Post-Traumatic Growth: Normal Reactions to Abnormal Incidents

Jerry Knapp

We all gain valuable tactical and skill-oriented fireground lessons from close calls we experience. Immediately after the tactical after action review (AAR), the close call is over for the people who witnessed it. It may never be over for the firefighters who lived through it and experienced it. Left unrecognized and untreated, this significant emotional event could become a negative issue with lasting consequences such as post-traumatic stress disorder.

On the positive side, a close call—the near death experience—may change you very favorably through post-traumatic growth. Chief Bobby Halton noted this in “Post-Traumatic Growth” (Fire Engineering, Editor’s Opinion, December 2016):

It is true we are at risk; even the strongest among us in the most supportive and just environments can develop PTSD, but we can emerge from trauma experiencing various degrees of post-traumatic growth (PTG). What we must begin to do now is share the new message of exposure to volatility and trauma, PTG, the other side of the story, as we share our warnings.

“In a way, it shouldn’t be a surprise that trauma can spark positive changes. Stories of people who have risen from traumatic experiences and changed for the better can be found in cultures around the world. From the oldest heroic myths to the stories of the lives of sacred religious figures to superheroes in blockbuster movies like Batman, who watched as his parents were murdered and dedicated his life to battle crime, we learn that traumatic events have the power to transform us into better people and make our lives more meaningful.”1

Behavioral Health

Behavioral health is the general clinical description and has become a buzzword in the fire service. That sterile definition does not do justice to the national fire service experience. Michelle Fayed, a firefighter/paramedic from Miami-Dade (FL) Fire Rescue, notes the risk, “Firefighters are three times more likely to die by suicide than in the line of duty. The data show that suicide rates are on the rise; a major study shows that from 2013-2017, the rate of firefighter suicide increased at a shocking 89% rate.”2

According to the National Fire Protection Association, the Firefighter Behavioral Health Alliance reported that 91 firefighters and 17 emergency medical technicians died by suicide in 2017. We need to include behavioral health as a required training topic for probies and for an annual refresher course for incumbent members.

Eric Greitens, a former Navy SEAL, explains resilience and PTG: “The effects of the ‘volatility of the trauma experience’ are not simply good or bad; they can be both. Which one you embrace is your choice. How we respond to, control, and use the effects of the trauma experience is critical to our well-being as firefighters. We need to understand how these experiences can affect positively and negatively you, your family, and your brother and sister firefighters.” Greitens advises: “Focus not on wiping out your anxiety but on ‘directing your anxiety to worthy ends.’”3

The word emotion as used in this article does not refer to the typical outpouring of emotion such as crying, laughing, or being angry. It refers to the deeper, complex mind-body interaction during and after stressful situations or close calls. A detailed account of the emotional toll and the roller coaster ride experienced during and after the close call will facilitate your putting into context the lessons learned presented later.

Your Brother’s Keeper

The crew and I were returning from a hazmat call that involved a car, a tractor trailer, and a fuel spill. It was a routine call. We stopped the leak and pumped off the fuel. I was driving our rig on the off ramp of the interstate as a van was approaching from behind the driver’s side of the truck at a very high speed. I saw the female driver hit the rear driver’s side of my truck and then her van spin around; the van was instantly going backward next to my truck at 60 miles per hour (mph). I looked out of my driver’s side window into her van. There was a child seat in the rear. Tires screeched; she spun off and disappeared from my view. I thought she rolled it. I told the firefighter in the passenger seat to call for emergency medical services and extrication.

The van spun off into the drainage ditch alongside the exit ramp. I ran over to the van and shouted to the driver, “Are you hurt?” She was on her cell phone and refused to talk to me. The fire department we had just assisted arrived. The chief said, “Thank God, you are okay; I thought you guys needed to be extricated from your truck!” He was rattled, and so was I after just witnessing this violent accident and thinking that I may have had a role in causing it.

Firefighters assisted the woman out of her van. The chief hugged me right there in the middle of the ramp. The hug settled me down instantly. I could feel the stress fade away. It was a healing action for an injury I did not know I had. The highway patrol issued the van driver many tickets, including one for unlicensed operation.

The takeaway lessons from this incident are the following. First, think of a close call as an emotional injury that may heal quickly or never fully heal. Like an infection, it bears watching. This one healed quickly with no scar. Second, you can have a tremendous positive healing effect on members who have experienced a close call. Understand how vulnerable they are at that time. Think of it as an open, bleeding wound on their soul.

If their arm were bleeding, you would immediately apply direct pressure. Consider how hurt and damaged the person is at that moment and after the close call, and realize that you can do him much good at that point and in the future. You don’t have to go around hugging everyone who is hyper-nervous, but look for signs. They include the mechanism of injury—the event or the sequence of events could cause an emotional injury, nervous behavior, pacing, seating, unusual personal behavior, anger, withdrawal, and crying, for example. Evaluate the persons, listen to them, talk to them, put away the macho “get over it” attitude, and have some compassion. Brotherhood, remember? We do this all the time for victims, primary and secondary surveys for injuries, and a 360° size-up for fires. We need to consider applying some basic emotional size-up and first aid to our brothers and sisters.

