In a job where so many of the dangers are obvious, firefighting also has a few hidden ones that are often not spoken about.
In a post 9/11 world, the first responder community has finally begun to embrace the presence of trauma within its ranks. Once regarded as a military-specific diagnosis, post-traumatic stress has been proven to affect significant percentages of firefighters, from young rookies to seasoned veterans.
Where There’s Smoke
Some 150 years ago, firefighting was pretty much that. Battling and extinguishing fires. These days, firefighters’ duties and the types of emergencies they respond to land on a much broader spectrum.
From motor vehicle collisions and medicals, to fire alarm activations, building and wildland fires and even house lockouts, the variety of what we respond to is almost never ending. Add to these trainings, inspections, vehicle checks, public education, and administrative duties, and it’s really no surprise that stress is a main component of the job.
However, until recently, most in the job quietly denied the existence of the “unseen” danger lurking in everything we do day-to-day.
Stress and trauma.
Burnout
The Mayo Clinic defines burnout as a type of work-related stress characterized by emotional or physical exhaustion, and a reduced sense of accomplishment.
In the past, it has been given less attention than PTSD, however burnout is likely more common in firefighters than most think. The defining difference is that PTSD almost always involves a life-threatening event, whereas that is absent in burnout.
Think about it.
How many of us or our co-workers have been through moments of genuine mental, emotional, and physical fatigue or exhaustion where we lose our identity and struggle to feel like what we do matters?
Some of the other signs and symptoms of burnout include:
- Lack of interest or motivation
- Forgetfulness
- Hopelessness
- Procrastination
- Exhaustion
- Cynicism at work
- Anger or irritability
- Inconsistent sleep habits
Moral Injury
The National Center for PTSD defines moral injury as the psychological harm that results from a betrayal of one’s core moral beliefs or values, such as witnessing or perpetrating acts that violate one’s conscience. Symptoms typically include guilt, shame, and withdrawal, and again it differs from PTSD in that it’s focused on ethical violations rather than fear.
With a lot of what firefighters do and see day-to-day, our own morals and ethics get challenged both on the street and, at times, with administrative decisions and actions. Even the act of refraining from “lifesaving” care to a patient while acting according to our medical protocols or doctor’s orders, can result in moral injury.
Some of the other signs and symptoms for moral injury include:
- Self-hatred
- Despair
- Anger
- Hopelessness
- Moral confusion
- Substance abuse
- Poor self-care
- Recklessness
- Difficulty concentrating
- Change in outlook on the world
Compassion Fatigue
Before we get to defining what compassion fatigue is, I’m just going to go ahead and say I feel a large percentage of firefighters have this condition.
Psychology Today defines this condition as the emotional and physical exhaustion caused by prolonged exposure to trauma and suffering while helping others, leading to a diminished ability to empathize and support those in need.
Literally all of the duties of our job line a majority of us up to experience the symptoms of compassion fatigue if we’re not cognizant of it.
Some of those symptoms include:
- Exhaustion
- Disrupted sleep
- Anxiety
- Headache
- Upset stomach
- Irritability
- Numbness
- Decreased sense of purpose
- Emotional disconnection
- Self-contempt
Post Traumatic Stress Disorder (PTSD)
The “big bad” one in the group that typically gets all the attention is post traumatic stress disorder or PTSD. In recent years, a lot of those in the psychological world have begun to replace disorder with injury since, from a scientific perspective, post-traumatic stress is an injury.
Regardless of what letter ends the acronym, PTSD is a serious condition that has certain criteria that needs to be met in order to make the diagnosis.
The National Institute of Mental Health states that criteria as exposure to a traumatic event, followed by intrusive re-experiencing of the event (flashbacks), avoidance of trauma-related reminders, negative changes in thoughts and mood (blame, detachment), and marked alterations in arousal and reactivity (hypervigilance, sleep disturbance). These symptoms must last for more than one month, cause significant distress, and interfere with daily life, and not be attributable to medication or other illnesses.
The list of overall symptoms can be extensive and is derived from the above criteria. However, with the acceptance of the existence of trauma and the fact it can affect firefighters, there are some misnomers to put to rest.
Not Everyone Gets It
First of all, just because you get exposed to an event that could be classified as traumatic, stressful or even life-threatening, does NOT mean you have burnout, moral injury, compassion fatigue, or PTSD.
It’s important to learn about all four, especially staying aware of the symptoms, but what’s more important is being in touch with your own disposition and any changes in your behaviors.
The reason for this is that two people can be exposed to the same event and be affected by it completely differently. Being aware of your own mental, emotional, and physical states is key to staying on top of any changes that result from experiencing a stressful or traumatic event.
The next step, and just as important, is education on the other dangers of the job we do day in and out – the hidden ones that are often not spoken about that can cause just as much harm, and even cost you the career you love.
It’s time the fire service took mental health and wellness more seriously, and that starts with knowing the difference between burnout, moral injury, compassion fatigue, and PTSD. With that knowledge, the path is paved for a more healthy and successful career, along with personal life.
