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Think about your first day on the job as a firefighter.

You’re in your 20s, and maybe you play football or baseball on top of working out three to five days a week. The soreness you felt from wearing the gear and lugging around ladders and hoses all day was a good soreness. Now fast-forward 15 or 25 years into your career, and think about how you feel when you get up in the morning. Do aches and pains slow your ability to get out of bed? Do you have an ankle injury, a bad back or an injured shoulder or neck?

Injuries and the fire service go hand in hand, no matter how much we don’t like to talk about that. The gear alone weighs about 50 pounds, not to mention the running, lifting and climbing in all types of weather across various terrains by ourselves or while rescuing other people. Eventually, something’s going to give. And we have some data to back that up.

The National Fire Protection Agency, based on its 2014 National Fire Experience Survey, estimated that 63,350 firefighter injuries occurred during fireground operations in 2014. In more than half of those cases (52.6 percent), the leading type of injury was strain, sprain or muscular pain.

But when an injury occurs, do you actually go on medical leave, or do you work through the pain? My guess is that most of us, for a variety of reasons, work through the injury because we don’t want to be seen as weak. Most of us also have side jobs that we work to assist in paying the bills and the mortgage, so staying home from the fire house means staying home from the side job, too.

When we opt to not stay home and properly heal, the process of managing the pain from our injuries has to be a priority. Some people stretch, take aspirin or ibuprofen. Others use prescription painkillers to manage the pain. Some of the latter group starts to abuse those drugs and make things more dangerous by mixing in alcohol. The body naturally builds up a tolerance to those painkillers, so we take more, whatever we can do to feel normal and feel better. Those who don’t have a confidant, a good doctor or a program that explains how dangerous this path can become may find themselves struggling with substance abuse to numb the physical and mental pain they’re experiencing.

That’s one of the many reasons I worked with Rosecrance in Rockford, Illinois, to create the Florian Program, which offers an inpatient treatment unit specifically for firefighters and paramedics struggling with substance abuse and job-related post-traumatic stress disorder, anxiety and depression. Rosecrance Florian provides a platform to discuss the importance of behavioral health education and peer support within the fire service, and we’ve organized and participated in some amazing discussions and forums across the country within the past year.

Injuries involve both physical and mental hurdles that people have to overcome. So, safety training has to include not only the physical nature of our jobs but also how to safely manage and recover from an injury. For example, a doctor’s advice to take painkillers “as needed” can be interpreted many different ways: That could mean one pill every six hours for you but one pill every two hours for me, based on how we tolerate pain. Pain is relative, so education about medication is critical, especially when visits to the doctor often seem like they’re over as soon as they start and prescriptions include powerful drugs such as oxycodone, codeine and Vicodin.

We can be another line of defense for our brothers and sisters who may be struggling with injury-related substance abuse. Better training can help us recognize the signs and symptoms of abuse so we can refer the person in need to peer support or the fire department’s employee assistance program before the problem gets out of control. It’s important to help people dealing with chronic pain understand and live with their new reality: that their pain is never going away and their jobs as firefighters may be over. Experiencing the loss of quality of life and a job requires serious mental health support.

Take the case of Frank Farias, a longtime friend and fellow firefighter with the Chicago Fire Department. Frank is an extremely gracious person who volunteers as a member of our Florian Program Advisory Committee and meets with our clients during their inpatient stays to offer peer support.

Frank’s history with injuries started with a routine medical call back in 2004. He was on an ambulance rotation picking up a patient who slipped and fell at a fast-food restaurant. As Frank and his partner were lifting the patient onto a stretcher, the 350-pound man slid toward Frank, Frank grabbed him and ended up wrenching his back. He got some X-rays and pain pills at the hospital and was down for about two days. But then it was back to work, kid.

“And I wanted to get back to work,” he said. “Whether we’ve got a side job or it’s pride, most (firefighters) want to get back to work because we’re trying to provide a better life for our families and for ourselves. There’s a pressure to get back.”

Frank hurt his back on a simple, easy run. But subsequent injuries affected him both physically and mentally.

A serious fire in December 2005 at a store in Roscoe Village took out several guys with carbon monoxide poisoning. The fire was in the store’s basement where boxes lined the walls from floor to ceiling. As the guys later found out, those boxes were filled with ammonia, bleach and cheap plastic toys – not a good combination.

“Guys were dropping like flies,” Frank vividly recalled. He spent five days in the hospital, and several guys spent more time in hyperbaric chambers to help them recover. Frank developed environmental asthma and short-term memory complications from that event. And to this day – like we all do with certain fires and rescues – he tells the story with such detail that it sounds like it happened yesterday.

