My Response to Post-Traumatic Stress

Firefighting culture is steeped with tradition of more than 100 years and counting. We enter this field to make a difference in people’s lives. We train extensively on firefighting tactics, medical procedures to save lives, and how to become officers and leaders. Seasoned firefighters and officers have a duty to pass down their invaluable knowledge to the junior members. While at the firehouse, we are a close-knit family, although we may occasionally “bicker.” Each firefighter has an obligation not only to keep the public safe but also to keep each other safe. We wash the trucks, cook, eat, and hang out with our brother and sister firefighters, knowing we “have each others’ backs” during any type of emergency. We go out together when off duty, spend time with each other’s children during special events, and even put in some “manual labor” for our fellow members struggling to make ends meet.

One thing the firefighter culture has not taught us, however, is how to share things we cannot handle, like the traumatic events we see daily. The firefighter culture breeds the strong and the brave. We are taught early in our medical and firefighting careers that there is no situation we cannot handle. This goes back to the adage, “When in doubt, call the fire department.”

I began my fire service career, like many of us, to make a difference in people’s lives. Little did I know that this would eventually catch up with me: In 2015, I was diagnosed with post-traumatic stress disorder (PTSD) after more than 26 years of service as a first responder. (See box “Post-Traumatic Stress Disorder.”) As it was explained to me by Chief Peter Lamb and Captain Keith Jackson of the Attleboro (MA) Fire Department, “We all start off with an empty backpack when we are fresh out of the academy gearing up to make a significant difference in people’s lives. At some point throughout our careers, our backpack gets overstuffed with many traumatic events. We must find ways to work through our feelings so we can stay healthy for our families and for those we protect daily.” Jackson was director of the Critical Incident Stress Team for southeastern Massachusetts.

I believe that I am no different from any other first responder trying to make a difference in people’s lives; however, I feel I am in the minority because I eventually asked for help. This is a sad statement, and I feel strongly about it. The culture of the fire service must change so we all may live happy and productive lives. It is time to break through the stigma of weakness associated with mental health. First responders are called to do many things the public does not want to deal with. Over time, I strongly believe a piece of us is left with every patient we could not help. That is a steep burden to live with. I understand I chose this profession, and I truly believe it is the best job in the world.

Also, I know that there are many first responders struggling just to get through their day. We must look out for each other just as we do on the fireground. Sometimes just a simple conversation with brother or sister firefighters is all it takes for them to open up about what is bothering them. Approaching fellow first responders is one of the toughest things to do, but if they are struggling, there is no one better to turn to than a peer because that person has lived it. That is the truest sense of the “Brotherhood.” The next step is getting professional help so they can “unload” some of the burden from traumatic calls in a safe manner.

Before I share some of my personal struggles with PTSD, I want to relate a few short words spoken to me by the original team of doctors who treated me in the emergency room when I first sought help: “PTSD is a part of your life, but it will become more manageable with hard work and therapy.”

I tell you that this is true, that I have progressed from the days when I was hospitalized many times with suicidal ideation. I attempted suicide by carbon monoxide poisoning at least twice within the past three years. This seemed likely to be the right and only answer for me at the time. I just wanted to be left alone and fade away. I honestly thought my presence was a “burden” to every individual I came in contact with. After having been in that lonely place, I had a deeper understanding of patients I treated with suicidal ideation or even those who committed this lonely act.

How I Felt and What I Experienced

What drove me to the point of suicide ideation and finally to seek help? I was in a “dark place” and very lonely. I just wanted to end the pain. I isolated myself from my family, thinking that in “my safe place” no one could ask anything of me. I did not know what to do. I did not understand these negative thought patterns, which were “cyclical” in nature. These patterns repeated themselves over and over until I found myself in that “dark place.” Even when the traumatic events stopped in the reality sense, they still haunted me, which automatically turned my mind to a “negative thought process.” What helped me to break this cycle was the trio of therapy, medication, and exercise. For me, they worked only if employed simultaneously. They did not work if I used them separately.