First Aid

Yes, this is what we do—car accidents, fires, rescue calls, medical calls, and deaths—and we are tough. We tell ourselves we must expect to see horrible things, human suffering, death—but we must never forget that we are human and we have never been trained to deal with that. You or your buddy may be experiencing a normal reaction to a very abnormal experience. Maybe this is the call that breaks the camel’s back and cracks your buddy’s emotional shell.

Laughter may sometimes be appropriate to break the ice, but consider the emotional status/injury of your colleague as a first priority. Humor may be good medicine, but use it carefully and at the right time. According to Al Seibert’s The Survivor Personality, “Playful humor enhances survival for many reasons. Mental efficiency is directly related to a person’s general level of emotional arousal. People are less able to solve problems and make precise, coordinated movements when strongly worked up. Laughing reduces tension to a more moderate level and efficiency improves.”4

Making light of a bad situation shows the person is bigger than the trauma, is not afraid of it, and can actually have fun with it as though it were a game. Humor can allow reason to prevail in our brains.4

Major Close Call

My captain and I were evacuating the last house at a major natural gas emergency. A contractor had struck and punctured a 60-pounds-per-square-inch (psi), two-inch plastic natural gas main under the street with a tunneling device. A large volume of gas was pouring out of the damaged main for about an hour and could not vent up through the ground because of the lack of an excavation and the deep frost layer. Gas migrated underground into the house closest to the leak. We were on scene with two engines, one truck, and one heavy rescue along with two gas technicians from the gas company for about 43 minutes when the house exploded. We were near the front door when all hell broke loose; the situation changed in a microsecond from an annoying routine gas leak to a life-and-death situation. I was not prepared for the emotional roller coaster ride and PTG that followed the explosion.

Emotional Highs and Lows

The first emotional low came as the house exploded. In that microsecond, I saw the house come apart in slow motion. It’s amazing how fast you know you are at the mercy of the incident and you are 100 percent out of control. You are instantly resigned to your fate. It was a helpless but also calming feeling: This is the way it is. Just like being at the top of the roller coaster’s first giant hill, you are going; no stopping it now! Something white flew over my head, probably the front door. I saw my boots several feet off the ground and felt the overpressure from the explosion.

Low point. The next thing I recall is being on the road, about 30 feet from where I started, on my hands and knees looking at the curb and wondering how I got there. There was a very high degree of mental confusion. Blood dripped from my fractured cheekbone and formed a puddle below me. It was deadly silent: Am I dead? Time stood still. It is kind of scary when you have to ask yourself that question; it is definitely a low point. No one else was around; it was all white as far as I could see, and there was no noise, just dead silence.

High point. Blood was flowing—a good sign, I thought; I was, to some degree, alive. I had an emotional high because I was not dead.

Low point. But, I knew that I had been severely traumatized and still may die. Then, I saw in the street near me a roll of toilet paper and some fiberglass insulation from the house, and I thought I knew what had happened.

Medium point. Now, I am a bit happier—the confusion is fading, and I am starting to understand.

Angry. Then, I became extremely angry: Am I to die here next to a roll of toilet paper and debris? Will they carry me out of this field of trash?

(Several years later, I can still see every bit of debris—wall studs, siding, insulation, gypsum board on the road, every drop of my blood—exactly as it was then.)

Low point. Then came guilt, another really intense emotional low to add to the soup: I did not get a chance to say goodbye to my wife and son. What will they think?

Then I heard a voice, “Stand up.” It was an authoritative, clear, and compassionate voice. I stood up, and I saw them—all the people I ever knew, loved, or had been a significant part of my life but had passed away. Now, there they were. They were lined up at a 45° angle, just watching and just being there.

High and low. Did they all come for me? What an honor! It was a high and a low at the same time. Everything was white. Is this my escort to heaven? Could I be that lucky? What a profound and humbling experience! My living loved ones and friends were lined up behind me, as if in silent support. I saw all of them without turning my head. I just saw them and knew they were there. None of them said anything or even moved a muscle.

The first thing I heard was, “I think I’ll stay.” It was my voice. I don’t know why I said that. I did not feel my lips or mouth move. The group faded away. Talk about confusion! Is this real? I have no idea how long this took, and it did not matter.

High. It was deadly quiet. I heard the voice again, “Take three steps.” After I took the second step, I knew I would survive. I don’t know how or if it was right or wrong; I just knew. I was 100 percent confident. I don’t know how long this took. This was an emotional high, a real high.

To this day, I wonder about this experience. It was so powerful and yet disarming and completely humbling. Many people feel an overwhelming spiritual growth after a near-death experience; this was mine. There was a huge relief when I learned that 75 percent of people who have near-death experiences describe a similar voice.

