Continuing Education Course

Recognizing and Combating Firefighter Stress By P.J. Norwood and James Rascati

TRAINING THE FIRE SERVICE FOR 136 YEARS

To earn continuing education credits, you must successfully complete the course examination. The cost for this CE exam is $25.00. For group rates, call (973) 251-5055. Recognizing and Combating Firefighter Stress

Educational Objectives On completion of this course, students will

1) Learn why Firefighter Stress and Post Traumatic Stress Disor- 3) Understand the key part of stress’s multiple definition. der (PTSD) has been a taboo topic in the fire service. 4) Learn the warning signs of stress. 2) Discover how stressful the firefighting profession is on fire- fighters.

BY P.J. NORWOOD percent for PTSD in the fire service is well above the national AND JAMES RASCATI average for adults, which is 6.8 percent. It is well established that firefighters are impacted by critical incident stress.A lso, ver the past few years, there has been a suicides within the fire service community continue to escalate positive trend in firefighter training; firefighter aware- at an alarming rate. O ness; and instructors’ writing, teaching, and preach- Alcohol abuse has been and continues to be an issue for ing toward firefighter fitness. It is a topic that had been taboo both career and volunteer firefighters. It is estimated that the for many years in the fire service. Many firefighters across the alcohol abuse disorder rate is seven to nine percent for adult country are focusing on their level of fitness, and many depart- Americans and anywhere from 25 to 30 percent for firefight- ments have put mechanisms and programs in place that encour- ers.1 Alcohol abuse has been a culturally accepted way to deal age weight loss and increased physical fitness. with the stress inherent in our profession. Prior to the advent However, although the fitness drum is being beaten, there is of employee assistance programs (EAP), critical incident de- still an area of firefighter wellness that is not being discussed. briefing, or other counseling services, some firefighters dealt Firefighter stress and post traumatic stress disorder (PTSD) with stress by self-medicating with alcohol. are real threats to the American fire service.A s you are read- ing this article, a firefighter is feeling the stress of the job, WHAT IS STRESS? which is creating unhealthy behaviors that only compound Stress is defined in multiple ways, but the key part of every the problem. There is ample clinical evidence that untreated definition mentions the short- and long-term changes to the stress impacts physical health. In addition to cardiovascular body. Look at the following excerpt from the definition of problems, stress is correlated with increased alcohol and drug stress and consider the effect it has on your system: abuse, depression, obesity, back problems, and the worsening of diabetes. Upon immediate disruption of psychological or physical equilib- rium, the body responds by stimulating the nervous, endocrine, and immune systems. The reaction of these systems causes a HOW BAD IS THE PROBLEM? number of physical changes that have both short- and long- As we are all aware, our job may be the best job in America, term effects on the body. but it is also extremely stressful. In 2012, firefighting is second on the list of most stressful jobs in America. This stress has led Now consider the stress your body is under every day to early retirements, injuries, divorces, suicides, and firefight- during the normal duties of your job. Multiply your body’s re- ers partaking in risky behaviors. Suicide, divorce, substance sponse with a career spanning 20 to 25 years or more. We are abuse, and heart attack rates among firefighters are the high- affected every day by the stress, both physically and emotion- est in the nation. Furthermore, the rate of 16 percent to 24 ally, and we must begin thinking of our emotional stress as www.FireEngineeringUniversity.com firefighter stress ● it directly relates to our physiological well-being and overall Warning Signs of Stress fitness. Some signs that stress may be affecting you or your cowork- There is no way to predict what will and what will not af- ers are the following: fect you. It may be a critical or multiple death incident; a call • Physical: headaches, diarrhea, indigestion, upset stomach, that you can relate to, say, an injured child of similar age to tiredness. your child; an incident that doesn’t turn out as expected or • Emotional: anxiety, irritability, sadness, inability to make planned; a long rescue where you “bond” with the victim; or decisions. the death of someone you know or to whom you have ties— • Behavioral: lack of interest, sleep problems, clumsiness, all have different effects on us. It also can be an everyday overeating or other changes in eating habits, increased “routine” call that for some reason has a negative effect on use of alcohol or other drugs. you. It does not have to be a high-profile call or one of the • Job-related: change of performance, being argumentative, above examples. Any call at any time can sneak up and have a isolation, tardiness, excessive calling in “sick.” negative effect on you or a coworker. Warning signs of risky behaviors that may be linked to Every firefighter’s response and ability to process stress stress include the increased use of drugs or alcohol, increased has some variations. You cannot predict what will affect one short temper, impulsive behaviors, and significant changes in firefighter and not the next. For some, the daily political en- personality. vironment within the firehouse, city, or town plays a role.W e have the added issue of bosses who don’t want to be bosses. GETTING HELP They allow a lot of problematic behavior to continue because If you are feeling the stress from a job-related incident, they don’t want to be seen as a “bad guy” or to be accused of communicate with a trusted source, friend, coworker, clergy, “forgetting where they came from.” Ignoring the daily issues spouse, or family member and an employee assistance pro- that occur does not sit well with the troops who do the right gram. Know that you are not alone. You are not the first fire- thing every day. These scenarios will wear down firefighters fighter to experience job-related stress. Opening the lines of

