Firefighter Syndrome – Understanding Unseen Psychological & Physical Risks

by AmericasFeatured NewsHealth and Safety

A recent article from the University of Hawaii sheds light on the often-overlooked challenges faced by firefighters in their line of work – firefighter syndrome.

With firefighters having to grapple with a variety of scenarios that can cause trauma, both physically and mentally, are we ignoring a potentially health time-bomb by not addressing the elephant in the room?

We address this very real and present concern in the chapters below.

The Science Behind Firefighter Syndrome

Chris Frueh, a respected psychology professor at the University of Hawaiʻi at Hilo, teamed up with researchers Isabella Zingray and Gina Rudine, offering insights into the wide-ranging medical, psychological, and social risks firefighters grapple with.

Due to the nature of their job, firefighters are constantly exposed to chronic stress and life-threatening situations.

These repeated exposures can lead to serious physiological changes, such as traumatic brain injuries and toxic exposures.

Frueh commented on the objective of their research:

“What we want to do is provide a framework for people who are midcareer to late career to retired to begin to understand their injuries and to begin to be able to understand how to take care of themselves and how to look for medical care that they may need.”

A Disparity in Medical Research

It’s concerning to note the significant gap in medical research concerning firefighters’ health.

In 2021, a study highlighted that firefighters remain one of the least researched high-risk groups.

There was a 30 to 1 ratio in medical journal articles about veterans compared to firefighters.

Frueh emphasised the disparity, stating: “It means we know almost nothing about the types of injuries and health problems that firefighters develop over the course of a career.”

A Framework for Understanding & Support

Frueh’s team, inspired by their previous work on “Operator Syndrome” with military special operators, introduced a framework addressing what they’ve termed “Firefighter Syndrome”.

This comprehensive approach aims to provide holistic support for first-responders.

The ambition is for this groundwork to have a positive effect on firefighters not just in Hawaiʻi, but across the world.

They’ve also crafted a questionnaire, allowing firefighters to self-assess and gauge potential elements they might be experiencing.

This public-domain tool is available for medical professionals and firefighters, intended to inform and guide them back to safety.

Firefighter Syndrome Characteristics

The framework highlights a variety of concerns:

  • Traumatic brain injury (TBI) and toxic exposures.
  • Hormonal issues.
  • Sleep problems.
  • Chronic pain and orthopedic issues.
  • Substance abuse.
  • Post-traumatic stress disorder (PTSD) and depression.
  • Challenges with memory, concentration, and cognitive functions.
  • Issues with family relations and intimacy.
  • Constant state of high alertness.
  • Problems transitioning between home and work.

Frueh elaborated on its importance: “An individual firefighter can look through it and see ‘Oh, my goodness, I check these boxes.’

“It can also be used as a way to educate spouses or family members—and, importantly, to review with their healthcare providers.”

Moreover, the researchers provided guidelines for firefighters, addressing essential topics from suicide risk assessment to finding a reliable primary care provider.

Conclusion

The often-overlooked challenges firefighters face in their profession, both physically and psychologically, deserve our attention and action.

The disparity in research concerning their health risks compared to other high-risk professions is alarming.

Equipping these brave individuals with knowledge, resources, and support systems can make a world of difference, ensuring their well-being as they continue their vital role in our communities.

Trauma Risk Management takes centre stage at the FSPA conference

by AmericasEventsFeatured News

Understanding trauma management in the fire service

Dr Kristen Wheldon, a renowned Licensed Psychologist and the President & Founder of the Fire Service Psychology Association, is set to present on Trauma Risk Management at the upcoming FSPA Conference.

Scheduled for day two, on October 6th 2023, her session promises insights into current strategies for managing acute stress within organisations.

Key areas of focus in Trauma Risk Management

Participants attending the conference will delve into:

  • Organisational methods for addressing immediate stress.
  • The progression of peer support programs in the fire service.
  • The undeniable advantages of psychological first aid models.
  • The essential role clinical oversight plays in fire service behavioural health initiatives.

About the conference: A blend of fire service and psychology

Taking place in Atlanta, Georgia, the sixth annual conference is set to span two days from 5-6 October 2023.

Hosted at the Exhibition Hall – Midtown Room at Georgia Tech, this event offers attendees an in-depth look into the intricacies of the fire service, coupled with the latest in psychological research.

A unique networking opportunity, the conference aims to bridge the divide between professional psychology and the fire service.

Attendees have the added benefit of earning up to twelve continuing education credits, proudly sponsored by the American Psychological Association.

For more information and registration details, visit the official FSPA Conference page.

