By Mark Lamplugh
Post-Traumatic Stress Disorder (PTSD) is most often associated with soldiers coming home from war zones. For many of these men and women, living with PTSD means revisiting the pain and negative emotions they felt in a moment of crisis, very much as they experienced them the first time around, despite attempts to move on. It can quite literally feel like being trapped in the past.
Firefighters often face similarly traumatic events in their line of work. As first responders, we continually put our lives on the line to aid others. The physical risk is present and unambiguous, and the resulting wounds are more easily treated. Unfortunately, the signs and extent of emotional damage are opaque and sometimes ignored.
There’s really no telling what effect a potentially traumatic event can have on an individual firefighter. What can be a “This is why I do it” moment for one can be a “This is why I’m retiring” moment for another. If everyone processed emotional trauma in the same way, identifying and coping with PTSD would be far more straightforward. This, as we know, is not the case.
As such, departments need to recognize when potentially traumatic events occur and provide the requisite support for their firefighters in the aftermath. Part of that support involves recognizing the signs of PTSD, which I will discuss below.
Risk Factors for PTSD
Stress is a fact of life. It’s unavoidable. Hardships test us and, much of the time, we come out stronger for it. We get better. We overcome.
But, for some who experience a traumatic event, this may not be the case. According to research by Dr. Matthew Tull in “Rates of PTSD in Firefighters,” you are at greater risk for PTSD if you:
- Begin your fire service career at a young age.
- Have underlying mental health issues.
- Were in close proximity to death.
- Hold a supervisory position.
- Experience multiple traumatic events in close proximity.
- Are unmarried.
- Were previously in treatment for another disorder.
You do not need to fulfill any or all of these factors to suffer from PTSD.
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Symptoms of PTSD
According to the Department of Veterans Affairs, the four main types of PTSD symptoms are the following:
- Reliving the event. Memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. For example, you may have nightmares. Or you may feel like you are going through the event again; this is called a flashback. You may see, hear, or smell something that causes you to relive the event, called a trigger. News reports, seeing an accident, or hearing a car backfire are examples of triggers.
- Avoiding situations that remind you of the event. You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.
- Negative changes in beliefs and feelings. The way you think about yourself and others changes because of the trauma. This symptom has many aspects, including the fact that you may not have positive or loving feelings toward other people and may stay away from relationships. You may think the world is completely dangerous, and no one can be trusted.
- Feeling keyed up (called “hyperarousal”). You may be jittery or always alert and on the lookout for danger. You might suddenly become angry or irritable. For example, you may have a hard time sleeping or concentrating. You may be startled by a loud noise or surprise.
If you suffer from symptoms like these, performing your job as a firefighter, not mention everyday life, will be difficult.
So, now what?
How to Manage PTSD: Prevention
In their article “Understanding Post Traumatic Stress Disorder,” authors Paul J. Antonellis Jr., Floyd “Shad” Meshad, and Dabney Stack argue, “Firefighters suffering from PTSD who receive proper intervention can recover fully and lead productive lives and have successful careers.”
The other side of the coin, sadly, is that, “Many will receive no intervention and will live with the symptoms of PTSD, attempting to cope using destructive behavior. PTSD symptoms may even force some firefighters into retirement.”
Clearly, doing nothing and hoping it goes away isn’t the best way to deal with PTSD. So, how do you treat it effectively? The National Fallen Firefighters Foundation’s system for preventing and treating PTSD offers an excellent framework for healing, beginning with the After Action Review (AAR).
The AAR is a military concept adapted for use by firefighters. Rather than biding time until the next call, firefighters analyze what happened and how they reacted. Meetings can be either formal or informal depending on the complexity of the event, but the aim should be to achieve a sense of perspective for those involved. As Firefighter Nation’s Bill Carey says, “[After Action Review] is not a lecture or a gripe session, or a time to gather and hand out blame and to ridicule others. Instead, the AAR is informal, flexible, and focused on learning.”
Curbside Manner is all about helping yourself heal by helping others heal, namely distressed civilians in their time of crisis. By creating a sense of safety and calm, firefighters can establish a positive relationship with victims. This serves two main functions: It helps firefighters address urgent problems and it makes the interaction more personal. This has been demonstrated to help firefighters recover mentally in the wake of a traumatic event.
For those who are experiencing persistent stress after about a month, the Trauma Screening Questionnaire may be administered as an additional component. A “Yes” answer to six of the 10 following questions necessitates a referral to a mental health care professional. It does not, however, constitute a diagnosis.
- Do upsetting thoughts or memories about the event come into your mind against your will?
- Having upsetting dreams about the event?
- Acting or feeling as though the event was happening again?
- Feeling upset by reminders of the event?
- Do you have bodily reactions (such as fast heartbeat, sweatiness, dizziness, stomach pains) when reminded of the event?
- Difficulty sleeping?
- Irritability or outbursts of anger?
- Difficulty concentrating?
- Heightened awareness of potential dangers to yourself and others?
How to Manage PTSD: Treatments
A range of treatments have been proven to be effective in treating PTSD. Before you begin, the National Center for PTSD recommends setting goals for treatment, like reducing your PTSD symptoms, learning how to live with them, or improving professional or personal relationships. You can speak with your therapist about your goals and even the process of therapy itself. This will help your therapist determine a course of treatment that best suits your needs.
According to the National Center for PTSD, the main types of treatment are:
- Cognitive therapy. Your therapist helps you understand and change how you think about your trauma and its aftermath. Your goal is to understand how certain thoughts about your trauma cause you stress and make your symptoms worse. You will learn to replace these thoughts with more accurate and less distressing thoughts.
- Exposure therapy. Your goal here is to have less fear about your memories. By talking about your trauma repeatedly with a therapist, you’ll learn to get control of your thoughts and feelings about the trauma. This may be hard at first. But, over time, you’ll feel less overwhelmed. This is called “desensitization.”
- Eye Movement Desensitization and Reprocessing (or EDMR). While thinking of or talking about your memories, you’ll focus on other stimuli like eye movements, hand taps, and sounds. For example, your therapist will move his hand, and you’ll follow this movement with your eyes.
- Group therapy. Many people want to talk about their trauma with others who have had similar experiences. Sharing your story with others may help you feel more comfortable talking about your trauma and can also help you build self-confidence and trust. You’ll learn to focus on your present life rather than feeling overwhelmed by the past.
- Family therapy. Your kids or your partner may not understand why you get angry sometimes, or why you’re under so much stress. They may feel scared, guilty, or even angry about your condition. A therapist helps you and your family to communicate, maintain good relationships, and cope with tough emotions. Your family can learn more about PTSD and how it is treated.
- Medications. Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medicine. These can help you feel less sad and worried. They appear to be helpful and, for some people, they are very effective. SSRIs include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft). Talk to your doctor about which medications are right for you.
Whatever your treatment, the important thing is that you seek help if you are experiencing symptoms of PTSD. It’s not easy, especially when reaching out seems harder than pushing others away. But, with a robust support system, you can learn to live with the past and make a better future for you and others.
Mark Lamplugh is a fourth-generation firefighter and former captain with the Lower Chichester (PA) Fire Company. He is the senior vice president of business development with Station House Retreat (www.stationhouseretreat.com). Lamplugh is also nationally recognized in Crisis Stress Intervention through the American Academy of Experts in Traumatic Stress. He has helped hundreds of firefighters, police officers, veterans, EMS personnel, and civilians nationwide find help for addiction, alcoholism, PTSD, and mental health support. He can be reached for comment at [email protected]