Trust, peer involvement, early intervention and union buy-in all are critical in addressing the stress and emotional disorders that afflict firefighters.
The fall occurred over a long period of time — so long that the one falling wasn’t even aware that it was happening, until it was too late. When it ended, the landing was hard and painful.
“The two most important things in the world to me were working and drinking,” said David Byrnes, a 28-year veteran of the Spokane Valley (Wash.) Fire Department, now retired. “And I couldn’t do either.”
That’s because, in October 2008, Byrnes was fired from his job as a regional homeland-security coordinator, which was his post-retirement gig. The reason for the dismissal was his second DUI arrest; after the first one, he had been suspended for a week without pay. The drinking was nothing new.
“I was a heavy drinker all my life,” Byrnes said.
Indeed, it had started when he was a young man and continued throughout his firefighting career. The fact that he could function well as a firefighter had given Byrnes the illusion that he could handle it. But no one can handle alcoholism, not without help.
What Byrnes didn’t realize is that the emotional traumas he experienced while on the job exacerbated his drinking problem, in the same manner that an accelerant exacerbates a structure fire. Looking back on it through the prism of hindsight, Byrnes now can see that warning signs clearly were there.
“A fellow firefighter — a good friend of mine — had died in a fire,” Byrnes said. “I was told to tough it out, that people die all the time in fires. But I now realize what a significant event that was in my life. For a year afterward, I occasionally would start to cry, and I didn’t know why. I do now.”
After being fired, Byrnes had the opportunity to appeal the action. However, the night before the hearing was to be held, he experienced what some alcoholics call “a moment of clarity,” and decided to drop the appeal.
“I decided that I needed to take my medicine,” Byrnes said.
In mulling how he had gotten himself into the mess that he was in, he realized that he had lost his sense of purpose and sense of self. Worse, he thought back to the times when he had contemplated suicide after the only thing that really mattered to him beyond the booze — his work — was yanked away from him.
The epiphany that Byrnes experienced was terrifying. But it also was catalyzing. For years, he never wanted to admit that he had a problem. “I never wanted to look at it,” he said. Now, Byrnes not only wanted to stare the demon in the eye, he wanted to overcome it.
But first, he needed to understand it. Counseling helped him to do that. What Byrnes learned was that the traumas he experienced in the fire service deepened the drinking problem that took root decades earlier, when he was in the military. Byrnes also learned that the post-traumatic stress disorder from which he suffered is a multi-tentacled monster. “With PTSD, it’s never just one thing,” he said.
Byrnes now is alcohol-free. More important, he is alive — one of the lucky ones. Unfortunately, not every firefighter is as lucky.
The Downside of Stoicism
Sometime during the sixties, the Baltimore Colts were playing the Chicago Bears at Wrigley Field. It was a brutal contest, as they always were whenever the two teams tangled back then. In the second half, Johnny Unitas, the Colts’ Hall-of-Fame quarterback, took a hit to the face that broke his nose, this being an era of single-bar face masks. With blood gushing from his nostrils, Unitas reached down to the turf and scooped up some mud and shoved some into each nostril to stanch the flow. He then marched the Colts down the field for what turned out to be the winning touchdown.
A similar culture of stoicism has existed in the fire service for decades, and it has contributed to what has been, until very recently, a general lack of understanding regarding PTSD. The condition is nothing new in the fire service — it arguably has been present since the first bucket brigade was formed, which is believed to have occurred during the Roman invasion of Britain in the year A.D. 43. What is new is that, within the fire service, more and more people — chiefs, officers and firefighters — are beginning to pay attention to it.
“Because of their role as caregivers to others, it often is difficult for firefighters to ask for help or even acknowledge that they need help, for lots of reasons” said Dr. Jennifer Fyler, a Harvard-trained psychiatrist who oversees residential and outpatient treatment programs for PTSD-afflicted first responders at the Brattleboro Retreat in Vermont.
“There is a perception that they need to be strong all the time, or they won’t be able to provide care to others,” Fyler said. “That’s worth questioning, but it certainly is part of the culture.”
Mark Burdick, chief of the Glendale (Ariz.) Fire Department agreed.
“The thing that firefighters always pride themselves on is that they’re fixers — they fix problems,” he said. “When people don’t know where to go or what to do, they call the firefighters. … So, you have guys who think they can fix anything, so why can’t they fix themselves?”
One of the challenges of dealing with PTSD is that its symptoms are not as easy to discern as those resulting from physical trauma. For instance, when a firefighter falls down a flight of stairs and breaks a leg, swelling and discoloration quickly ensue, which triggers a trip to the emergency room. An injured psyche is far more difficult to diagnose, particularly in the short term.
“When a firefighter or EMT arrives at the scene of an accident and encounters a person who is dead or has been grossly injured, it is very traumatic,” said Dr. Robert Simpson, president and CEO of the Brattleboro Retreat. “But these people have learned to disassociate from it — they put it someplace else and go on. But that doesn’t really resolve it. That’s the problem; it becomes cumulative.”
On top of the stresses that the job creates — and they are considerable, given the horrific events that they witness on a daily basis — firefighters also experience all of the same pressures outside of the fire station that the rest of the world experiences: marital strife, financial difficulties, health issues, children behaving badly. Eventually, it all becomes more than the firefighter can bear.
“Neurobiologically speaking, we see that the stress hormone system in the body becomes dis-regulated,” Fyler said. “The nervous system always is on high alert … while at the same time, the brain’s capacity for gathering information, analyzing the situation and making decisions in a nuanced and complex way has been suppressed. It’s almost as if there’s so much noise from the alarms that the brain can’t focus. It no longer can weigh options in a calm way — it gets overwhelmed.”