My experience was comforting, humbling, and rewarding. It overpowered my thought that I was crazy. That thought lingered until I read Dr. Eben Alexander’s book Proof of Heaven.5 He is a highly trained neurosurgeon whose brain was attacked by a rare illness, putting him into a coma and near death. He describes in great detail his experience, especially of an angelic being guiding his journey that resulted in a miraculous recovery that his doctors thought would be impossible.

Reality Returns

Low. Standing in the street amid the smoke and dust, the first thing I heard was firefighters yelling, “Where is Kenny?” Kenny is my captain. I looked up. A firefighter was dragging him out from under the debris. He looked dead. Emotional low.

High, High. Then, I heard him scream from his injuries. Good news. Emotional high. A massive relief.

Paramedics Laura Gluck and Todd Rhiherson were doing heroic work, not knowing if additional explosions were coming. They began to place him on a backboard. I tried to help, but I was slobbering blood all over him. They were sending us to the trauma and burn center.

Low. The radio talk was about the helo landing zone. This must be bad; I must be bad, I thought. Emotional low.

Low. I have taken severely injured and burned patients there. Kenny could barely breathe and was in and out of consciousness. It didn’t look good. I knew I had some burns on my head, and my face continued to bleed, but I didn’t know what my head and face looked like. Again, I was thinking: Is the burn and trauma center for me? Kenny is bad. Am I bad, too? A real low.

As I walked back to the ambulance, two firefighters, one a very crusty member and the other a probie at her first fire, were staring at me with a look I will never forget. I must be in bad shape, I thought. I walked to the ambulance. No one was there. The effort was appropriately for Kenny: six broken ribs, difficulty breathing, loss of consciousness, shoulder and neck injuries, and burns. How bad am I?

Low. Laura (paramedic) said she was sending me to the burn/trauma center. I summoned the courage to look in the mirror on the driver’s side of the ambulance. I took a deep breath and thought: You really need to do this. But I was really scared. Emotional low.

High. The mirror showed that, as my friend Pat described me, I was “still ugly” but not burned or disfigured. Pretty high at this point, or at least relieved.

There were still several other significant emotional highs and lows to come, but Laura inserted an IV line in my arm, took an EKG, and put me on oxygen. Although the two emergency medical technicians did an outstanding job with primary and secondary surveys, they were clearly emotional. Let’s say, some tears flowed.

Low. That set me to thinking: Maybe I just don’t get how bad I am! We had been en route to the trauma center for about 10 minutes; things were starting to clear up for me. “Laura,” I said, “I think I’m alright.” She looked at me with that “You are an idiot” look and appropriately responded with a logical diagnosis based on the mechanism of injury: “The house exploded right in front of you; you may have a head/brain injury and critical internal injuries.” They saw it happen and correctly assumed the worst, based on the mechanism of injury.

Effects of Emotions

To gain some insight into PTG, it is critical to understand the huge effect emotions (body-mind connection) may have on us during and after the trauma. Lawrence Gonzales in Deep Survival: Who Lives, Who Dies, and Why describes human emotions:

“Emotion is an instinctive response aimed at self-preservation. It involves numerous bodily changes that are preparations for action. The nervous system fires more energetically, the blood changes its chemistry so that it can coagulate more rapidly, muscle tone alters, digestion stops, and various chemicals flood the body to put it in a state of high readiness for whatever needs to be done. All of that happens outside of the conscious control. Reason is tentative, slow, and fallible while emotion is sure, quick, and unhesitating.”6

He goes on to explain how emotion controls the body. I can tell you that my emotions were pushed well past where I have ever experienced them. It is uncharted territory until you have been there. It takes time to figure out where you are emotionally.

Gonzales likens the human organism to a jockey on a thoroughbred in the gate: a small man and a big horse that if it gets excited in that small metal cage can cause the jockey to get mangled or possibly killed. So, the jockey takes great care to be gentle. The jockey is reason; the horse is emotion. Emotions are so powerful, they can make you do things you’d never think of doing, and they can allow you to do things you’d never believe yourself capable of doing. The jockey can’t win without the horse, and the horse can’t race alone. In the gate, they are two, and it is dangerous; but when they run, they are one, and it’s positively godly.”6

The positive side of this relationship is the increased physical ability to react instantly to threats, such as not stepping into the path of an oncoming car and people lifting 500-pound boulders or cars off victims. But if we allow secondary emotions to take control of us and prevent us from reasoning during the crisis, we may not survive the period of stress because we may do inappropriate things. Secondary emotion may overrule our reasonable decisions and, hence, our actions, which may determine if we live or die. Our body has experienced the thrill and pleasure (emotion) of safety and success or even the rush of taking a chance, and it can override reason.6

Pilots landing jet fighters on aircraft carriers know from their emotions that there is safety on the deck once they land. It is complex neuroscience; but these few lines describe it enough for us to begin to understand it:

