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Health & Wellness: Leadership’s Role During Traumatic Events

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In the fire/EMS service, we are learning that mental health conditions occur at higher rates for first responders compared to the general public. We are routinely exposed to physical and emotional trauma, sometimes on a daily basis. Leadership must be aware of this emotional trauma, the effects on their membership and intervention methods to reduce the stress associated with it.

Recognizing signs and symptoms

Most people in this world do not see what we first responders see, and they cannot relate to what we feel after a tragic call—the change of mood, the feeling of depression, the attempts to file away those images from that traumatic event in hopes they never return. It is not surprising then that for many firefighters, a traumatic incident or the accumulation of witnessing trauma over time can have a significant impact on their mental wellbeing.

You may notice that one of your members is struggling from one of those calls, or a series of stressful bad calls that just won’t leave their minds. You might have overheard them discuss their sleepless nights, their nightmares and their increased anxiety. Or it might be the opposite; they may be isolating themselves or shutting down in response to the grief or sadness.

As a leader of your crew or organization, you must recognize the severity of these critical incidents and the stress that is felt by each of your members. You also need to be aware of the signs and symptoms that come from traumatic emotional stress. It is important to be able to recognize the signs that someone may need help. Many in the fire service try to hide or downplay what they are experiencing, perhaps out of fear of how others might perceive them, or because the department’s culture doesn’t foster open communication, or maybe because of lingering misconceptions about mental health.

Some of the more common signs that someone is struggling include:

  • Avoiding people, places or activities that could remind them of the traumatic event(s)
  • Trouble sleeping or nightmares
  • Trouble concentrating as their mind wanders easily
  • Overwhelming guilt or shame
  • Recurring distressing memories of an event or series of events
  • Irritability with angry outbursts
  • Drinking or using prescription medications too much

Unfortunately, I know all too well what it is like to walk in their shoes. I have recently recovered from a state of depression caused by a major incident that triggered a landslide of many of those traumatic events that had been filed away.

Mental health issues are real, and no one should feel embarrassed or ashamed to ask for help. This is a concept we need to embrace throughout the fire/EMS service culture. Train your officers and firefighters on what to look for and teach them the avenues that are already in place for those who need help.

If you are the one struggling from emotional trauma, don’t be afraid of professional help. Many responders won’t seek the help of a professional because of the stigma that it shows weakness. That is so far from the truth. There are some things that we can’t fix by ourselves, and the way your mind works is one of them. It is important as first responders that we recognize when we truly need help. The treatment can only start with you standing up to say that you need help and that you want your life back.

8 tips and takeaways

From one leader to another, here are some tips to help guide you when you recognize someone is struggling from the effects of emotional trauma:

  • First and foremost, be compassionate. We use compassion on every call. Talking to someone who is struggling with emotional trauma doesn’t require any special training. Let the person know you are there for them and that they are important to you.
  • Notice what you are observing that creates concern and have a conversation with them. Explain to them the signs and symptoms that you have noticed and that you want to help. A conversation away from the firehouse or ambulance base might be more comfortable and might allow one to open up.
  • Periodically check in with the individual. Volunteer firefighters can hide by just staying home and struggling in silence.
  • Avoid asking questions that prompt limited or vague answers. For instance, when I ask my firefighters, “How are you doing?” 99.9 percent of the time the response will be, “I’m okay, chief.” Instead, phrase the question in a way that will encourage a more detailed and open response, such as: “That child drowning call will stress me for a while as she was the similar age as my daughter. How is this going to affect you?”
  • Listen actively. When you get someone talking about the stress they are feeling, do not interrupt them. Just keep listening and let them open up.
  • Do not try to compare one of your prior traumatic events in an attempt to lessen their traumatic event.
  • All conversations must be in confidence. The only way an individual in crisis is going to open up is trusting that you will keep what they say in confidence. The exception is if they express that they are planning to commit suicide, at which point follow department protocol to get them through the crisis point.
  • Only offer help to your ability, then suggest options for additional help, such as a local peer support team, a seasoned veteran or behavioral health specialist.

A simple “I will listen when you are ready” can go a long way. Sometimes you will need to give the person time to heal by themselves and then be there for them when they are ready to talk or show emotion.

Those in the leadership role need to be true leaders and recognize the signs when one of their own is struggling with behavioral health issues. They must also clearly provide avenues and programs for their first responders to follow when they find themselves struggling with these traumatic and violent events. Simply offering an employee assistance program (EAP) to your members is not enough. Build a support system of peer support teams, area chaplains, stress debriefing teams and other medical professional resources. Leaders need to know the advantages and limitations of each resource, as well as how firefighters might confidentially access these resources.

