Health and wellness
Trainer’s Corner: September 2012
By Ed Brouwer
This is the final instalment in a four-part series on surviving PTSD. Read Part 1; read Part 2; read Part 3. This series is 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.
|Training firefighters to deal with trauma, stress and grief is no less important than training them to be safe on the fire ground.
Firefighters often use humour to survive emotionally; however, it is a dark humour that is not always appreciated by those outside the fire service. Unfortunately, some responders will self-medicate with alcohol, drugs or other meds to control anxiety, stress, fear and anger. The danger, of course, is that self-medication can lead to substance abuse.
When your children wear T-shirts displaying statements such as “My dad saves lives for a living, what does your dad do?” it sets a high standard. Shirts with messages such as “All men are created equal, a few become firefighters”, “First in – Last out”, and “Hero Inside” all paint pictures of invincibility.
I fear at times we begin to believe that we have a duty to save every life and stop every fire and God help us if we lose a home to the fire dragon.
The “We are the Rescuers” (same tune as “We Are The Champions” by Queen) mindset can and does keep us from calling a mayday, which would save our physical body, and it keeps us from asking for critical incident stress management (CISM), which could save us from mental destruction.
It’s strange how we consider deploying the rapid intervention team (RIT) to rescue our own but hide from the critical incident response team.
Although our families see us as heroes, our communities sometimes have different opinions. Being confronted with a lack of support and compassion by the citizens you live to protect, or dealing with personal attacks through negative media coverage can add to the already high stress level.
I’ve sat through community meetings at which certain people have attacked our fire department and have torn strips off of our fire chief (a volunteer with 15 years of service). Now, just the fact that you are thinking, “That is nothing, why in our community . . .”, tells me we have a problem.
Most of us have come to grips with the fact that John Q. Public will most likely never get what we do. Local newspaper headlines report the sad news of another fallen hero, the tragic death of a brave firefighter who has died in the line of duty, one of our own who sacrificed his or her life so that others may live or so that homes and property would be saved from the ravages of fire. Most civilians half-heartedly acknowledge the event while searching through the rest of the paper for a baseball score, stock-market figures, want ads or horoscopes. Most civilians cannot relate to this type of tragedy nor can they comprehend the depth of grief that every member in the fire service feels. Their lives are not changed by this tragedy.
Unfortunately, this is not true for the family and co-workers of the fallen firefighter; life as they knew it will never be the same again.
A line-of-duty death impacts the lives of all members of the department and their families. It is imperative that everyone is given information about grief and how to cope with the pain and suffering it creates.
It is very important to the physical health and emotional well-being of these men and women that they are given an outlet through which they can express their feelings. As a result of this life-altering event, they may question their self-worth. Surviving this type of tragedy is, at times, almost unbearable.
How does one survive? When someone dies, our response to the loss is equal to our relationship with the person; the stronger the emotional bond the more intense the grief. In addition, the manner of death (sudden or anticipated) and our personal-life stressors influence our grieving.
When someone dies suddenly (auto accident, heart attack, line-of-duty death) we experience immediate grief: there is no time for goodbyes or I-love-yous. There is no opportunity to express how much we value the friendship, or ask forgiveness. Our grieving process may be complicated by everyday problems such as job-related stress, family struggles (such as divorce), financial worries or personal health issues.
These distractions can greatly influence our ability to focus on our grieving, which can delay or even suppress the grieving process.
The International Association of Fire Chiefs’ Foundation (IAFCF) has said 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.”
In addition, it says, “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.”
These concerns have attracted the attention of the Canadian Association of Fire Chiefs (CAFC). I am pleased to inform you that the CAFC unanimously passed a resolution in September 2011 to lobby the federal government to create a committee to examine post-traumatic stress disorder and its subsequent addictions among fire services personnel across the country, and to provide funding for treatment services.
Perhaps your department has had to cope with the agonizing pain of losing a fellow firefighter in the line of duty. Everybody (I’m sure they mean well) asks how you’re doing. To be honest, there were times I just wanted to reply, “How the hell do you think I’m feeling?” Then there are times when I’m mad because nobody asks how I am. But by reinvesting in life and sharing love with others, you will honour this hero who made the ultimate sacrifice. In so doing, the deceased will never be forgotten.
A final note to fire-service trainers: We 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. Without coping skills, emergency-service professionals can experience unhealthy side effects, such as stress, high blood pressure and depression, as well as disabling illnesses including heart attacks, substance abuse and post-traumatic stress disorder. There are many strategies that can be beneficial for people suffering from PTSD, starting with understanding and support as quickly as possible. These individuals often need to be debriefed about the trauma and need opportunities to freely vent without outside judgments. Some will require more counselling and professional attention.
Sometimes anti-anxiety or anti-depression medications can help. Most can benefit from a program of stress management that leads to controlling their physical responses to fear and anxiety.
The greatest resource in the Canadian fire service is the firefighter, and although every firefighter is provided with turnout gear, we give them nothing to protect them from the ravages of emotional trauma. We must equip them to deal with death, crises and suicide. Firefighters must be given opportunities to talk about the pressures involved in traumatic situations, to understand what others have experienced in similar situations, and to know that they are not alone in their feelings.
With all the investment in firefighter training, PTSD prevention could be insurance against loss or injury due to events that would trigger a PTSD response. Every effort must be made to save not only the lives of firefighters, but also their emotional health. Recent research has questioned the usefulness of single-session debriefings, but there is support for longer-term interventions, and there is the promise of new types of interventions for disaster victims.
Here is some good news: even though firefighters might be at high risk for stress as a result of their jobs, it is important to note that most firefighters will not develop PTSD. Several factors have been identified that may reduce the likelihood of firefighters developing PTSD – the most important is having social support available either at home or through the department.
Studies have shown that firefighting personnel should have access to physical activity in fire stations, confidence-building social support from other firefighting personnel and group cohesiveness from their own crews to help to reduce stress.
If you find yourself experiencing symptoms of PTSD for longer than one month, don’t ignore it; seek professional help. There are proven effective treatments to relieve PTSD. Talk to trusted family members and friends. Seek help early. PTSD can be treated successfully. Cope with symptoms in positive and adaptive ways – exercise, healthy nutrition, connecting with others.
The following points may help you:
- Recognize and accept what you cannot change.
- Talk to people when you feel like it. You decide when you want to discuss your experience. Talking about an event may be reliving it. Choose your own comfort level.
- If your department provides you with formal mental health support, use it.
- Give yourself permission to feel rotten.
- Recurring thoughts, dreams or flashbacks are normal and usually decrease over time.
- Communicate with your loved ones at home as frequently as possible.
- Remember that getting back to normal takes time. Some of you were never “normal” to begin with. (Sorry, I had to put that in there!) That actually brings up another good point: appreciate a sense of humor in yourself and others. It is OK to laugh again.
Please, become familiar with the signs of this silent killer called PTSD. Be assured that there is a road out of this terrible place. Please, buddy, talk to someone about what you are feeling; you don’t have to go it alone.
In a firefighter’s world, survival is the only benchmark of success.
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