3 Tactics for Combating Firefighter PTSD

Firefighter PTSD - LexipolBy Sean W. Stumbaugh, Battalion Chief (Retired)

In my last article, I shared some insights I gained about firefighter post-traumatic stress (PTS) from Jeff Dill of the Firefighter Behavioral Health Alliance (FBHA). But understanding firefighter PTSD is obviously just the beginning. It begs the question, what can we do to address this alarming problem among our ranks?

By no means do I have all the answers, but following are three tactics Jeff and the FBHA deem critical for helping our personnel not just cope with the stress of the job, but overcome it.

#1: Internal Size-Up and Self-Care
We know what a size-up is. We practice sizing up situations often, especially at promotion time. But what is an internal size-up? For me it was coming to the realization that the “Red Man” I referenced in my last article was not a leadership strategy, it was anger caused by a lack of control. There are times for “righteous anger,” but such situations are few and far between.

If you are experiencing irrational anger, maybe it’s time to look under the hood. “We have to ask ourselves, why are we acting this way?” says Jeff Dill. “Why am I so angry, why did I respond like that when someone asked me a simple question?” Jeff recommends completing an internal size-up (self-evaluation) to see if you need some help. Are you medicating to cope with your emotions? Are you drinking a lot? Do you have a drink as soon as you get home from shift? Are you taking drugs not prescribed to you or using medications not as intended? Are you angry with your spouse or partner? Do you kick the dog? Such actions may be the source of firehouse jokes, but they are manifestations of a real problem.

Self-care is a better way to deal with stress. Most of us try to stay physically fit to perform our jobs. You may work out profusely and do functional drills to push your body, but do you do any exercise to help you relax? “Self-care could be going for a walk or a hike, or doing yoga or meditation,” Jeff says. “It’s creating peaceful time where you can relax.” Maybe you swim some easy laps to clear your head and get the blood flowing. Or you could make time to read, take classes or socialize with others. There are a lot of ways to practice self-care that may help you.

#2: Confidential Support
We have discussed what you can do to help yourself; now, what should our departments do to help their members? Most fire departments offer some form of Employee Assistance Program (EAP). These programs have had mixed levels of success. In an FBHA survey of 800 firefighters, 80 to 90 percent reported having very little faith in EAPs. Jeff cites three reasons (or perceived reasons) firefighters avoid EAPs:
• Uncertainty about confidentiality
• Fear of losing job promotion
• EAP counselors do not understand firefighter culture

Confidentiality is a big concern. If a firefighter explains their struggles through their chain of command, there is the fear that the issue will affect perception when it comes to promotion. This fear is real. Departments must support a culture that allows members to seek help without this fear of promotion loss. Critical Incident Stress Management (CISM), confidential peer support and chaplain programs are some of the components that can be pursued. Whatever approach, confidentiality must be the cornerstone and cannot be violated.

CISM teams have been part of the fire service for years; their effectiveness is well documented. Access to CISM teams is highly encouraged and very important; however, CISM teams are generally reserved for large-scale, acutely tragic events. But what about the day-to-day exposure to stress and tragedy?

Peer Support Teams are different than CISM teams and serve a more constant purpose. (View the recent webinar on peer support teams featuring Lexipol’s Gordon Graham.) Peer Support Teams can be developed using internal members of the agency. It is a good idea to have the membership choose who should be on this team. The team members must be trusted and must also be allowed to keep conversations fully confidential (there are exceptions, such as when a firefighter expresses suicidal intent). Peer Support Team members have the advantage of being close to the member who may be struggling. They live in the firehouse, so they can easily observe behavioral changes.

One of Jeff’s recommendations in dealing with the struggling member is to “challenge with compassion.” He encourages members to be direct and deal with problems before they get too big. The compassionate approach is the key to success. A properly designed Peer Support Team will possess the training and confidential tools to confidentially, compassionately assist members or find the help they need.

Chaplains, usually from outside the ranks, can also be an effective tool to meet the emotional and spiritual needs of struggling members. These persons must be trusted confidants and should have a basic understanding of the fire culture.