Our job may be the best job in America, but it is also extremely stressful.

in the department, causing stress that affects everyone. The communication will help you process your personal response stress is compounded by today’s budgetary constraints, office to the stress. If your department has a peer support program, or crew politics, and even the pressure from the governing talk with someone on the team. If you do not seek assistance, bodies to do more with less. the stress will impact you negatively for many years. As you move through the ranks, communication with others EFFECTS OF STRESS changes. Supervisors should not “complain” to ranks below Stress of the job has many physical and emotional effects them. Doing this only adds stress and slowly chisels away at the on firefighters and their families. Everyone processes the department and company morale. They should communicate stress differently. Some of the documented effects include but upward, which can add additional stress to officers because are not limited to divorce, depression, alcohol or substance the pool of those with whom they can speak shrinks and also abuse, financial hardships, gambling, poor work habits, car- because they may not want to talk to their superiors about diac disease, high blood pressure, and obesity. We must begin “issues” they may be having. This highlights the importance of looking at stress as a killer of firefighters. Stress is not the di- having a network of relationships outside of your department rect agent, but we must start to track death rates of firefighters and outside of the fire service. off duty and after retirement. I believe if these data were to be If someone you work with is showing signs of job-related captured, we would directly correlate many of those deaths to stress, listen and observe. Be empathetic, not judgmental. the stress that was affecting firefighters’ health for many years. Remain calm, and help define the problem through clarifying To help address the problem, we must identify what it is do- questions. Offer an ear or a shoulder. Facilitate contact with ing to us and our coworkers. Firefighters spend countless hours a member of your peer support team (if there is one), an em- in and out of the firehouse with the same people.W e routinely ployee assistance program, or other licensed behavioral health spend more time with our fellow firefighters in the firehouse professional. than with our own families. We must start to tune ourselves in to If your coworker is resistant to seeking professional help, signs and symptoms that indicate that stress may be affecting our remind him that there are excellent treatments available and fellow firefighters. If we cannot recognize that there may be a that such services are confidential. If your coworker declines as- problem, we will not be able to help them if there is an underly- sistance and continues to demonstrate job-related stress, do not ing problem. abandon him. Keep in contact while sharing your concerns and