IFSJ Comment

In the demanding world of the fire service, the mental well-being of firefighters is paramount.

This conference, with its focus on Trauma Risk Management, acknowledges the importance of psychological health in the industry.

The inclusion of esteemed professionals, like Dr Kristen Wheldon, underscores the emphasis on providing quality information and tools.

The fusion of practical fire service knowledge with cutting-edge psychological research offers a holistic view, aiming to enhance the support structures for those bravely serving in the front lines.

By facilitating education and fostering connections between the fire service and psychology professionals, the FSPA conference truly champions the well-being of its heroes.

About Fire Service Psychology Association (FSPA)

The Fire Service Psychology Association is a pioneer in promoting mental health and well-being within the fire service community.

Founded by Dr Kristen Wheldon, the organisation actively bridges the gap between psychology professionals and firefighters.

Through events like their annual conference, FSPA continually strives to equip fire service personnel with the tools and knowledge to manage the unique stresses and traumas they encounter.

With a vision rooted in supporting the mental resilience of these brave individuals, FSPA remains at the forefront of change and innovation in the industry.

Central Council of Appeal holds Emmen Municipality liable for former firefighter’s PTSD

by AmericasFeatured NewsHealth and Safety

Firefighter’s prolonged exposure to trauma

The Central Council of Appeal has recently ruled that the Municipality of Emmen is responsible for the post-traumatic stress disorder (PTSD) developed by former firefighter Ruud Lohuis, according to NL Times.

The court recognised the municipality’s failure to provide appropriate aftercare to Mr Lohuis, who faced 25 traumatic incidents during his service.

Mr Lohuis served as a firefighter and diver at the Emmen fire brigade between 1982 and 1993.

Throughout his service, he was subjected to several distressing experiences that continue to have a significant impact on his mental health.

The aftermath of unresolved trauma

These encounters ranged from perilous diving incidents to dealing with the aftermath of fatal accidents, which often involved retrieving bodies from vehicles.

Mr Lohuis was also regularly faced with severely injured individuals, suicides, and numerous unsuccessful rescue attempts. His work incapacitation followed a distressing incident where a roof collapsed on him.

Despite the series of traumatic experiences, Mr Lohuis stated he received no aftercare for his trauma, leading to a decline in his personal life that resulted in the loss of his family, job, and friends.

In 2014, Mr Lohuis was diagnosed with PTSD by the mental health service in Emmen. While subsequent treatments have helped him manage his daily life better, he believes the damage to his relationships is irreversible.

Legal victory highlights importance of addressing PTSD among firefighters

Mr Lohuis sought justice from the Municipality of Emmen, attributing his mental health issues to his job.

While his initial objections and the initial court case were unsuccessful, the Central Appeals Tribunal – the highest court for civil servants – ruled in his favour in June.

According to Ferre van de Nadort, Mr Lohuis’s lawyer, the ruling signifies an “important turnaround” for aid workers.

“”PTSD has been recognised as an occupational disease by the police and the Ministry of Defense, but the fire brigade and other emergency services have not reached that stage yet. This opens the way for that,” he remarked.

Upon hearing the ruling, Mr Lohuis reflected, “That’s very important. I didn’t fight for nothing. It means a lot to our profession. I hope colleagues don’t have to go through the same thing as I have for the past 20 years.”

When approached for a comment, the Municipality of Emmen declined to discuss the ruling, citing the procedure as still ongoing.

They also refrained from making any statements about their (former) employees.

IFSJ Comment

This ruling marks an important milestone in recognising the mental health challenges that firefighters face. It underscores the need for appropriate support mechanisms, including aftercare, to mitigate the impact of PTSD on our brave firefighters.

Understanding and addressing firefighter PTSD can save families from the distress that Ruud Lohuis and many others have endured.

This landmark judgement sends a clear message to fire and rescue service providers everywhere: mental health is paramount, and ignoring it may have legal repercussions.

Tennessee passes Bill creating PTSD presumption for firefighters

by AmericasFeatured News

Tennessee has taken a major step towards supporting its fire fighters by unanimously passing legislation to create a post-traumatic stress disorder (PTSD) presumption for them. The James “Dustin” Samples Act, named in memory of a brave firefighter who succumbed to PTSD after years of battling the disease, has been championed by the Tennessee Professional Fire Fighters Association (TPFFA).

Thanks to the tireless lobbying efforts of the TPFFA, the bill has now passed both the Tennessee House and Senate and is expected to be signed into law by Governor Bill Lee. The act seeks to honor the legacy of Samples, who devoted 22 years to his profession and bravely fought PTSD for many years.

