Learning Resilience in the Fire Service

By Hersch Wilson

Did you get a flu vaccine this year? Most likely you did, because as firefighters and EMS providers we have a higher than normal exposure risk when it comes to some infectious diseases like the flu.

But here is the next question: What if you could get a “vaccine” for post-traumatic stress disorder (PTSD) or its sister, acute stress disorder (ASD)?

The fact is that as members of the fire service we are exposed to horrific events at a far higher rate than civilians. This exposure leads to a PTSD rate of nearly 20 percent among firefighters and paramedics. (This is probably a low estimate since there is still a stigma attached to PTSD. In a recent IAFF study of 7,000 firefighters, 81 percent reported that they thought admitting they had PTSD was a sign of weakness.)

Of course, no such shot exists, but there is intriguing research that points to a set of behaviors that might help inhibit PTSD from occurring and lessen the symptoms when it does.

These behaviors come under the umbrella title of “Resilience.”

“Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress . . . It means “bouncing back” from difficult experiences.” –American Psychological Association

An important caveat: The goal here is not to minimize the pain and sometimes anguish we experience after bad calls or to suggest that the damage to the brain caused by PTSD is not significant and potentially long-lasting. Even the most resilient individual on the planet would be traumatized by what we see over the course of our careers as firefighters.

But that doesn’t mean we should throw up our hands and think there is nothing we can do, or that we should just “suck it up.”

There is no magic pill or shot we can take to immunize ourselves against PTSD. But we can always be learning and taking small steps to help our departments cope with PTSD. This article is written in that spirit.

There are eight core practices that if learned, can lead to, if not an immunity from PTSD, maybe a fighting chance to stave off its worst symptoms.

Practice #1: Understand PTSD

Understand that PTSD is not a character flaw or a sign of weakness. PTSD is an injury to the nervous system. It is vital that department officers and firefighters understand what PTSD is and how it manifests. Knowledge is power.

Practice #2: Have a strategy for coping with stress

Firefighters who have coping tactics for dealing with stress are less prone to PTSD. Highly resilient folks have an active coping approach to deal with stress in their lives. They proactively practice ways to solve the problems that create stress or learn how to manage stressful emotions. In other words, after a bad call, it’s a good idea to have a plan in place for dealing with the aftermath. It doesn’t have to be complicated. There are simple practices that when learned can help, from using breathing techniques to mindfulness practice, to long walks, to yoga, to talking with another firefighter, to whatever works for you.

Practice #3: A regular exercise routine

Part of a good plan is regular exercise. Exercise is not just about physical strength and endurance. It also helps build mental and emotional “hardiness.” Exercise is a mood elevator; it releases endorphins in the brain that make you feel better. Next, exercise is linked to increased brain plasticity, the ability of the brain to learn and to create and strengthen new neural pathways.

It is not about spending hours in the gym. But a routine of running, walking, or just 30 minutes in the gym on a regular basis can help build emotional resilience and some protection against PTSD.

Practice #4: Optimism and humor

This may seem corny, but the fact is that optimism is a powerful tool. Optimistic people report that their problems are temporary and limited in scope. Individuals who are depressed tend to report that their problems are permanent and intractable. This can leave them more vulnerable to PTSD.

Humor has always played an important role in the fire service as a way to reduce stress. Now science has caught up to what we’ve known. Humor, even the often dark and private humor of the fire station, plays a protective role. It can lighten the mood, and it strengthens the bonds in the department. It is also therapeutic; firefighter humor in the face of tragedy can release tension and stress.

Practice #5: Be in a community

Simply put: “Individuals with strong social support tend to be more resilient than those without.”1 Highly resilient individuals belong to communities. This is why we call the fire service a brother and sisterhood. Social support does a number of things; it helps us keep our perspective, we discover that others share our same experiences and emotions, and it reduces loneliness (a predictor of PTSD.)

Practice #6: Purpose

Another hallmark of resilience is a sense of purpose, what researchers call a “moral compass.” It can be religious, spiritual, or secular, but the belief that we are dedicating our lives to a cause higher than ourselves is powerful. In a study done in England during World War II, it was found that there was less post-traumatic pathology among those who helped others after bombings versus those who didn’t.1

Practice #7: Re-frame your thinking

How you think about your role in the traumatic events you encounter as a firefighter is crucial to your ability to “bounce back.” The vital point is that we have choice in how we think about and remember these events.

For example, it is not unusual for memories of a bad call to hijack our thinking and thus our emotions. The “movie in our mind” just plays and plays. In those moments, we need to consciously work on re-framing the memories. First, remember that bad things happen, and they are out of our control. It’s just the way the universe works. Second, frame the event by remembering that when that pager does tone us out, we run towards trauma to help others. Third, frame the traumatic event (or the career of traumatic calls) by understanding that the highest possible purpose any of us can have is to be in service to others — especially in their worst moments.

Psychologists call this “cognitive flexibility” or the ability to see and think differently about the events in our lives. It is a learned discipline but one that can pay big dividends for us.

Practice #8: It’s not my emergency

Psychologists throw around the term “transcendent detachment.” It is really a reframing concept. It is the discipline in the middle of the bad call to remember, “It is not my emergency.” You can be passionate about getting the job done, about caring for the patients, and at the same time “be apart” from the intense emotions of a scene. I would suggest that this takes time and practice.

Unfortunately, experience — years and years of horrible calls — doesn’t by itself give you protection. In fact, experience by itself is a predictor of PTSD. Stress is cumulative. Stress adds up over the years. It is the discipline of how you manage those calls physically, emotionally, and mentally that seems to be important in reducing the risk.

Final points

It’s important to repeat that there is no magic bullet, no absolute protection from PTSD. There will always be the call — or a career of calls — out there that will pierce the best defenses. But these eight practices can help.

Next, in the fire service, we are only in the beginning stages of understanding PTSD and how it can “disorder” our lives. There are promising therapies and drugs that can help. But those are for afterward, sometimes months after experiencing the initial symptoms of PTSD.

Resilience is what we can work on and learn before we have the horrible crash or catastrophic fire — or ideally as we begin our careers as firefighters. Resilience is learnable; it can be a taught and practiced by the entire department.

As officers and training officers we have a responsibility to keep our firefighters and EMS folks safe. We drill and drill about safety procedures at fires and crash scenes. But our job is to also keep our departments, and the individuals who show up every week, emotionally safe. Teaching resilience, whether it is these eight principles or content based on your own research, is as valuable and important as teaching how to correctly use bunker gear. Both will save firefighters from injury and even death (firefighters have a higher risk of suicide than the general population.)

It means more work and another training concept or two every year, but it will pay off with a safer and healthier fire department. And that is something we can all get behind.

Be brave. Be kind. Fight fires.

Hersch Wilson is the assistant chief with Hondo Volunteer Fire and Rescue in Santa Fe County, NM. He has been with the department since 1987. In his “other life” he is a writer and a soccer coach. Visit him at Herschwilson.com or on Facebook at ‘Hersch Wilson-Firefighter.’

Reference:

1 6 Keys to Resilience for PTSD and Everyday Stress: Teach Patients Protective Attitudes and Behaviors. Haglund, Margaret. Current Psychiatry, April, 2007