“The body knows where safety is; and when you’re a rookie and really afraid, any successful landing carries with it an explosive, almost orgasmic, sense of release. The pilot had developed a powerful secondary emotion which told him that safety, and even ecstasy, could be found on the ground (or the deck) and that if he could just get the hell down, he’d be all right.”6

Emotion can replace or override reason. “The pilot ‘spots the deck’: He focuses too much on the thing he feels is most important at the moment, the deck—home. Doing this breaks up the natural flow of the pilot’s scan, which ought to include his meatball (landing guidance from the ship)—line up, airspeed, altimeter, and angle of attack. Once he fixes on his landing area, he’s done for.”6 This is one explanation of why people die: Emotions overtake proper procedures they have been taught and even practiced to proficiency in the past. The jockey lost control of the horse.

It is important to understand how making choices based on emotional responses can often make the difference between life and death in emergency situations and that they can profoundly affect us as a result of the close calls we will have as part of our job. That’s why pilots die flying their aircraft into the stern of the carrier instead of landing safely on the flight deck. Firefighters/medics need to understand this. It should be included in recruit survival training just like practicing escape with a reduced profile or with our self-contained breathing apparatus.

Humor

Liberal doses of humor delivered swiftly and decisively by other firefighters often are a “treatment” for our emotional injuries. Gonzales concludes: “Although strong emotion can interfere with the ability to reason, emotion is also necessary for both reasoning and learning. Emotion is the source of both success and failure at selecting correct action at the crucial moment. To survive, you must develop secondary emotions that function in a strategic balance with reason. One way to promote that balance is through humor.”6

We all know that firefighters need little encouragement or guidance in using humor. What is important, though, is to understand that it can both prevent (depress emotion, elevate reasoning, and alleviate the stress of the moment) and treat (help your brain to operate in the reasoning mode).

For months after the explosion, firefighters from other departments would ask me if I rang the doorbell and caused the explosion. At first, it made me really mad that they thought I would do that. However, humor was the best self-administered medicine here. “No, I used a flare to light the way,” I would say. We would laugh, releasing the tension of the original conversation that usually led to a more tactically responsible discussion. What was really fun was the expression on their faces when I replied. You could see it flash across their forehead, “I just asked this guy a really stupid question!”

Driven

We arrived at the trauma center. As I was being wheeled into the emergency room past the hospital staff, I knew at that moment that I would not become a victim to this alarm. I felt a huge surge and drive to close the loop on this experience. I determined then and there that I would get out of this hospital and get started as soon as I could—like right now. My surrogate Dad, Ned Hobbs, a World War II veteran and survivor of numerous European theater invasions and bloody combats, said to me years ago, “Don’t ever get that invalid mentality, that you always need help and can’t do things for yourself.” Suddenly, those words came back to me and became very important to the point of obsession.

This was my secondary emotion that overcame my reasoning: I had to get out of the hospital, sooner rather than later. Anywhere but the hospital was safe. Going home was all I could see as an option. Home, safe home, was where I could get away from all this. PTG has good and bad effects. It is hard to know when to soothe and calm the powerful thoroughbred and when to encourage it.

After a CAT scan, blood tests, x-rays, and every other test known to medical science, the very professional ER doctor wanted to keep me for observation. I repeatedly and politely refused the medical advice of the doctor and staff that had taken such great care of me. I knew better, but I was driven. I signed myself out, and my wife drove me home. She and many others tried hard to convince me to stay just one night. As a former paramedic, I knew better: The mechanism of injury was severe. I had been a projectile in an explosion; I had been hit with parts of the building; and I had a bad concussion, broken facial bones, and burns, but I was leaving sooner rather than later.

The ER doctor explained to my wife and me that I needed to wake up every hour to check my mental status. She was concerned about bleeding on my brain from the severe concussion, the mechanism of injury, and the force of the blast. I stupidly said that that was no problem; we could do that. As a former medic, I knew what to look for in other people, not myself. Regardless, I wanted out. I was driven. A little too much PTG.

I signed the forms, and they released me. My wife and I walked to the exit. She left me at the entrance to get the car from the parking lot. Snow was coming down, the same snow I had seen all my life. It was different now. The snow was wonderful. It hit my face and felt good; but, there alone, I knew I was changed. I was still scared and trying to process the past 12 hours, and I knew I was very lucky to survive.

Why was I feeling different? It’s hard to describe, but I knew I was different now—not better, not worse, but different. I was changed by the experience but did not know what was to come, if anything, but a return to normalcy. I now describe the experience to other firefighters as a scar that I have to learn to live with. It can take over your life if you let it. Sometimes you have to work hard to keep it in the box in which you put it. It keeps trying to get out; the lid keeps opening, but you have to keep it under control. Let it out when you want it out and put it back in when you want it to go away so it does not consume you.

