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December 16, 2012

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Firefighters at Risk ~ The Negative Effects of Stress and Trauma on the Human Spirit

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by Peggy Sweeney
The Sweeney Alliance

PTSD and Emergency Services

This video outlines some of the causes, signs and symptoms of Post Traumatic Stress Disorder (PTSD). PTSD, when gone untreated, can lead to such extremes as suicide.

In 2000, I wrote a research paper on the effects of traumatic stress and grief on firefighters. As a firefighter, EMT-B, and mortician, I witnessed first-hand the physical, mental, and emotional traumas these men and women experience daily in the field. I strongly believed then, as I do today, that programs such as Grieving Behind the Badge must be provided to help reduce the staggering number of heart attacks, suicides, unhealthy addictive behaviors, and high divorce rates in the fire service as well as the emergency medical service and law enforcement communities in general.

I have taken the information from that research paper and condensed it here. You will note throughout this article that several fire service organizations (including the International Association of Fire Chiefs Foundation) consistently recommended programs to help reduce mental and emotional stress for firefighters. That was in 2000! Today, there is still NO solution to the problem. Post-traumatic stress disorder (PTSD) in the fire service is a REAL problem. Firefighter suicides continue to escalate at a rapid pace. Critical Incident Stress Management (CISM) and Critical Incident Stress Debriefing (CISD) alone are not the answer.

 Authors Note: The terms emergency service professional and emergency service worker in this paper refer to firefighters (paid and volunteer) along with trained professionals skilled in pre-hospital care to patients (first responders, emergency medical technicians, and paramedics). The terms firefighter, emergency service professional, and emergency service worker are interchangeable. The use of the male gender is in no way meant to overlook or make light of the many contributions women make to these professions. This terminology is used for simplicity and ease in reading. In addition, the term grief in this paper means the feelings and emotions following any loss that contributes to a person’s stress levels.

INTRODUCTION

Today, in the United States, what were once considered safe environments are now battlefields. No longer are schools, homes, places of business, or churches safe from violent acts of aggression. Moreover, our society is witnessing an alarming increase in homicides, rapes, domestic violence, child abuse, and highway injuries and deaths. The aftermath of these traumatic events is having a devastating and adverse reaction on everyone. Nowhere is this more apparent than in the emergency service professions: the men and women who serve their communities as firefighters and pre-hospital caregivers. Their daily experiences with life-threatening and highly stressful events are affecting them physically, mentally, and emotionally. Furthermore, divorce, substance abuse, and heart attack rates in these professions are among the highest in the nation. Efforts have been made to address some of the critical needs of these community servants. However, there is a lack of opportunities to cope with job-related stress as well as personal trauma and grief for firefighters, their families, and fire department chaplains.

History and Background of the Problem

Many jobs are considered dangerous and stressful by their very nature. Firefighting is one of the most life-threatening and emotionally traumatic occupations. The high levels of stress that firefighters routinely encounter can lead to chemical dependency, physical illness, emotional problems, post-traumatic stress disorder (PTSD), and poor interfamily relationships including divorce. The lack of public support and compassion by citizens, government agencies, and business officials for the risks these firefighters endure and the occasional negative editorial coverage by the news media adds to their anxiety level.

Firefighters receive little if any training or support to help them cope emotionally with traumatic stress. Following a distressing incident (the death of a child, a mass fatality, or the death of a fellow firefighter in the line of duty) some fire departments may implement a critical incident stress debriefing (CISD) or offer the assistance of a department chaplain. However, only a small number of departments offer educational programs on coping with traumatic stress and grief for the firefighters, their families, and department chaplains.

Evansville Fire Captain Don Spindler runs out of a burning apartment building at 869 Covert Avenue carrying Aaliyah Frazier, 4, who was unconscious but breathing when found trapped on the second floor of the building. Her sister, Akeleigh Frazier, 3, and mother, Kristyn Frazier, 24, were also pulled out of the fire and administered CPR before being transported to the hospital.

