That firefighters suffer a higher-than-normal number of occupational injuries is a well-documented fact. Physical factors such as work environment, turnout gear restrictions and weather are, of course, the primary cause of these injuries, but psychological issues also are contributing factors. Being injured is a traumatic experience for those who have devoted so much time and energy to their fitness, occupational and recreational achievements. Then, suddenly and without warning, all of it can be taken away by the twist of an ankle.

Training officers and departmental fitness trainers need to be aware of the psychological reactions to injuries, how to recognize injury-prone personality characteristics, what signs of impending injury are and how mental strategies can accelerate the recovery process. Psychological factors play a role in injuries, and subsequent rehabilitation and sports psychology techniques can prevent future injury and promote accelerated recovery.

Athletes and firefighters share many characteristics: Both are highly motivated, part of a team and expected to perform at higher-than-normal exertion levels. We can consider fire suppression personnel to be occupational athletes. Therefore, I will use the words “athlete” and “firefighter” synonymously.

The relationship between injuries and psychological factors is primarily viewed as stress related. If a circumstance is perceived as threatening, there is an increase in anxiety, that can cause a variety of changes in focus and muscle tension, which in turn can lead to an increased chance of injury.

Two major theories can explain the stress-injury relationship. One view is attentional disruption, a disruption of focus by a stressor not related to the activity at hand. This lack of attention can cause injury because the firefighter isn't aware of peripheral activities or misses adjustment cues. A firefighter in a fire suppression activity could be preoccupied with an ill mother and not be paying attention to the directions of command personnel. He or she could miss a critical exchange and sprain an ankle or collide with other team members. Even veterans need to be reminded to focus and to attend fully to the activity at hand as they may take certain routine situations for granted.

The second view is that high stress levels can be accompanied by considerable muscle tension that interferes with normal coordination, increasing the opportunity for injury. Research has demonstrated a direct relationship between life stress and injury rates. These stresses focus on major life changes perceived as good or bad, such as losing a loved one, getting a promotion, having a baby or getting a divorce. Be aware of such life changes, assess their impact, monitor them and provide support as needed.

Personality characteristics also can be contributing psychological factors to injury, especially individuals who exhibit high levels of Type A and C behavior. Type A people often are seen as aggressive and hard driving. They are ruled by the clock and obsessed with accomplishing more than time will allow. Type C people are viewed as dependent, sweet, passive, gentle and nice. However, inwardly they are often resentful, unforgiving, worried, anxious, bored, frustrated and apathetic. Type C people often feel helpless, useless and unworthy and often experience excessive guilt and despair. Type A and C behavior can be seen as self-destructive extremes. What complicates the picture is that many people do not fit nicely into one classification or another, but mesh the qualities of more than one behavior pattern.

The following risk factors also have been identified in varying combinations to be contributing psychological factors to injury:

• High levels of negative and/or positive life changes;
• Exhibition of poor reaction and movement time due to poor attentional focus;
• High or low pain tolerance;
• High levels of extroverted or introverted behavior;
• Behavior associated with insecurity, overprotection and dependency;
• Behavior that reflects the firefighter feeling little control over the situation at hand;
• Behavior that reflects a poor self-concept and self-esteem;
• High levels of anxiety; and
• High levels of depression.

Another personality type, identified as accident prone, is said to possess a number of negative traits: aggressiveness, anger, attention demanding, easily offended, easily bored, competitiveness with inability to lose graciously, excitement, feelings of inferiority, frequent conflict with authority, frustration, guilt feelings and an unconscious need for self-punishment. People with this type of personality exercise even when injured, believing the problem will go away on its own. They are afraid the injury is going to “shut them down” and don't want to deal with that eventuality. It's easier for them to work through the pain than to deal with the psychological issues associated with his obsessive behavior. Officers and peers can inadvertently exacerbate this problem by fueling this obsession, viewing such people as merely highly motivated instead of displaying obsessive-compulsive behaviors that are physically destructive and potentially dangerous.

Even with the best training regimen and psychological preparation, injuries happen. This is an inherent risk in all physical activity, but how a firefighter reacts to an injury can affect the rehabilitation and subsequent return to active duty. The injured often experience a five-stage grief response consisting of denial, anger, bargaining, depression, acceptance and reorganization. The theory originally was developed from the work of Dr. Elisabeth Kübler Ross in her book On Death and Dying.

