For generations, fire service PTSD has been an unspoken and largely undiagnosed condition. However, understanding the circumstances that trigger fire service PTSD can lead to treatment, improved morale, and even save lives.
You don’t always get to choose your battles; sometimes they choose you. When that first call comes in, you don’t know what will be waiting on the other end; a burning building, a natural disaster, or an act of violence that requires prompt emergency medical services. But when the fires go out and the healing begins, the battles don’t always end. Compassion fatigue, burnout, and eventually post-traumatic stress disorder (PTSD) can manifest themselves out of the mental and physical trials of the everyday first responder.
Understanding the symptoms that compound into PTSD and learning how to manage them won’t only improve morale, but can also save lives, according to Paul Costello, FF/EMT-P, a 25-year veteran of the fire service.
COMPASSION FATIGUE
Defined as “an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper,” compassion fatigue serves as a common precursor to PTSD.
While largescale emergencies and rescue operations do contribute to compassion fatigue, oftentimes it’s the mundane tasks that have the strongest impact on first responders. Fires are at an all-time low, meaning primary care and mental health calls will take up a majority of first responders’ time. Think of each company member’s psyche as a personal barometer; with each passing call, those barometers will gradually inch closer and closer to the end of the dial, signifying an escalating growth of compassion fatigue. While every individual’s barometer is different, the lurking danger of burnout will inevitably set in.
BURNOUT
Occupational burnout is defined as “a state of physical, emotional or mental exhaustion combined with doubts about your competence and the value of your work.”
Developing a negative worldview as a result of burnout doesn’t only run the risk of adversely affecting your personal life, but it is dangerously contagious to your family and colleagues as well. Think about the bright-eyed and bushy-tailed rookie arriving for his or her first day on the job and immediately assimilates to the burnout of a 20-year veteran. Influenced by how the veteran reacts negatively to day-by-day nuances, pretty soon the rookie exhibits his or her own gradual tilt into compassion fatigue and a faster descent into burnout.
Being the dull tool in the toolbox doesn’t just affect you, but it also affects outcomes.
“It’s almost cancerous in a manner of speaking with how it can impact your employees,” said Costello. “One of the things I firmly believe is it affects outcomes but you have to override it. Realize that you’re there as an advocate whether or not a call is exactly as dispatch has described it. It’s still that person’s emergency. You have to accept it as a reality in our profession.”
EMERGENCE OF FIRE SERVICE PTSD
Like a wildland blaze at the height of fire season, PTSD will overwhelm first responders in the form of anxiety, depression, substance abuse, sleep deprivation, panic attacks, and violent or suicidal thoughts. While many cases compound through a linear ascension of compassion fatigue and burnout, single traumatic events, such as the recent shootings in Las Vegas, can profoundly accelerate the symptoms of PTSD.
Despite glaring warning signs, the fire service maintains a troubling track record of refusing to seek help. The idea that an individual will be seen as weak or passed over for promotion if they seek counseling are common concerns for the everyday firefighter, but this type of self-deprivation creates a vicious cycle of compassion fatigue which leads to burnout and eventually develops into the bottomless pit of fire service PTSD.
NEED HELP? GET HELP
Just as you rely on your crew when entering a burning building, you certainly don’t have to fight PTSD on your own. Some insurance plans in the fire service feature an employee assistance program that provides a certain number of free visits to a licensed clinical social worker or behavioral therapist. These sessions provide you an outlet to unload your feelings and emotions while receiving guidance on how to deal with them in the future.
Are you a chief? Sometimes the most powerful form of leadership is to lead by example. Dental visits are recommended twice per year; why doesn’t mental health carry the same weight? Normalizing annual “tune-up” visits to a cognitive therapist is a healthy way to stay on top of PTSD. When an effective leader can sympathize with what a company member is going through, crews will want to emulate that behavior.
“This is a tough business that’s a slog at times with daily wear and tear,” said Costello. “You’re dealing with other people’s problems and emergencies and trying not to let the process as a whole grind you down. Whether your career is 20, 25, 30 years, if you’re going to be successful you’re going to have to have these tactics to defend yourself.”
Fire Service Health and Safety Part I, the first installment of a two-part online training series from TargetSolutions, explores numerous topics pertaining to firefighter health and wellness, including a section dedicated to anxiety and fire service PTSD. The course outlines the
concepts, science, and economics of fire service-related health and safety as modern firefighters need to understand these interconnected concepts.
Understand your limits, seek treatment, and then pass on that knowledge to future generations. You’re not in this alone.
If you or someone you know is contemplating suicide, please call the National Suicide Prevention Lifeline at (800) 273-8255.
ABOUT TH
E CONTRIBUTOR
Paul Costello is a veteran paramedic, firefighter, fire service instructor, and TargetSolutions subject matter expert who has assisted in the development of numerous fire-related training courses. He played a pivotal part in the direction and production of TargetSolutions’ award-winning 1410 Evolutions training bundle, a 14-course video-driven series that was shot on location with the St. Charles Fire Department in St. Charles, Missouri and Pasco County Fire Rescue in Land O’ Lakes, Florida.
Aaron Zamzow is a firefighter and EMT for the City of Madison Fire Department in Wisconsin. He is also a degreed personal fitness trainer and author as well as the owner of 
raining with the prestigious 
