Health & Safety

Hidden Scars and the Road to Resiliency

Firefighters in crisis turn to their peers

By Dustin Hawkins

The smell of transmission fluid on asphalt, the sound of helicopter overhead, or a federal in the distance breaks us away from the present moment and robs of us of our focus and peace like an unwelcome visitor invading our home at the dinner hour.

When the conversation of post-traumatic stress arises, often the focus is based around an individual that has experienced a single traumatic sentinel event that is clearly identifiable within their “life timeline.” This single individual traumatic event can often be pinpointed to a specific injury. Or perhaps the affected person would identify this event as “the single worst experience of their life.”

The conventional definition of post-traumatic stress disorder (PTSD) cites a signature, terrifying event that a person has either witnessed or experienced. Symptoms may include flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event.

This is in according with understanding PTSD as a human experiencing one sentinel event. Let us turn to the humans behind the badge. Our first responders are immersing themselves into 25-30 years of the trauma stress continuum. They personally witness, interact, and provide aid in calls for service that repeatedly fall into the Criterion A: Exposure to Trauma category of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

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The DSM-5 definition of trauma requires “actual or threatened death, serious injury, or sexual violence.” By this definition we find that an alarming number of our calls fall into this category. However, most first responders do not readily identify themselves as repeatedly experiencing traumatic events. A common response offered is “It is not our emergency,” or “It’s just part of the job.” There’s also the seemingly invincible defense rhetoric of: “These things just don’t bother me because I don’t get attached,” or “When the call is done I just file it away and it doesn’t affect me anymore.” Such mental maneuvering provides false hope and takes the “human factor” out of the human condition.

It is time we all take a closer look at the protocols and programs that we should be offering nationwide for the men and women behind the badge. They are all human beings who are not designed to be exposed to trauma on the continuum and come away completely unscathed.

Every first responder can vividly remember at least one “bad” call that lingers in their mind. These significant incidents can leave a path of painful perspective that can adversely affect the firefighter either immediately or later in their personal and professional lives. In the past, firefighters were deemed “weak” if they talked about their feelings or problems they were experiencing due to their work environment. Unfortunately, many firefighters have developed co-occurring substance abuse issues or dealing with the struggle of suicidal ideation, sometimes culminating in suicide.

Firefighter suicides have plagued the fire service across the nation. Only recently has the vast number of suicides become known and discussed. Jeff Dill founded the Firefighter Behavioral Health Alliance, only organization in the U.S. that is actively tracking and verifying suicides among firefighters and emergency medical personnel. The Alliance’s data shows 1,150 verified cases of firefighter and EMT suicide, with the vast majority (884) occurring to active-duty personnel. A recent study showed first responders have post-traumatic stress disorder (PTSD) and depression at a level five times that of civilians. In addition, the organization also reported that more firefighters and police officers died by suicide in 2017 than all line-of-duty deaths combined. Specifically, 103 firefighters and 140 police officers died by suicide in 2017, compared to 93 firefighter and 129 officer line-of-duty deaths.

Collaborative Action

Suicide, post-traumatic stress, and catastrophic addictions have become the epidemic that is taking the lives of our fellow first responders. The Florida Firefighters Safety and Health Collaborative (FFSHC) is a 501c3 organization that focuses on four central topics of: firefighter cancer prevention, health and fitness, firefighter safety, and mental wellness. The Mental Wellness Team provides a multitude of tools and resources to create a more balanced approach to a holistic and dynamic healing for our first responders.

The Mental Wellness Team has chosen to take a detailed look into the current programs and protocols to which we have entrusted first responder’s mental wellness. Through dedicated action and a collaborative approach, this diversified team has effectively identified the current system’s shortcomings and continues to offer constructive alternatives to help empower Florida’s first responders and their families. The FFSHC Web site (floridafirefightersafety.org) provides free training, protocols, and informational resources available to all members, regardless of organizational affiliation. The site resource folder contains specific policies and procedures on funeral procedures, chaplain programs, mental health self-assessment, and peer programs.

As our team and dedicated members work tirelessly to bring the emotional impact of our jobs out of the shadows, we are here to help bridge the gaps. The team incorporates many behavioral program components such as suicide prevention, employee assistance programs (EAPs), peer support, recovery centers, and chaplain programs. Statewide Peer Support Coordinator Jeff Orrange ([email protected]) is compiling a sharable list of diversified peer support teams (IAFF Peer Support, Illinois Peer Support, UCF React, Nova Peer Support, etc.) across the state of Florida. The intent of this list is to provide an accessible list of peer team leaders and resources in each region is to create a platform of assistance in critical areas such as team development; standard operating procedures; and the effective and diversified training opportunities available across Florida.

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One of the unique programs the Mental Wellness Team has developed and delivered is a two-day clinician awareness class to provide mental health clinician’s an understanding of firefighter culture, lingo, lifestyle and an intimate and detailed look about what the job entails. This training includes both classroom and live scenarios, including wearing turnout gear, observing a live-burn training scenario, and interacting in fire stations (many clinicians have never been inside one.) They also get the opportunity to engage with firefighters both at the stations and the training ground all while actively participating in evolutions. We will continue to work with all providers to be able to eliminate many of the obstacles our firefighters are facing and assist Florida’s firefighters in getting they help they need.

The FFSHC has designed a portal program, RedLine Rescue, which designed to provide a standardized and accessible peer portal for firefighters, single-role entities, and all first responders alike. This portal and curriculum will be an outlet for EAPs, clinicians, and mental wellness providers to obtain cultural awareness programs to facilitate a more effective and responsive interaction between provider and first responder. Redline Rescue will be available for family members to offer educational opportunities and accessible resources to equip them with the necessary tools to evolve to a more healthy and resilient family unit. This resource tool provides an anonymous and accessible system. The peer providers accessed on this site facilitate a more affective recovery process and offer educated assistance mechanisms to a specially trained provider through our cultural awareness program. Redline Rescue will provide, maintain, evolve and deliver a baseline curriculum to Bureau of Training and Standards for incoming firefighters as well as sustain an outlet for the existing firefighters and fire officers in the state of Florida by offering and building resiliency tools.

Positive Outcome

Following traumatic incidents such as the Pulse nightclub and Stoneman Douglas shootings, the Florida legislature listened to the needs of first responders and unanimously passed S.B. 376. Governor Scott signed the bill that expanded workers’ compensation coverage for first responders disabled with PTSD. In short, the bill provides workers compensation benefits to first responders; providing that, under certain circumstances, PTSD suffered by a first responder is an occupational disease compensable by workers’ compensation benefits. It specifies that benefits do not require a physical injury and are not subject to certain apportionment or limitations. This bill, known as the PTSD Bill, went into effect October1, 2018.

In addition, Florida Chief Financial Officer and Fire Marshall Jimmy Patronis called PTSD a “hidden killer” of first responders. In support, the Florida Fire Marshal’s Office is also addressing firefighter mental wellness through the development of mental wellness educational curriculum, which will be introduced in the firefighter minimum standards. The educational curriculum may also be used as a stand-alone training program for existing first responders.

The above advancements will help firefighters recognize critical stress incidents and learn and implement effective resiliency tools. These programs, coupled with the decisive support from S.B. 376, will provide compensable benefits for long-term mental scars suffered by first responders.

Dustin Hawkins is the mental welness co-chair for the Florida Firefighters Safety and Health Collaborative and is a chaplain and driver -engineer for Indian River County (FL) Fire Rescue.