Firefighters and Trauma

Issue 3 and Volume 12.

By Christine Pao and Jana Tran

Firefighting is one of the most dangerous and stressful occupations in the world. Day in and day out, firefighters place themselves in harm’s way to come to the rescue of those in need. First responders such as firefighters are exposed to trauma as a natural and unavoidable part of their work. For this reason, firefighters need to be incredibly resilient.

But what is it, exactly, that makes firefighters’ jobs so stressful? In many large fire departments, firefighters are not merely responding to fire calls; their job is much more complex and varied. Firefighters in large urban fire departments, such as the Houston (TX) Fire Department (HFD), are expected to answer emergency medical services calls as well. This means that putting out fires is not the only requirement of their job; often, firefighters must respond to motor vehicle accidents, burn victims, severely injured victims, and violent deaths. On the job, it’s very likely that firefighters will face a number of different traumatic situations.

Post-traumatic Stress Disorder

It’s no surprise, then, that firefighters are at high risk for developing post-traumatic stress disorder (PTSD). In fact, an International Association of Fire Fighters’ report released in September 2016 found that firefighters exhibit levels of PTSD rivaling that of combat veterans.

Should we be sounding the alarms? Is this something to be concerned about? On one hand, yes – this is a startling statistic. When it comes to firefighters, the brave men and women who protect and serve us, any number above 0 is a cause for concern when we’re talking about mental health. Protecting those who protect us should be our top priority.

PTSD has been studied extensively among various at-risk populations, including veterans, but there is a lack of research on PTSD for emergency responders such as firefighters. Even though we know the hazards that firefighters face on a daily basis, there are shockingly few studies that look at mental health issues, such as PTSD, within firefighter populations.

However, there is good news: More and more steps are being taken today by fire departments to study PTSD, recognize signs and symptoms, and take action to treat it.

Recent Statistics on Firefighters

One such study was conducted recently at the HFD, where it found a prevalence rate for PTSD of 12.6 percent among the firefighters. A total of 3,036 participants in 2008 completed the survey, roughly 76 percent of the department at that time.

What does this number mean? Looking at the overall population, lifetime prevalence rates for PTSD have been found to be around 6.8 percent among American adults. The rate varies at 3.6 percent for men and 9.7 percent for women. Other studies have found prevalence rates to be as low as 1 percent for men and 2.2 percent for women. Compared to firefighters, prevalence rates of PTSD within the general American population are relatively low.

It is well known that veterans, on the other hand, have high rates of PTSD because of the traumatic events they encounter in the service. Veterans are perhaps the most widely studied group with regard to PTSD. For Vietnam veterans, one study found PTSD prevalence rates of around 15.2 percent for men and 8.1 percent for women. In another study, Gulf War veterans exhibited a prevalence rate of 12.1 percent. More recently, Operation Enduring Freedom and Operation Iraqi Freedom veterans were found to have a prevalence rate of 13.8 percent for PTSD. And overall, a study conducted in 2011 analyzed 3,157 United States veterans and reported a lifetime prevalence rate of 8.0 percent and current prevalence rate of 4.8 percent for PTSD.

As you can see, prevalence rates are indeed higher for firefighters than the overall population and comparable to that of combat veterans. The statistics found by the HFD confirm that PTSD is not a myth or a rare disorder that affects only a select few – PTSD is a very real concern for firefighters.

The HFD study also found that certain factors placed firefighters at higher risk of developing PTSD symptoms. According to this study, some of the risk factors for PTSD include poor health, alcohol dependence, depression, being single, and high levels of stress.

What Can We Do?

How can we begin to combat the issue of PTSD among firefighters? The first step is breaking down the barrier of stigma. The topic of mental health is often not a welcome one for many who build their careers around bravery. Fire departments often foster strong values such as courage and pride. While these characteristics can help firefighters thrive and adapt within a highly stressful job environment, they can also make it hard for them to talk openly with others about their mental health concerns.

Obviously, no one wants to be seen as weak among their peers, but this may lead many firefighters to minimize their symptoms when facing psychological distress. Fire departments should therefore approach the issue of mental health with openness and sensitivity. Screenings for PTSD and other disorders should be made common practice. Conversations about mental health should be made the norm – not taboo.

Mental health professionals, along with fire department staff and personnel, need to be trained to recognize signs of PTSD. Preventive measures such as education and outreach may be especially effective because they teach firefighters to recognize the signs of PTSD in themselves and their fellow firefighters. Fire departments should also ensure that firefighters have access to resources so they can get help if they need it.

Prevention and treatment also need to be tailored to firefighters. Any type of treatment should specifically address the unique challenges that firefighters face. Importantly, certain factors on the job may add to overall stress levels and need to be considered by every fire department. For example, many firefighters work unique shifts. As a result, many choose to work at a second job, often in other fire departments. This may compound their exposure to trauma and create additional stress, as they have less time available to seek support from family and friends.

Treatments for PTSD also need to target risk factors such as alcohol dependence and depression, as confirmed by the HFD study. And while it’s crucial to look at risk factors, protective factors also need to be understood.

Why is it that some firefighters are better able than others to cope with trauma? There are probably factors at play that help certain firefighters recover from trauma and prevent them from developing PTSD. Protective factors and potential coping strategies need to be explored, along with risk factors, to make sure we have the most comprehensive picture when we are treating firefighters.

Effort Adaptation

There is no doubt that PTSD rates can be startling, and it’s not an easy topic to talk about. But as we become more aware of the types of challenges that firefighters face, we have to adapt our efforts to better serve those who serve. With proper prevention and treatment, we can provide firefighters with the help they really need and deserve.

Christine Pao is a doctoral student in the counseling psychology program at the University of Houston. She works with the Houston Fire Department’s research team to increase the understanding of the role of traumatic stress in firefighters’ lives. Pao is currently completing an externship at the Michael E. DeBakey VA Medical Center in Houston.

Jana Tran is an alumna of the University of Houston counseling psychology program and has dedicated her life to working with survivors of trauma. The work she does in her current position with the Houston Fire Department has garnered attention from her colleagues as well as national achievement. Tran was awarded the 2015 American Psychological Association Achievement Award for Early Career Professionals. She works with survivors of trauma and serves as a therapist, supervisor, and consultant for firefighters and their immediate family members.