Firefighters are fussy about equipment, as they should be. It warrants the attention we give, cleaning and washing and caring for it. It’s second nature and inarguable to double-check essential things like the suction and automated external defibrillator. We adhere to checklists for rig maintenance and follow-up accordingly when something is out of whack.
We’re darned good about the care we give our equipment because we know that, used correctly, well-maintained equipment will save our lives. That O-ring in the self-contained breathing apparatus/mask connection? Glad you replaced it! That rope or webbing used for an emergency bailout from the second-floor window? Might want to replace it, too. Pressure testing of hoses and load testing of ladders? Yep, done.
All this equipment has a “minimum breaking strength” (MBS). MBS is the point at which an item will fail or break. Manufacturers typically build in safety factors, usually four to six times (sometimes up to 10 times) greater than the MBS, just in case.
But what about the MBS of your most valuable piece of “equipment”—your own body? Each of us is an occupational athlete. Many of us do take good care of ourselves—working out, lifting weights, maybe doing some cardio. But it’s rare to see much more than lip service given to the importance of stretching for flexibility, eating nutritiously, or sleeping sufficiently. And beyond the physical, there’s the care and nourishment of our emotions, minds, and souls. Don’t roll your eyes; please read on.
Because, in fact, we do break sometimes. Everyone has a minimum breaking strength, one that isn’t contingent just on encountering “the big one.” Sometimes it’s a leg or a back but, more often, the injury lies deeper. It’s well-documented that people serving in the emergency services leave in droves, and it’s a sure bet that much of that has to do with being broken somehow.
Over time, we’ve benefited collectively from the outstanding work of people such as Jeff Mitchell and the International Critical Incident Stress Foundation he helped create, plus the broad efforts, especially by the military, to address post-traumatic stress disorder (PTSD). More recently, we’ve seen psychological first aid (PFA) arrive on the scene. Hats off to these important components of our history.
Now, happily, a seismic shift in the conversation is coming ’round the bend. An emerging generation of evidence-based work offers a helpful angle of approach to that dark underbelly of vulnerability that no one wants to discuss (until they can’t avoid it). There’s new vocabulary that leads away from the long-standing, subliminal signal that we’re somehow weak or unseemly if we react negatively to the intense, ultrahazardous, and unfair world we populate.
The new term that I can’t wait to spread is “stress injury.” What a refreshing, less-punitive, and more relatable term! We know how to address injuries; we do it all the time. We can do the same for stress injuries—in our patients and among ourselves. As noted in the Responder Alliance Web site, “Anyone can be injured. Like other injury types, stress injuries are best supported when recognized early and mitigated.”1 As EMS/rescue expert Laura McGladrey, who is also an emergency and psychiatric nurse practitioner, says, “By nature in our profession, we have exposure after exposure (and a lot of other stressors, too). I’m not sure we could expect the human machine to undergo what we do without changes, yet when the machine does start to change, we call it a disorder? No, let’s start thinking of this as a ‘stress injury formation.’” New terminology, new approach. Nice.
This shift means that our reactions to what happens out there aren’t couched in mental health terms. When trauma, loss, moral/ethical betrayals, and outright wear and tear add up and you react to it, you’re not crazy. You’re injured. And, just like every other injury type, prevention is possible. The early stages of stress injury can, with awareness, be arrested before major harm occurs. It is not necessary to break or even come near your MBS.
The term “Stress Continuum Model” was initially coined by the U.S. Marine Corps to emphasize that injuries occur on a continuum. It is a much more usable system than other tools we’ve had so far for managing reactions to our risky, difficult, sometimes heart-breaking world. It’s like knowing that a heat source, unaddressed, can lead to full-thickness burns, but it won’t if prevention or care is provided in the early stages.
According to McGladrey, who is a vocal proponent of altering the conversation about stress, “An injury has an onset. It has subtle cues that occur before it’s evident on the outside, and then a time when it makes itself known. Then it starts to get the attention it needs, and then you have a diagnosis.” Like other injury states, it’s not that we can be perfectly fine one minute and facing over-the-top PTSD the next. This is not to say that PTSD doesn’t exist; it surely does. But it is counterproductive to try to fit the rest of our (normal) reactions into a rigid, all-or-nothing model.2
There’s a LOT we can do before we reach our MBS, both for ourselves and for our colleagues. What a relief to know our reactions involve an injury and not mental illness. Maybe this could help reverse the dismal retention numbers among the ranks, because we need to stop the hemorrhage of people leaving the field.
Yes, we break. Why wouldn’t we? Some of us break a little, and others break so hard that the only answer, lately, seems evident in our devastating epidemic of suicide. It’s time for a new approach, and this one might be it.
1. https://www.responderalliance.com/stress-injury-formation, accessed October 19, 2020.
2. For more information and ways to address stress injury, go to https://www.responderalliance.com or search for the Rescuer MBS Podcast (dedicated to exploring the issue of stress injuries in first responder communities).
KATE DERNOCOEUR, retired firefighter/NREMT, serves as a medical examiner investigator as well as a SARTECH-II with Kent County’s SAR K9 unit in western Michigan. She retired from the Ada (MI) Fire Department in 2019 and was a paramedic for the Denver (CO) Paramedic Division (1979-1986). Her emergency services career began in 1974 with the Vail (CO) Mountain Rescue Group. Educated as a journalist who also earned an MFA in creative writing, she has written extensively for EMS publications, including JEMS, since 1979 and was a frequent speaker at EMS conferences from 1984-2004. Her book Streetsense: Communication, Safety and Control was released in its 4th edition in 2020. She also coauthored Principles of Emergency Medical Dispatch with Dr. Jeff Clawson, MD (first edition, 1988), among other books. Her blog, “Generally Write,” is at www.katedernocoeur.com.