About one in four first responders suffers from moderate to major depression, according to an ongoing University of Arkansas for Medical Sciences study that seeks to examine the effects of job stress on firefighters and emergency medical technicians.
Married to a firefighter herself, Sara Jones, a psychiatric nurse practioner and assistant professor in the College of Nursing at UAMS, said much research has gone into the causes and treatment of post-traumatic stress disorder in veterans and law enforcement officers but not much is known about the effects of trauma on firefighters and EMT’s.
“The research was not that abundant,” she said. She opted to focus solely on fire and medical first responders for her research study, which aims to not just examine the problem but provide solutions for first responders who may be suffering in silence.
Jones said she sought to gain some understanding about PTSD, depression, anxiety, sleep disorders and substance abuse experienced by first responders. The anonymous survey was set so that it wouldn’t register the IP address of the respondents so they could be assured of privacy.
Jones also offered a voluntary question about whether first responders would be willing to be interviewed in person and offer their insights about whether the trauma they witness as part of their jobs affects their psychological well-being. To her surprise, over 200 first responders were willing to fill out the survey and a few dozen were willing to talk. She has spoken with 21 so far and has more calls to make. The interviews take up to two hours, and participants receive a $25 gift card to Walmart as a thank you for their time.
Jones said many were hoping to help change a culture that may have encouraged silence.
“You’ll be looked at differently. Not only as a person, but also as someone you’re running into a fire with, that they might be concerned about how you are going to handle a situation or even about their own safety,” said Jones.
But she said she’s finding a generational and cultural shift that is slowly making mental issues OK to talk about on the job.
Steve Metcalf, a longtime paramedic with Emerson Ambulance in Jonesboro, said first responders sometimes have to have very blunt conversations with each other about what they see on the job.
“It can sound like it’s insensitive, but it’s really not. It’s just a coping mechanism,” he said. He urged members of the public who might overhear a crude conversation among EMTs about blood and bodies to keep in mind that “we’re just people, too,” and that it’s a way for them to process their stress.
Metcalf noted that divorce rates seem high among first responders, and speculated that it may be because spouses notice how much time is spent forming intense bonds with co-workers and helping strangers. Some spouses may feel like a lesser priority.
“We tend to spend more time with our partners than we do with our wives and children. We work anywhere from a 24-hour shift to a 72-hour shift. I’ve worked 86 hours straight,” he said.
Not everyone is cut out to be a first responder, he said, and sometimes they don't find that out about themselves until they are already on the job.
“They’ll work two or three shifts and then they quit,” he said, of brand-new EMT’s, “because they can’t deal with what they see.”
Tim Grimes, a recently retired firefighter and EMT with the Hot Springs Fire Department, said the symptoms of PTSD don’t go away after retirement.
“Certain things, I will never forget,” he said.
He mentioned smells and sights that can unexpectedly trigger memories at odd times. He wouldn’t grill outside for two years after zipping burn victims into body bags. He can’t enjoy a movie that includes a fictional car crash or someone falling off a deck in a scene that’s supposed to be funny.
“In my mind, if I see someone fall off a balcony and strike their head, I just think, 'OK, I’ve got to stabilize their spine,'” said Grimes.
Helping people is a hard habit to break in retirement, he said, and involves a sense of loss about one’s own usefulness.
"If you survive in EMS until you retire, it's still part of your life. You come up on an accident, you stop and help," said Metcalf.
First responders agreed that the most difficult memories involve children, particularly a child who didn’t make it. There is also some stress involved with the lack of closure, since they don’t usually find out what happened with a patient unless they happen to notice an article in a newspaper or an obituary. They acknowledged that it can be hard to help the same person, such as someone suffering from a drug addiction, over and over again without feeling like an enabler.
Jones said her survey found that sleep disturbances are extremely common among first responders, due to shift work that involves irregular sleep hours. Frequently, traumatic experiences show up as nightmares or even night terrors. Metcalf said he had at least two night terrors, and Grimes said sleep disturbances were a constant problem for him.
“I could not lay in bed at night and turn my head off, turn my brain off. I just kept going over things and over things,” said Grimes.
He said he’s gratified that the culture is slowly shifting towards a more open discussion of psychological trauma on the job. Fire departments already offer employee counseling services, such as with Southwest EAP, as part of their benefit packages, and Jones is hoping that her study will become part of the conversation when it comes to policy change.
“It’s showing that there’s a problem, but more importantly, something is going to be done about it,” she said.
She hopes to create a toolkit where first responders can remove any barriers to getting the counseling or other help they may need after experiencing trauma on the job.
“It has to be implemented at the ground level. It has to be guarded by the top people. You have to have a way to say I need help without fear of losing your job and without fear of being thought of less,” said Grimes.
CORRECTION: A previous version of this story said that interviews with first responders are conducted by phone and that they are paid for their time. According to the study author, Sara Jones, the interviews take place in person and participants receive a $25 Walmart gift card.
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