Signing myself out was not the best decision I ever made, but now I understand why I did it. It turns out that it was a bad decision: My legs turned black the next day from massive bruising from the explosion, and I could not feel half of my face from the fracture when I woke up the following morning. I spent the next day at numerous doctors. I should have stayed in the hospital. The horse took control of the jockey.

PTG—Resiliency

Psychology has largely ignored the phenomenon of PTG even though it is discussed in the literature and reportedly goes back to ancient times.1 It was only in the 1980s that a handful of researchers began examining PTG. And, what they found is startling. In study after study, about half or more of trauma survivors reported positive changes as a result of their experience. Sometimes the changes were small—they felt that life had more meaning and that they had grown closer to their loved ones. Others experienced life-altering changes that involved embarking on a career or life path they never would have considered before and transforming them and how they viewed the world.1

The area in which I experienced long-term personal growth was resilience. It did not come quickly (I certainly did not understand it). It took a couple of years and many conversations; research; a lot of reading; and, yes, counseling. “Resilience is the virtue that enables you to move through hardship and become better,” explains Greitens. “No one escapes pain, fear, and suffering. Yet, from pain can come wisdom, from fear can come courage, and from suffering can come strength—if we have the virtue of resilience.”3 The words are different, but it is the same message Uncle Ned had taught me years earlier: You must be resilient to survive. I had no idea when I would ever use his advice. It was years later. We need to be trained in, teach, and practice resilience.

My experience has given me more personal strength. I know I can get through the hardest times. It will not be easy, but I am confident that I can meet and overcome whatever challenges life has in store for me.

Whether you are a member of a Navy SEAL team or an Olympic athlete, you will need to deal with those same universal questions that have always plagued humans and we all have to answer: How do you focus your mind, control your stress, and excel under pressure? How do you work through fear and build courage? How do you overcome defeat and rise above obstacles? How do you adapt to adversity?3

Greitens shares other lessons from his experiences that may be helpful to firefighters dealing with the stress of the job: “What worked for us in the SEAL teams, what works for Olympic athletes, what worked for the Greeks 2,500 years ago—much of the same stuff, directed at the same human questions. How do you focus your mind, control your stress, and excel under pressure? How do you work through fear and build courage? How do you overcome defeat and rise above obstacles? How do you adapt to adversity? These are the universal questions. Everyone has to answer them.”3

There is no free lunch in life! Being stronger, wiser, or at least thinking you are has its downside, which I had no clue about. About eight months after my close call, one of my hockey teammates provided some good advice. Master Sergeant Santiago Perales Jr., a career heavy weapons platoon leader, put his arm around my shoulder and said very directly as he turned and steered us away from the locker room, “We need to talk.” What appeared to be a father-son talk was a bit ironic, since I am old enough to be his dad.

He looked me in the eye at very close range: “Look, you are not Superman.” That was all he said as he stared at me for what seemed forever. “I had guys in Iraq who survived multiple roadside bombs. They thought they were Superman. They thought they were bulletproof. Some of them died because they did stupid things. They were not bulletproof, and you are not either. Do you understand?”

I felt like a young private, but the point was well taken.

“Don’t do anything stupid. Let’s go get changed.”

When I could find the words, I thanked him for his advice. Actually, I thanked him repeatedly until he told me to shut up and drink my coffee. His advice was hard won through extreme experiences; sharing it seemed like a real brotherly act. Unfortunately, firefighters have little training or experience to initiate or guide these conversations with fellow firefighters, so we usually shy away from it.

The Superman analogy became interesting again long after the above conversation. My department experienced a fatal residential fire. Finding the victim slumped over his kitchen table at noon on a weekend with two rooms of his house pushing fire out of four windows was surprising for our members. During the critical incident stress debriefing, one of the stress team leaders knew of my history and said something like, “When Jerry takes off his Superman costume ….” I joked that my costume had a large “L” for lucky, not “S” for Superman. The Superman mentality can very easily get out of control.

PTG is not static. Greitens advises: “Don’t expect a time in your life when you’ll be free from change, free from struggle, free from worry. To be resilient, you must understand that your objective is not to come to rest, because there is no rest. Your objective is to use what hits you to change your trajectory in a positive direction.”3

Tactical Growth

Post-traumatic tactical growth (PTTG) was easier, but there is no free lunch here either. Soon after the incident and during the first two years, I had numerous conversations with a good friend and fellow firefighter, Dan Moran, coordinator of Rockland County (NY) Hazardous Materials. He listened a lot. He and I dissected the tactical side of the call and determined that the training the natural gas companies provided to firefighters was inadequate. It is at the awareness level. Obviously, we operate at the command/technician/specialist (in hazmat terms) levels on the scene of a natural gas release. More importantly, utilities did not share their procedures with the local fire department.