Stress in the Fire Service

With the advancement of fire prevention technology, such as flame-retardant building materials, smoke detectors, and sprinkler systems, fire departments are responding to fewer and fewer fire calls than ever before. However, for the more than one million firefighters in the United States, firefighting is still considered a very hazardous and highly stressful occupation. Firefighters are at greater risk of injury and death than most other professions as the result of flames and intense heat, “poisonous, flammable, or explosive gases and chemicals, or radioactive or other hazardous materials” (Bureau of Labor Statistics, 1999).

Firefighters are usually first on the scene of accidents, suicides, and acts of violence (assault and battery, rapes, bombings, school shootings, etc.). Emergency service workers respond to floods, earthquakes, and airline crashes where the death toll and property destruction is overwhelming. They care for victims of domestic violence and child abuse. Firefighters extricate mangled bodies from motorized vehicles following an accident and provide medical assistance to homeless patients on the streets of inner cities. At times, they must physically restrain patients who are combative due to mind-altering drugs or head injuries. Likewise, they comfort parents and family members when a child or loved one has died. All too often they must cope with grief following the death of a fellow firefighter in the line of duty.

In this video, Professional firefighter, Larry Rusk, with the Ottawa (Canada)
Fire Department shares his battle with PTSD

Research has shown that “forty-three percent of all adults suffer adverse health effects from stress” (Miller, L., 1997); however, it is the men and women in the emergency service professions that are at a greater risk of suffering long-term stress that can lead to post traumatic stress disorder (PTSD). The “rate for diagnosable PTSD among firefighters was 16.5 percent compared to a one percent to three percent rate for the general population—about one percent higher than PTSD rates of Vietnam veterans” (DeAngelis, 1995, p.36). The International Association of Fire Chiefs’ Foundation (1991) has stated that

“Stress is one of the most serious occupational hazards in the fire service, affecting health, job performance, career decision-making, morale, and family life. Emotional problems, as well as problems with alcohol and drugs, are becoming increasingly evident. High rates of attrition, divorce, occupational disease, and injury continue… [and] suicide is a real and tragic alternative for some.”

In addition to the life-threatening and job-related stress they encounter in their professional lives, firefighters must also cope with an array of personal and family issues as well. These factors may include, but are not limited to, a troubling child in the home, the death of a loved one, “aging or invalid family members, terminal illness, divorce, and the daily demands of raising a family” (SAMHSA, 1995). “Some firefighters take their problems home to their [spouses] and families or seek outside employment (moonlighting) to compensate for the stress and frustration of the firefighting job” (IAFCF, 1991). Many of these emergency service workers feel that their families and friends do not understand the magnitude of their duties nor the emotional strain they must endure on a daily basis.

Stress Among Volunteers in the Fire Service
Volunteer firefighters comprise approximately seventy-one percent of all firefighters in the United States (NFPA, [2008 update]).  Most do not receive monetary compensation for their efforts. Most volunteer firefighters have full-time jobs in addition to their duties and responsibilities at the fire department. However, these firefighters are exposed to the same dangers, experience the same job-related stress, and must cope with grief just as their comrades in career (paid) departments. They fight fires, save lives, and protect property. Many are trained as first responders, emergency medical technicians, or paramedics. Some receive additional training in specialized areas, such as vehicle extrication, high-angle rescue, hazardous materials, confined space, and water rescue. Volunteer firefighters respond to major disasters, motor vehicle accidents, domestic violence and child abuse calls, and school shootings. They are placed in life-threatening situations and many of them are victims of violence. Sadly, one hundred firefighters die in the line of duty each year. The majority of these firefighters are volunteers (National Fire Protection Association, 1999).

Although some volunteer departments are in large cities most are in small, rural communities. Therefore, these “emergency workers frequently know the victims and/or their families thus compounding their levels of stress and emotional trauma” (SAMHSA, 1995). Furthermore, many rural departments may only respond to ten or fifteen calls per year. These firefighters “may not be as regularly exposed to certain types of incidents and may not be as emotionally desensitized (SAMHSA, 1995). Because of this, many volunteer firefighters in rural areas with few calls may find it just as difficult to cope with stress and grief as firefighters who respond to many calls in larger cities. “Stress is a major problem in volunteer fire departments and it’s a big reason for attrition” (Streng, 1985, p.24).

