Firefighters and paramedics are called first responders for good reason: They’re most often the first people to arrive during an emergency, be that a car crash, fire or other 911 call.
They’re trained to respond quickly and effectively to those incidents, helping victims who are injured and who’ve just experienced severe trauma. These emergency scenes are chaotic, but first responders don’t have time — and often don’t take time after — to process and truly understand how those scenarios can affect them.
I talked to a firefighter who was in treatment for substance abuse several months ago about the suicide of a friend. He called it “business as usual.” As bystanders, our ears perk up when we hear the sirens of a fire truck or ambulance, and we might slow our cars to stare as we pass a crash scene. But for firefighters and paramedics, responding to those emergencies is business as usual. It’s what they do.
But when trauma becomes business as usual, it’s essential to help first responders understand how absorbing other people’s trauma can affect their struggles with addiction and mental health. Experiencing the impact of trauma doesn’t signal weakness. It’s just that over time, first responders’ natural empathy and the reality of their professions collide, and emotions and behaviors can become a challenge to manage.
That’s at the heart of vicarious trauma (VT), which we address as part of the Rosecrance Florian Program, a treatment program in Rockford, Illinois, designed to help firefighters and paramedics struggling with substance abuse and mental health issues.
Rosecrance Florian Director Dan DeGryse asked me to incorporate my grief and loss expertise into the program. This meant addressing the impact of vicarious trauma on the lives of fire service personnel.
Support for grief and loss is crucial to people seeking treatment for substance abuse and mental health issues. Think of a time when first responders are unable to save a child who drowned or save a family from a burning home. Those firefighters and EMTs might not have known those victims, but they still experience loss. It’s normal to grieve, and they should be allowed to.
There’s a risk of first responders internalizing the trauma of the incidents they respond to. Over time, those experiences can make a person feel unstable, and that makes daily life unmanageable.
It’s important not to treat vicarious trauma as something abnormal or unhealthy, or to make it seem like firefighters and paramedics aren’t fit for their roles.
I meet with fire service personnel once a week as part of a four-week series focusing on vicarious trauma with the goal of helping participants understand and process grief and loss. The sessions include the following topics:
understanding and assessing VT;
addressing VT through self-awareness and self-care;
resolving VT through intentional activities that increase awareness and connections;
VT exercises that generate self-knowledge and personal tolerance levels.
Each session can stand on its own. Someone in his or her first week of treatment might come in during the third week of the sessions and still benefit from the discussions and activities.
In the first session, a self-care questionnaire asks clients to rate various activities with the numbers 1-4, with 1 being “never” and 4 being “frequently.” The activities ask clients such questions as whether they get enough sleep, whether they play with their children and whether they pray/meditate. The VT sessions are based on the work of Karen Saakvitne and Laurie Anne Pearlman, authors of the book, “Transforming the Pain: A Workbook on Vicarious Traumatization.”
The VT questionnaire asks participants to agree or disagree, on a scale of 1-4, with such statements as, “I have choice and control over my work,” and “I feel I am in control of my life.” Responses range from 1, “strongly disagree,” to 4, “strongly agree.”
The questionnaires give clients the opportunity to reflect on who they are and how they’ve changed. The goal is to help them begin recognizing and owning that change. That’s important because trauma does change people. Sometimes we get so used to the changes that they become our “normal.”
It’s one thing to tell someone, “Because you’re a firefighter and you’re here, you’ve got VT, so let’s work on it.” That’s not protocol. You don’t want clients to get defensive. Instead, exploration of VT should be a process of self-discovery and recognition of getting better.
Another firefighter in treatment told me that some traumatic images can’t be “unseen.” It’s important to be aware of the potential impact of those unforgettable scenes that linger in the mind. Those who experience negative changes because of VT need to be mindful and deliberate about responding in ways that help them remain whole.
The self-care questionnaire based on the Saakvitne and Pearlman model gives clients the opportunity to look at five different dimensions of their lives — emotional, spiritual, psychological, physical and professional — to ascertain the vulnerable areas. The key is to become aware and start down the path of self-care by addressing these areas.
Dan, a 25-year veteran of the Chicago Fire Department, volunteered to sample the questionnaires. He spent 14 years as the coordinator of the Chicago Firefighters Union Local 2 Employee Assistance Program. Even Dan was surprised by some of his answers.
“We become disassociated with the things that we see: death, destruction, trauma,” he said. “The questionnaires were a great template to identify things and be able to share. That’s what I’ve been looking for the 14 years I’ve been serving firefighters.”
We work on exercises to help firefighters and paramedics become more aware of their needs, and each client is different. It’s all about wholeness and being able to have those discussions with people who understand or who have had similar experiences. We learn from one another’s experiences through these connections.
One of the biggest assets for first responders is family support. Recognizing that and giving yourself access to family members through vacations or spending leisure time with them is therapeutic. Family activities help counter vulnerability to VT. After a work life of dealing with frequent traumatic experiences, normal family time offers a reprieve from having to be the “hero.”
We hope to benefit fire service personnel by helping them achieve recovery and sustain it when they do return to duty, which presents the likelihood of re-traumatization. The goal is to empower people with coping skills so that trauma doesn’t trigger self-defeating behaviors such as substance abuse.