Stress, Cortisol Can Complicate Firefighting

By Dan DeGryse

As firefighters, we go from 0 to 60 mph in a matter of seconds when we hear the bell ring at the fire station.

We race to gear up and to process the information about where we’re headed. But we don’t prepare our bodies for that rush of adrenaline. Given the unexpected nature of the work, I’m not sure how we would or could. It’s not as easy as warming up or stretching before exercising.

Our bodies release adrenaline and cortisol when they’re stressed. Cortisol is a stress hormone–actually, a steroid hormone (I call it a hormone on steroids). It’s great to get you going, but is it healthy for our hearts to race 10 to 15 times a day? That’s 30,000 instances of a racing heart just on the job alone if you do the math over a 30-year career.

I started researching cortisol–how it affects the immune system, the digestive tract, concentration, etc.–a few years ago after studying the suicide rate within the Chicago (IL) Fire Department. I looked at other main causes of death, and heart disease topped the list, as it does nationally. Diet, exercise, smoking, and heredity are some of the main risk factors for heart disease, but excessive stress can contribute to those risks.

What if I get that injection of cortisol and my heart goes through the roof, but then I find out it’s a false alarm? Now what? How do I get my heart rate back to normal, and where do the adrenaline and cortisol go? My understanding is they get absorbed back into the body, and that made me wonder if we truly know the effects of what happens when that occurs.

When I hear the firehouse bell go off, it’s like a jolt. Even though it may not be for me, I can still feel my heart race a bit, and I have to sit there and breathe, relax, and try to calm down. That’s just an attempt to get my body back to its neutral state; that doesn’t reduce the amount of adrenaline and cortisol that were just released in my body.

Former U.S. Fire Administrator Olin Green wrote in 1991 about the dangers of stress within the fire service. But after more than 25 years on the job, I hadn’t heard anything about that until I started researching the topic. I never looked at stress as a possible hindrance until now. And I don’t want the next 25 years to pass without addressing it.

For many years, we’ve talked about improving personal protective equipment: bunker gear, helmets, self-contained breathing apparatus, hoods, gloves, and boots. We’ve also found out that the heat buildup inside of our bodies and the skin exposure to carcinogens are as dangerous as us breathing in something toxic.

I’m finding out that adrenaline and cortisol, which are naturally occurring and necessary for us when in our fight-or-flight mode, are potentially hurting us from the inside out.

The cortisol in our bodies is typically highest in the morning to help get us going. The level of cortisol lowers throughout the day in sync with our circadian rhythm. The level is lowest–half of the morning level–at night. But if we’re constantly stressed by the firehouse alarms or during runs, what are the effects of the continually higher levels of cortisol on our minds and bodies?

Although there is research available on this subject for military and police personnel, I haven’t found any related to the fire service. My hope is that further research on the topic geared toward the fire service will help spread awareness about the physiological effects of stress we experience throughout our careers.

For example, when I look at my own physiological responses regarding this issue, I can tell you that when I come home after a long shift and being up most of the night, I feel like I’m shaking from the inside out. I try to meditate before I go to sleep so I don’t have that feeling.

Another example of the physiological effects of cortisol: I spoke to a coworker who has 27 years on the job, and he told me he wakes up pretty much every night at 1 a.m. He wrestles around, gets up to walk around, and then tries to go back to bed. He had a sleep study, and the technicians figured out that he typically doesn’t have one minute of rapid eye movement (REM) sleep, which helps give us more energy during the day. Cortisol levels also fluctuate during sleep, according to the National Sleep Foundation.

Some people take medication to help them sleep, while others might have a drink before bed. Self-medication can quickly progress to addiction. We know that all too well.

That’s part of the reason why I split my time between work as a battalion chief with the Chicago Fire Department and Rosecrance, a leading provider of addiction and mental health treatment services in Rockford, Illinois. In fall 2014, I worked with Rosecrance to help launch the Florian Program, which is the first program in the country dedicated to treating fire service personnel with an eight-bed coed inpatient unit.

That program aims to help firefighters and paramedics with serious substance abuse and mental health issues such as post-traumatic stress disorder, anxiety, and depression. Knowing what we know now about cortisol’s overall effects on our long-term well-being, we are incorporating its significance into our program.

Florian clients will have their cortisol levels tested initially when they check in for treatment. Dr. Raymond Garcia, medical director at the Rosecrance Harrison Campus, where the Florian Program is located, will evaluate those tests to check for abnormalities and to see if there’s a need to incorporate techniques for clients on how to de-stress. Clients whose cortisol levels have been identified as abnormal will be retested at the end of treatment to evaluate progress and treatment success.

We can educate them about stress and cortisol and give them tips on what to do when they return to their jobs, because they’ll face the same triggers and traumas as they did before treatment.

Research has shown that low-intensity exercises, yoga, meditation, breathing techniques, and acupuncture can help reduce cortisol release in the body. Avoiding sugar and caffeine is best after a jolt of cortisol. Eat fruit high in vitamin C and food high in protein (eggs, lean meat), zinc (seafood) and magnesium (spinach), and avoid high-carbohydrate foods and sugary desserts.

And what if there’s a way to change the tones in the firehouse? We don’t have all the answers yet. Until we do, let’s research and study the issue first.

Because doing nothing for the next 25 years is unacceptable.

Dan DeGryse is a battalion chief with the Chicago (IL) Fire Department and director of the Rosecrance Florian Program.

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