The Veteran Firefighter and Post Traumatic Stress Disorder

  In the course of over a decade of continuous war, America’s soldiers, sailors, Marines and airmen have served in nearly every climate and conflict type imaginable, from the burning sands to the frozen peaks of mountains. By now, most Americans are aware of the concept of PTSD, or Post-Traumatic Stress Disorder.  Once known as “shell shock” or “battle fatigue”, PTSD is now recognized by the American Psychiatric Association in the DSM-5 as a psychiatric disorder.  It is increasingly recognized as being prevalent among both veterans, and first responders such as firefighters. 

  Firefighting is one of the most popular careers for returning veterans, alongside law enforcement and security work. Many veterans are attracted to the disciplined environment, the feeling of worthwhile accomplishment, the sense of camaraderie, and even the adrenaline rush from a successful call.  In many ways, firefighting culture and military culture share common ground - the attitude of self-sacrifice and the ethos of protecting one another: “you get my back, I’ll get yours”. However, both firefighters and veterans are at a greatly increased risk of developing PTSD, and are also more likely to attempt to hide their suffering and deal with it personally.  In this article, we will address the issue of PTSD amongst veterans serving as firefighters, and what to do if you feel you are showing symptoms. 

What is PTSD?

The Diagnostic and Statistical Manual of Mental Disorders is the American Psychiatric Association’s handbook for treatment specialists, outlining the criteria and major symptoms for each mental disorder.  The criteria for PTSD is broken down into 8 sections, labeled A through H.  It is worth analyzing this definition in order to gain a more thorough understanding of the disorder.  

Criterion A addresses the experience of trauma, which must include actual or threatened death, violence or injury.  The violence or injury can take any form, so long as it represents a serious threat to life and limb - this is why we see PTSD among both soldiers and victims of abusive relationships.  Furthermore, Criterion A stipulates the different ways by which this trauma can be experience:

• Direct exposure (ie, the injury happens to you)
• Witnessing the trauma
• Learning that a close friend or relative was exposed to trauma
• Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

The last is perhaps of the most interest to firefighters and medics, as they are extremely likely to experience these conditions while on the job, as well as witnessing trauma first-hand.

Criterion B addresses the ways in which the traumatic event is relived, which is one of the hallmarks of the disorder.  To qualify as a PTSD sufferer, the trauma victim must experience at least one of the following:

• Intrusive thoughts
• Nightmares
• Flashbacks
• Emotional distress after exposure to traumatic reminders
• Physical reactivity after exposure to traumatic reminders

 All of these seem to be fairly common to PTSD sufferers, although of course everyone reacts differently.  These are something to watch out for in a first responder, as the day-to-day realities of the job will often bring reminders of past trauma.  Pay attention if a colleague expresses that they have been having work-related nightmares - sometimes colloquially referred to as “work dreams”. 

Criterion C stipulates simply that the sufferer will avoid circumstances that replicate the trauma.  

Criterion D gets into the psychological ramifications.  Here, we begin to see some of the symptoms that may be readily recognizable to coworkers, although these are primarily internal feelings.  The sufferer must experience at least two of the following:

• Inability to recall key features of the trauma
• Overly negative thoughts and assumptions about oneself or the world
• Exaggerated blame of self or others for causing the trauma
• Negative affect (meaning persistent negative feelings)
• Decreased interest in activities
• Feeling isolated
• Difficulty experiencing positive affect

You are more likely to notice these effects in someone else through conversation, or careful observation throughout the day.  Some of these appear very similar to the symptoms of other disorders such as depression, which can make identification difficult.  This is one reason to always be respectful and open-minded when talking with a colleague about what’s going on in their mind - it can be difficult to know what someone else may be going through, and making assumptions can be counter-productive.  

Criterion E deals more with visible reactions, which you are likely to notice in a fellow firefighter.  Specifically, most of these are reactions to stress.  Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

• Irritability or aggression
• Risky or destructive behavior
• Hypervigilance
• Heightened startle reaction
• Difficulty concentrating
• Difficulty sleeping

Again, it is important to remember that just because you or a coworker suffers from a few of these symptoms, it does not necessarily indicate that you are a PTSD sufferer.  However, when the individual begins to display multiple symptoms from multiple criteria, it becomes a cause for concern.

The remaining 3 criteria are simpler, and can be summed up in a sentence each.  Criterion F states that the symptoms must persist for at least 1 month.  Criterion G states that the symptoms must create distress or impairment.  And Criterion H states that the symptoms must occur independently of other illnesses (eg, depression) or substance use (eg, alcohol).