Being a leader

When dealing with post-traumatic stress, you need to understand post-traumatic growth, defined as a positive change experienced as a result of the struggle with a major traumatic event. Learn to turn the negative into a positive and how to grow from the incident. Post-traumatic growth is about surviving those traumatic events and coming out a better person. For me, writing this article and teaching behavioral health classes so firefighters don’t have to struggle with the things we see is my post-traumatic growth. I want to take what I have lived and learned to help others survive in this fire/EMS service.

As a leader it is also important that we prioritize taking care of ourselves. Have a person in your life who understands this service and one who you can lean on when you feel overwhelmed or stressed so you can confidently continue your leadership role with your organization. When dealing with behavioral health, one must be knowledgeable and understand the difference between burnout, anxiety, depression and post-traumatic stress. It is important that we prioritize taking care of our own members and ensure their mental wellness and emotional health.

Life Happens—A Fire Service Approach to Behavioral Health and Wellness

By Darin Wallentine, deputy chief safety and wellness, Tucson, AZ, Fire Department; John Gulotta, captain safety and wellness,
Tucson Fire Department; and Dr. Patricia Haynes, PhD, LCP, CBSM, University of Arizona, Health Promotion Sciences
A fire service career consists of one-third of your life spent at work, with the other two-thirds challenged with balancing the needs of your personal life, relationships and family commitments. This ever-increasing challenge can make it difficult for firefighters to find success in both their personal and professional lives. The Tucson, AZ, Fire Department is no stranger to the struggles of fire service behavioral health and psychological trauma. Since 1881, Tucson firefighters have answered the call when the station alarm sounds, responding to nearly 90,000 calls last year alone. The changing landscape of the modern fire service has increased the need for programs and organizational support geared toward psychological assistance for our fire service personnel. This increasing need has even fostered Arizona legislation, signed in support of the recognition of the growing prevalence of PTSD and psychological crisis in the fire service.

Background

Beginning in 2014, the Tucson Fire Department began developing a more robust behavioral health program by hiring a licensed clinical psychologist as a part of our occupational medicine contract. This valuable resource resulted in a partnership between the psychological subject matter expert and a fire department in need of psychological support and services. Along with implementing the other aspects of the Urban Fire Forum and Metropolitan Fire Chiefs Behavioral Health Programs and Policies roadmap, the Tucson Fire Department is committed to developing a broadened approach toward firefighter psychological support and assistance.
As we move forward with our behavioral health programs, we understand that emergency response is second nature to fire service personnel. In fact, from day one of recruit training, firefighters are indoctrinated with this philosophy of “you call, we haul.” It shouldn’t be a surprise that fire service personnel, trained and conditioned to react to whatever is thrown at them, struggle with developing their own proactive mindset when it comes to psychological health. The need for this proactive mindset is evident in our fire service culture in the Community Risk Reduction initiatives sweeping the country, and is where we at the Tucson Fire Department began to take a deeper look at preventative approaches to psychological assistance.

Life Circumstances Assistance Policy

In an effort to seek innovative solutions to the mounting psychological problems faced by the modern fire service, the Tucson Fire Department Behavioral Health Committee developed a “Life Circumstances Assistance” policy. This policy was developed and designed for emergency personnel on 24-hour shifts who are experiencing difficult, challenging personal circumstances such as divorce and family change. Through this policy, our firefighters may request 30 calendar days of modified or light duty, offering the flexibility of a traditional 8–5 work schedule in order to accommodate appointments with counselors, attorneys or other professionals. This traditional work schedule aligns with the professionals’ availability during normal business hours. The intent of this program is to minimize work-related barriers to professional assistance during difficult times. We are committed to reducing stress and preventing these struggles from becoming insurmountable personal hurdles with the potential to bleed into work life. Employees who have taken advantage of this program have reported that the policy has been very helpful, allowing them to attend appointments without utilizing large amounts of sick or vacation leave. Moreover, they have expressed appreciation for the extra benefit of recovery sleep during a stressful period in their life. The program has not been over-utilized, and most of the employees taking advantage of the program are eager to return to their crew by the end of the 30 days.

Conclusion

As news reports and social media posts continue to herald the growing numbers of psychological stressors facing public safety professionals, the fire service, and the Tucson Fire Department in particular, has come a long way in identifying stress, sleep disorders, anxiety, PTSD and suicide as symptoms of deeper problems that are ravaging our profession. Prevention efforts like the Tucson Fire Department’s “Life Circumstances Assistance” policy are one of many innovative initiatives designed to help our fire service family succeed in a profession that places service over self.