Abstract
Firefighters and emergency medical services personnel, also known as EMTs or paramedics, have a very rewarding yet demanding job. Demanding in obvious ways such as the physical requirements to withstand high temperatures when putting out fires, working in over fifty pounds of gear, working long 24-hour shifts and lifting heavy patients. But it is also demanding emotionally and mentally. These first responders face long work hours with minimal sleep, witness injuries and fatalities of helpless adults, kids, animals and even their own co-workers, as well as attempt to maintain steady relationships as a parent or spouse. Mental and behavioral health are not a popular topic for those that choose to build who their career on bravery, selflessness, and of those that build a closed knit brotherhood with their co-workers. They face a large stigma of being “weak or vulnerable” when openly discussing difficult times dealing with an event or situation. This paper discusses common negative psychosocial outcomes such as PTSD, alcohol dependence and substance abuse, depression, anxiety and suicide, and divorce rates. These mental and behavioral issues are unfortunately far too common amongst firefighters and EMS personnel across the United States. Included is also a personal reference from a current full- time firefighter and paramedic from Springfield Fire and Rescue division.
Keywords: firefighters, PTSD, mental health, divorce, alcohol dependence
Negative Psychosocial Outcomes and Impacts on Firefighters and EMS Personnel
The International Association of Firefighters and the International Fire Association of Chiefs have raised the increased attention on behavioral and mental health problems such as drug and alcohol dependency, depression and anxiety, and PTSD. When these issues go unnoticed and unaddressed, they effect marriages, relationships with their children, performance issues within their job, and can ultimately lead to thoughts and actions of depression and suicide. Facing the negative stigmas on mental and behavioral health in this line of work is ultimately the first step to receiving help and guidance and creating awareness and preventing others from suffering with similar issues and potentially taking their own life or interfering with their relationships.
Posttraumatic stress disorder is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault. People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. (What Is Posttraumatic, 2017). It expresses itself through a broad spectrum of signs and symptoms and is important to be diagnosed by a licensed healthcare professional.
Studies show that almost forty percent of firefighters exhibit symptoms of PTSD. PTSD causes them to have a hyperactive lifestyle, withdrawal themselves from social situations, have a loss of appetite, and have issues falling asleep. Physical signs include headaches, nausea, constant fatigue. Emotional signs include anxiety, fear, irritability, feelings of self-blame, and intense mood swings. Cognitive signs are difficulty concentrating, feeling confused or disoriented, worrying about death, and difficulty making decisions. Events that trigger PTSD are witnessing a shooting or stabbing, someone getting killed, witnessing child or infant, or losing a co-worker. (Gagliano, 2015). A study conducted at Houston Fire Department found the rate for PTSD was 12.6% amongst the 3,036 firefighters that participated in the survey. (Pao & Tran, 2017).
The terms drug abuse and alcohol abuse are defined as the use of chemical substances that lead to an increased risk of problems and an inability to control the use of the substance. Substance abuse has negative effects on how you feel about yourself, how you manage problems or changes in your life, and your relationships. (Aging & Health, n.d.) Improper use of drugs and alcohol play a large role in poor mental and behavioral health, as
well as causing health issues in the body with organ systems such as the liver and heart. These health issues can result in losing their job, and if serious enough losing their life.
In 2014, the Center for Fire Rescue and EMS Health Research conducted a survey designed to identify the rate at which firefighters consume alcohol. Researchers surveyed 423 firefighters and fire service administrators. The results showed that 85 percent of career and 71 percent of volunteer firefighters reported past-month drinking. Fifty-six percent of career and 45 percent of volunteer firefighters reported past-month binge drinking. The common 24-hour shifts, averaging of ten days per month, allows a lot of free time for drinking related activities. It is also difficult for firefighters to adjust their sleep schedule back and forth from work and being home. (Tagliareni, 2018).
Depression is characterized when an individual an overwhelming feeling of sadness or a loss of interest and pleasure in most usual activities. Other symptoms that are associated with major depression include decrease or increase in appetite, insomnia or hypersomnia, constant fatigue, feelings of worthlessness or excessive and inappropriate guilt, recurrent thoughts of death and suicidal ideation with or without specific plans for committing suicide, and cognitive difficulties, such as, diminished ability to think, concentrate and make decisions. Insomnia and constant fatigue can affect firefighter’s abilities to maintain a somewhat healthy sleep schedule, which could increase their chances of error on the job. Thoughts of worthlessness and guild can lead to thoughts and actions of suicide Diminishing ability to think, concentrate or make decisions can also increase risk for the daily tasks and intense thinking they are required to do for skills on the job. (Depression, n.d).
