Proactive PTSD Prevention Measures for Firefighters

Over time, responding to fires and struggling to save lives can come at a steep personal cost.

Post-traumatic stress disorder (PTSD) is primarily associated with military service. Still, according to the International Association of Fire Fighters Center of Excellence (IAFF COE), one in every five firefighters will experience PTSD at some point during their career. That compares to a 6.8 percent lifetime risk for the general population.

According to a 2016 National Institute of Health study quoted in the article above, firefighters and other first responders develop PTSD at a similar rate to military service members returning from combat.

PTSD and its symptoms

PTSD is a serious mental condition that can develop after a person has experienced or witnessed a traumatic event involving physical harm or threat. PTSD affects the brain’s prefrontal cortex, amygdala, and hippocampus and can interfere with processing information, learning, and regulating emotions.

Symptoms can include flashbacks and nightmares, avoidance behaviors, negative changes in mood and thoughts, and hyper-arousal such as irritability, anger, and insomnia. In extreme cases, severe depression and suicide can result.

Rushing into a burning building to look for victims certainly qualifies as a traumatic event, though each firefighters’ risk for developing PTSD is unique. Some responders may never experience PTSD. Others may develop symptoms immediately after a harrowing experience, while others may not show the effects until months later.

Cumulative PTSD

Cumulative PTSD can be even more dangerous than PTSD caused by a single traumatic event because it is more likely to go unnoticed and untreated. A single tragedy that affects a whole unit will receive more attention than a buildup of day-to-day stress that can be just as debilitating.

Consider what happened to former North Attleboro, Massachusetts, captain Richard Stack. Stack had been a full-time firefighter for 20 years and a registered paramedic for over 25 years.

In 2015, Stack was diagnosed with PTSD after exhibiting many of the conventional symptoms, including thoughts of suicide. In his published first-person account, Stack admitted that he initially thought his diagnosis would be seen as a “weakness” and he feared being stigmatized. However, after receiving professional treatment and spending countless hours with other firefighters sharing their experiences, he did an about-face on his perceptions about PTSD within the ranks.

Though he eventually learned how better to cope with the debilitating condition, Stack retired in November 2018 at age 50.

Wide-ranging implications of PTSD

Fire departments need to be proactive and vigilant to identify those struggling with PTSD.

The heavy loads firefighters carry aren’t just physical. They’re mental, too. It’s a job that values physical fitness, stamina, and the ability to keep cool in volatile situations. Because of their public persona as rescue specialists who run into burning buildings, firefighters suffering from the effects of PTSD might think that vulnerability and depression would be seen as a weakness.

According to Fire Engineering, firefighter suicide deaths have eclipsed line-of-duty deaths (LODD) every year since 2009.

In 2019, firefighter deaths by suicide represented 30 percent more fatalities than line-of-duty death (LODD).  

And those are just the suicides reported through the Firefighter Behavioral Health Alliance system. Many others may go unreported.

PTSD affects more than the individual; it can also affect entire units, with devastating results:

  • Absenteeism and low performance from personnel suffering undiagnosed PTSD can affect unit morale and cohesion.
  • A department fighting fires at less than full roster strength can result in more physical damage, injuries, and fatalities to citizens and fire personnel.
  • Unaddressed PTSD cases can make it more difficult to retain experienced firefighters due to longer hours and uneven workloads.

Combat PTSD with early intervention

There are a number of steps departments can take to proactively deal with potential PTSD cases:

  • Incidents involving fatalities could be red-flagged by department administrators, meaning they automatically elicit a “trip-switch,” which encourages counseling with a mental health professional or department chaplain.
  • Fire personnel involved in dangerous incidents with or without fatalities should be encouraged to take time off and discuss their experience with a counselor, colleague, or employee assistance program.
  • PTSD should be destigmatized as a psychological problem and considered a normal response to firefighters’ extraordinary stressors. In other words, PTSD should be presented as a common, job-related condition of first responders.
  • Awareness of PTSD and identifying symptoms can be used as a means of building camaraderie among department members.

Partnering to fight PTSD

To help fire departments nationwide combat PTSD, Envisage has created webinars, courses, and posters on depression, other mental health issues, and suicide prevention.

Additionally, here are a few tips Envisage has offered fire departments in the past regarding confronting PTSD:

  • Those with PTSD may be trying to hide it from others. Be aware of any changes in behavior.
  • Don’t argue with the science. Depression is a chemical imbalance in the brain; anxiety and stress hamper decision-making. Accept a person’s feelings as real.
  • Demonstrate a willingness to listen to struggling teammates and remind them that resources are available to help them cope.
  • Be direct; ask if they have thought about hurting themselves. (Related resource: How to have a supportive conversation about suicide)
  • Listen without judging, and after listening, connect the subject with sources that can help address their pain.

PTSD and other psychological trauma are natural reactions to the stressful situations firefighters and first responders confront. The identity of those seeking help must also be kept strictly confidential. Sharing this privacy protection with everyone in a department should relieve the hesitation many feel when coming forward.

By proactively focusing on PTSD awareness, educating firefighters about the symptoms, and providing confidential access to treatment, fire departments can help minimize the effects of PTSD in their ranks and the damage it can do personally and professionally.

Sources: International Association of Fire Fighters Center of Excellence, Police1, WebMD, Sun Chronicle, Firehouse, Delmarva Now, Fire Engineering, Firefighter Behavioral Alliance

Posted on Jun 29, 2021