Fire EMS Casualties of War

Twenty-year-old Johnny was third generation firefighter/EMT. Johnny was engaged, enthusiastic, and worked hard at being proficient at his craft. He felt he was ready to respond to life threatening emergencies. Nothing prepared him for incident that changed his life forever. The day he picked up a lifeless baby out of swimming pool with parents screaming for him to desperately save their child. Nothing prepared him for the inevitable outcome of the child not making it. On TV and the movies everyone lives. All children are saved. Then there’s a hero’s ceremony where the family presents him with a medal. That’s not how it ends in real life. Back at the station the chief gives the whole crew the obligatory, “Hey you all ok?” Johnny looks around before he gets ready to say he’s a bit upset. Everyone else nods their heads that they’re good. Johnny doesn’t want to be different and instead of saying something, just nods along with the rest of them.

Johnny comes from a proud family of fire service providers. His grandfather and father were fire chiefs. His mother, an EMT. They seemed not have any emotional issues from their time serving. However, Johnny has recurring nightmares from this event. He vividly feels the limp body in his hands. He sees the parents’ desperation and despair in their faces. He thinks back with a list of “what ifs”. If we moved with more energy, like we do for structure fires? Did I do CPR right? Did I train enough? Those parents counted on me and I failed them. That two-year old was too young to die. He wakes in a cold sweat, heart racing and breathing heavily. The anxiety makes him want to scream out. He needs help, but then he would be a wimp, a sissy. “buck up Johnny, buck and act like a man dammit!” “Be a strong firefighter” “There’s no place for weakness in this business.”

Johnny starts drinking to hide to the emotional pain, but the buzz makes life tolerable. During this period Johnny has a medical procedure and is prescribed Oxycodone for pain. He notices as takes his medication the physical pain is gone and the emotional pain is numbed. As days go by one Oxy turns into two. Soon it’s 5-10 a day. The prescription runs out. He finds access to drugs on the street. He loses his job. He starts stealing, finally he ends up in jail. They send him to rehab. Finally, one day he comes out of the drug induced fog and asks himself, “How did I get here?”

That’s the question I am asking today How did we get here? How did Johnny and thousands like him became emotionally and mentally injured and we didn’t see it coming or didn’t do anything about it. In my 41 years, I’ve known providers who have had significant emotional and mental issues that created dysfunctions. Everything from marital break ups, alcoholism and suicides. These outcomes can be attributed to a mix of stressors both on and off the job. We have extensive national campaigns to recognize and intervene in behavioral / mental health issues in the fire and EMS services. We have a plethora of posters and social media posts all over the place advising us to: Call this hotline, use this service. We have classes, we have emergency services mental health organizations popping every day, with all these resources to address our emotional problems.  With these resources, you would be led to believe all firefighters and EMS personnel should be as happy and well balanced as Mickey and Minnie Mouse. Instead, we have closets full of Tommy Gavin’s who hide their pain, despair, and desire for real help.

Who are they and with the plethora of resources why are they hiding? These are fire and EMS personnel who are humans first. They are humans put into a stressful environment every day. Humans who are tasked with trying to fixing other humans who can’t be fixed. These expectations put heavy stressors on these humans’ shoulders. How do they end up becoming dysfunctional? It’s due to the lack of personal interaction from supervisors; and fellow fire and EMS personnel when dealing with mental and emotional crisis. They are the every day as mental health injured of the fire and EMS wars. They’re due to the lack of attention by fire and EMS agencies. Lack of effort to have comprehensive and interactive mental health programs to deal with these issues as we battle fire, despair, and death in the streets every day.  We as a service know the mental health toll these battles take on our troops. Yet we don’t take enough action, put enough energy to engage our personnel in developing coping skills and the toughness it takes to do this job. Not just in discussion, but effectively train them to survive these mental health scars and injuries.

