by Captain Rick Smith (retired)
Santa Maria (CA) Fire Department (1982-2012)
Trust, peer involvement, early intervention and Union buy-in are all critical in addressing the stress and emotional disorders that afflict firefighters. In December of 2010, I had had enough of the eventual stressors that had plagued me for the past 33 years of being a firefighter.
I had been dealing with claustrophobia since early in 2008. I had no idea what and/or how the claustrophobia was affecting me in both my daily living and at the Firehouse. I was sleeping for as little as two hours a night, I was having night terrors and, at times, a feeling of being awake but I couldn’t move my body. I was having uncontrolled nose bleeds, rashes and just an overall feeling that I didn’t want to be at the Firehouse any more than I had to be. I avoided working any overtime unless being force hired.
With all of the symptoms that I had, I avoided their meaning because I knew that the outcome could and would mean the eventual early retirement of my CAREER. I look at the role of a firefighter as a career, not a daily job or work…not 8-5. That was the one thing that stopped me from seeking early assistance and intervention. I avoided most training that involved any kind of tight quarters or wearing my structure gear.
At this point (December 2010) I took some time off and decided to throw up the white flag, not that I was quitting by any means, but that I needed some assistance. I did some extensive research on the issue but came to no definitive conclusion as to what was causing the claustrophobic events.
In December of 2010, we took the lung capacity test. Along with that test, we were told to fill out a small question and answer section. One of the questions was ”do you have claustrophobia?” I answered YES. This startled the nurse at first but then it became an issue. She had me make an appointment with our City’s Doctor who said that I should go down the road with a workers compensation request. I did so and was promptly DENIED. Before I had filled out the workers comp paperwork I notified my Battalion Chief and he had no idea what to do. It went as far as the City Manager who placed the answer back on the Chief. The only thing the Chief could do was to take me off of the Engine Company and place me on a light duty assignment in the Prevention Office.
The City asked that I meet with them and the Reasonable Accommodations Committee. I met with the committee on March 14, 2011. This committee consisted of my shift Battalion Chief, my Union representative, the City’s Risk Manager and the City’s Human Resource Manager. In the meeting, I was asked what my job as a Fire Captain consisted of. I read the responsibilities letter of a Fire Captain. I then had to explain that it’s the Captain and the firefighter that go into a structure fire. The Risk Manager and Human Resources Manager had no idea about this; it became a major concern for them.
I was told that the City’s insurance had DENIED my claim and that I would have to basically find out the reason for my claustrophobia on my own time. I was placed on PERSONAL sick and vacation leave until I could come up with some sort of conclusion. I asked the Human Resources Manager if this was the road they really wanted to go down. They told me their “hands were tied”. I said that they were the ones that tied the hands! They still said that I would have to find out on my own.
When I exited the door I promptly called our Union’s attorney. I talked with the lead attorney and he immediately took the case. I had no idea that I would continue to be off duty and still fighting for my rights.
The attorney told me it would be a great idea to seek the assistance of a physiologist in my area and start the process. I found a psychologist in San Luis Obispo and made my first appointment. Within fifteen minutes she diagnosed that it was work-related stress that was causing my claustrophobia. She told me that we don’t have claustrophobia, but that it is how the stress manifests itself. She worked with me to try to get my stress level down. She accomplished this through cognitive thinking patterns. These patterns helped but I still have areas that I need to work on. She also told me that the work-related stress was Post Traumatic Stress Disorder/Disease (PTSD) much like what the veterans’ from war come back with.
People who say PTSD is a psychological issue, and you should “just get over it,” are wrong in every sense of the idea. The event that causes PTSD causes the autonomic and central nervous system to be affected, as well as decreases the mass of the hippocampus and causes the amygdala to be over reactive within the brain.
• The hippocampus is a major component of the brain in humans and other mammals. It belongs to the limbic system and plays important roles in the consolidation of information from short-term memory to long-term memory and spatial navigation
• The amygdala is an almond shaped mass of nuclei located deep within the temporal lobe of the brain. It is a limbic system structure that is involved in many of our emotions and motivations, particularly those that are related to survival. The amygdala is involved in the processing of emotions such as fear, anger, and pleasure. The amygdala is also responsible for determining what memories are stored and where the memories are stored in the brain. It is believed that memory recording is determined based on the emotional response and impact an event creates.
I read and researched quite a bit on this issue that plagues firefighters. I had no idea that I was not alone in this arena but there were support groups and fire departments that are working on this very issue.
Since I chose to have an attorney involved, I had to use an AME (Agreed Upon Medical Exam) over the City medical exam. I was given a date to take a deposition and then a psychological test. One was scheduled for August and the other was not scheduled until October 2011. Talk about waiting. This was very difficult for me because just like a firefighter when we are handed something we get the task accomplished as soon as possible. But this waiting period was killing me!
I went to my deposition and the attorney asked mostly medical condition questions. Every time he had a question, I had a door to close behind it, meaning I diverted the answer back to “it’s work related!” The question period was completed in under an hour, I was pleased, and my attorney answered a few questions I had after the session.
