Curt Varone’s voice falters as he describes an all-too-familiar scene.

Kneeling on the floor of a stranger’s home, performing CPR and trying to keep someone alive, often with frantic family members watching in shock.

“Then you look up, and you’re looking right at their wedding pictures,” Varone says, pausing until he can finish his thought. “It’s hard to even talk about.”

Even for a seasoned Rhode Island firefighter with more than 50 years of experience.

Varone, also a lawyer and forensic psychologist who trains fire departments around the country — including Kansas City and Kansas City, Kansas — speaks of his son, a former firefighter who is now a trauma surgeon. In the operating room, he says his son treats the patient in a sterile, controlled environment, then steps outside to speak with the family.

Firefighters rarely have that separation. They rush into burning buildings and respond to crashes and work sites where people are badly injured or dying. Their workplace is defined by chaos, with no way to control what awaits around the next corner.

“I can’t explain to you in enough emotion the horrors that we see and the circumstances under which we see them,” Varone says.

“We’re dealing with a lot of sadness. But we’re also dealing with a lot of risk.”

The danger is not limited to flames or collapsing structures. There’s the threat of exposure to toxic substances and the long-term threat of cancer. And drunken drivers who slam into emergency vehicles and workers at crash sites. Or the possibility that a routine call can turn deadly in an instant.

And the images that linger long after the sirens stop.

For firefighters, the job can mean carrying other people’s worst moments home with them. For some, that burden can eventually lead to drinking, drug use, depression, anxiety or thoughts of suicide.

In recent years, The Star has reported on Kansas City Fire Department employees who have been charged with crimes, including the cases of seven firefighters alone who have had a combined 21 DWI convictions, as well as more serious offenses, such as involuntary manslaughter, felony harassment and drug charges.

And while the challenges of the job don’t excuse the criminal actions, researchers and legal experts said, those experiences can often contribute to their behavioral issues.

“Seeing people hurt, maimed, seeing real life-or-death situations, I think in some ways, that’s a little more psychologically stressful than putting out a fire,” said Christopher Haddock, a Lee’s Summit researcher who has conducted and published studies on alcohol abuse among U.S. firefighters. “They’re dealing with human misery.

“There’s a saying in the fire service: ‘Your worst day is our every day.’ They see everybody’s worst day every day.”

Four hundred calls a day

In Kansas City, the fire department’s 35 fire stations, including one at Kansas City International Airport, handle about 145,000 calls a year — roughly 400 a day, said Battalion Chief Michael Hopkins, a KCFD spokesperson.

He said 80-85% of those calls are EMS-related, often putting firefighters in situations that Haddock described as more psychologically stressful than putting out a fire. The call volume has increased by 2-4% annually, Hopkins told The Star in a sit-down interview.

“When we know a significant event has happened … we initiate the process immediately with what we call a critical incident debriefing, and we’ll notify Local 42 as well as 42 CARES,” Hopkins said.

One example Hopkins cited was the mass shooting at the 2024 Kansas City Chiefs Super Bowl victory rally, which killed Lisa Lopez-Galvan and injured roughly two dozen others, including several children, who were struck by gunfire. Dozens more were injured in the ensuing chaos after shots erupted in the crowd.

Hopkins also noted the death of Graham Hoffman, a paramedic who was fatally stabbed by a woman in April 2025 as he and another paramedic were transporting her to an area hospital.

“We ensure the unions come out and check on them, and then that 42 CARES responds out to that fire station to check on them,” Hopkins said. “Not only that day, but over the following days and weeks, just to make sure everybody’s OK.”

Established by the International Association of Fire Fighters Local 42 — which represents the ranks of captain and below — 42 CARES offers counseling, crisis intervention, trauma-informed therapists and on-site social work support to current and retired firefighters, paramedics, EMTs and support staff, along with their families.

“Sometimes that’ll start the engagement right there. Sometimes it doesn’t,” Hopkins said. “But sometimes just that visit out there and saying, ‘Hey, here’s the cards. Here’s the information. Don’t forget about these resources.’

“A lot of times, somebody will reach out several days later and say, ‘You know, I didn’t have an issue the day it happened, but now you know what? I haven’t been able to sleep the last couple nights, and would like to talk to someone.’”