Whether all of these stages are experienced is widely debated. Rather, many people feel such emotions and thoughts simultaneously or revert back to categories once they have gone through them. The key is recognizing the current stage of grief response and being sensitive, supportive and aware of what the other person is experiencing.

Jim Gavin, a professor in the department of Applied Human Sciences at Concordia University in Montreal and a sport psychology counselor, says, “When athletes or exercisers have strong identity ties to their physical activity, they are thrown into a state of shock or disorientation. It's in this state that they will experience many of the five stages of grief. They can spin in this cycle of disorientation for extended periods of time. It's not until they can view the injury without blame — that is, not blaming themselves, circumstances or somebody else for their injury — can they move forward in the recovery process.”

Team leaders are, by and large, very optimistic and may tend to over-motivate recovering personnel. Good listening skills and empathy is what is needed early in the recovery process. Gavin believes, “A person fresh into injury needs to go through the emotions with a compassionate listener, someone able to be empathic without rushing into giving advice or motivating pep talks. If after a significant period of time, perhaps three months depending on the severity of injury, they are still spinning, it would be advisable to discuss it with them. Let them know that they appear to be stuck and that talking with a mental health professional could help break this unproductive cycle.”

Be prepared to supply them with a referral or recommend that they get a referral from their primary injury care provider. Provide them with the information, but let them make the decision to follow through. It's important to let them know that you will remain supportive and available for them. If they are not receptive to counseling, recommend that they talk with someone they respect and feel is credible, such as someone from their church, a business mentor or a teacher — someone they trust who is not directly or indirectly involved in the injury.

Although there's no orderly or fixed psychological process, you can expect the injured to experience three general categories:

1. Injury-relevant information processing

   The injured focuses on such information as the pain of the injury, awareness of the extent of the injury, questions about how the injury happened, and recognizes the negative consequences. Three primary emotions reported shortly after being injured are frustration, depression, and anger.

2. Emotional upheaval and reactive behavior

   Once the realization that a firefighter is injured and that cessation of activity is required for recovery, the individual may become emotionally agitated; experience vacillating emotions; feel emotionally depleted; experience isolation and disconnection, and feel shock, disbelief, denial or pity.

3. Positive outlook and coping

   The firefighter accepts the injury and deals with it, initiates positive coping efforts, exhibits a good attitude, is optimistic and is relieved to sense progress.

The speeds at which the injured move through these stages vary. One person may move through the process in a day or two while others may take weeks even months.

Some injured personnel may experience fear and anxiety, although they are unlikely to display it while at work or with their peers. They worry about whether they will recover and if re-injury will occur. Lack of self-confidence becomes an issue as they lose physical conditioning, and lowered confidence can result in decreased motivation, substandard performance or additional injury. Many firefighters have difficulty lowering their expectations after an injury and may expect to return to a pre-injury level of performance. When this isn't the case, they tend to push too hard to return to their previous status, exposing themselves to chronic or reoccurring injury.

It's important to keep in touch with employees as they go through the rehabilitation process. Injured personnel need social support and positive empathy. They need to know that their team members and administrators care. Encourage fellow firefighters to call or send e-mails to the injured. It can be a simple but effective way to keep the injured person involved in group dynamics and encourage them to adhere to their rehabilitation plan so they can return sooner. Firefighters are part of a team, and every team needs cohesiveness, which is developed and nurtured through support, compassion and empathy, especially in hard times.

Self-concept is an individual's set of beliefs concerning one's appearance, ability, potential, limitations and sense of worth. When an individual's self-concept is tied almost entirely to physical ability and occupation, the self-concept will assuredly suffer in the face of an injury. When the injury disrupts the process of need fulfillment that the firefighter experiences through participation, a psychological abnormality of body image and self-concepts occurs. Many athletes who experience a lengthy injury suffer from decreases in self-esteem and self-worth and increased anxiety and depression. These factors can greatly impede rehabilitation.

The expectation of firefighters to perform physically at very high levels creates stress that comes from peer pressure, demands of the occupation and the public's perception of them as heroes. Recognizing injury-prone characteristics, watching for signs of excessive stress and using sports psychology strategies can help your department maintain lower injury rates and faster recovery time when injury occurs.

---

Daniel Ball is the owner of Compass Fitness & Wellness in Seattle, specializing in behavioral wellness, fitness coaching and public safety personnel fitness. Contact him at 425-844-4039 or 1dball@attbi.com.