Critical Incident Stress Program
A vital and intrinsic aspect of emotional help for firefighters is Critical Incident Stress Debriefing (CISD). “Critical incident stress is a normal reaction experienced by normal people following an event that is abnormal” (NFPA, 1997). CISD is a “reactive form of treatment either on the scene of a disaster or within a short period of time after the disaster by means of a debriefing” (IAFCF, 1991). The “main goal [of CISD] is to lessen the long-term psychological impact of the event and to accelerate the recovery process” in the emergency service worker (Clark, 1991). Clark also states that CISD is “used solely to regenerate the normal support process.” A CISD is implemented following “mass casualties… fatalities involving children, fatalities or injuries involving fire department members, and any other situation that affect the psychological… well-being” of an individual (NFPA, 1997). Please note that CISD does not afford the emergency service professionals preventative training or long-range, follow-up support and education. Therefore, the firefighter may experience recurring, adverse side effects as the result of continuous emotional trauma. These side effects can include, but are not limited to, anxiety, insomnia, gastro-intestinal problems, and an increased risk of heart attacks and severe depression.

Chaplaincy Program
“Chaplaincy programs are beneficial in helping fire department members deal with the stress of their work” (IAFCF, 1991). In addition, chaplains provide emotional and spiritual help for firefighters and their families as well as CISD members. Firefighters who do not initially “relate well to outsiders will often turn to and accept the help of a chaplain who practices strict confidentiality when dealing with personal problems” (IAFCF, 1991).

CONCLUSION
Traumatic events, including mass casualties, injury or death of children, life-threatening situations, or a line of duty death have a profound impact on the mental and physical health of firefighters. Without coping skills, emergency service professionals can experience unhealthy side effects, such as stress, high blood pressure, and depression, as well as disabling illness including heart attacks, substance abuse, and post-traumatic stress disorder (PTSD). Personal life issues such as divorce, long-term illness, or death of a family member, etc. can have a negative effect on them as well. Although research has shown that there are some resources available for firefighters and their families to cope with stress, there is a need to have a training program that will provide information on grief, suicide and addiction prevention, and promoting emotional wellness for everyone.

The International Association of Fire Chiefs’ Foundation (1991) states, “continuing education and training within fire departments are favored by many as tools for alleviating stress.” Furthermore, “Specific training in dealing with death, crisis and suicide are needed, and orientation programs may help recruits better prepare for the physical and psychological rigors of their new profession.” SAMHSA (1995) has made the following recommendations:

“When the first firefighters arrived they began battling the fire in the front of the structure,” Roberts said, “and a bystander told them that two children were in a bedroom in the back of the house. A crew went to the back of the house and actually dove through a window of a bedroom. The room was not on fire but was full of smoke. “The firefighters immediately found one child and then located the other,” the chief said. “Neither was breathing, but firefighters immediately went to work on the scene, administering CPR and oxygen, and they were able to get them breathing again.”

1. “information about normal reactions [to stress and grief], education about ways to handle them, and early attention to symptoms can speed recovery and prevent long-term problems.

2. “The use of prevention and treatment strategies can potentially decrease or eliminate negative effects of stress such as decline in job performance, burnout, high turnover rate, health problems, and family problems for workers.

3. “Such training should be an integral and ongoing part of regular training programs. Protecting emotional safety is just as important as protecting physical safety.”

Teresa Floren (1984, p.43) suggests that there is a “strong need to provide a more humanistic approach in the training of emergency [service] personnel.” Also, “we need to learn more about death and dying, the stages of grief, what to expect from a suddenly bereaved family and how we may most helpfully interact with family members.” Furthermore, emergency service workers must be able to talk about the pressures involved in traumatic situations, to understand what others have experienced in similar situations, and know that they are not alone in their feelings. Finally, the National Institute of Mental Health states that “The use of both prevention and treatment strategies can potentially decrease or eliminate negative effects of stress” (1990).

If fire departments and organizations want to reduce the number of lives that are lost from physical illness, substance abuse, and suicide in the fire service then they must provide firefighters with help and coping skills. Training them to deal with trauma, stress, and grief is no less important than training them to be safe on the fire ground. No longer can job-related stress in the fire service be ignored. It is the duty and responsibility of every fire service officer to provide for and enhance the emotional wellness of his or her department. Without the support and dedication of everyone stress and grief will continue to take a toll on firefighters and their families.