There was an ongoing interior battle raging within me: I felt that I should have been mentally strong enough not to have to seek help. There was even a time when I was “too proud” to take medication.

I suffered from nightly traumatic episodes that revolved around the pain and the suffering I witnessed throughout my career. My wife and daughter tirelessly reassured me that the episodes were just bad dreams. It was difficult, however, for me to go back to sleep while fearing what might be waiting for me on the other side.

I suffer from flashbacks: I could see emergency lights flashing and in perfect detail much suffering in the faces of the patients. I literally hear the crackle of glass under my fire boots and smell the gasoline that spilled on the roadway. I still feel the pain of crawling into mangled vehicles and seeing the horror on the victims’ faces. The feeling of glass shards from accident scenes penetrating my medical gloves on scene still haunt me to this day.

I also find myself dissociating if I hear a spoken word or a song on the radio or smell something associated with those scenarios. These things send me right back to the traumatic incidents, just as if they were happening in the here and now. This dissociation experience takes me back to incidents in detail but does not ground me in what exactly is going on around me at any moment in time. It is as if I am daydreaming and the traumatic incidents are constantly revolving around me, and I just can’t break the cycle. Obviously, this is a frightening experience. Now, however, I can sense when this is about to happen and take safety measures. These triggers that I once feared have become more manageable. I do not know all of my triggers, but I am now equipped to better handle them when I realize they are coming. Many times, I just have to ground myself and let certain feelings pass before I move on. It sounds rather simple, but it is very difficult, especially when you are trying to make sense of all the emotions coming right at you.

Triggers?

I was a captain on the fireground and became the incident safety officer. This became a detriment to me and my family because I felt as if I was always on duty. I could not leave work at the firehouse; I became hypervigilant in every aspect of my life. I was constantly waiting for the next big event to occur. As firefighters, we are programmed to be ready 24/7, and I was not able to let that go when I was home with my family.

One of the last events that significantly affected me occurred on my way to my daughter’s gymnastics competition. Unfortunately, I remember this incident quite vividly and will never forget it. I witnessed a young man walk in front of a semi-trailer on the highway; it was obvious that he did it intentionally. People were driving around the carnage, and I could not understand why they were not stopping to help. I called 911; no first responders were on the scene. This young individual was displaying obvious signs of death, and that scene brought me back to many other patients we tried to save in similar circumstances. This event triggered a fast-moving mental image of scenarios from my previous calls. The closest thing I could think of to describe the experiences would be a never-ending, constantly changing video of racing thoughts. Although I never touched this young victim, I honestly thought I was rendering aid to this traumatic arrest. I could not understand why this was happening, and I felt that I needed to make sense of it.

I was progressively struggling on and off the job. My hands would shake when I was performing my paramedic skills. I could not make sense of this because I had performed these skills hundreds of times without issue. At about this time, my coworkers began to notice that “something was different with me.” They never said too much to me because I think they knew how proud I was to be a firefighter.

I also noticed that I was easily startled when I heard loud noises; they reminded me of traumatic calls.

My Life Began to Change

One day in 2015, I was off duty and my fellow fire brothers and their wives came to my front door. My wife Claudia helped organize this intervention. They would not leave until I was seen by a professional. I resisted, but to no avail. That night, my life changed forever. Lt. Curt Chretien stayed with me through the process of getting a psychological admission at the local emergency room. The psychiatric team evaluated me. The doctor asked, “Have you ever heard of PTSD?” I responded, “Yes, many people who have served in the military have that condition.” He said, “Rick, I honestly believe you suffer from this condition.”

This news hit me significantly. I had no idea that first responders could develop this condition. I did not want to accept this “label” because I automatically associated it with weakness. I had come to learn that PTSD was not like a broken hand or a laceration that could be quickly stitched up. It was to become a lifelong battle.