“Our members are exposed to trauma on a daily basis, putting them at significant risk for developing PTSD and other behavioral health concerns,” said TPFFA President Matthew Tomek. “This legislation will enable us to honor Brother Samples’ memory and allow our members to get the help they need early. We are grateful to all our friends in the General Assembly for supporting this bill.”

The new presumption will enable fire fighters to access workers’ compensation benefits for PTSD under certain stipulations. The disorder must be diagnosed by a mental health professional, and must be the result of a direct witness to the death of a minor, an individual whose death involved serious bodily injury, or responding to an event where there was a victim with a serious bodily injury or a responder, co-worker, or family member of a responder who sustained a serious bodily injury or died.

The act not only presumes PTSD as a work-related injury for fire fighters, but also establishes a grant program to help employers cover the cost of workers’ compensation claims. Employers will need to provide mental health resiliency training as part of their regular education program to qualify for the grant.

The James “Dustin” Samples Act will take effect on January 1, 2024. Tennessee has taken a significant step in supporting its fire fighters and acknowledging the inherent risks and trauma that come with their profession. The TPFFA is proud to have championed this legislation and will continue to fight for the health and safety of its members.

Exclusive: The stress of firefighting with Fire-Dex

by Breaking NewsIFSJ Exclusives

Lauren Burke DeVere, President, Fire-Dex talks about the impact of firefighting on mental health

The physical dangers of working in fire service are well known. Fewer people, however, are aware of the psychological risks that come with the job.

Fear, stress, anxiety, depression—firefighters commonly experience a range of negative emotions when performing their duties. The intensity of traumatic events and the constant threat of danger can leave even the most veteran emergency responders feeling vulnerable. Understanding how to achieve and maintain good mental health is therefore essential for continued safety and long-term success in their careers.

Yet the topic of mental health is often swept up in the commotion of station life and quickly forgotten about. At Fire-Dex we manufacture head-to-toe turnout gear for fire departments and have become very aware of the mental health issues affecting firefighters.

Recognising the symptoms

The first step toward mental health preventive care is learning to recognise both physical and psychological symptoms. It is not uncommon for physical symptoms of poor mental health—fatigue, headaches, insomnia, digestive problems—to manifest themselves.

Psychological symptoms of deteriorating mental health may include difficulty concentrating, negative thinking, an inability to enjoy activities, difficulty connecting with colleagues, family and friends, and/or an overall feeling of being overwhelmed. If a firefighter notices that they are experiencing any of these symptoms, or that a fellow firefighter is struggling, they should not hesitate to reach out to a friend or counselor, or to gently open the door to a conversation as a concerned party.

PTSD is real, and it is a real problem for firefighters. About 20% of fire service professionals meet the criteria for PTSD at some point during their career according to a Journal of Occupational Health and Psychology study. To put this in perspective, less than 7% of the general population will experience PTSD over the course of a lifetime. It is important to stay mindful of the fact that one in five firefighters is likely to deal with the effects of PTSD at some point, which can manifest in different ways, some being more subtle than others.

Rest, relaxation and reflection

Self-care is important, and while it may seem obvious, all firefighters should permit themselves the necessary time to unwind. This may include relaxation techniques such as yoga or meditation, physical activities or exercise, getting enough sleep as well as maintaining a healthy diet. It can also help to develop and maintain a strong social support system; firefighters need to build relationships with fellow firefighters and friends both inside and outside of their organisation.

In conversation with fire service professionals, it has occurred to me that the personal problems these heroes face can seem insignificant compared to any number of disasters, emergency situations or other traumatic events they have experienced. Acknowledging that one’s own struggles and needs are both authentic and deserving is not an easy step. Allowing time to process these feelings can do just as much to put the mind and body at ease as rest and relaxation.

The power of words

It is also notable that good mental health is closely associated with healthy sleeping habits. Sleep itself is a form of self-care that can help to relieve mismanaged stress and anxiety that tends to build up during the day. Often, it is not until a person has managed to relax in a peaceful setting that these feelings begin to subside.

Studies on college campuses, in prisons and in rest homes, for instance, have found that journaling about negative events is an incredible way to process them. It is easy to be intimidated by the thought, or to think that one must write a lot in order to benefit; however, the simple act of repeating even one line over and over—of simply committing the thought to paper—can be therapeutic.

Or for those outright opposed to the pen, a peer support group can make it much easier to talk about the difficulties of PTSD. Many departments have formed their own support groups led by veteran firefighters. Breaking through the stigma of mental health is the biggest barrier to seeking out this type of assistance.

