Trainerís Corner: June 2012
Surviving PTSD Ė part 2
Written by Ed Brouwer
This is part 2 in a four-part series intended to provide information. It is not to be used to diagnose or as a cure. If you or someone you know is thought to be suffering from post-traumatic stress disorder (PTSD), seek professional help immediately.
Research has shown that firefighters will often exhibit the symptoms associated with PTSD at home and attempt to mask these symptoms at work. Therefore, I highly recommend that the Canadian fire service provide some level of training for spouses and family members to recognize PTSD symptoms.
|Responses to collisions, particularly those involving children who have something in common with the responder’s children, are likely to cause post-traumatic stress.
Symptoms may include difficulty sleeping or concentrating, haunting memories, and anxiety, which itself has symptoms including chest pain, rapid or irregular heartbeat, shortness of breath, hyperventilation, and, sometimes, overwhelming fear.
Although PTSD symptoms vary, there are common ones, such as reliving the event through memories, nightmares or flashbacks, avoidance and emotional numbing, increased alertness and aggression or insomnia, headaches, and profound sadness. PTSD can also lead to drug or alcohol addiction, depression or other illnesses.
Generally, a period of time elapses between the trauma and the onset of PTSD behaviours. The time frame with acute PTSD is much shorter than with chronic PTSD, in which years can pass between the trauma and the fallout.
The main difference is how individuals are able to cope. Some may turn to or away from their faith, peers, friends and families. Others feel shame and guilt, whether they are responsible for the event or not; perceptions and assumptions are made based on personalities and upbringing.
High levels of social support at home and at work have proven to significantly lower odds of developing PTSD. The social support that develops in the firehouse can help to insulate firefighters from the impact of traumatic experiences. This is particularly true if the firefighter fits in with and is accepted by peers. However, withdrawal from social relationships is common in firefighters who develop PTSD.
According to a 1999 study by a group of researchers, high levels of work stress (problems with supervisors, and other work-related problems) were associated with a three- to four-fold increase in the odds of firefighters developing PTSD.
Ian Crosby, co-ordinator of the wellness and fitness centre for the Calgary Fire Department, says just one to two per cent of CFD’s members are diagnosed with PTSD each year.
“There’s that stigma attached to it, I think, in the general population anyway,” Crosby says, “but in emergency services I think it’s compounded even further.”
“You’re dealing with people that tend to have a rescue mindset, where you’re helping others and not necessarily looking to whatever issues you might be having internally. You tend to kind of put that aside.”
So, have you ever . . .
If so, please understand that you are not alone.
- felt so tense, discouraged or angry that you were afraid you just couldn’t cope?
- had an extremely stressful experience that you try not to think about, but cant?
- felt constantly on guard or been on edge (jumpy) more than you really need to be?
- wondered why you get upset seeing a certain scenario in a movie?
- had reoccurring nightmares?
- felt suicidal?
- self-medicated with drugs (prescription or other), alcohol, food, sex?
Another study by that same group of researchers compared 203 firefighters in urban departments in the United States with 625 Canadian firefighters; 22 per cent of the American firefighters and 17 per cent of the Canadians were found to have PTSD. Other researchers have found that between 33 per cent and 41 per cent of firefighters experienced emotional distress, and 21 per cent of ambulance service workers had PTSD. These researchers concluded that the high level of PTSD suggests a mental health problem of epidemic proportions in urban professional firefighters in the United States.
The following incidents are most likely to traumatize firefighters:
These incidents were compiled by combining research with the numerous stories of firefighters and emergency service personnel treated by Dr. Nancy Davis, a clinical psychologist who specializes in PTSD among first responders.
- Witnessing the death of an emergency responder or viewing the body at the scene, especially that of a friend or partner. Trauma is often increased if the firefighter believes he or she should have protected the person who died, if he or she trained the dead peer, or if the dead firefighter or EMT/paramedic was temporarily serving in the survivor’s place. Trauma is increased when firefighters or EMTs/paramedics imagine themselves as the ones who died, then visualize the impact their death would have on those they love. Survivor guilt increases the impact of the traumatic experience.
- A reasonable belief that death or critical injury is imminent and certain, such as being in the middle of a burning building as the structure collapses, or being caught in a wildfire.
- Viewing the body of a child, particularly if the firefighter or EMT/paramedic is a parent, and even more so if their children are the same age and sex as the dead victim, or if the child victim is similar in some other way to their children.
- Dealing with the death of a child due to irresponsible adults, such as drunk drivers or careless parents. The impact can be greater if the body of the child has been burned or dismembered.
- Hearing a citizen scream for help from inside a burning building, and, because the fire is too involved, being unable to save that individual.
- Being blamed for the death of a citizen, particularly a child victim, by department members, family members of the victim, or the media.
- Feeling guilty or responsible for violence or death, whether irrational or based on fact. Two events that seem to lead firefighters or EMTs/paramedics to blame themselves for a death or injury and suffer accompanying guilt are: the deaths of a peer during a shift that they would have been working had they not taken leave, been sick, been on vacation; and responding to a call minutes after a firefighter or EMT/paramedic has lost his or her life.