The Strong Ask for Help

I want to declare here and now that the negative stigma that has been associated with PTSD and related disorders and firefighters must go. I allowed this myth to postpone my seeking help. Furthermore, I challenge the fire service culture thought process that labels firefighters suffering from PTSD as weak individuals. As I see it, fellow brother and sister firefighters who ask for help are strong. Asking for help is one of the most humbling experiences on the path to recovery, and it takes much more courage than attempting to deal with issues in unhealthy ways that may include excessively abusing alcohol or recreational drugs or turning to gambling or infidelity, to name just a few of the common escape mechanisms.

Although we are told throughout our career that nothing is impossible, PTSD can absolutely destroy you personally and affect all the individuals in your life. Friends and family saw me struggling with “something,” but they did not know how to get me the help I needed. You only can begin the process of getting help. You must be willing to seek treatment from a professional, preferably one who has had first-hand experience as a first responder, who can fully appreciate what you have experienced throughout your career; it takes a long time to explain what you have been through on the front line to someone who has not gone through it. If within the first few visits you are not satisfied with the counselor you selected, move on to another who might be a better fit for your needs.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is an anxiety disorder that haunts many firefighters after witnessing a traumatic event. “One in five firefighters will suffer from symptoms of PTSD at some point in their career,” according to new data from the International Association of Fire Fighters (IAFF). The next time your platoon is seated in the front room for training, look around—one in five firefighters will be affected by PTSD. How many of your brothers and sisters are having a tough time dealing with events they have witnessed? It’s closer than you think! “Stress is one of the most serious occupational hazards in the fire service, affecting health, job performance, career decision making, morale, and family life. Emotional problems, as well as problems with drugs and alcohol, are becoming increasingly evident. High rates of attrition, divorce, occupational disease, and injury continue—[and] suicide is a real and tragic alternative for some.”

According to the Anxiety and Depression Association of America (ADDA), symptoms of PTSD may include “re-experiencing the trauma through intrusive distressing recollections of the event; flashbacks and nightmares; emotional numbness; the avoidance of places, people, and activities that are reminders of the trauma; and increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered.”

Stress is a “normal” reaction to an event. PTSD, however, becomes more intrusive and debilitating for some firefighters. Symptoms can occur up to a month or longer after a particularly traumatic event a firefighter witnesses or was a part of. Refer to www.ptsd.va.gov for the cluster of symptoms a person must meet to be diagnosed with PTSD. Many health professionals now call it post-traumatic stress instead of PTSD, a societal shift in how the condition is perceived—removing the stigma associated with the word “disorder.” After a long battery of tests, I was ultimately diagnosed with PTSD in 2015.

Post-Diagnosis

It took me months to accept the PTSD diagnosis, and there are times even today when I have trouble accepting it. I slowly began to heal throughout many months of treatment. I was admitted to the McLean Hospital LEADER (law enforcement active duty emergency responder) program in Belmont, Massachusetts, where I received individual and group therapy. When I was discharged, I was feeling strong.

A few weeks passed, and I began to spiral again into that dark place where I was lonely, hopeless, and helpless. I believed that there was no hope for me and that I was all alone in my suffering. I just accepted that not sharing this pain with my fellow firefighters was just the way the culture was. My thoughts became flooded with the traumatic calls in which I participated. I thought I could handle the situation.

More Help

Then, one day at the firehouse, I was getting ready to train one of the new members of the department. I introduced myself to the recruit. That was as far as I got. I knew I needed more help.

I contacted my union (Local 1992), and Chief Michael Brousseau drove me to the local emergency room. I asked, “Are you driving me to the emergency room as the boss or as a friend?” He replied, “As a friend, Rick.” I replied, “Thank you.” This is something I will never forget: I knew that the union and the chief were supporting me 100 percent. This support became instrumental while I was going through yet another inpatient stay.

At this point, I was keeping my mental health issues a secret from other members. Eventually, I saw so many doctors and counselors that I could not make sense of what was going on.