‘I don’t think anybody really talked about feelings’

The Kansas City Fire Department currently employs 1,463 staff with a mix of educational backgrounds. In the past, mental health and the lingering effects of trauma were seldom discussed among members of the department.

“I think people are starting to understand it a little bit more,” said Battalion Chief Riley Nolan, another KCFD spokesperson. “When we first came on over 20 years ago, I don’t think anybody really talked about feelings. You just kind of dealt with it and you moved on.”

But it’s more common now for firefighters to open up about what they’re going through and seek help after dealing with traumatic events, Nolan said.

“I think 42 CARES has done a great job of getting out there and talking to people and making sure that they know what resources are available to them,” he said. “So I think that continuing with that message, it’s something you never want to stop, because the moment you stop advertising or talking about it or saying it’s out there is when people start forgetting about it.”

Nolan acknowledged that there are still some within the department who try to handle challenging situations on their own. And don’t do it well, he said.

“I don’t think that’s just fire department-related,” he said. “That could be in any business.”

But when you’re in a job where you live for long stretches with your co-workers, Nolan said, you tend to notice when something doesn’t seem right.

“You do see the changes in people,” he said. “And you try to help and make sure that they do know that there are resources available to them.”

Not a ‘window front EAP’

In 2019, Kansas City clinician AJ Pittman and her supervisor, Eric Rose — Local 42’s secretary-treasurer — realized that more could be done to help those struggling with mental health issues.

“We just saw a need, and we thought we could do better than what they’d been receiving,” Pittman said. So they developed 42 CARES “and really tailored it to the needs of the members in Kansas City,” she said. CARES stands for “connect, assess, refer, educate, support.”

The program operates out of the IAFF Local 42 union hall and is believed to be the only behavioral health program in the country run by a local union in the international organization, said Pittman, the 42 CARES director.

Local 3808, which represents KCFD battalion and division chiefs, also participates in 42 CARES, as do other area fire departments, she said. Their costs are covered by their unions or the cities they serve.

Pittman said the program goes beyond what a typical Employment Assistance Program provides.

“Prior to this being here, there was something — I call it ‘window front EAPs’ — where they look like they have a great EAP program, but oftentimes they fall short because they may not be privy to the areas in which they really struggle in,” she said. “And so we wanted culturally competent clinicians to work with not just our members, but the families as well.”

Those using the program can remain anonymous, Pittman said: “Some people don’t give their first name. Some people don’t give their last name. I don’t press it. We just need to know which department they are with, just for tracking.”

The fire departments don’t know who is using the program, she said: “Absolutely not. No way, shape or form.”

Pittman said 42 CARES works with clinicians throughout the Kansas City area whom she and her staff know, trust and have vetted. Once the staff finds out what kind of therapy the participants would like to have, they are connected with the clinician who best fits their needs.

“Do they want traditional talk therapy? Or maybe somebody has a kiddo who needs play therapy,” Pittman said. “We even have an equine therapist. So it’s not like we just say, ‘Here’s a list of three clinicians. You’ve got to figure it out.’”

Their strategy has evolved over the years, Pittman said.

“We used to have this approach of like, ‘What’s wrong with you?’” she said. “And now we have more curiosity about ‘What happened to you?’”

Stress, anxiety and PTSD are the top issues 42 CARES assists participants with, Pittman said. And substance abuse, she said, “is definitely on our radar.”

For substance use disorders, PTSD and other behavioral health issues, she said, the program works with the Center of Excellence, a residential treatment facility in Maryland exclusively for IAFF members. 42 CARES covers the costs of the treatment, Pittman said, including travel expenses.

When a tragedy or crisis occurs, she said, every case is different.

“Some people may pull me aside and say, ‘I’m really concerned about this person,’” she said. “At the right time, I may check in with them, or I might just allow them to be supported.”

It’s important to know when to stand back and take in what needs to be done, she said, then follow up after they’ve had time to be with their co-workers, connect with their own families and have a night or two of sleep.