- Having a dead victim become personalized, rather than just an unknown body, through interaction with grieving family members or friends. Continued association with the pain of survivors through investigations also can personalize dead victims. During my investigative research for my HOT session, Calling A Mayday, this last point became very real for me. Most of my time was spent studying one particular fire – the Charleston’s Sofa Super Store fire. I read hundreds of pages from the investigation reports. I researched the lives of each of the fallen brothers, and then listened to hours of recorded radio transmissions from the fire ground. Without reservation, I admit the tragic deaths of the Charleston 9 impacted my life.
- Having a victim die in the arms of a firefighter or EMT/paramedic, or en route to the hospital, particularly when the victim is a child or adolescent.
- Being exposed to particularly bloody or gruesome scenes, especially for a great length of time (viewing victims with severe burns, seeing the suffering of victims and/or the grief of their loved ones).
- Observing an event involving violence or murder, but not being able to intervene. (“She was screaming for my help but there was nothing I could do.”)
- Feeling personally responsible for someone’s life, for example, after administering CPR to a patient at the scene or en route. Whether a victim dies en route to the hospital or survives, symptoms may occur as a result of the stress hormones released during long rescue operations.
- When citizens at the scene threaten to kill or critically injure a firefighter or EMT/paramedic unless some condition is met. (For example, “If my father dies, you die. You had better save him.”)
- Being referred to as a hero after being involved in an incident where other fire- and rescue-service professionals died or were critically wounded. The living rescuer’s sense of guilt over living or not having saved a peer and/or friend can dramatically increase PTSD symptoms.
To this point I have focused on firefighters, paramedics and ambulance personnel, but what about the support groups who work alongside us (flaggers, city and highway crews)?
When Crosby and I spoke about PTSD, we both commented on the plight of tow truck operators, wondering whether they ever receive help regarding the traumatic accidents to which they respond.
Until recently, I really didn’t think about the ability of tow truck drivers to deal with this traumatic situation. After a crisis, they may feel out of control, depressed, confused and angry. They may feel numb and not feel anything at all. They may experience physical reactions such as headaches, sleeplessness and/or nightmares, stomach upset, even vomiting. Someone needs to tell them that it is normal to react this way after a critical incident.
Consider what the responding agencies would have experienced in responding to the following three MVIs:
A horrific head-on crash killed five people outside Williams Lake, B.C. The victims were reportedly on a family trip to Vancouver. The SUV in which they were travelling crossed the centre line of Highway 97 into the path of an oncoming tractor-trailer, according to Cpl. Madonna Saunders of the Prince George RCMP. Both vehicles ended up in a ditch engulfed in flames, killing all five passengers in the SUV;
In Shakespeare, Ont., a van carrying 13 migrant workers from South America ran a stop sign before it was broadsided by a truck. The violent impact killed 11 people at a rural intersection; and Police in Alberta investigated a fiery head-on collision involving two pickup trucks that killed seven people on a busy stretch of highway between Edmonton and Fort McMurray. The crash occurred in snowy conditions on Highway 63 near Wandering River.
RCMP confirmed that six of the nine people involved in the collision died at the scene of the crash. The seventh person, a teenage girl, later died in hospital.
In all three cases, post-incident debriefings were delivered by mental health workers and peer de-briefers. (These experts should have experience in the emergency services with which they work, giving them all-important credibility.)
Debriefing is popular with emergency workers and aid workers, because many of them see it as their only chance to talk about their experiences. It allows them to do so as a matter of routine, without the stigma of therapy, which they sometimes fear could be detrimental to their careers.
The first step in battling critical incident stress (CIS), a precursor to PTSD, is to be prepared. Take care of yourself before a critical incident – exercise, a good diet, and downtime are helpful. Keep hydrated by drinking water, know your stress levels and recognize when you need a break. Build relationships with loved ones – they will be your strongest defence.
Know the enemy: When we get an adrenalin rush, there are some 10,000 chemicals dumped into our bodies. These chemicals take an average of 18 hours to get rid of when unchecked. Drinking water helps flush these chemicals from our bodies and exercise sweats out the chemicals. Avoid caffeine, sugar and alcohol, as they just add more chemicals to the mix.
Know your support system: Your spouse and/or family can help you heal. Don’t shut them out. You don’t have to share the gory details, but do share how you felt. Hold a hand. Talk to them. Find someone you trust, talk about the incident.
Know where to get help: Chaplains, peer support and employee assistance programs are all good places to start. If you know someone who has recently battled CIS, don’t ignore them. Reach out to them and offer help.
Ed Brouwer is the chief instructor for Canwest Fire in Osoyoos, B.C., and Greenwood Fire and Rescue. The 21-year veteran of the fire service is also a fire warden with the B.C. Ministry of Forests, a Wildland Urban Interface fire suppression instructor/evaluator and a fire-service chaplain. Contact Ed at