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encouraging him to seek appropriate intervention. chopharmacology. Since we know that stress impacts many If at any time you have concerns regarding his safety at physiological problems, there is no reason firefighters should work—that is, fitness for duty—you must bring this to Com- not be receiving behavioral health interventions whenever mand’s attention so they can take appropriate action. necessary. Fire department peer support can be a valuable resource to LET’S CHANGE THE PATTERN help firefighters.T he overall objectives of firefighter peer sup- Departments that are more psychologically minded recog- port should be the following: nize the importance of providing assistance, either counseling • Provide information and education. or support, to firefighters who may be struggling with the • Provide an ear or a shoulder to lean on. stressful aspects of their jobs. Firefighters have always talked • Identify at-risk firefighters. about the family nature of their crew. The fact that we work; • Minimize stigma. sleep; eat; and, for some, play together for an extended period • Diminish stress/dysfunction and increase coping ability. of time creates an “extended family.” This is both good and bad dynamics. The relatively closed culture of firefighting CRITICAL INCIDENTS IN THE FIRE SERVICE does not easily lend itself to talking to someone outside of the The other valuable benefit of peer support is that the profession or family. This is especially true for talking with an peers are involved after the occurrence of critical incidents. EAP or mental health professional. However, it is recommended that firefighters receive spe- When firefighters recognize that their alcohol abuse, pre- cific training in psychological first aid with an experienced scription drug abuse, or stress is getting out of hand, they are and similarly trained behavioral health therapist. There are reluctant to seek appropriate psychological intervention. Many a number of challenges in providing psychological first aid times, this stems from the false notion that using an EAP or services to firefighters. First, some departments are relatively other behavioral health services will “jam them up in their closed cultures that are not readily acceptable to nonfire- career.” This perception is inaccurate and potentially deadly. fighters.A s stated previously, many departments are like Licensed behavioral health professionals, whether through an families and are very protective of each other, especially EAP or a licensed therapist in private practice, must maintain from “outsiders.” If EAPs and other mental health profession- confidentiality.T he only exception to confidentiality required als are not known to the firefighters, it may be difficult to by law is if someone presents a danger to himself, to others, gain their trust and respect. or to children or the elderly. Another challenge is dealing with the “macho mentality” that sometimes exists and that has nothing to do with gender. FIREFIGHTER PEER SUPPORT We know that all firefighters are physically tough. However, A number of progressive departments have developed peer how many departments teach their firefighters how to deal support programs. There are many models of peer support. effectively with the emotional aspects of their jobs? It has not Some consist of firefighters who have specialized training in been uncommon to hear a commander express the “suck it specific areas like alcohol abuse, depression, suicide, stress, up; it’s your job” refrain when attempting to deal with the and family issues. Others combine trained firefighters with emotional impact of a horrific event.W e describe these leaders their EAP or other licensed behavioral health professionals. as not being psychologically minded. It is, therefore, not sur- Still others have an interest in and are committed to volunteer- prising to learn why there are high rates of alcohol abuse and ing their time and efforts with no special training or linkage divorce among firefighters: Historically, they have not been with licensed behavioral health practitioners. taught more adaptive ways to deal with their stress other than In general, the intent of these programs, regardless of the using alcohol. model, is to provide support, a needed shoulder to lean on, We believe that the best way to address these challenges is to or to link with the appropriate EAP or therapeutic resources have a peer support team comprised of trained firefighters who if professional intervention is necessary. The fact remains that volunteer their time and behavioral health professionals, both the majority of firefighters, when and if they do need profes- of whom have been trained in providing psychological first aid. sional intervention, may not seek it on their own for a variety Each brings their respective training and expertise to the task. of reasons. For some, there are confidentiality concerns, or they worry their job will be impacted in a negative way. ••• For others, it challenges their notion of being macho tough firefighters who should be able to handle whatever is thrown We, the authors, one a firefighter and the other a social their way. And, of course, there is the ever present issue of the worker, recognize that neither profession is going to stop all stigma some firefighters feel—that they are less of a firefighter fires or cure everyone. However, with the proper precautions if they are getting help. Although the stigma has lessened (fire safety training, flame retardant materials, fire detection greatly over the past 20 years, it still exists—and in a signifi- devices, standards and regulations) and taking care of one’s cant way. physical and emotional health, we may help mitigate the dam- Nevertheless, there are better treatments today than ever age and destruction from fires and the inherent stress firefight- before, both in terms of psychotherapy/counseling and psy- ers encounter in their jobs.

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We must all take a vested interest in our ● P.J. NORWOOD is a deputy chief training officer for the East Haven physical and psychological well-being. We all (CT) Fire Department and has served four years with the Connecticut have dreams of retiring someday. Let’s make Army National Guard. He has authored the DVD Dispatch, Handling the sure we achieve our dreams without extra psy- Mayday (Fire Engineering, 2012), coauthored Tactical Perspectives of chological baggage to carry around. Take care Ventilation and Mayday DVDs (2011, 2012), and was a key contributor to the Tactical Perspectives DVD series. Norwood is an FDIC instructor, a of yourself today for a better tomorrow for you contributor to Fire Engineering, a member of the Fire Engineering Univer- and your family. ● sity faculty, and host of a Fire Engineering Blog Talk Radio show. He has lectured across the United States as well as in Singapore. He is certified Endnote to the instructor II, officer III, and paramedic levels. 1. Boxer PA, D Wild. “Psychological distress and alcohol use among firefighters.”Scand J Work Environ ● JAMES RASCATI, LCSW, has more than 35 years of experience in Health; 19(2): 121-125. PubMed: www.ncbi.nlm.nih.gov/ behavioral health. He is a partner at Behavioral Health Consultants, LLC pubmed/8316779. in Hamden, Connecticut, and is the director of organizational services. He is also a clinical instructor of psychiatry (social work) in the Yale Univer- sity School of Medicine, Department of Psychiatry. He has developed an REFERENCES expertise and interest in working with firefighters and police officers. He U.S. National Comorbidity Survey (NCS) Replication. NCS is funded by the National Institute of Mental Health has developed police and fire peer support teams for eight law enforce- (Grants R01 MH/DA46376 and R01 MH49098), the ment agencies and four fire departments in Connecticut. He is also certi- National Institute of Drug Abuse (through a supplement fied as an instructor by the Police Officer Standards and Training Council to R01 MH/DA46376), and the W. T. Grant Foundation (Grant 90135190). for the areas of cultural awareness and diversity, substance abuse, suicide recognition intervention and management, stress management, and su- Career cast 2012, Victoria Brienza, http://www.careercast. pervisor/subordinate relations. com/jobs-rated/10-most-stressful-jobs-2012.

