by Peggy Sweeney The Sweeney Alliance
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 believe today, as I did then, that programs such as Grieving Behind the Badge and First Step Hope: Not All Wounds Are Visible 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/corrections communities in general.
This video outlines some of the causes, signs and symptoms of Post Traumatic Stress Disorder (PTSD). PTSD, when gone untreated, may lead to suicide.
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 National Fallen Firefighter Foundation and the National Volunteer Fire Council, consistently recommended programs to help reduce mental and emotional stress for firefighters. That was in 2000! Today, there is still NO working 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.
Author’s 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.
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 inter-family 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 carry out 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.
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, gastrointestinal problems, and an increased risk of heart attacks and severe depression.
“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:
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.
Copyright Peggy Sweeney. All rights reserved.
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 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 email@example.com
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.