I was admitted as an inpatient to the International Association of Fire Fighters Center of Excellence (COE) in Maryland, where I remained for 45 days. This facility is for firefighters struggling with substance issues, anxiety, depression, and PTSD. I immediately bonded with fellow firefighters from throughout the country who were struggling with similar issues. Dr. Abby Morris (IAFF COE medical director) and the staff helped to make me more resilient. I was taught to meet these overwhelming traumatic feelings head on rather than hide from them. This sense of resiliency I was taught was instrumental in my continued recovery. For the first time in years, I felt that someone understood me. On Day 45 of treatment, I ran in the 2017 Marine Corps Marathon in Washington, D.C. Many of my fellow firefighters came out to support me.

Today

My recovery has taken a lot of hard work, and it seems slow at times, but I am making progress and am looking forward to starting the next chapter in my life. I considered it vital to reconnect with my daughter Madison. I missed many pivotal moments in her life because of my being a first responder, just as all of us do. My constantly being hypervigilant just made our relationship more strained. Madison is truly the only reason I am still alive today. I could not fathom her growing up without a father and with the kind of damage that that could do to her throughout her life.

I have good days and bad ones, just like everyone else; but now, I can always talk to my peers at the firehouse and throughout the country. I still feel that they are the only ones who really understand what I am going through. Although I have met many health professionals along my journey, peer support continues to be the most helpful in my recovery.

I continue to work hard while battling this illness. Just like every one of my brothers and sisters, I have good and bad days. The good days far outweigh the bad ones, though. Before treatment, I did not know what a good day was. Many health care professionals have told me that although I may never be rid of some of these issues, they will become more manageable. Those close to me have seen a remarkable difference in the person I am now and the person I was before treatment.

The most important thing I have learned is how to use resilience when I am triggered. Resilience has made life easier. Knowing and understanding my triggers have helped significantly as well. I do not know all of my triggers, but just knowing some of them and being well-equipped to prepare and ground myself for these feelings help me to overcome these trying moments. As stated, I wish I would have learned how to employ this tool many years ago, but I am grateful that I now have a good grasp on how and when to use this vital tool

A Message to My Brothers and Sisters

My sole purpose for writing this article is to show you that you are strong if you ask for help and to tell you that help is available and it works; I am living proof of that.

For those of you who are worried about ruining your career if you seek help for depression or PTSD, I have a short success story to share. The first time I was hospitalized, I held the rank of lieutenant. After returning to work after being hospitalized a second time, I was promoted to captain. Brousseau and fellow interviewers told me that I was the best of several candidates for the job. The chief tells me that he has never regretted promoting me to captain. This is something very dear to me.

My brothers and sisters, know there is help out there. Standing up to the emotions you are feeling can be a matter of life and death. I would not be here today if I was not willing to fight through my PTSD. We do not need to see any more of our brothers and sisters commit or attempt suicide. I am a prime example of an individual who went from having suicidal ideation and PTSD to a healthy productive member of society.

The crucial step in beginning the healing process is to ask for help. If you are not comfortable with approaching your officers, turn to the union or other peers. You will find many brothers and sisters willing to help without judging. Two facilities have been instrumental in my treatment. The first is the McLean Hospital LEADER Program, instituted in the aftermath of the Boston Marathon Bombings; it is in Belmont, Massachusetts (844) 742-6235. The second is the IAFF COE in Upper Marlborough, Maryland, (301) 327-1955. Feel free to contact me at stacknafd1@gmail.com.

Reference

Firefighters at Risk: The Negative Effects of Stress and Trauma on the Human Spirit. Peggy Sweeney https://grievingbehindthebadgeblog.net/2014/06/24/firefighters-at-risk-sweeney/.


Richard Stack, NRP, MPA, is a fire captain/paramedic with the North Attleboro (MA) Fire Department. He has been a nationally registered paramedic for more than 26 years and a career firefighter for more than 20 years. He has a master’s degree in public administration/fire science and undergraduate degrees in psychology, fire science, and building construction.

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