Trainerís Corner: May 2012
Surviving post-traumatic stress
Written by Ed Brouwer
This four-part series is intended to provide information. It is not to be used to diagnose or as a cure of any kind. If you or someone you know is thought to be suffering from post-traumatic stress disorder (PTSD), seek professional help immediately.
You’ve just left the hall, your shift has finally ended and you are on your way home. You are stopped for a red light. You close your eyes for a moment as Paint it Black by the Rolling Stones plays on the radio. Just then you hear “beep!” Half in a daze, you lift your foot off the brake and begin to roll through the intersection, only to realize the light is still red. “What?” Once again the driver behind you blows his horn – beep, beep! You look up, but the light hasn’t changed. You look in the mirror and say, “Idiot, it’s a red light.” Beep, beep, beep! You give a glare that could stop a charging rhino and mutter, “Are you out of your freakin’ mind? One more time, buddy! Just one more . . . ” Beep, beep! “You gotta be kidding me! Really? Really?”
|The trauma and stress associated with long-duration or mass-casualty incidents, or those involving children, is often left unchecked; PTSD is the most common mental-health challenge among Canadians.
Beep, beep! You slam the selector into park as you jump out of your car and storm toward the driver behind you – who happens to be grinning like a fool. You reach in through the window, grab the guy by the shirt, pull him halfway out, and yell, “What do you want?!” The now fearful driver stutters, “Your . . . your . . . your bumper sticker says, honk if you love firefighters!” Stunned, you look at your bumper, then you realize you are standing in the middle of the street, holding up traffic with the light now green. You smile sheepishly as you notice for the first time the three wide-eyed seniors in the back seat. It isn’t until you are back in your vehicle that you realize you have something in your hands. Funny, you think. It looks a lot like a clerical collar.
Reactions like this are not normal – you do know that, right? Joking aside, we are going to take a look at what is labelled the silent killer: post-traumatic stress disorder. I realize that reading about this type of subject is as exciting as watching paint dry, but I urge you to reconsider. I will do my best to make it an easy read, just four short columns that may even save your life.
Canada has had its fair share of high-profile fires in recent years and we all know that being a firefighter is considered one of the most dangerous and stressful occupations. Recent studies have indicated that fighting fires puts a tremendous strain on cardiac systems. In the past 20 years, heart attacks have accounted for about 50 per cent of on-the-job firefighter fatalities.
Just when you’d think things couldn’t get much worse for firefighters, out comes a study on PTSD and critical incident stress, or CIS.
It has been reported that fire departments across Canada are seeing an increase in PTSD symptoms among firefighters. I’m not sure if there is an actual increase or if it just seems that way because we are beginning discuss the problem openly.
PTSD is one of several anxiety disorders that affect one in 10 people, making it the most common mental-health problem, according to the Canadian Mental Health Association.
With the advancement of fire-prevention technology, fire departments are responding to fewer fire calls. However, these same fire departments are now receiving more non-fire emergency calls. When our department became first responders, our motor-vehicle incident (MVI) and medical callouts outnumbered our fire calls 15 to one.
But, it wasn’t just the increase in call volume; it was the fact that we were now usually the first on the scene of fatal MVIs, suicides, farm accidents, multiple fatality landslides and even homicides.
When I joined the fire service it was to put the wet stuff on the red stuff. We never worried about being exposed to the dangers of communicable diseases such as hepatitis or AIDS. Seldom, if ever, were we affected by the intense reactions of citizens who lost a loved one at a call to which we responded. There was enough on our plates with the toxic gases from fire. Now, as first responders, we have the added responsibility of treating critically injured victims, which, in itself, can be a source of further trauma.
I can tell you this: the pictures in my mind that I could do without seldom come from an actual fire. One MVI early in my career has stayed with me. I lay beside a man who was pinned from the waist down by his flipped-over, loaded semi-truck; we talked as calmly as two guys having a coffee. Yet I knew the whole time that as soon we freed him, he would bleed out.
The end of my 20-minute friendship was a mad dash down the centre line of the highway with him on the stretcher headed for the medevac helicopter.