Notes

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COURSE EXAMINATION INFORMATION To receive credit and your certificate of completion for participation in this educational activity, you must complete the program post exami- nation and receive a score of 70% or better. You have the following options for completion. Option One: Online Completion Use this page to review the questions and mark your answers. Return to www.FireEngineeringUniversity.com and sign in. If you have not previously purchased the program, select it from the “Online Courses” listing and complete the online purchase process. Once purchased, the program will be added to your User History page where a Take Exam link will be provided. Click on the “Take Exam” link, complete all the program questions, and submit your answers. An immediate grade report will be provided; on receiving a passing grade, your “Cer- tificate of Completion” will be provided immediately for viewing and/or printing. Certificates may be viewed and/or printed anytime in the future by returning to the site and signing in. Option Two: Traditional Completion You may fax or mail your answers with payment to PennWell (see Traditional Completion Information on following page). All information requested must be provided to process the program for certification and credit. Be sure to complete ALL “Payment,” “Personal Certification Information,” “Answers,” and “Evaluation” forms. Your exam will be graded within 72 hours of receipt. On successful completion of the posttest (70% or higher), a “Certificate of Completion” will be mailed to the address provided.

COURSE EXAMINATION 8) Suicide, divorce, substance abuse, and heart attack rates among firefighters are the highest in the nation. 1) Over the past few years, there have been positive trends all of the a. True following except: b. False a. Training b. Firefighter Awareness 9) The fire service has a rate of _____ percent to _____ percent for c. Fitness PTSD, which is well above the national average for adults. d. Firefighter Stress a. 10/20 b. 15/30 2) What area of firefighter wellness is not being discussed in the fire c. 16/24 service? d. 14/55 a. Training b. Accountability 10) The alcohol abuse disorder rate is _____ to _____ for firefighters, c. Firefighter stress and PTSD with the national rate for adults ranging from seven to nine d. Firefighter safety percent. a. 25/30 3) There is ample clinical evidence that untreated stress impacts b. 10/15 physical health. c. 50/75 a. True d. None of the above b. False 11) The key part of every definition of stress mentions the: 4) Stress is correlated with which of the following? a. Short and long-term changes to the body a. Alcohol and drug abuse b. Suicide rate b. Depression c. alcoholism rate c. back problems d. Psychological changes to the person d. All of the above 12) There is always a way to predict what will and what will not 5) Stress is also correlated to which of the following? affect you. a. True a. Poor training b. False b. Obesity c. poor attention span d. Apathy 13) Stress is compounded by which of the following? a. Budgetary constraints 6) In 2012, firefighting is ______on the list of most stressful jobs b. Office or crew politics in America. c. Doing more with less a. First d. All of the above b. Second c. Third 14) Some of the documented stress processing effects include which d. Fourth of the following? a. Alcohol and substance abuse 7) Stress can lead to which of the following? b. Gambling c. poor work habits a. Early retirements d. All of the above b. Divorces c. Suicides d. All of the above

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15) If firefighters cannot recognize that there may be a problem, 18) Lack of interest, sleep problems, clumsiness, overeating or they will not be able to help themselves if there is an underlying changes in eating habits, increased use of alcohol and other problem. drugs are which signs of stress? a. True a. Physical b. False b. Emotional c. Behavioral 16) Headaches, diarrhea, indigestion, upset stomach and tiredness d. Job-related are which signs of stress? a. Physical 19) Change of performance, being argumentative, isolation, tardi- b. Emotional ness, calling in “sick” are which signs of stress? c. Behavioral a. Physical d. Job-related b. Emotional c. Behavioral 17) Anxiety, irritability, sadness and inability to make decisions are d. Job-related which signs of stress? a. Physical 20) The overall objectives of firefighter peer-support should include b. Emotional Identifying at-risk firefighters. c. Behavioral a. True d. Job-related b. False

Notes

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