We talk the talk, but don’t walk the walk. Why, from my experience and extensive discussions with fire service personnel, leaders and mental health professionals / advocates, most fire and EMS agencies don’t have behavioral / mental health services or a guideline how to use them. For most it’s a piece of paper on a shelf to meet a compliance requirement. If they do have an EAP, the people working there have no clue of what emergency services personnel encounter. Most fire and EMS agencies haven’t taken any training on how to manage mental / behavioral health emergencies, even though there is a wealth of free resources available. When thirty percent of a recent recruit class responded to a confidential questionnaire about mental health that they won’t seek help due to stigma.

When thirty percent of a recent recruit class responded to a confidential questionnaire about mental health that they won’t seek help due to stigma, there’s a big problem. This is of serious concern. It demonstrates our lack impact in this area. In today’s age where more firefighters are dying from suicide than all other reported LODDs, it’s my experience over 40 years, as well of many I discuss this issue with in emergency services; officers still don’t want to deal with emotional issues. Not only don’t they want to talk about them, they don’t want to offer the training. Many still believe we must be the tough salty fireman and tough it out. Through inaction these leaders are silently condoning our mental health issues. How many “Johnny’s” are we creating every day. We continue to put most of the emphasis on tactical training, which is used 10-30% of the time and little or no training on mental health issues which you deal with almost 100% of the time. I’m not saying tactical training is not important, I’m saying we need to put balance in how we raise our young. In fact, there are places in tactical training where mental health toughness should be built in.

This can be a brutal business and you need to be able to deal with it. Not everyone who wants to be in the fire & EMS services are cut out for it. Earlier this year a chief officer spoke up at a class I was teaching. He said after 20 years of seeing the worst of the worst and being able to manage it just fine, two incidents in the previous year had taken its toll on him. He recounted how he had the same feelings as Johnny and many other emergency service providers; that admitting he had a mental issue made him soft. He admitted to the stigma of mental health issues initially kept him from seeking help. However, he finally became brave enough to admit this issue was not only affecting him, but his relationship with his family and friends. He then sought professional help. He commented that on the first visit he could already feel a burden being lifted. This is what we need more of. Leaders who come forward, who expose their vulnerability in a raw manner to their troops. To show them up close and personal, it’s ok to come forward. We acknowledge your bravery to come forward.

The fire and EMS services would be well served to look at themselves as a tribal community. The American Heritage Dictionary describes a tribe as, “A unit of sociopolitical organization consisting of a number of families, clans, or other groups who share a common ancestry and culture and among whom leadership is typically neither formalized nor permanent.” describes tribes as “any aggregate of people united by ties of descent from a common ancestor, community of customs and traditions, adherence to the same leaders, etc.” Successful fire and EMS departments, companies and crews share more in common with a tribal description, than a family. Tribes are organizations built for survival. Tribes while supportive and nurturing, weed out weakness. Those who can’t fish or hunt are not put on the frontlines of day to day survival. Everyone in the tribe is expected to work hard, through adversities to pull their weight. Learning at an early age survival isn’t easy. In the tribal family, you are taught, nurtured and provided insight to work through your issues to be able to deal with adversity, but no one catches your fish for you. Additionally, tribal leaders have a keen sense of awareness of their warriors physical and mental state and will intervene with sage advice and support to get through the tough times. They don’t wait for a crisis to happen and have everyone sit around in a circle to trying to get everyone emote, and then believe everything is going to be alright.

If we took a tribal process, we’d teach our young (recruits) early that life isn’t fair, you’re going to be involved in some extremely emotional events. They may leave scars, but it comes with the job. Like physical scars, they heal, you move on and most make you stronger. Like physical scars, most only need a band aid to heal. The correlation here, is someone to talk to, talk through these feeling and emotions. In the rarer events healing requires an intensive intervention that special resources that they will be referred to. All along the tribal leaders relate to their people, assessing and providing needed support. Their people know they are there. They can feel their presence. These are leaders who lead from the front, up close and personal. Not afraid to display their emotional battle scars, to let their people know it happens to all and getting help is not a weakness, but a building block for a leader. They guide them through the healing process. These are leaders who understand the potential problems, know their people and get involved and not watch behind the office glass.