There is a lingering stigma over first responders that makes is very difficult for employees to admit and acknowledge mental or behavioral issues such as anxiety, depression, or suicidal thoughts. A study completed by Jeff Dill, a captain for the Illinois Fire Protection District, whom is a licensed counselor specializing in firefighter behavioral issues, confirmed 360 firefighter suicides between 2000 and 2013. The information he receives is completely voluntarily, therefore only reflects a fraction of the nation’s 30,000+ fire departments. This number could be drastically lowered if firefighters were more likely to admit and freely talk to their chain of command, or health professionals if needed.
Having a behavioral health issue such as this can heavily impact a marriage in negative ways. These factors of extreme stress and PTSD contribute to the divorce rate for firefighters, which is approximately three times that of the general population. One of the most difficult things is that spouses cannot fully grasp what they’ve experience or what they’re going through. (Gagliano, 2015). This separation of understanding ultimately can separate each member of the relationship resulting in divorce.
The best way to find out if the research on these topics is real and a prevalent issue by is discussing it with an actual firefighter and paramedic to see what he actually feels and experiences. Devin Whip, a full-time firefighter and paramedic works for Springfield Fire and Rescue Division. The first question asked, “Do you feel that there is a stigma that prevents first responders to not discuss or pursue any help for mental or behavioral issues?” The response was, “First responders are driven by pride tradition and passion. Pride is a part of the stigma because none of us want to show weakness or emotion in front of the citizens we serve and the crew we work with. We are the fixers when things are broken, we are the agency that is called when people are having the worst experience of their lives. We are individually as hard on ourselves just as the job is on us because we want to succeed and not let anyone down. The important factor is finding the balance between accepting what comes with the job and still taking care of ourselves.
The second question asked was, “have you personally known a co-worker that has experienced substance abuse, depression, divorce or suicide related actions due to an incident on the job?” The answering response was, “First responders see things that shouldn’t be seen by any human being. I know of a person that was no longer able to come back to the job because of anxiety attacks when he was near ambulances due to being on an incident that involved the death of his son. The person went into a rapid decline in his mental health and unfortunately turned to alcohol to avoid the pain.”
The last question asked was, “What can fire departments or organizations and associations do to reduce the amount of behavioral and mental health issues? Devin’s answer was, “Most fire departments have implementations in place called Critical Incident Stress Management or CISM for short. This is when within 72 hours of an unsettling incident, the fire company discusses their emotions with one another and even some trained professionals in some cases. At my fire department, we are lucky enough to have an individual that has a masters’ degree in psychology and has worked as a mental health ambassador prior to working for the fire department, so when we have any incident she comes in and helps us work through our CISM.” (Devin R. Whip, personal communication, December 4, 2018).
Firefighters clearly endure extreme stress and experience many physical, mental and emotional difficulties due to what they are exposed to on their job. The most important factor in reducing the amount of the negative psychosocial outcomes such as depression and anxiety, alcohol or substance abuse, divorce, suicides, etc. that are often caused from a high stress career such as firefighting is to create awareness of what is currently happening to employees. Many studies have been conducted on the multiple negative mental or behavioral effects, but don’t receive enough publicity to let the shocking statistics make an impact. More fire departments should incorporate a plan for employees to cope with a traumatic event that they experienced, and allow easier access to have conversations with the proper healthcare professional if needed in their situation. Spouses and family members should learn the signs and symptoms of these behaviors and to know the red flags of when to help their loved one receive help.
References
Aging & Health A to Z. (n.d.). Retrieved December 5, 2018, from http://www.healthinaging.org/aging-and-health-a-to-z/topic:drug-and-substance-
abuse/
Depression. (n.d.). Retrieved December 5, 2018, from https://adaa.org/understanding- anxiety/depression
Gagliano, A. (2015, May 19). Living with trauma in the firefighter marriage. Retrieved November 17, 2018, from https://www.fireengineering.com/articles/fire_life/articles/2015/may/living-with- trauma-in-the-firefighter-marriage.html
Pao, C., & Tran, J. (2017, March 28). Firefighters and trauma. Retrieved November 17, 2018, from https://www.firerescuemagazine.com/articles/print/volume-12/issue- 3/features/firefighters-and-trauma.html
Tagliareni, S. (2018, May 18). Firefighters and addiction. Retrieved December 5, 2018, from https://www.drugrehab.com/addiction/firefighters/
What Is posttraumatic stress disorder? (2017, January). Retrieved from https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
Wilmoth, J. A. (2018, May). NFPA journal. Retrieved November 18, 2018, from https://www.nfpa.org/News-and-Research/Publications/NFPA-Journal/2014/May-June- 2014/Features/Special-report-Firefighter-behavioral-health