Additionally, by talking with firefighters from across the nation, especially at the Fire Department Instructors Conference (FDIC) International, we learned that most fire departments’ standard operating procedures for gas emergencies are very weak—usually because the utility in their area does not share with them procedures for response to natural gas emergencies.

Driven by PTTG, I set up a meeting with utility regulators in New York State and explained that the training firefighters get from the utility was not sufficient and that the most effective solution would be to share the procedures the utility gas technicians used on gas leaks. This briefing, combined with the recent history of “not so successful” fire department responses to natural gas emergencies across our state, resulted in several significant actions that will increase training for fire departments in New York State.

Improvements in Training

Following are some of the program components we obtained:

  • Working with state gas company regulators, we secured $150,000 to build at our county training center a full-scale training site we named “Leak Street.” This funding also bought excellent gas meter simulators and a live fire prop with which firefighters can practice using hose streams to drive gas fire away so they can shut off the meter.
  • Recognizing the widespread nature of the problem, the New York Public Service Commission funded a second Leak Street at another training center in New York with the intention of building these centers across the state.
  • My FDIC International “Tactical Response to Natural Gas Emergencies” presentation (2017-2018), the gas emergency response training program used by the 26 fire departments in Rockland County, resulted in my meeting Pipeline and Hazardous Materials Safety Administration and Georgia Fire Chiefs Association representatives who had successful Pipeline Emergency Response Initiative (PERI) programs. We created “NYPERI,” the New York version of this program, with the sole purpose of providing practical, procedure-based training for New York firefighters.
  • Through NYPERI, we began working with the Fire Department of New York (FDNY) and jointly discovered a new laser-based natural gas detector that greatly speeds the size-up of natural gas emergencies.

The downside of my newfound tactical growth is that it takes time to make the changes in procedures or training, especially those that are absolutely critical and time sensitive. I will be patient, but will continue to push forward. Tactical growth was the easy part; it also was the visual part that closed the loop once and for all.7

Lessons Learned

The event can completely overtake you if you let it. For a solid two weeks, I spent most of my days and part of those evenings talking to family and friends and firefighters who visited me at home, writing thank-you cards, and returning phone calls not only to firefighters but seemingly to everyone. The town supervisor called me and presented me with a $500 gift card from the local grocery; fruit baskets arrived multiple times a day. Our mailbox was stuffed with cards from all across our nation. Then, there were doctors’ visits for follow-up for burns, my facial fracture, concussion, and my badly bruised and discolored legs. The outpouring of compassion was beyond belief; to this day, I am extremely grateful for all the love and support.

All of this positive support was great, but it consumed my time almost day and night. It seemed that I could not get away from it. After a few days, we had a get-together—kind of a group hug—at my firehouse. This was very healing; it unofficially confirmed that, for the most part, we were all okay. Kenny was still in the hospital, but he was on the road to recovery, although it was 13 months before he returned to work. I got to thank the paramedics who cared for me, and on a visit to see Kenny, I got to thank the hospital staff. It was really nice, but these events kept dragging the explosion to the forefront of my thoughts. I just wanted to get over it, put it back in the box for long-term storage.

Great things continued to happen for weeks/months. In church, a parishioner stood up and said she was grateful that Kenny and I survived and for what all firefighters do for our community. I was invited to the town’s Rotary meeting, where I received the “Service Above Self” award. The county executive presented me with the Outstanding Citizen award.

I learned that my recovery would take time and that I should embrace all the well-wishers; appreciate their kind thoughts and acts; and, most of all, enjoy my survival of the close call. I came to understand that it was both a public and a private event. This was also an opportunity to thank those who cared for me and to remind everyone that this was a team effort, a full fire department and emergency medical services success.

Growth trajectory. You may be rocketed into action by the power of your experience, power, strength, and resolve you never knew you had. You may not even know the source of the momentum. Enjoy it; use it like a newfound power tool.

Rumination. For some people, telling your story over and over helps. Each time you reinforce the fact that you survived, the impact of the traumatic and often dramatic event lessens. Talk to your friends and coworkers. It helps. Simply hearing it out loud changes things for the better and sets you on a course for growth.

Here again, the trauma provides both positive growth opportunities and negative choices. “And choosing to wallow in the negative emotion for too long can become debilitating and an impediment to change. What is required instead is ‘deliberate rumination’—a thought process driven by the individual, not the trauma.”1 When deliberately ruminating on a problem, you are actively involved in thinking about how the event has impacted you, what it means for you, and how you can live your life going forward given the challenges the event has posed. “The trauma survivor is actively taking the challenges that the trauma has introduced into the assumptive world. Deliberate rumination is the way that people begin to rebuild themselves.”1

You need people; people need you. I put a few names of people who were part of my experience in this article as a reminder that we need the help of others to get through and recover from a close call. So many more people helped. Firefighters are not good at asking for help; we fix everything from broken water pipes to raging fires. Sometimes, we need fixing. A better way to think of it is “annual maintenance.” Part of taking care of each other is recognizing when to ask for help for ourselves and each other.