Sometimes the trauma manifests in subtle ways: a firefighter may begin to have trouble sleeping or show signs of chronic fatigue. He uncharacteristically may react angrily to losing a game of ping pong with a fellow firefighter or suffer panic attacks. Or, as is often the case, he may start to drink more.
“They’ll get together as a group, and they’re full of feelings about what they had to face that day, but there’s no appropriate way to discharge those feelings,” Fyler said. “In that setting, they may have a drink or two. While that seems to work at first, it can become a problem in itself.”
Byrnes can attest to the verity of Fyler’s assessment. Byrnes’ friend was killed after the fire was extinguished and part of the building collapsed — had his friend been standing 10 feet away in either direction, he would have been spared.
“We had no organized way of relieving that grief,” he said. “So we just went out and got drunk.”
Regardless of the manifestation, it is imperative that fire-service leaders do whatever they can to nip such problems in the bud, according to Frederick La-Montagne, chief of the Portland (Maine) Fire Department.
“We’re not in a position to diagnose stress disorders,” LaMontagne said. “But obviously, if you’re sensing abnormal behavior, it is incumbent upon everybody to check with that person to see if everything’s OK.”
But that’s not always easy to do, especially for chiefs and officers who have not been formally trained to deal with PTSD or other emotional traumas, something that Spokane Valley’s Byrnes readily acknowledged.
“I wish there had been some help a long time ago,” Byrnes said. “But that’s nothing against my leadership — doctors weren’t being trained on this stuff back then.”
The Tide Begins to Turn
Some departments are making access to facilities like the Brattleboro Retreat — where tactics such as meditation, yoga and peer-to-peer interaction are employed to treat patients — available to afflicted personnel through employee-assistance programs. LaMontagne heads one such department, and the Boston Fire Department is another. Lt. Willy Ostiguy, who coordinates the Boston department’s employee assistance program, said that Brattleboro’s emphasis on peer involvement is a key element in its success in treating firefighters for PTSD and other emotional disorders.
“They are able to let their guard down because they are with their peers,” Ostiguy said.
Fyler concurred that peer-to-peer interaction is a giant piece of the therapeutic puzzle.
“They say to themselves, ‘These people get it,’ because of the shared experiences,” she said. “They can connect with these people in a very comfortable way that wouldn’t be possible if they were interacting with PTSD sufferers from the general population.”
Meanwhile, other departments are choosing to develop internal programs that are focused on prevention. One such program is Spokane Valley’s Open Phoenix initiative.
“We wanted to do something that would allow us to catch some of these issues before they became significant issues, before somebody ruined their career or, to the extreme, committed suicide, as some departments have experienced,” Chief Mike Thompson said. “There are some indicators that manifest themselves early on, before things get to the point where they need some serious help. At that point, it takes a lot more time and effort to address the problem.”
At the heart of the Open Phoenix program — started as a one-year pilot phase last month — is a 140-question evaluation that originally was developed for the military. The questionnaire will be administered when firefighters take their annual physicals, and their answers will be reviewed by medical personnel. Should a red flag arise, the firefighter would be referred to a remedial program that could be as simple as intradepartmental mentoring or as complex as outside counseling by trained professionals.
There is anecdotal evidence that suicide is on the rise in the fire service — everyone interviewed for this article seemed to think so — but no hard data exists to support or refute the contention. (The U.S. Fire Administration only tracks on-duty fatalities, according to Mark Whitney, fire program specialist. He added that only two suicides have been reported to thein the last 11 years, and only one of those occurred while the firefighter was on duty.)
Nevertheless, the Phoenix Fire Department decided to address the problem after four of its firefighters — three active members and one retired member — committed suicide in a seven-month period last year.
“That certainly got my attention and that of my counterpart in labor, the president of union Local 493, Pete Gorraiz. After one of the last [funeral] services, he and I went to lunch and talked about it,” said Chief Robert Kahn. “The fire service is complicated. The people who get into it have strong personalities, are aggressive and run on adrenaline. They are not unlike those who become members of the Navy Seals or Army Special Forces. They have a strong will to succeed. But that often makes them hard people to help.”
The result of that conversation was a joint labor-management mental health task force that developed 16 recommendations that could be incorporated into the department’s long-term strategic plan. The process involved interviews with two focus groups — one that consisted of members with a minimum of five years of experience and another with members who had at least a decade of experience. Of the two, the members of the former group indicated that they would be more likely to seek help outside of the department than those in the latter group, according to Deputy Chief Brian Parks, who serves as program manager for the task force.
“Confidentiality was the issue,” Parks said. “They didn’t want their names on a piece of paper; they didn’t want their names written down anywhere. I understand that. So, we wanted to make sure that we had a variety of resources for them to go to.”
Parks added that getting union buy-in for such a program is critical.
“It shows that everyone is working together to solve this problem,” he said. “Instead of this being just a management effort, it brought the whole department together.”
Byrnes, who is serving as a consultant to Spokane Valley’s Open Phoenix initiative, wholeheartedly agreed, saying that the department involved the union from the very beginning.
“If the chief and the union president aren’t walking down the same path together, it’s going to be very difficult,” he said.
Meanwhile, after seeing what occurred with its neighbor, Glendale launched a suicide-prevention program that evolved from an initiative that originally was launched to provide crisis counseling to victims of emergencies. According to Lynette Jelinek, the department’s crisis response division manager, it is imperative to establish a relationship with the person who is suspected of being suicidal.
“The most important first step is to establish trust — they have to know that you care and that you’re going to support them and that you’re going to get them some help,” Jelinek said. “If they are talking to someone they trust, they will be honest with you. They want to be helped. They are in so much pain, and they see suicide as the only way to end the pain. You have to show them that there’s another way.”
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