Stress Reliever

This article first appeared in the
Fire Chief magazine, February 2007

When can a firefighter’s stress cross into a debilitating post-traumatic stress disorder? Paul Antonellis Jr., a retired fire chief from Salisbury, Mass., is a certified employee assistance professional and addiction specialist whose research on line-of-duty deaths evolved into an interest on PTSD. He is co-author of Posttraumatic Stress Disorder in Firefighters: The Cases that Stick with You.

Why did you write a book about PTSD? For the past 15 years I have traveled across the country speaking on line-of-duty deaths and I kept hearing about post-traumatic stress: how many people are suffering from it and are still on the job.…

Shannon Mitchell, Ph.D., offered to co-author the book and add a clinical perspective. A lot of administrators don’t know how to handle a psychological injury versus a physical injury where you have x-rays to read. Our driving force was that we wanted to create a book that was not clinical, but a book that a firefighter, lieutenant, chief or family member could pick up and make use of it.

Is PTSD considered a disease? It’s considered more of a disorder, an anxiety disorder. Essentially, the brain goes into a fight-or-flight mechanism when we experience that traumatic call. Typically we come off that autopilot of fight or flight in a couple days. In PTSD … you stay in that fight-mechanism or auto-zone and you never come off of it.

Paul Antonellis

What’s the difference between depression and PTSD? From a clinical standpoint, a person can’t be diagnosed with PTSD until 30 days post-incident. What he or she would typically be diagnosed with is acute stress disorder within the first 30 days, with specific criteria he or she must meet. A person could be diagnosed with PTSD, but we all know that firefighters aren’t going to go within the first 30 days, but [will] wait until it’s really, really bad.… We wait until the last straw, and unfortunately that straw can be drug addiction, gambling [or] absenteeism from work, and productively levels fall.

What I’ve seen is a firefighter or EMT will start coming in to work late, so the officer disciplines him for being late instead of asking why for the past 15 years he’s been on time versus the past three months.

One of the hallmarks of PTSD is avoidance. [Sufferers] avoid talking about the incident or the symptoms. If confronted, they will blow it off or simply downplay it. If I’m suffering from PTSD and get in a fight with a colleague, it’s more macho to be disciplined for fighting in the firehouse or showing up late, rather than saying a couple months ago we had a bad call, my behavior is erratic, and I need help.

Is it possible to prevent PTSD? It’s more education than prevention. It’s making people aware that they are not the only ones and there is help. Just because you receive the diagnosis of PTSD doesn’t mean it has to end your career. I know people who have active PTSD and are working and fully functioning. In our society, the thinking is that it’s a psychological injury so you can’t be a cop or firefighter or EMT and that is not the case.

Are younger generations more inclined to ask for help? I think younger generations are more inclined to ask for help and recognize that stress is part of the job. It’s almost become common practice to say, “I see a psychologist and this is why.…” I think [they are] more inclined to seek mental health care because they can prolong their careers, stay healthy and lead productive careers.

What can chiefs or officers do if they feel something more is going on? It’s always important for supervisors to talk to employees if they suspect something is going on. The hallmark of PTSD is denial, avoidance.… You can lead a horse to water but you can’t make it drink. You can offer someone an [employee assistance professional] and make it as confidential as you can. I think we need to educate the family because it impacts them also, and that’s the secondary trauma because it will put a strain on relationships.

Another area I’m starting to see [signs of PTSD in is] chiefs and officers who have retired from the job. Everyone thinks once you retire and get the golden watch that you’ll live happily ever after, but PTSD can be a delayed response showing up a year or several years later.… We need to start tracking how many people are affected by PTSD.

Write down the factual stuff, and don’t make an assumption it’s PTSD; you’re not a clinician. [Tell someone,] “Here’s what I’ve noticed on your behavior and it’s not consistent with your past. I may have to order you to EAP.” Be supportive. Be understanding. Be there.

About the Author: Paul Antonellis retired at the rank of Fire Chief after serving more than 20 years in the fire service in Massachusetts. He also served as a part-time police officer for ten years and has more than 18 years of experience as a Certified Employee Assistant Professional (CEAP) and a Certified Addictions Specialist (CAS). He is currently on the adjunct faculty of three colleges, teaching in the undergraduate and graduate Fire Science, Labor Relations, Justice, and MPA programs, and also serves as a curriculum development specialist, responsible for developing new courses or converting traditional classroom courses into online courses. Paul has taught more than 70 graduate and undergraduate classes. He has authored and published two books and more than 25 articles on various topics in the field of fire service and law enforcement and has traveled nationally and internationally to speak on various topics relating to emergency services. Antonellis just published his third book, Labor Relations for the Fire Service with PennWell Publishing. Professor Antonellis holds an A.S. in Fire Science, an A.S. in Criminal Justice, a B.S. in Fire Science Management, and a master’s in Labor and Policy Studies with a concentration in Human Resource Management.