EAPs are a good tool but they need to be effective. EAPs are typically selected through a bidding process; the low bid usually wins. Fire service leaders should resist the temptation to select the cheapest program and instead opt for the most effective for the money you spend. “Our recommendation is that the department get involved in that bidding process, interview them, ask about whether they have people who have experience with fire/EMS,” Jeff says. If you’re interested, FBHA can provide a list of 12 questions to ask a potential EAP provider.

#3: Supporting Families and Retirees
Most firefighters don’t show up on the job just as individuals; they have a family at home who is depending on them. Therefore, a firefighter’s behavioral health is not only important to the firefighter and the department, but also to their family. Departments should consider involving the firefighter’s family in any behavioral health program. Participation should of course be voluntary, and the firefighter and their family should have the option on how involved they want to be, but offering education and support should be an option every agency considers.

An educated firefighter family will recognize emerging behavioral issues. Knowing how to handle these issues properly is essential. Jeff and the FBHA have expanded their educational workshops to include a program for families. “It’s important that family members understand what their loved ones go through, but just as important that they understand what they and their children go through,” Jeff says. Family health and wellbeing is another aspect of a firefighter’s successful career. If a firefighter’s family falls apart, the firefighter is likely to struggle immensely on the job, which puts everyone at risk.

Retirees are also subject to behavioral health issues when they finally hang up the helmet. Jeff noted that retiree suicide is an issue; some firefighters have taken their own lives within the first week of retirement. Now, of course, not every retired firefighter is in deep trouble; most retirees I know planned well and are really enjoying their new lives. However, as I stated in my last article, not everyone is prepared for this drastic life change.

Departments can help their retiring employees enter in to this new life by extending counseling services to retirees and encouraging them to think about what they want to do in this next phase of life. Some of the options Jeff suggests are:
• Visit a career counselor to see if you have other vocational interests
• Go back to school and earn a degree in something different
• Explore potential business interests
• Volunteer for your agency or other worthy organization
• Join the CERT or do fundraising for firefighter charities
• Become a peer support member or chaplain

“We interviewed 125 newly retired firefighters and EMTs and the top three issues they identified were loss of identity, loss of belonging and lack of purpose,” Jeff says. For most of us being a firefighter isn’t what we do, it’s who we are. Losing that connection can be difficult. Find something that will give you purpose in life and do that with your whole heart (even if it’s “just” going fishing).

Are We Making Progress?
My last question for Jeff was, “Are we making progress?”

Jeff told me that yes, we are making progress, but the problem will not go away soon. “As firefighters, we’re used to get it done, resolve the problem and move on,” he says. “That’s not going to happen in this case. It takes understanding, time and financial commitment to create the programs and the teams. But what gives me the hope is the amount of people who call FBHA to ask what they can do to help, to get the message out. There are so many more organizations getting involved.”

Being aware of the problem, and caring about your people, are the first steps in making a difference in the lives of your firefighters. To obtain more information, and start down the path in your organization, visit the Firefighter Behavioral Health Alliance at http://www.ffbha.org/.

I want to thank Jeff Dill and the Firefighter Behavioral Health Alliance for taking the time to meet with me and share this information. I also want to thank you, the reader, for taking time out of your busy day to read this post. My hope is that it encourages you to take positive steps to better manage the stresses in your life and career and to take steps to help those around you. Stay safe!

Lexipol’s Fire Policy Manual and Daily Training Bulletin Service provides essential policies to support the physical and mental wellbeing of fire department personnel. Contact us today to find out more.

SEAN STUMBAUGH is a professional services representative for Lexipol. He retired in 2015 after 32 years in the American fire service, serving as battalion chief for the Cosumnes Fire Department in Elk Grove, Calif., as well as the El Dorado Hills (Calif.) Fire Department and the Freedom (Calif.) Fire District. Sean has a master’s degree in Leadership and Disaster Preparedness from Grand Canyon University, a bachelor’s degree in Fire Science from Columbia Southern University, and an associate degree from Cabrillo College in Fire Protection Technology. In addition to his formal education, he is a Certified Fire Officer, Chief Officer, and Instructor III in the California State Fire Training certification program. Sean has taught numerous state fire training courses and has been an adjunct professor with Cosumnes River College in Sacramento. Sean is now continuing his career by serving as the volunteer Para-Chaplain for the Daisy Mountain Fire District in New River, AZ.

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