The emotional wellness of firefighters is at risk! Stress and grief are problems that are not easily detected or easily resolved. Severe depression, heart attacks, and the high rates of divorce, addiction, and suicide in the fire service prove this. Grieving Behind the Badge should be made available to all emergency service professionals, their families, recruits, and fire department chaplains.

Copyright Peggy Sweeney. All rights reserved.

Interested in reading more articles on the topics of post-traumatic stress and suicide in the fire service?

PTSD and More
Suicide ~ Let’s Talk About

About the Author: Peggy Sweeney is founder and president of the Sweeney Alliance, a mortician and bereavement educator, member of the Comfort (TX) Volunteer Fire Department, and former EMT-B. For more than twenty years, Peggy has written and conducted numerous workshops for the public in general. In addition, she hosts two monthly support groups in Kerrville, TX: for parents who have had a child die (Halo of Love) as well as bereaved adults and teens (Comfort and Conversation).

In 1997, Peggy wrote the Grieving Behind the Badge training program and taught this program in the United States and Canada to help the men and women who serve their communities as firefighters/EMS, law enforcement and correctional officers, and emergency dispatch personnel. Peggy and Shannon Pennington (North American Fire Fighter Veteran Network), currently offer the First Step Hope: Not All Wounds Are Visible curriculum, a riveting, one-of-a-kind classroom experience that combines grief and loss education with first-hand trauma and  post traumatic survival skills.

Peggy and Shannon strongly believe that the need to understand and cope with recurring traumatic events and the emotional challenges of emergency response and law enforcement are not being met. They have devoted their time and individual talents to make a positive change in these professions and reduce the number of suicides which are becoming all too common. If you would like to request a First Step Hope brochure, please contact Peggy through her email peggy@sweeneyalliance.org

DOWNLOAD THE FIRST STEP HOPE BROCHURE

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REFERENCES
Bureau of Labor Statistics. (1999). 1998-99 Occupational outlook handbook. Washington, D.C.: U.S. Department of Labor.

Bush, R., Schaenman, P. & Thiel, K. (1998). Recruitment and retention in the volunteer fire service: Problems and solutions. Washington, D.C.: National Volunteer Fire Council and United States Fire Administration.

Clark, William E. (1991). Firefighting principles and practices. Saddle Brook, NJ: Fire Engineering Books and Videos.

DeAngelis, T. (1995, February). Firefighters’ PTSD at dangerous levels. APA Monitor, pp. 36-37.

Floren, T. (1984, March/April). Impact of death and dying on emergency care personnel. Emergency Medical Services, 13 (2), pp.43-47.

International Association of Fire Chiefs Foundation. (1991). Stress management: Model program for maintaining firefighter well-being. Washington, D.C.: Federal Emergency Management Agency and The U.S. Fire Administration.

Miller, L. & Smith, A. (1997). Stress in the workplace. Washington, D.C.: American Psychological Association.

National Fire Protection Association. (1997). Fire department occupational safety and health program. Quincy, MA: Author.

National Fire Protection Association. (1999). Fire departments. Quincy, MA: Author.

National Fire Protection Association. (2009, October). U.S. fire department profile through 2008. Quincy, MA: Author.

National Institute of Mental Health. (1990). Human problems in major disasters: A training curriculum for emergency medical personnel. Rockville, MD: Author.

Streng, P. (1985, December). Stress and the volunteer fire department. The International Fire Chief, p24.

Substance Abuse and Mental Health Services Administration. (1995). Disaster work and mental health: Prevention and control of stress among workers. Washington, D.C.: Author.

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8 Comments Post a comment
  1. Ann Gonzalez
    Jan 22 2014

    Both of my sons are EMT firefighters and I have listened to their stories and watched them grieve, and I worry about their future. When will they have seen too much? I’m including a poem I wrote about one of them; it’s a true story.

