough and smart for that. I was sitting in a class with several of my peers, two of whom were sitting in front of me were good friends of mine. During a break, I asked them both this question: “What do you guys know about sleep patterns?” One of them was very knowledgeable and began to tell me all about fatigue, and its effects on the body. When he finished talking, I remember asking them: “What do you know about dreams?” They both asked what kind of dreams, and I was comfortable enough with both of them to open up.
I am walking down the highway, but there are no cars anywhere in sight. I am wearing a department t-shirt, my turn-out pants, and boots. Ahead of me, in the road, single file, I see people sitting in chairs on the highway. I approach the first chair in the line ofhundreds and recognize its occupant as a patient that had died while I was there. While I am standing in front of this chair, the person opens their eyes, looks at me, and says: “I am dead because you didn’t help me.” They then close their eyes, and I move on to the next chair, with the same result. OVER and OVER and OVER again.
I go on to explain that this dream is happening every time I fall asleep, and it’s starting to wear me out. When I look at my buddies, they are both looking back at me with a total look of concern and begin to offer any help they can to get me through this problem. One of the guys explains that what I described is a “textbook” symptom of very dangerous stress. I spend the next few weeks seeking out other brothers, and mentors trying to talk it out of my head. It worked. But I found out that I am not immune from mental stress, and certainly not too tough for mental stress.
The things we see, we can’t un-see. The dangerous things we have to do are part of the job. But I urge you to keep your eyes and ears open. Watch for the signs, in others and yourself. And be your brothers keeper. I am lucky my brothers were mine.
Stay Sharp, Stay Safe
John 15:13 Greater love hath no man than he who will give up his life for a friend.
Firefighters, all too often, may lose their lives protecting the lives of total strangers.
Ghosts by James Cook:
Any amount of time put into this career will most certainly riddle the corners of your brain with calls that shake you, give you chills and/or wake you up with cold sweats, some months or even years after the run. We all have them or something like them. I call them my “ghosts”. Everybody handles them different, some are good at separating themselves from the incident and never think twice about it. Some wear every bad run on their sleeves, and you know, that’s ok too.
Without too many details, one of my “ghosts” that visits me regularly is from a Christmas eve fatality wreck. Kids in an unfortunate circumstance put my crew and myself on a scene that would later prove difficult to separate myself from, because of a decision I made in a split second that could have not only cut my career short but could have potentially made a patient unable to walk ever again.
That’s just one of a few I have, I handled it my way and went on about life. Some don’t handle these calls easily and others never even show a sign that they cared. But what resources do you have if you need to talk about your “ghosts”. At that time all I really had was my brothers, which I think should be our number one crutch for situations like these. Some departments have a full blown PTSD resource, which is great and had i asked, my department might have had one as soon as possible but I don’t actually know.
The point I’m trying to make is to use your resources, make an effort to rid yourself of your “ghosts” when they begin to interrupt your daily life. Discuss with your brothers, your officers or chief officers whenever you need to. Get it off your chest, get help. Professional and volunteer civil servant suicide rates are way too abundant. Firefighters are notoriously tough, BUT IT DOES NOT MAKE YOU LESSER OF A MAN TO REACH OUT TO YOUR BROTHERS OR ANYBODY ELSE FOR SOME HELP.
Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that can occur after someone experiences a traumatic event that caused intense fear, helplessness, or horror. PTSD can result from personally experienced traumas (e.g., rape, war, natural disasters, abuse, serious accidents, and captivity) or from the witnessing or learning of a violent or tragic event.
- While it is common to experience a brief state of anxiety or depression after such occurrences, people with PTSD continually re-experience the traumatic event; avoid individuals, thoughts, or situations associated with the event; and have symptoms of excessive emotions.
- People with this disorder have these symptoms for longer than one month and cannot function as well as they did before the traumatic event.
- PTSD symptoms usually appear within three months of the traumatic experience; however, they sometimes occur months or even years later.
Although the symptoms for individuals with PTSD can vary considerably, they generally fall into three categories:
– Individuals with PTSD often experience recurrent and intrusive recollections of and/or nightmares about the stressful event. Some may experience flashbacks, hallucinations, or other vivid feelings of the event happening again. Others experience great psychological or physiological distress when certain things (objects, situations, etc.) remind them of the event.
– Many with PTSD will persistently avoid things that remind them of the traumatic event. This can result in avoiding everything from thoughts, feelings, or conversations associated with the incident to activities, places, or people that cause them to recall the event. In others there may be a general lack of responsiveness signaled by an inability to recall aspects of the trauma, a decreased interest in formerly important activities, a feeling of detachment from others, a limited range of emotion, and/or feelings of hopelessness about the future.
– Symptoms in this area may include difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, becoming very alert or watchful, and/or jumpiness or being easily startled.
Risk Factors for Firefighters
A few studies have also looked at what factors might put firefighters at greater risk for the development of PTSD. A number of risk factors for PTSD among firefighters have been identified. These include:
- Being previously in treatment for another disorder.
- Starting work as a firefighter at a younger age.
- Being unmarried
- Holding a supervisory rank in the fire service.
- Proximity to death during a traumatic event.
- Experiencing feelings of fear and horror during a traumatic event.
- Experiencing another stressful event (for example, loss of a loved one) after a traumatic event.
- Holding negative beliefs about oneself (for example, feeling as though you are inadequate or weak).
- Feeling as though you have little control over your life.
Protective Factors for Firefighters
- Even though firefighters might be at high risk for stress as a result of their jobs, it is important to point out that most firefighters will not develop PTSD. In fact, several factors have been identified that may reduce the likelihood of developing PTSD among firefighters after the experience of multiple traumatic events.
- One of the most important protective factors found was having social support available either at home or through work.
- In addition, it has also been found that having effective coping strategies available may lessen the impact of experiencing multiple traumatic events.
- This is not surprising in that, among people in general, the availability of social support and effective coping strategies have consistently been found to reduce the risk for developing PTSD following a traumatic event.
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