A study published in Psychiatric Services indicated that 58% of participants reported stigma-related barriers when seeking help for suicidal thoughts during their firefighting careers. Firefighters with fewer years of service were also less likely to access treatment than those with more years, which underscores the importance of educating young professionals, especially, to the effects of depression and PTSD.

When enough is enough

When the symptoms of poor mental health become too much to handle, seeking professional help is always the best course of action. Finding the right professional is essential; it is important that they not only have experience dealing with firefighters, but also that they are available in a timely manner as the circumstances of a career in fire service can change quite suddenly.

Feeling comfortable with this person is also important as it makes the process of sharing one’s inner thoughts and feelings more bearable. If a firefighter feels they are not connecting with their therapist, they should not hesitate to look for a different one.

Mental health is an important issue, and it is essential to understand how to treat and prevent further physical and psychological issues. Recognising the symptoms, establishing a routine of self-care and speaking up when problems persist are all critical steps to maintaining good mental health.

For those seeking more information, organisations such as the Firefighter’s Support Alliance and the International Association of Fire Fighters through its Behavioral Health Program offer a variety of education programs and training sessions that can help individuals identify their problem areas and equip them with the skills to better manage stress and anxiety.

A career in fire services can be incredibly rewarding, but with this profession comes risks, both physical and psychological. Caring for mental health and well-being is key to ensuring that firefighters stay safe, happy and successful in their roles.

This article was originally published in the March edition of IFSJ. To read your FREE digital copy, click here.

Fire contaminants linked to mental health issues among UK firefighters

by Featured News

New research has found that toxic contaminants in fires are directly linked to increased rates of mental health issues among firefighters.

The findings support last year’s ruling from the International Agency for Research on Cancer, which says that exposure through working as a firefighter is carcinogenic – and goes a step further, by also highlighting the mental toll that firefighting can take.

The research, commissioned by the Fire Brigades Union (FBU) and independently carried out by the University of Central Lancashire (UCLan), is based on a survey of over 10,000 serving and retired firefighters across the UK, representing almost a quarter (around 24%) of the UK’s total firefighter workforce.

UCLan’s research, which has been led by Professor Anna Stec, professor in fire chemistry and toxicity, explores the link between firefighters’ exposure to fire effluents and mental health. 20% of respondents reported having a mental health condition. The rate of anxiety among surveyed firefighters was twice that of the general population, while the rate of depression was nearly three times that of the general population.

In addition, firefighters who noticed soot in their nose or throat for a day or more after attending incidents and firefighters who remained in their (often contaminated) protective equipment (PPE) for over four hours after incidents were also 2x as likely to report mental health disorders.

Firefighters were also significantly more likely to report any mental health condition if they identified noticing the smell of fire smoke on the body even after washing (1.3x more likely), or eating with sooty hands (1.3x).

Firefighters who worked in stations with no designated clean and dirty areas were more likely to report any mental health condition (1.2x more likely), as were firefighters working in stations which smell of fire (1.2x).

The findings, published in the Scientific Reports journal , also showed that 4.1% of surveyed firefighters were found to have a cancer diagnosis.

Riccardo la Torre, Fire Brigades Union national official said: “We already knew that fire contaminants were very likely causing cancer and other diseases in firefighters. Now, we have evidence that cements that belief and also shows that contaminants can impact their mental health. No firefighter should suffer unnecessarily and there is much more that fire services can be doing to reduce exposure to fire contaminants.

“We demand to see more action on prevention, health monitoring, and facilities and contracts for proper PPE and workwear cleaning. Ministers and Fire Bosses can no longer bury their heads in the sand on this life and death matter. It is of absolute urgency that they act and this research only reinforces that point.

“These are independent, statistically significant, peer-reviewed findings that are specific to the UK. I’m proud that the Fire Brigades Union commissioned this project to properly address such an important issue. The evidence is now undeniable and the days of hearing that we are behind other countries on this matter must surely end.

“We must act now to make firefighting a safer profession. This is an occupational hazard and no one should get ill, or worse, just for going to work. It’s important we learn and make the improvements in memory of every firefighter we have ever lost to these terrible diseases.”

Professor Anna Stec, Professor in Fire Chemistry and Toxicity at UCLan, said: “The findings of the UK Firefighter Contamination Survey not only confirm what we already know, that firefighters face a higher risk of cancer than the general population, but also brings to light new challenges firefighters have to face.

“Previous research on the mental health of firefighters has focused on psychological factors, but we now have evidence that there is a strong relationship between mental health and exposure to fire effluents. Everyone deserves to feel safe at work, and these studies show that measures such as health monitoring and reducing exposure from contaminants at the workplace will play an important part in protecting firefighters, both mentally and physically.”