    Miracles
    by Ann Gonzalez

    She walked into the station,
    The girl with her legs mangled a year ago
    Wrapped impossibly around the pedals
    Folded like an accordion by the weight of the dash
    Smashed and broken
    When her car slid gracefully across the ice
    Headlong into the fire truck.

    I watched my son relive the moment,
    Holding onto his harness, his partner not even belted in yet,
    Just pulling out of the station on a call. The crash and then
    Grabbing the sides of his seat,
    The truck careening across a field, threatening to roll
    This close to a tree, the shock, the screaming,
    Running to the car, sliding tools across the icy road.

    I know the story by heart,
    Have seen the tears roll down my son’s face as he remembers,
    As he feels it all again, haunting him, night after night, for weeks.
    But you got her out, yes we got her out. Clearly not the point.

    Am I going to die? No.
    Am I going to lose my legs? We’ll let the doctors see.
    I need my hand to roll the dash, I’ll only let go a minute.
    You can call me, call me.

    So many traumas, so many broken bodies.
    Why does this one hurt so? You got her out.
    Yes, we got her out. And she’s walking, walking. Yes, she’s walking.
    And she found you again, to thank you. She remembered your name.
    Yes, she remembered.
    And the tears keep coming in little streams down his cheeks.

    Reply
  2. Lisa Weisbrod
    Jan 15 2014

    My husband a firefighter/paramedic for 16 years took his own life May 4, 2013. I believe a combination of family issues and stress let to this terrible act to end his pain. The things he left bottled up inside him made him get a to a dark place that he couldn’t see out of. I myself am an RN, we shared a lot but I in know way ever thought someone who safe lives for a living would wind up taking his own. All the things you see on TV about the brotherhood and crap about how the firefighters are just sexy beasts saving lives makes me sick. The brotherhood dissipates 2 weeks after the funeral and as the spouse I am left with the blame that I couldn’t keep him happy and prevent this. Men do not talk and they do not want to seem weak. So many times my husband was teased and talked about because he had a sensitive side, which eventually took him to his grave prematurely.

    Reply
    • Jan 15 2014

      I am so very, very sorry to hear about the death of your husband. I appreciate your candid comments and will surely add them to the Grieving Behind the Badge blog.

      My business associate and I are working diligently to educate firefighters and all first responders and to reduce the number of suicides by working with those with post traumatic stress and their families to get the help they need to live with the mental and emotional traumas.

      Know that what your husband experienced by his fellow firefighters is NOT uncommon. I would assume that his chief turned a deaf hear to unwanted comments and did not reprimand this behavior. Shannon and I are on a mission to change that repulsive behavior.

      I hope you will subscribe to my newsletter
      here as well as review Shannon Pennington’s (my associate) website here. He is a 26 yr career firefighter retired and living with PTSD.

      Please feel free to contact me by email or phone (830-377-7389) if I can help or you just need a shoulder to cry on or you want to vent.

      Reply
    • Scott
      Jan 23 2014

      Hi Lisa. I just want you to know you are in my prayers. Don’t ever take the blame or feel guilt for your husbands death.
      I have been a firefighter for 18years now and I can relate to the pain your husband was going through. I came close my self to taking my own life but with the will of god he some how helped me come out of that dark place. People really don’t understand the physical and mental stress firefighters go through. The sleepless nights, “fitting in” with the men, and the horrible depressing things we see day in and day out.
      In a strange way I am glad I went through and am still going through my struggles. It makes me a more empathetic and compassionate person who understands a fellow firefighters struggles. What motivates me today is being a friend and listener to a fellow firefighter.
      I read your comment Lisa and it just motivates me to help other firefighters!! Your husbands death will not go in vain! Your husband’s job in life was to help others in need and save lives and he’s continuing to do that from heaven! May god bless you Lisa!

      Reply
  3. Mary
    Nov 8 2013

    being a spouse of an officer firefighter, of 28yrs, it can be difficult at times for him to separate himself from the position at home; causing resentment on both sides. Any advice for a fire chief on how to let go of work for a few hours and maybe actually enjoy being with his family instead of resenting it?

    Reply
  4. Feb 4 2014

    Thank you for sharing this on your blog.
    Peggy Sweeney, author

    Reply

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