“And that’s been, I think, a little more difficult for people to understand, because it can look like we’re not doing anything,” Pittman said. “But we’re really letting the natural process play out and heal naturally, and then we come in and definitely follow up and do what we need to do.”

She added, however, that “if it’s something high-risk, like suicide, we’re not going to sit back.”

‘90% boredom and 10% panic’

A key element of the fire service culture, and one that is often evident when it comes to behavioral issues, experts and researchers say, is alcohol.

“In any profession that is 90% boredom and 10% panic, which is the fire department, it pulls toward substance abuse,” said Haddock, co-author of the 2022 study, Norms about Alcohol Use among US Firefighters. “They see everybody’s trauma, and it’s traumatic. You know, as humans, we experience trauma by watching other people going through a trauma.”

The fire service has a long history of alcohol use, Haddock said. The profession initially had been a blue-collar job, and in its origins in the Northeast, going to the pub and drinking after a long day of work was customary.

Today, Haddock said, he no longer considers the fire service a blue-collar occupation.

“In most places, firefighters are highly educated,” he said. “They’re paramedics, and most of them have college degrees. Many of them have master’s. I consider it a white-collar occupation with blue-collar roots, really, at this point.

“But it still retained that blue-collar background … to where the bar and the pub became part of the culture. So, you know, when the kids graduate from high school or college and go into the fire service, that’s what they’re met with. When you join that society, you’re joining a society of people who celebrate partially through drinking. I think in some places that’s changing. Evidently, Kansas City is not one of the places.”

The culture surrounding the use of alcohol has diminished in younger generations, at least anecdotally, Haddock said. But it is “ingrained” in social elements that surround the fire departments.

“One of the themes that came up in interviews we did with firefighters is how ingrained alcohol is in the social culture of the fire service,” Haddock said. “When they have weddings, or when they have promotions, or retirements, it would be unthinkable not to have a heavy consumption of alcohol as part of that.”

Haddock said his research team found that firefighters have among the highest rates of alcohol use of any profession, with somewhere around half of firefighters reporting a binge episode in the past month.

During their interviews, Haddock said the researchers found a lack of recognition by firefighters that their consumption levels were considered excessive.

“When we would explain to them what the medical definition of a binge drink was, we would sometimes get laughter,” he said. “And I think the laughter was just, it was so shocking to them. It wasn’t that they were being dismissive of it. It was like, ‘Are you kidding? That’s every day.’

“I think they thought that was an absurdly low number.”

Haddock and his colleagues have since transitioned their research into sleep issues, partially because it’s an area that is impacted by alcohol use.

“So one of the hooks we were trying to use in some of our intervention research was to let them know that alcohol impacted all the other things they’re worried about, including sleep, fitness, body composition,” Haddock said. “When you’re used to being woken up in the middle of the night by a blaring alarm, it kind of jacks up your sense of nervous system.

“And sometimes that even bleeds over into their home life, where they’re hyper vigilant during sleep, because they know they may have to go on a call at any time.”

A form of self-medication

Varone, who became a firefighter in the 1970s, manages an online site called Fire Law Blog that features stories from across the country about legal issues involving the fire service. There’s no shortage of articles that highlight behavioral and mental health problems — among them, alcohol abuse.

“Early in my career, drinking in firehouses was a common practice,” Varone said. “That was just the way it was, and it was part of our culture.”

He said the New York City Fire Department, or FDNY, “has had an enormous problem dealing with alcoholism.”

“Going back into the 1930s and 40s, the fire department rules and regulations allowed firefighters to have a beer with each meal,” he said. “So certainly not anything recent, but nonetheless, when alcohol becomes part of an organization’s culture, and you tell new firefighters ‘no drinking, no drinking, no drinking,’ and then their first day in the fire station, somebody hands them a beer, it becomes accepted.”

While the fire service “has come a long way in the last 20 to 30 years with regard to alcohol,” Varone said, drinking remains a form of self-medication for the trauma and stress those in the profession endure on the job.

“And if somebody’s been arrested, it’s a symptom of a deeper problem,” he said. “So let’s get the person the resources that we can.

“But if we treat it strictly as a disciplinary matter, and we just punish them, then that’s the end of it until the next time. And that doesn’t address what led to it.”

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