In October, I took a psychological exam, which consisted of some 500 questions and an hour visit with a doctor. After the questionnaire, I met with the doctor who told me that I was definitely suffering from the following:
• Hypervigilance – an enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors whose purpose is to detect threats. Hypervigilance is also accompanied by a state of increased anxiety which can cause exhaustion. Other symptoms include: abnormally increased arousal, a high responsiveness to stimuli, and a constant scanning of the environment for threats. In hypervigilance, there is a perpetual scanning of the environment to search for sights, sounds, people, behaviors, smells, or anything else that is reminiscent of threat or trauma. The individual is placed on high alert in order to be certain danger is not near. Hypervigilance can lead to a variety of obsessive behavior patterns, as well as producing difficulties with social interaction and relationships. Hypervigilance can be a symptom of post-traumatic stress disorder (PTSD) and various types of anxiety disorder. ~ Wikipedia
• Agoraphobia – the fear that something bad was going to happen at work. Wikipedia states that agoraphobia is “also an anxiety disorder characterized by anxiety in situations where the sufferer perceives the environment as being difficult to escape or get help. These situations include, but are not limited to, wide-open spaces, as well as uncontrollable social situations such as may be met in shopping malls, airports, and on bridges. Agoraphobia is defined within the DSM-IV TR as a subset of panic disorder, involving the fear of incurring a panic attack in those environments. The sufferer may go to great lengths to avoid those situations, in severe cases becoming unable to leave their home or safe haven”
He also said that I was in a “permanent and stationary” state (I could be fixed but I would eventually break again) and that I should be compensated 100% medically.
On December 7, 2011, I received a letter from the City stating that I could not return to work and that I would receive a full disability retirement.
On February 13, 2012, I received a letter from the City’s insurance company advising me that they are now ACCEPTING my claim. Nowhere in the letter does it apologize for their “mistake”. They never owned up to their oversight on my claim. This is where I have one of the hardest parts of my whole ordeal.
On March 14th, the City’s Finance Director called and said it would work out if they retired me on March 14th since that was the ending time of my workers compensation.
Everyone, myself included, thinks that we as firefighters are the heroes and that we drive down the street in our shinny yellow and red fire trucks, waving at kids and parents, we spray water on fires and teach children about Stop, Drop, and Role. But, we are the ones that go into burning structures when everyone else is running out. We are the ones that go up the flight of stairs to attempt a rescue while everyone else is flying down them to avoid the hot gases, smoke and flames.
I would venture to say that the public at large has no idea what happens behind closed doors when we come barreling in. The average person has no idea what it is like to perform CPR on a person, yet alone on someone that is in your family and very close to you.
The average person has no idea what it is like to tell a mother and father that their little baby has just passed away from SIDS (Sudden Infant Death Syndrome).
The average person has no idea what it is like to be holding a patient’s head for traction in a horrific DUI (driving under the influence) automobile accident only to find out it is your very own niece.
The average person has no idea what it is like to go into a structure fire, let alone go into and find out that there are fire victims and you can’t save them.
The average person hasn’t attended to someone after they have committed suicide by hanging, shooting him or herself, or a drug overdose.
The average person has not witnessed another emergency worker after they have died in a car accident.
I guess the final “it’s getting better” was when I had my yearly appointment with my family doctor. My cholesterol was high, 270 with medication. I was doing everything in my powers to get it lower but nothing was helping.
I had taken a blood test prior to my appointment so the doctor could read it and tell me where I was in regards to my cholesterol numbers. “Rick, “my doctor said, “I have two pieces of paper here; one is your current cholesterol number and the other is my disgusted doctor cholesterol number”. So basically, Door #1 or Door #2. I chose Door #1. “Good choice, Rick” he said. “Your cholesterol is 160!” “160???!!!” I asked. “YES 160!! You dropped 60 points. So what did you do?” I said…RETIRE!!! “That’s it” he said “Work related stress!!! You are living proof that work related stress destroys the body”.
So all the things that I had been dealing with, stress, bad sleep patterns, weight gain, night mares, alcohol use, actually meant something now.
Management looks at us as a “BUSINESS”. We are not a business. We have many traditions in the fire service, many I have seen and witnessed. Some good, some bad. But the best tradition we have is HONOR.
But we all are told to “toughen up” and take the heat. Most people know to call the fire department because they fix EVERYTHING! But after a while of doing just that, toughening up and fixing everything, we need to ask the question “who is going to rescue us? Who is going to be there when we need help, when we need fixing?”
About the Author: Rick Smith is the Owner and Chief Instructor for RS Communication Consultants. His company is a two-way radio consulting firm specializing in public safety. The company provides a comprehensive service while assisting agencies with their two-way radio pricing, purchase and training. Some of the training that his company provides is instruction in workplace PTSD (Post Traumatic Stress Disorder) and Level II Dispatcher.
Rick has been involved with two-way radio communications since the early 1970’s. He is deeply involved in communications’ committees throughout California, including Secretary for Firescope Communications Group. He is the Communications Unit Leader for the Los Padres National Forest Incident Management Team 7. He is an instructor at the local college in the Fire, EMS and Police academies. He has been an instructor at Firehouse World and at IWCE Las Vegas. You may contact Rick through his email email@example.com or website