Listen to others. Another key tactic toward recovery and growth is listening to the advice of your friends. A good friend and captain of our EMS unit, Teri Hamilton, called me a few days before Kenny was being transferred from the trauma center to the rehabilitation hospital. She very politely insisted that I ride in the ambulance with him. I tried to beg off, as I was really just getting back to some semblance of order and thought I was well on the way to full recovery. She said, “This is important; you need to do this.” From the tone of her voice, I knew it was something I should do. So, I agreed.

Flashbacks. The ride to and from the trauma center was about 30 minutes each way. Of course, it was a happy time and was celebrated with fire truck escorts, banners, and a small crowd. When we brought Kenny to the world-class rehabilitation hospital that, coincidentally, was in our first-due area, in many ways, we experienced a sense of our coming home. This was very healing for me. It was the antithesis of a funeral—a joyous occasion featuring timing and events, a motorcade, escorts, and press coverage. It was a time to heal, and I was so glad that I was a participant. Listen to your friends.

The emotional horse got away from me that day for a short time before I knew what had happened. The ambulance crew brought Kenny on the stretcher out of the ambulance—a few waves and pictures—and they wheeled him toward the main door of the hospital. A crowd of about 75 people followed. What I was seeing through my emotions was a casket being pushed into the church with grieving friends and family behind. The hospital staff members with white coats were the ministers, the security staff in uniform was the fire department honor guard; of course, his family was there, many fire department members, and many mourners. I was blindsided by this image, and it took some time to figure out. My fire department had had a line-of-duty death several years ago; and, of course, after 9/11, we had attended far too many funerals for FDNY friends. My emotions connected the dots instantly but incorrectly. There would be flashbacks. Dr. Steven J. Levy, my excellent counselor, said there would be; this was the first.

Social support. Research shows how important social support is. One of the studies, published in Lancet, noted: “A study of those affected by the terrorist attacks in New York City on September 11, 2001, found that those with low levels of social support were more likely to report symptoms of PTSD.”8 A few days after the explosion, I needed my family to be together. We had a family get-together, a survivor party. My wife made a cheesecake. It was similar to a birthday party. Now, every January 16, she makes a “Main Break Cheesecake.” Then, we put away the remembrance, like a birthday, until next year. The incident goes back in the box. We remember it for a short time and then move on with our lives.

During our first family get-together, my father-in-law provided some experienced-based wisdom. He was 90 years old, a retired police officer, and a World War II veteran who served with the Flying Tigers. Surely, he had an experience that he would not share except for the lessons he learned from it. He said: “Listen to me. You know what happened before the explosion and after. You will never know what happened in between. So, stop trying. Let it go and move on.” I’m not sure of what he saw in my behavior, but I surely took his advice. Listen to your family.

Stop, drop, and pray. As you may have guessed, there can be a huge spiritual side to your positive growth. It is a common result in many survivors. Take a few minutes each day, stop what you are doing, drop everything, and contemplate your experience. Be thankful for your gift of life, that you survived; be grateful, and pay your spiritual dues.

Learn to live with it. It is not going away; learn to enjoy it. My neighbor introduced me to a new neighbor as, “This is Jerry, the guy that got blown up.” For a while, I thought this was disheartening—yup, I’m the jackass that got blown up. Silently, I said to myself, “Yup, I have got to be one of the luckiest firefighters on the planet. Every day is a really good day.” This turns the perspective of myself as a flying piece of light explosion debris to a very, very grateful and happy survivor. Sometimes, I can’t help myself and describe my new career with the circus as the guy who gets shot out of the cannon.

Not everyone is sympathetic. This may be hard to believe, but I was explaining to a supervisor at the training center why building Leak Street and training firefighters on tactical response procedures were so important to close the emotional loop for me. He looked up and said, unsympathetically, something to the effect of, “Well, you had better get over it.” Expect some folks to be jealous of your experience, or maybe they just cannot understand it.

Counseling Lessons

Sometimes you need help, period. This was a super valuable lesson. I fought it for a long time until my wife and Kenny both looked me in the eye and frankly said, “You are acting like a &*!$* and better do something.”

“Not me,” I thought. “Psychologists are for crazy people. I’m fine.” But, I wasn’t fine. I learned that sometimes in your life you need help figuring things out. It took a great deal of personal courage to make the appointment and walk into that psychologist’s office.

In the town where I grew up, there was a very large state facility for the developmentally disabled, and it had a huge stigma attached to it. It housed a wide variety of clients from the poor souls so mentally disabled they would tear off their clothes and lie naked on the floor to those who would sit near the pond on a tree stump with a steering wheel pretending they were driving a car. That was 50 years ago, but the stigma of mental health ran deep.

One of the guys who works at my training center, Mike Healy, was an Employee Assistance Program director for the Metropolitan Transportation Authority. Retired, he now focuses on firefighter behavioral health. I beat around the bush and asked him if he could recommend a counselor. That sounded better than a psychologist. He recommended Dr. Levy.