The strobe lights caused the scene to pulsate as a dozen portable lights illuminated the path between the paramedics, firefighters, RCMP and myriad news crews.
He died before we even loaded him. I really can’t explain what I felt – it was a mixed bag of emotions. I became angry, so angry in fact that I threw my helmet at a reporter trying too hard to get a picture of my now-dead friend.
Two days later, I tracked down the number of the driver’s family. I will never regret making that call – it was a very important step in the healing process for his wife and kids, and, yes, for me as well. It validated for me what we as firefighters do.
Studies have found that firefighters generally reported that medical emergencies and gruesome motor vehicle incidents were the most upsetting types of calls that they received.
Statistics provided by Veterans Affairs Canada stated more than 1,700 Mounties were receiving PTSD pensions, up from 1,437 in 2010. Consider this: it is understood that our national police force and military members may suffer from this disorder, but what about firefighters, who regularly attend critical incidents?
Firefighters, paramedics and EMTs are routinely exposed to horrific scenes involving death and injury. Traumatic incidents occur on the fire ground, in motor vehicle incidents, at hazmat incidents and in other situations. These already traumatic events are even more horrifying if they involve the deaths of children. Many of us have comforted parents and family members at the back of the pumper, using the apparatus to shelter them from viewing the mangled wreckage that was their teenager’s car.
More horrific yet, when you arrive first on scene of a reported MVI with fatalities, you recognize the mangled wreckage as belonging to a family member. That realization comes like a slow-motion slide show being played out through the windshield of the rescue unit.
In the state of horror, your thoughts, feelings and actions uncouple. That may be why we refer to such states as wigged out, losing your mind, becoming unglued or becoming unhinged. In that state of feeling externally disconnected from reality, and internally from your prior normal self, horror leads to feeling vulnerable. Feeling vulnerable is a very unstable emotion, and unless something intervenes to make it go away, it quickly can escalate to feeling that the next blow will shatter you. This triggers the feeling of terror. Then, terror internally moves very quickly into panic, and then panic pushes you to fight or flight.
These horrific scenes are not easily released by mind, body or spirit.
In an article titled, “Firefighters’ PTSD at dangerous levels”, published in the APA Monitor in 1995, T. DeAngelis said 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 . . . .”
Although line-of-duty deaths are not that common an occurrence in the Canadian fire service, it takes just one LODD to change a department forever. In some LODD cases there is a very real chance of survivor’s guilt: the survivors often ask, “How is it that I survived when others more worthy than me didn’t?”
Survivor’s guilt is based on the harshest of realities – the death of comrades and the struggle of the survivor to live. Often the survivor has had to compromise himself or the life of someone else in order to live. The guilt that such an act invokes – guilt over simply surviving – may eventually end in self-destructive behaviour by the survivor.
Sept. 9, 2011: Few people were aware that Jack Slivinski Jr., a member of Philadelphia’s elite fire-rescue squad, had been quietly drowning in survivor’s guilt in the seven years since his supervisor suffered fatal burns after racing into a collapsing building to rescue Slivinski Jr. and another firefighter, unaware they’d both got out. It is now believed that Slivinski’s suicide was the tragic result of PTSD because he felt responsible for the death of Lt. Derrick Harvey, 45.
You might ask why no one at the department noticed that Jack was suffering from PTSD. It’s a good question, but although PTSD is diagnosed by symptoms, it takes a professional who knows PTSD to distinguish this disorder from other disorders.
Those with PTSD usually can’t tell you that they have the disorder, unless they have been diagnosed and are in therapy. It’s not like having a cold or the flu; they may or may not remember the traumatic event. They may deny outright that they are having a problem, other than the day-to-day life stresses.
Fire officers should be trained to identify the factors leading to stress and know the steps to solving these concerns through group interaction strategies.
In a nutshell, PTSD results from exposure to a stressful event or a series of events that overwhelm normal coping responses. The issue before us is something we must start talking about! As long as we are silent about PTSD, it will gain power and control of Canadian fire services. I hope that awareness will be the first step to victory for us.
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