Fast-forward to 2008, when Frank was helping fight a fire at a tall, brick apartment building. As he and his partner were searching above the fire floor, a bed, a window and a windowsill came crashing down from above and landed on Frank. He bounced up and threw the stuff off of him, thanks to the adrenaline pumping through his body. But he later found out that the accident herniated five discs in his back and tore his shoulder out of the socket. Had he not been wearing his oxygen tank, he would have snapped in half.

A few years ago after returning to the job, Frank was pulled off of a landing and fell down 25 stairs, resulting in two career-ending injuries (broken back and torn left hip labrum). That’s when the self-medicating started because it became harder to live with the chronic pain from all of those injuries. He was drinking and entered a dark depression, but he knew well enough to reach out for help from his friends. Frank sought out psychiatric help and was eventually diagnosed with post-traumatic stress disorder. He went on disability and off the job for good about two years ago.

“It’s hard to not go back to work, but as I speak to other people about what happened and do peer work, it’s therapeutic and another notch in my belt toward recovery,” he said.

Frank’s working to start a foundation that would help firefighters struggling with a variety of issues, including mental illness and substance abuse. He’s an avid fisherman and wants to use fishing to help others recover.

You also might know John Walters’ story. John started in 1986 as a volunteer firefighter in Port Washington, New York. He joined the New York City Fire Department in 1995, working his way up to special operations and then to the famed Rescue 1 in Manhattan. John, like many FDNY firefighters, experienced immense loss after the 9/11 attacks. He suffered burns while fighting a fire in 2002 and had part of his right leg amputated after a taxi cab crashed into the back of his fire truck.

John’s only 47, but his injury forced early retirement from FDNY. He enjoys visiting his old fire station but doesn’t make it a regular thing.

“It’s like the gravy, but you’re missing the meat-and-potatoes part of the meal,” he said. “I love going to the fire house, but it’s easier not to go. It’s not like I have a mental block or a phobia when I see it. It’s just depressing; I want to get on that damn truck every time. I’d rather turn the page and move into a new set of challenges.”

John now lives in Myrtle Beach, South Carolina, and works with former Navy SEAL Ryan Parrott at Sons of the Flag, a nonprofit resource for burn survivors. He presented at FDIC 2016 this year about how to deal with major line of duty injuries and as part of a leadership panel discussion (which I am fortunate enough to moderate) with other experts on substance abuse and mental health.

John was gracious enough to attend our Florian Program Advisory Committee meeting back in July. He spoke about his experiences and is open about the six weeks he spent at Rosecrance last year when he was struggling with his own personal health issues. He ended up being a big help to me as we were launching Florian, and he mentored many of the young men in treatment for substance use.

“I lead by example because it’s the only thing I know how to do,” John said. “When you have something happen to you and it’s not on your terms, it’s beyond difficult to deal with. Under normal circumstances, that’s difficult to deal with. But when you’re a firefighter, your brain doesn’t turn off. You have to fill that void somehow.”

John is a big supporter of the peer support structure we use for Florian. He and I have talked a lot about the two-pronged problem we have within the fire service: retirees who become fish out of water when they leave the fire service after so many years and younger people derailed from service because of injuries or behavioral health struggles. Pairing retirees with Florian clients for peer support sessions is a great way to address both issues.

Another CFD colleague of mine embraced that camaraderie and brotherhood in the Florian Program. This brave coworker came to Rosecrance for help with substance abuse and mental health.

Social drinking with the guys had turned into isolated drinking to numb the pain we experience from seeing tragedy every day on the job. After addressing his alcoholism, my friend returned to work but was hit with a major back injury that resulted in surgery and chronic pain. He was only 33, but the simple act of playing with his children left him in agony.

Doctors prescribed pain medications, but he knew use could quickly turn into abuse. He was depressed, and his sobriety was in serious danger. So he came back to Rosecrance, and I encouraged him to stay.

“I wasn’t there again because I was abusing alcohol,” he recalled. “I was there because the Florian Program would save my life again. The discussions, the walks around the track, the meetings, the meals outside, the brotherhood – all of these things brought me up, put my head on right and brought me back to who I am. And no matter what happens, God has a plan for me.”

My valued coworker and friend recognized that it’s OK to drop your guard and be open and honest about your struggles because the person sitting next to you likely has experienced the same pains. Most of us in the fire service are not good at being patients, which is a contradiction because we expect people to listen to us and be good patients themselves. Let’s take steps to follow our own advice more often.

Of course, these are just a few instances where the job has had a significant or detrimental effect on firefighters. I know there are many more out there who are managing pain, discomfort and recurring injury on their own. You don't have to do it alone – there are peers and professionals who can provide support.

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