So, when you feel like something is just not right, ask for help. It is hard, very hard, but you will really appreciate the healing journey. No matter how you describe it, the monkey on your back or the load on your shoulders, this is the best way to get rid of it.

Dr. Levy explained that I was having a normal reaction to an abnormal circumstance. He followed this immediately in the first session with music to my ears, “You are not crazy!” This set the tone for future sessions. I could not have learned this from the exact same comment in the firehouse no matter who or how many times they said it! Care by an expert is required.

“You can’t make sense out of nonsense, so stop trying.” This is another well-constructed “Doc-ism.”

I did not understand flashbacks until Dr. Levy explained them to me. He said I would have flashbacks stimulated by sounds, smells, and situations that will instantly remind me of the event and take me back there. Up to this point, I was not aware of the power of flashbacks. They are powerful and instant and get out of control quickly. I recall the skeptical look on Doc’s face when I said they have not been a problem for me. I did not realize that the “hospital funeral” was the first one. He knew they would be coming and predicted I would experience them.

About two years after the close call, my fire department was operating at a gas leak in an unoccupied house. One of the officers on scene radioed, “There is a strong odor of gas coming from the house. We need to force the door,” a situation and transmission just like the one that almost killed me. My eyes opened wide, and I literally ran and hid behind the closest engine. I was not cowering, shaking in the fetal position on the roadway, but I did find myself behind the rig sooner than I expected. When I got there, I realized what happened. I looked around and thought, “Did anyone see that?” If they did, no one said anything to this day. Although flashbacks have not been a severe problem for me, during the winter when the snowplow driver drops the plow, that night’s sleep is over for me. I don’t recall hearing anything of the house exploding, but the plow must sound like it. Listen to your counselor. He is trying to make your life easier.

Neuroscientists, psychologists, and other researchers talk about the mind-body connection. When I look at pictures or discuss my close call at length, the left side of my head where I was struck by part of the house that caused the concussion hurts. I have given up trying to understand this.

Flashbacks are powerful and often uncontrollable. As an example of their speed and power, my dad, a Marine combat veteran of vicious campaigns on Guadalcanal, Tarawa, and Saipan, suffered flashbacks. My mom learned quickly to use a broomstick to wake him after he, thinking she was a Japanese soldier who had infiltrated his fighting position during the night, nearly choked her to death one morning. His flashback was to the hand-to-hand combat. In the dark, he connected the dots instantly but incorrectly. Respect the power of flashbacks.

It is critical that you learn about the effects that volatile and traumatic experiences can have on you. Firefighters don’t get this training, but we need to so we can lower the number of firefighter suicides and decrease other less dramatic but devastating effects. This article provides a glimpse into the effects of and scientific facts supporting PTG. Use this information to learn and grow and become a better, stronger, and more resilient firefighter.

Author’s note: If you are in or are planning a fire/EMS service, career or volunteer, you will find it extremely helpful to read the books referenced in this article. They provide a perspective that will help you to counterbalance the trauma and suffering you will experience during your career.

References

1. Rendon, Jim. Upside, The New Science of Post-traumatic growth. Touchstone., 2015, pages 9,13,76.

2. Fayed, Michelle, “Mental Health First Aid for Firefighters,” https://www.fireengineering.com/2018/12/18/208138/mental-health-first-aid-for-firefighters-michelle-fayed.

3. Greitens, Eric, “Resilience: Hard-Won Wisdom for Living a Better Life,” New York City: Houghton Mifflin Harcourt 2015; first Mariner Books et. 2016, page 109, pages 3-4,23.

4 Siebert, Al Ph.D. The Survivor Personality. Perigee Books/Berkley Publishing Group© 2010,page 194, ISBN: 978-0-399-53592-5.

5. Alexander, MD, Eben, Proof of Heaven, A Neurosurgeon’s Journey into the Afterlife. Simon & Schuster, 10/23/2012.

6. Gonzales, Lawrence in Deep Survival: Who Lives, Who Dies, and Why. (pg 31) New York and London: W. W. Norton & Company, 2017, pages 31,34,37,38,40.

7. Knapp, Jerry and Moran, “Tactical Response to Natural Gas Emergencies,” Fire Engineering, March-April-May, 2017.

8. Pearlman, SE, et al, “Short-Term and Medium-Term Health Effects of 9/11,” Lancet 378:9794, Sept. 2011.


JERRY KNAPP is a 43-year firefighter/EMT with the West Haverstraw (NY) Fire Department and a training officer with the Rockland County Fire Training Center. He is chief of the hazmat team and a technical panel member for the Underwriters Laboratories research on fire attack at residential fires. He authored the Fire Attack chapter in Fire Engineering’s Handbook for Firefighter I and II and has written numerous articles for Fire Engineering.

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