Stress Reading for Responders
As firefighters, we are trained to read smoke and other fire conditions. As EMT’s and paramedics we are trained to read or recognize symptoms that might endanger our patients. In contrast, firefighters and other responders often have serious limitations in determining high stress levels, anxiety and mood problems in themselves. Several variables contribute to problems in recognizing behavioral wellness issues which include negative stigma (toward mental health assistance), fear of weakness and the way we are programmed (trained) as responders. We worry more about taking care of others, than ourselves.
Why is this an important issue to address? We have an increasing level of suicide due to chronic stress and exposure to potentially traumatic incidents. Firefighters and EMS are much more likely to die from suicide than line of duty deaths. Responders are exposed to many situations or job stress….things we cannot “unsee”. The years of exposure are a big reason why responders are at least twice as likely to experience Post Traumatic Stress or diagnosed PTSD than the general population. Stressors in our occupations can lead to problems which include depression, anxiety, alcohol/ addictions, PTSD, suicide, relationship and financial problems to name a few.
Entering the behavioral health system can be difficult for Firefighters and EMS as noted above. It is crucial for departments to implement an effective behavioral health and wellness program for our responders. Two words are key, implement and effective. The fire service has embraced the Peer Support movement with good results. This message has been successfully promoted by organizations such as the International Association of Firefighters (IAFF) and the International Association of Fire Chiefs (IAFC). Many Peer Support teams have been developed as a result. Sometimes these teams respond to potentially traumatic events (PTE’s) or critical incidents well. But they may be lacking in the educational or outreach portions of the peer support model.
Examples of education would be sending a steady stream of behavioral health education materials to the company firefighters and EMS crews. This education can be initiated by simply visiting crews to discuss behavioral wellness issues in an informal setting (e.g., stress, addictions, suicide, PTSD, depression/anxiety). This type of educational outreach needs to happen on a regular basis. Examples of outreach can consist of peer support team members visiting each crew or fire station with literature about behavioral wellness topics and staying around to talk with crew members and company officers. In addition, company officers or supervisors can lead these discussions with their crews. Hopefully, we as a fire service culture can put these practices in place without much difficulty.
Firefighters, EMS and all responders are trained to look after each other. For example, scene safety is such a concept. As a young firefighter/medic I was trained to look out for my brothers and sisters because “we don’t need more victims”. Watching out for each other is what we are trained to do. You might ask, “how do we do this, we are not trained therapists”? How should we watch out for each other?
Pay attention to each other, watch stress levels of others in your crew. Is someone on your crew acting different? Are they or their habits different? Has their attitude changed? We live together in these jobs and know each other better than typical coworkers. Often, a coworker will share these things with another person. Is someone working too hard or has the crew had some bad calls lately? Has someone disclosed financial or family problems? Is someone drinking too much or using “too much prescription medication? Has someone’s mood moved away from baseline (more down than usual)? These are all questions that might suggest that we should keep a closer eye on each other. Specifically, supporting each other more and encouraging self care is important. Self care such as engaging in hobbies and leisure activities are a portion of resilience. Resilience activity is the “medicine” for this and all types of stress. Resilience is simply self care and unplugging from our daily routine for as much time as possible. The bigger the dose, the likelihood of therapeutic result. You should ask each other, “what makes you happy” or “what brings you joy”? Simply put, this is resilience.
(Dr. Smith is an IFD Lieutenant (Ret). He is a Psychotherapist in Private Practice and Clinical Director, Indianapolis Fire Dept., Local 416, Hamilton County and Hendricks County Peer Support Teams