FHExpo17: Mental and Physical Health Addressed
A brief look at select Firehouse Expo 2017 sessions that examined topics related to the physical and mental health and well-being of firefighters.
Sports medicine in the fire service
Luis Rivera presented “Put Me Back in Coach: Bringing a Sports Medicine Model to the Fire Service."
For professional athletes, gaining access to medical care is an afterthought. From the moment an injury occurs, a multi-disciplinary team goes into action to ensure an expedited and accurate diagnosis and begins generating a plan that will promise the quickest and most complete recovery. If this is the standard of care for a professional athlete, why is it not the same for a professional firefighter? Undoubtedly the answer is because things have always been done a certain way in firefighter care. But I believe that now is the time to take a fresh approach to tactical athlete care and start to treat our public servants the same as public figures. It’s time to take a sports medicine approach.
The goal is to provide a model that offers pathways to direct and appropriate care as well as advocacy for firefighters so that they are not left to navigate the often-complex medical system on their own. This is started by establishing a network of providers (physicians, therapists and allied health professionals) who understand the demands of a firefighter’s job and what their day-to-day activities look like. This is done by having they themselves step into the shoes of a firefighter for a day so that they have a better appreciation for the role. Once this network is established, an injured tactical athlete is immediately connected to the appropriate provider based on their injury. This ensures that an accurate diagnosis is made at the onset of the injury and an appropriate treatment plan can be established.
The outcome of creating this type of network and pathway for access to care is multi-factorial. From a patient perspective, it has been found to create happier patients and employees. They feel better cared for, are more invested in the process and more confident that they are being returned to duty safely. From a department standpoint, it has been able to get firefighter back to duty more quickly and safely. This creates a tremendous savings for departments as they have fewer costs related to paying injured employees and don’t have to cover the costs of extra shifts. All of this also creates a more harmonious relationship within the department, as all parties feel like the best care is being given and that there is an investment being made in ensuring appropriate healthcare.
In a world in which athletes are role models to so many, perhaps it is time to look at the system that provides them care and make that the standard for those athletes who protect us on a daily basis.
Saving those who save others
Jeff Dill presented “Saving Those Who Save Others."
Traditions are alive and strong in the fire service. The practices and beliefs have been going on for a couple hundred years. One of these traditions relates to how firefighters are perceived by the public and each other, as well as how history has portrayed us. We are strong, brave and courageous. We help others, don’t burden others with our issues and handle things on our own.
There are several factors that connect with the perceptions of firefighters and how this can lead to an issue called “Cultural Brainwashing”—the way we think we are “supposed” to act. Why does this matter?
The Firefighter Behavioral Health Alliance (FBHA) tracks and validates firefighter and EMS suicides. As of Oct. 1, 2017, FBHA have validated 1,056 of these tragic events, with the numbers continuing to climb on a weekly basis.
Dill addressed how Cultural Brainwashing may be sending our brothers and sisters into depression or addictions, masking job-related post-traumatic stress disorder (PTSD) and ultimately lead some members to complete suicide. We need to remember that we are human beings doing a job that requires us to give of our hearts and our souls.
Some recommendations that Dill shared in the workshop:
- Be direct: When you see one of our brothers or sisters struggling, be direct in your words. Instead of asking, “Are you thinking of hurting yourself?,” ask “Are you thinking of killing yourself?”
- Practice: If you have never said these words or asked this question, then practice. It is tough to do, but you must feel comfortable in asking these questions. It might be scary inside, but it shows you can handle the discussion.
- Challenge with compassion: When talking, if something doesn’t sound right or you hear conflicting statements, then challenge them. If you don't completely understand a statement, ask for clarification.
- Perform an “internal size-up”: This is a vital function we can do daily. Ask yourself: Why am I acting this way? Why am I angry? Why don’t I sleep? Why have I turned to an addiction?
- Listen to others: The best way to see if you have changed is by listening to others. They see us better then we will ever see ourselves.
Remember, this job, no matter career or volunteer, has changed us. How can it not? The things we see and do, coupled with the pressure we often feel about how we are “supposed” to act, can take a toll. Always practice self-care. If you are struggling, seek professional help. This could be the strongest thing you will ever do as a firefighter!
Signs of stress
Brandon Dreiman presented “The Silent Grind: Stress in the Fire Service."
Without getting bogged down with lists of signs and symptoms or clinical measures, it is vital to give firefighters a basic understanding of common behavioral health issues faced in the fire service, as well as concrete take-home points for these issues.
Alcohol Use Disorder (AUD): Most people recognize that alcohol is frequently overused by firefighters. The take-home point for AUD is that you do not need to be an alcoholic in order have an alcohol problem. Minor use problems grow over time, and there is no reason to be addicted before seeking help.
Depression: If you or someone you know is seeking treatment for depression, make sure that the treatment prescribed is evidence-based. We know evidence-based treatments work, so we must be diligent in requesting them.
Bipolar Disorder: Not as common as the other issues, but the important point lies in suicide risk. Twenty-five percent of patients diagnosed with bipolar disorder commit suicide. If you know a firefighter who has been diagnosed with bipolar disorder and you suspect the person may be suicidal, take action, even if you are operating on just a gut feeling.
Post-Traumatic Stress Disorder (PTSD): While the list of symptoms is complicated and the diagnosis requirements are complex, we can still take away a simple and useful tool regarding PTSD. If you notice signs and symptoms of PTSD for two weeks, you need to seek out mental health assistance. There is a limited window to prevent PTSD, and the two-week cut off is crucial.
Suicide: If you believe a fellow firefighter is considering suicide, the single most important thing you can do is to ask him or her about it. Be direct. Ask either, “Are you thinking about killing yourself?” or “Are you thinking about committing suicide?”
A simple way to determine whether a firefighter may need mental health assistance is to remember your “ABCs.” If you see changes in a firefighter’s Attitude, Behavior or Cognition to the extent that it is affecting their life at home or at work, ask them about getting a mental health assessment. Regardless of the mental health issue, the ABC approach is a useful tool for non-clinicians.
