Tuesday, August 18, 2015

The last call: Responding to the emotional needs of first responders

Posted: Sunday, August 9, 2015
George Redner III

A fatal rollover accident involved five people under age 25, followed by a fatal sword stabbing involving a son and father, then a fire that left two neighboring department firefighters and a homeowner injured and seriously damaged the home — all occurring over the span of four days.
Those are among the emergency calls Langhorne-Middletown Fire Chief Frank Farry answered last week, after he learned that a popular 27-year-old firefighter and emergency medical technician died by suicide Aug. 1 when he stepped in front of an Amtrak train at the Levittown station.
Weeks like that one leave even veteran firefighters such as Farry mentally and physically drained. But it can send other emergency responders into life-threatening tailspins.
George “Reds” Redner III, a Tullytown resident, was buried Saturday. He was a volunteer with the Edgely Fire Co. in Bristol Township, worked as an EMT for the Bucks County Rescue Squad and was a paid firefighter at the Great Adventure theme park in New Jersey. He was about to start classes at the Philadelphia Fire Academy.
Redner’s death was a gut-punch for local first responders, who know the extreme emotional wear and tear that emergency responders experience regularly. It’s the kind of stress that sneaks up on a person long after a fire scene is cleared or a patient is in the ER. It can be triggered by something unrelated to work or it can manifest as troubled sleep or risky behavior.
“We’re focused on scene. You do what you are taught,” said Jeryl DeGideo, director of the Bucks County Emergency Health Services. “We don’t think of the mental side. When we’re on the scene, we are working. That is not where it happens; it happens when you’re writing the chart or go home and are hugging the kids.”
Little data exists on suicide and attempted suicide rates among first responders, particularly firefighters and emergency medical service workers, said Jennifer Taylor, a Drexel University public health professor who studies the issue.
“It’s been a really under-recognized problem,” she said. “We’re missing opportunities all the time.”
Anecdotal data suggest behavioral health problems among emergency responders may be widespread, with some studies suggesting that as many as 37 percent of firefighters exhibit symptoms of post-traumatic stress disorder, according to the National Fire Protection Association.
While attitudes are slowly changing, long-held social stigmas and stereotypes have discouraged first responders — especially firefighters — from admitting these problems and seeking help, Taylor said. She noted that, unlike police officers, most career firefighters and EMS personnel aren’t offered paid recovery time or stress-related leaves.
“Their occupation is so, so different. The public does not understand what our firefighters and paramedics walk into every day,” Taylor said. “No one really understands the cumulative effect of seeing the crap they see. The day-to-day insults to their emotional health are what add up. You have to give people the opportunity to recover.”
LIFE AND DEATH
At least 104 firefighters died by suicide nationwide in 2014, compared with 87 killed in the line of duty, according to the Firefighter Behavior Health Alliance. The alliance used statistics from one-quarter of an estimated 30,000 U.S. fire departments that provided information. So far this year, at least 68 firefighters have died by suicide, according to the alliance.
Suicides involving first responders in Bucks County are rare. Before Redner’s death, the only cases of first-responder suicide involved two police officers who took their lives in 2011.
No recognized national agency collects statistics involving suicides or attempted suicides involving firefighters and EMS workers. Hospitals also don’t track patient occupations, and death certificates don’t necessarily include occupational data either, making the information difficult to track, Drexel’s Taylor said. An estimated 70 percent of U.S. firefighters are volunteers, so their service might not be noted on a death certificate.
But it is a widely held belief that the combination of a fast-paced, emotionally charged job involving life and death, compounded by other job-related situations — such as lack of sleep, little time off and high call volume — other underlying personal stresses and a fear of admitting emotional fatigue increases the risk of suicide, according to behavioral experts.
“They are looked at as the heroes of our community. They’re brave and courageous. How could they be feeling this way? The stigma silences them,” said Cathy Siciliano, a spokeswoman for the Philadelphia chapter of the American Foundation for Suicide Prevention. “We need to make it OK for people to seek mental health treatment.”
Growing concern over the mental health of first responders has prompted a growing number of fire departments nationwide to hold in-house training and peer counseling as well as focus attention on behavioral health problems such as alcohol and drug abuse, depression and PTSD, according to the National Fire Protection Association, which estimates the USA had more than 1 million firefighters in 2010.
In Bucks County, where most fire companies are largely staffed by volunteers, programs are in place to address the immediate and long-term mental well-being of first responders and reduce barriers associated with the emotional health of community heroes.
Hours after Redner’s death was confirmed, the Bucks County Rescue Squad, where he worked as an EMT, posted a link to the “Share the Load” program (www.nvfc.org/help) on its Facebook page. The National Volunteer Fire Council program provides resources and information to help first responders and their families manage and overcome personal and work-related problems.
Last week, 75 first responders in Bucks County attended a Critical Incident Stress Management session at the Edgely Fire Co., where Redner volunteered. The program has been in place in Bucks since 1987, according DeGideo.
The 30-member volunteer, peer-to-peer crisis program is available 24/7 to first responders — including 911 dispatchers and emergency room doctors and nurses — who experience major stress-producing events, such as a police officer death or mass casualty incident.
The team includes trained volunteers from all emergency service disciplines, as well as two mental health professionals and pastoral care. The sessions include presentations from mental health professionals about how to identify physical and psychological symptoms of stress and how to address and defuse them.
“They see the worst of the worst,” DeGideo said. “Unfortunately what they see, they’ll probably see again. Sometimes you just got to get it off your chest.”
NOT ALONE
So far this year, the Critical Incident Stress Management team has responded to 11 requests for sessions, typically from the heads of fire companies, rescue squads or police departments, DeGideo said. The annual average is 12 to 18 requests, which can range from large groups to one-on-one help.
“It is a much needed service,” she said. “It keeps people in the business doing what they’re doing and it helps their families.”
The CISM team operates with a high degree of confidentiality. No names are recorded. What is discussed in the sessions remains private. No one is forced to talk or even participate.
John Costello is an Upper Southampton police officer and a member of the CISM team in Bucks County. He has seen attitudes toward the team’s work change dramatically over the last 15 years, as younger firefighters and emergency medical personnel have joined departments. The new generation is seeking more attention to manage emotional stress, bolstered by the medical community’s acceptance of PTSD as a legitimate and treatable mental diagnosis, Costello said.
“There is less of a stigma now than it was 25, 30 years ago,” he explained. “If you get somebody who is more tenured in an organization who is going to actively participate (in a CISM session), that is the best you can hope for.”
He added that police officers have become more open to participate in CISM programs, though he still runs into some who say they don’t believe in the concept. But Costello believes even if non-believers attend sessions, their mere presence could encourage others to feel comfortable.
“We can only hope we give at least the people the sense they are not alone,” he said. “Their reactions are not something that is going to make them crazy. Their reactions are normal. Our systems are so overworked and, if we can preserve what we have, that is the best we can hope for.”
As a fire chief, Farry said he requested the CISM team once about 10 years ago, after one of his young firefighters was involved in a non-duty related car accident during which a woman died, leaving the man emotionally shattered.
“There was not a dry eye in the room,” he said.
How first responders handle the stress associated with fire calls varies, not only from person to person, but from call to call, Farry said. After Redner’s death, he approached several younger members of his fire department to make sure they knew that if they had problems, he is always available.
He also regularly holds what he calls “tailboard critics” — informal post-fire call sessions at the firehouse — to check in and debrief members after a particularly difficult call.
“I need to be there to help the next person,” Farry added. “No one wants to appear weak; but you need to make sure the guys are OK.”

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