So how can we begin to cope with the raging problem that is PTSD? Well I'd like to think that just recognizing that it is a problem beings the process. We, as in the U.S. Fire Service, need to talk about it more. We need to make it ok for any firefighter to seek help. That help can come in many forms.

One of the most prevalent forms of help is the Employee Assistance Program (EAP). Many career fire departments already have some sort of EAP. If your department is like mine, than EAP is an after thought. No one take it seriously. They hand out the phone number every so often and hang a poster up in the station and that is it. EAP is a historically passive process. If employees do not take the initiative to seek out the EAP, they will never use it. A better system would be a Behavioral Health Assistance Program (BHAP). A BHAP should be involved in the fire department from day one. The members of the program need to be aware of the particular concerns of emergency workers. Members should be encouraged to take part in the program just as they are encouraged to take part in physical wellness programs.

The one acronym we are all well aware of is CISD or CISM (Critical Incident Stress Debriefing or Management). Most of us have had some rudimentary CISM, usually performed by someone who has no formal training. Heck most of us do parts of CISM without even knowing it. Just sitting around the kitchen table, the most important part of any firehouse, we talk about calls and have informal debriefings. While this a good step, a more formal system should be utilized when the situation merits. More information can be found from the International Critical Incident Stress Foundation.

Last time, we discussed Post-Traumatic Stress Disorder (PTSD) and it's prevalence in the American fire/EMS community. Now let us discuss the consequences of untreated PTSD. Not only does PTSD have an effect on your own well being, but it also can affect your department. Sufferers of PTSD are going to be less productive firefighters.  We all know the firefighter who has burnt out, nothing that happens is going to make this person happy. At my station the joke is you could give them 20 bucks and they would complain because it wasn't in fives. At least in my experience, in the departments I have been in, no one recognized firefighter burn out with PTSD. No effort is ever made to see what the root cause of the problem is. The assumption is just that they are bitter at the world and have always been that way. Well I can tell you that is a load of bull. No one ever gets into the fire service because they hate it. At one point that bitter firefighter was really excited about their job. They used to love the thrill of it, but now they are so burnt out that it makes them and those around them miserable.

While burn out is bad for the individual and the department, suicide is a much more permanent problem for sufferers of PTSD. Folks who have suicidal ideation are twice as likely to make an attempt if they also suffer from PTSD. It is very difficult for the U.S. Fire Service to get a handle on how big a problem suicide is. The Firefighter Behavior Health Alliance found a confirmed 360 U.S. firefighter suicides from 2001-2013. Suicide reporting for the fire service is very difficult to track. The majority of firefighters, in the U.S., are volunteers so their death certificate will probably not represent their firefighting activities. Also, suicide is not usually listed as a cause of death. Suicide is a mode of ending one's life, it is not however a cause of death.  Firefighters maybe especially susceptible to suicide. We put our bodies on the line. Every day we are exposed to pain and death. This exposure to pain and death may make the firefighter more accepting of their own mortality. Frequent exposure to pain makes us more accepting of it. On top of all this the numbers game is against us. White males make up the majority of the U.S. fire service. White males are also one of the most susceptible groups to suicide. Firefighters in their early careers are in one of the worst demographics. This maybe because of genetics, but it also may have to do with not having the mental resilience to all the pain and suffering they see. Firefighters near the end of their careers are also in a vulnerable demographic. These men and women are facing separation from the group that has helped them cope with all the pain and suffering for so long. As they retire there is going to be an inevitable sense of loss from the firehouse mentality.

We all know that fire/EMS personnel are a hard drinking bunch. There is a long standing tradition of drinking hard in the fire service. Where does that come from? We all are educated individuals and we know it's bad for us. Maybe, substance abuse is a coping mechanism for PTSD. I know tons of firefighters who after a bad call want to get a drink. I know a few firefighters who have ruined their lives and careers through alcohol. The real problem is alcohol and drugs do not help. This is not a healthy way to deal with PTSD. Alcohol is a depressant and can just make the depression from PTSD worse.

A higher rate of violence among veterans suffering from PTSD has been researched and noticed by the professional community. It stands to reason that firefighters who suffer from PTSD may also be at a higher risk for violence. On top of that many members of the U.S. fire service are veterans themselves. This is a dangerous combination. 

It is important to get help now. If you have ever had any of these problems it is important to seek professional advice. Reach out to your local suicide hotlines if you have any suicidal thoughts. You are too important to lose, we need you to stick around. Next time we will discuss how we can perhaps treat PTSD.

In 1995, I started on the path of my firefighting career. I started as a scared young kid who knew nothing. In the 20 years since that first fateful day, I have earned every ache and pain that I wake up with every day. Many of my brothers and sisters have had it much worse than me. Those of us in Fire/EMS understand that sometimes aches and pains are just part of the job. Your knees hurt from jumping out of the rig. Your back hurts from lifting patients onto stretchers. It is all just part of the gig. When the pain gets too much, we go see a doctor and get it taken care of. I've spent my time in the chiropractors office, just trying to get my back into some semblance of normalcy. I know plenty of firefighters who have had major surgery to get them back to shape. We hit the gym to try to keep ourselves in a peak physical shape, sometimes it helps. Sometimes, it makes things worse. The six weeks I spent in physical therapy, because I pushed myself too hard trying to run, were not fun. So we all get it, physical pain can be dealt with and we have no problems seeking help. Why then do we have such problems seeking help for mental issues?

I saw my first dead person at the age of 16. I have done CPR on hundreds of patients. I have seen human beings do terrible things to other human beings. That stuff adds up, it just has to. The mental aches and pains are just part of the job right? The difference is that the fire and EMS service is pretty bad at seeking help from mental health professionals. Through research, I have come to believe that almost every member of the fire service is walking around with some form of Post-traumatic stress disorder(PTSD). The sleepless nights thinking about bad calls. The bad calls that ruin your whole week. Even the run of the mill calls that just keep you at a certain level of general funk.

So what is PTSD? PTSD is defined by the American Psychiatric Association(APA) as an anxiety disorder. This disorder stems from witnessing, being a victim of, or even hearing about a traumatic stressor. These stressors include death, the threat of death, and serious injury. Sounds pretty much like every shift in the firehouse. Every day fire and EMS personnel are exposed to death and serious injury. Many times we put our very lives on the line to run into a harmful situation.  There are three types of PTSD recognized by the APA. Acute PTSD the symptoms last less than three months. Chronic PTSD the symptoms last longer than three months. Delayed PTSD the onset of symptoms is delayed at least six months from the traumatic stressor.

Symptoms of PTSD can include persistent symptoms of anxiety or increased arousal. Sufferers can experience "pyschic numbing." Pyschic numbing is a diminished response to external stimuli. A sense of doom may develop. Sufferers may become more detached from their emotions and the emotions of others. To top it all off sufferers of PTSD can have hypervigilance, increased irritability, nightmares and anxiety. If any of these symptoms sound familiar to you, seek professional help.

The average American population includes less than seven percent sufferers of PTSD. It has been estimated that as high as twenty-four percent of the American fire service is suffering from PTSD. Clearly this is a large problem for our community.  Next time we will be discussing some of the impacts of PTSD on the fire/EMS worker.