IAFF address firefighter behavioural health challenges

by Featured NewsSafety

The IAFF has made fire fighter behavioural health a top priority, opening the first-of-its kind IAFF Center of Excellence for Behavioral Health Treatment and Recovery and launching peer support training to help members spot and address behavioural health issues.

The IAFF said that firefighting is not only one of the most physically dangerous professions, but can also take a heavy toll on mental health, leaving fire fighters feeling overwhelmed, underappreciated, and often alienated from their families.

This mental state, often called “burnout,” which can wreck a fire fighter’s career, impact fire companies, and threaten family life.

The IAFF has announced it is expanding its behavioural health training curricula to help members continue their successful recovery post-treatment and to help outside behavioural health specialists better understand the unique challenges and stresses fire fighters and paramedics face on the job.

Helping Members in Recovery is a two-hour, self-paced course for fire service personnel who want to support a member who is currently engaged in or has recently completed treatment for a mental health or substance use disorder. ​The course covers common behavioural health problems in the fire service, levels of behavioural health treatment, and strategies for individuals and affiliate leaders to support members in recovery.

General President Edward Kelly said: “The resolute fire fighters and paramedics that make up this great union dutifully confront danger and trauma every shift while protecting their communities, and we know now it takes an emotional toll. We cannot ignore the great challenge of behavioural health in our ranks. We owe it to our membership and we owe it to their families,”

These efforts are accelerating, with the expected opening of a second IAFF Centre of Excellence on the West Coast in the first quarter of 2023 to help manage the rising demand within the fire service for behavioural health treatment. The original Centre of Excellence in Upper Marlboro, Maryland, just outside of Washington, D.C., has been booked to near capacity having treated and released more than 2,200 members over the past five years.

In Canada, the IAFF has entered a collaboration with Edgewood Health Network (EHN), Canada’s leading provider of behavioural health treatment services, to help treat IAFF members.

“We have seven facilities across Canada that offer inpatient therapy, outpatient therapy and several specialized programs,” said National Director of Business Development of Edgewood Health Network (EHN) of Canada Darrin Taylor during a roundtable discussion on behavioral health at the 2022 IAFF Convention in Ottawa, Canada.

“Having multiple facilities at our disposal helps prevent waitlists. If a fire fighter is in crisis but the closest center is full, EHN will escort that fire fighter to a facility with an opening.”

 Dr. Suzy Gulliver, behavioral health consultant to the IAFF and director of the Warrior Research Institute at S&W Healthcare System said: “Do we have a burnout problem? We hear anecdotally we do, and this survey will help us speak with greater confidence. Whatever the survey shows us, it will inform us where the hotspots are and give us targets for change.”

NVFC launches First Responder Helpline

by Featured News

On October 10, World Mental Health Day, the National Volunteer Fire Council (NVFC) announces the launch of the NVFC First Responder Helpline.

The new resource provides both immediate assistance in a crisis moment, as well as confidential counselling, resources, and referrals for a range of issues including stress management, family conflict, financial or legal concerns, addiction, grief or loss, and more.

The program is provided through Provident and supported by Business Health Services (BHS), a leader in providing emotional and behavioural health consultations, in partnership with Responders 1st Call.

BHS has been delivering mental and behavioural health services to organizations since 1983. The contact centre is staffed by master’s level clinicians with an average of five years of experience specially trained in assisting and supporting first responder groups.

In addition to immediate assistance in a crisis moment, the NVFC First Responder Helpline will also provide stress management and work-life services, including up to five telephone stress management coaching sessions (or the number of sessions allowed by state law) with master’s degreed counsellors, access to attorneys for a 30-minute phone or in-person legal consultation, referrals to consultants to assist with debt management and other financial concerns, and resources and referrals to help with childcare, elder care, or adoption.

NVFC chair Steve Hirsch, commented: “Emergency responders face the same stressors and concerns as everyone but add to this the fact that we routinely experience traumatic situations that most people never encounter in their lifetime.

“We are thrilled to be able to offer this new resource so that first responders and their families have a place to turn in times of need. The NVFC First Responder Helpline provides a wide range of assistance to help our members cope with traumatic incidents, everyday life stresses, work-related concerns, family issues, and more.”

The NVFC First Responder Helpline is provided to all NVFC members and their household family members. Members can access the number on the members section of the NVFC web site. Once logged in, go to Member Resources and then Member Benefits to find the number. Non-members can join for just $21 a year to access this and other NVFC member benefits.