Firefighters, Veterans & PTSD

PTSD research has been conducted steadily since the Vietnam era, particularly recently in the wake of the wars in Iraq and Afghanistan.  PTSD is a major and ongoing issue, and unfortunately one that remains somewhat murky.  Like all psychiatric conditions, PTSD is highly variable in aspect and is different for every individual.  In addition, some sources suggest that returning veterans may chronically under-report their own experience of the disorder.  Both firefighting and military culture stresses stoicism, and for this reason, PTSD sufferers may hesitate to report their condition due to a desire to seem tough and confident. 

Different studies have reported different rates of PTSD among veterans, varying from 14% to 30% (compared to roughly 4% among civilians).  Moreover, studies indicate that 50% of sufferers will never self-report.  The rate of PTSD is by far the highest among Army servicemembers, who make up 67% of military PTSD sufferers.  Rates are also much higher for those who suffer injuries, particularly brain injuries.  7% of veterans have both brain injuries and PTSD.  Those who suffer from PTSD are far more likely to develop additional disorders such as major depression, as well as substance abuse issues such as alcoholism. They are also far more at risk for suicide.

The United States has continued to attempt to approve its infrastructure for returning veterans with PTSD, but in many cases, care remains nominal.  50% of PTSD sufferers never seek treatment; only 25% will actually receive adequate treatment.  The remainder will bounce around from one healthcare provider to another, often being given the run-around by insurance companies or the VA, and often forced to pay exorbitant fees.  Many will become frustrated and stop seeking treatment.

The rates of PTSD prevalence among firefighters is even less clear, and seems to be somewhere between 7% and 37%.  There is currently no national organization which tracks the occurrence of PTSD among firefighters, and there have not been as many studies as there have been regarding veterans.  We know that it is a problem, but so far the solution has been left to individual departments and agencies to address.  Many programs have put an increased emphasis on After Action Reviews and providing mental health training to supervisors, as well as placing an increased cultural emphasis on the reality of the disorder. 

When you get two groups of people who already suffer from vastly increased rates of PTSD, and put them together, you have a recipe for a high risk.  Statistics for PTSD among military veteran firefighters are few, but we can extrapolate some conclusions based on the available evidence.  We know that firefighting itself can often be a source of trauma; in addition, we know that a significant percentage of veterans are already carrying trauma around with them, often without diagnosis.  We know from the DSM-5 criteria that exposure to trauma can often trigger PTSD symptoms.  Therefore, it is reasonable to assume that veterans who work as firefighters would be at greater risk. 

Although PTSD is a serious issue, there is hope. Many sufferers are treated successfully and are able to overcome their trauma to lead fulfilling, meaningful lives. However, successful treatment depends on quality professional care and timely identification of the issue.  

Join us Thursdays for the Thinline Online Recovery Meeting from Lionrock Recovery

First Responders who are or have struggled with mental health or behavioral health issues can join us every Thursday at 20:00 EST/17:00 PST. The meeting is entirely online via live secure video conference and is free of charge.

Direct Link at the time: http://bit.ly/ResponderRecovery

Lionrock Meeting link under Thursday: https://www.lionrockrecovery.com/online-aa-meetings-and-support-groups

 Sources

http://www.ptsd.va.gov/professional/PTSD-overview/dsm5_criteria_pts... PTSD: National Center for PTSD, PTSD and DSM-5

http://www.veteransandptsd.com/PTSD-statistics.html Veterans and PTSD, Veterans statistics: PTSD, Depression, TBI, Suicide.

About The Author 

Mark Lamplugh is a fourth-generation firefighter and former captain with the Lower Chichester (PA) Fire Company. Mark is President of the board for the Institute for Responder Wellness.  Mark owns Influence Media Solutions  which is his own Marketing, Public Relations, Digital Marketing, Branding, Business Development and Social Media company. He advises companies such Lionrock Recovery about first responder programs.. He just published his first book “Beginners Guide to Digital & Social Media” which is available on Amazon. Mark is a professional advocate for the behavioral and mental health of firefighters and other first responders. He’s been involved in the creation of several responder specific treatment programs and is one of the leading experts in bringing these programs to responders.  Lamplugh hosts his own talk show called "Firefighter Wellness Radio". He has published dozens of articles on responder wellness topics and is recognized by the American Acadamy of Experts in Traumatic Stress. He has helped hundreds of responders with getting help for behavioral & mental health issues. He can be reached for comment at ceo@influencemediasolutions.com