We have the resources to develop, condition and maintain a state of healthy well-being in emergency services personnel. It’s not rocket science. It doesn’t have to be complicated, but it must be comprehensive. It begins with making mental health wellness a top priority in your people and your department.  It also requires commitment, energy and engagement in all levels of the fire & EMS departments. It requires truly embracing mental well-being as a necessary state for a good performing firefighter. These organizational and individual attributes should be the foundation of our tribal culture.

My research found very few fire and EMS departments with Mental Health support programs. The ones I found, most were reactive after an issue developed, however they had comprehensive plans and resources that have been shown to be effective in mitigating stress reactions in emergency responders. Their policies support my recommendations.

Without getting deep into the details of how to build and foster an environment for mental well-being in fire and EMS personnel, (there are others much better suited for those discussions); the following are general recommendations to building that environment:

1. A broken hand doesn’t ride the apparatus. Same goes for the emotional injury. Fit for duty means mentally and physically fit for duty, not one or the other.

2. Mental wellness must have a commitment from the chief. Not just a “paper plan” or a few encouraging words. It takes a chief who rolls up his sleeves and gets in engaged in developing and maintaining a mental wellness fit for duty program. A chief who is trained and well versed in proper mental health processes and resources. A chief that exposes his vulnerability to show he’s human. A chief who shows it’s not a stigma to ask for help.

3. Mental wellness must be on-going, constant. Making this training accepted as important as tactical training. Provide everyone in the department with the tools to recognize those who need assistance, a check on how they are doing and to empower everyone to engage those who may have an issue to help them towards a solution.

4. Actively encourage daily mental health conditioning, like physical conditioning. Using processes such as working out, meditation, yoga, reading.

5. County, regional and statewide chiefs, unions and other related organizations should have discussions of mental and physical fitness on their agenda for every meeting. Practice what you preach.

While I could go on and on, these five points are a place to get started in stopping you from enabling mental injuries from being casualties of the fire and EMS wars. To prepare Johnny for the dying children, as well as being able to stretch a 1.75 down the hallway. To not only check on Johnny after significant events, but follow up weeks, months later. Mental health management and treatment is a continual process. We need to have a continual pulse on the overall wellbeing of our brothers and sister in emergency services. Show you care. Get up close and personal with your people. Just as every day is a training day. Every day is a Mental Health Conditioning day.

On the first day of Woodstock 1969 Richie Havens sung the song “Handsome Johnny” Johnny was mythical warrior who fought in every war from the Revolutionary War through the Vietnam War. Towards the end of the song these lyrics dealing with war resonate with our war on mental health illness in fire and EMS. and having allowed these mental health casualties of the fire & EMS wars to occur.

“Hey, it’s a long hard road, it’s a long hard road, it’s a long hard road, before we’ll be free. Hey, what’s the use of singing this song, some of you are not even listening. Tell me what it is we’ve got to do?”

Answer the last question. What is it that we must do to be serious that Johnny survives the mental health wars?

I would like to thank the following for their support and input to this article:

Boby Halton
Dena Ali
Dan DeGryse
David Witkanski
Steven Kavalkovich
Paul Jockimo
Nick Halmasy
Joshua Jessup
Rick Best
CJ Caulfield
George M. Evans

Anthony Correia is a 40-year veteran of the fire service, having risen through the ranks to various emergency service leadership positions. He is the retired director of the Burlington Township (NJ) Fire Department. Before that, he was fire chief in Warrensburg, Missouri. Correia is currently an active paramedic in Pennsylvania as well as a volunteer firefighter in New Jersey. He has completed the Executive Fire Officer Program as well as the Certified Public Manager program. Correia served as a chief officer in both fire and EMS organizations. He is actively involved in many emergency services related organization, both locally and nationally. Correia has experience in volunteer, combination, and career organizations. He has been an active educator for more than 35 years. Correia is an active blogger and has two millennial sons with different views on life, which required him to learn more about the whole generation.

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