Our driver engineer Jim was an accomplished Paramedic. Recently he seemed agitated after an incident where we responded to a major vehicle accident involving a mother and infant. The infant daughter died in Jim’s arms just as we extricated her from the vehicle. Jim feverishly did CPR while riding in the ambulance to the hospital.

After the incident he seemed withdrawn but we had responded to many incidences that were critical and we all bounced back with a little time. The thoughts were that Jim would bounce back too. 

Jim had always been the life of the party at the fire station and was a picture of health. Over the last few months since this incident Jim seemed irritable and short tempered. He complained of palpitations and didn’t pitch in with station work, whereas before, he led with a dynamic personality that made work fun for all of us.

Today, Jim was changed and struggling. I suspected that Jim was drinking as he came into the station looking hung over. His personal grooming was almost non-existent and the station captain ordered Jim to go shower. Everyone was concerned.

What generally happens to people when they are suffering emotionally is they withdraw. If not withdrawing, they become increasingly difficult or demanding forcing others to withdraw. Recognizing the dynamic that is going on is sometimes difficult.

Some of the personnel disliked Jim and the changes that overtook him. Others responded with concern, but no one could see the reason for the change. What Jim needs is to feel loved, honored and appreciated for his commitment to the job that is currently making him ill.

Suicide vs. Line-of-Duty Deaths

“Findings from a recent study suggest that police officers and firefighters are more likely to die by suicide than in the line of duty. Sponsored by the Ruderman Family Foundation, the study examined 2017 data on mental health issues among first responders around the country.

It found that 103 firefighters and 140 police officers died by suicide, while 93 firefighters and 129 officers died in the line of duty last year. According to the authors, the number of suicides is likely underreported and inadequately addressed within departments.

“There is not enough conversation about mental health within police and fire departments,” the authors wrote. “Silence can be deadly, because it is interpreted as a lack of acceptance and thus morphs into a barrier that prevents first responders from accessing potentially life-saving mental health services.

"They recommended that departments implement measures such as peer support programs, mental health check-ups, time off following stressful events, and training to help family members identify the warning signs of depression and post-traumatic stress disorder.” – USA Today April 27, 2018

Effects on First Responders

Psychological trauma is real, especially for first responders. OSHA reports that one of the top causes of firefighter deaths is suicide. Some employers respond with the thoughts, “I didn’t take this employee to raise. They do this simply because they do not know how to respond, or worse, do not know the trauma exist. First responders are good at disregarding their own feelings or they cover them up with inappropriate behaviors or humor. Sometimes responders are expected to, “Iron man up”. In other words ignore the very core of our humanity.

Firefighters' Mental, Emotional Health Not Getting Enough Attention

"According to national data, many firefighters are struggling with mental health issues. In partnership with the International Association of Firefighters (IAFF), NBC stations in California and New York recently surveyed 7,000 firefighters about the mental health challenges associated with their job.

"The survey found that 19 percent of respondents have experienced suicidal thoughts, 27 percent have struggled with substance abuse, and 65 percent are haunted by memories of traumatic work situations. More than 80 percent of firefighters said that asking for help would make them seem weak or unfit for duty. - NBC Bay Area, March 23, 2018

So, you might think you are bullet proof to emotions but life has a way of dealing a hand that goes bust. When this happens things can go south for the very best of the best. 

Here is a list of warning signs that will help recognize suffering in our team members. 

Warning Signs of Stress

Here are seven signs of emotional stress:

  • Overwhelming feelings
  • Moody
  • Irritable or agitated
  • Short tempered
  • Cannot relax or enjoy life
  • Sense of loneliness
  • Mental/Cognitive

Here are three signs of physical stress:

  • General aches and pains
  • Nausea, dizziness
  • Chest pain, rapid heartbeat

Here are four signs of behavioral stress:

  • Over- or under-eating
  • Insomnia or over sleeping
  • Isolating yourself from others
  • Procrastinating

Fighting Stress

Support of family and friends tend to buffer stress and reduce isolation, so surround yourself with the ones you love. An optimistic outlook provides a sense of control and boosts confidence so keep looking for the positive. A good sense of humor aids in the release of endorphins and makes one have a feeling of well-being. Faith and belief in a higher power or letting go and letting God take control of your life and death work.

Becoming aware of the internal conversations we have and understanding that these conversations drive us relentlessly to fulfill them (whether positive or negative). Calm yourself when having negative feelings. Seek knowledge and prepare for the difficult situations in life.

Immediate Self-Care

Being aware of your own internal conversations is a primary way to manage your own self-care. This awareness allows you a place to start, recognizing your own negative conversation. Once you recognize a negative conversation, you can analyze it but eventually you must disrupt it. Disruption can take place by taking immediate action. 

Action begins with realizing we all have human needs. We have a need for:

  • Certainty          
  • Variety
  • Significance

As a rescuer, we meet our need for variety by going into different businesses and homes and seeing how people live and work. I suspect rescuers also thrive on the need for contribution and when we can’t make a contribution by saving a life, we feel distressed. 

One of the things I would talk with myself about was, “I do not get to say whether a person lives or dies, I can only try.”  I would then create a new possibility in that I learned to let go and let God have life and death decisions. 

Also, letting go required me to think about and relive positive impacts I have had on people as a rescuer. Playing the positive story creates positive neuro pathways in the brain.  Life and death are in our words and thoughts. So as we speak and think we create these neuropathways that change our brain. 

So when dealing with overwhelming trauma:

  • Recognize the negative thought patterns,
  • Disrupt them with rapid action and intention.
  • Replace them with positive life giving stories and thoughts. 

Continuing the negative thought is a negative prime command to the subconscious mind which will end with poor outcomes.

Other Self-Care Steps

Physical activity will not only boost endorphins but it improves appetite and sleep.  It enhances confidence and provides for a mental “escape” from life’s challenges.

Monitor internal conversations. Meditation and journaling is a fundamental step in mastering our internal dialogue. Internal conversations drive us to do things we would not normally do. Paying attention to those conversations is the first step to controlling them. 

Relationships. Connections with others are vital to mental and emotional wellbeing. Some studies have demonstrated that close friendships can even have a dramatic impact on our ability to survive diseases such as cancer and may lower our risk of heart disease.

Having an attitude of gratitude is a powerful mental state. List out the things you have in life that you are thankful for and focus on them. Focusing on what is good creates a positive flow of energy in one’s life. Negative energy is contagious and consistent with fear, anger and other mental states. 

Actively avoiding negativity is a key self-care step because you are aware of the negativity and you actively choose to shift your mental state to the positive. 

Team Dynamics

Team dynamics include the following:

  • Clear roles and responsibilities
  • Clear communication
  • Mutual respect & inclusion
  • Knowledge sharing

Leaders should be aware of the impacts certain emergencies can have on rescuers. It is their responsibility to order Critical Incident Stress Management and it is congruent with constructive intervention and knowledge sharing. 

Team members should show respect for all members during critical incidences and no attempts at agitation or putting members in their place should be allowed. Re-evaluation of all aspects of team dynamics should be on-going for some time as chronic unrelieved stress damages immune system and decreases one’s ability to fight disease and infection.

Team members should know their limitations and if an event impacts you negatively, communicate with leadership of your need for support.                                                                      

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