Hey Medics and EMT’s. Can you imagine actually responding to a call with a known Opiate user who is OD’d and saying — to his or her loved ones, “Nope we can’t give you narcan because we’ve responded more than three times. So, he is just going to have to die. . . .
This would be the impact of one of the ideas floating around in the country now. It’s ethical wrong and a moral nightmare for us. The politician can get all righteous but it will be us refusing to treat. Think about it.
(A version of this article appeared in the NVFC Helpletter.)
If this hasn’t happened to you as a volunteer fire department officer, it probably will.
It goes something like this. First, there is a high-speed head-on collision with fatalities. All the dead are children in their teens. There is the dedicated and hard work of extrication of the injured, then the waiting for the Medical Investigators to show up before the deceased can be removed and placed in body bags. You are fiercely proud of your department.
But then, one of the younger guys stops what he is doing and says, “Hey, I think I know these kids . . . I gotta call my girlfriend.”
He walks off.
Another, who said he just couldn’t help with the bodies, is staring off into space.
A few months later, one of the department veterans says to you, “I keep having dreams. . . are we sure they were dead? They just looked like they were sleeping . . .”
My question to you, the volunteer officer, is what do you do? What is your game plan?
Post Traumatic Stress Disorder
The Word “Disorder”
”Disorder” is the disruption of the systematic functioning or neat arrangement of . . .
In the talks I give, I add that it’s the disruption of the neat arrangement of your life! It might be minor and short and long and acute, but certainly feels like disruption.
PTSD IS LIFE INTERRUPTED BY SIGNIFICANT TRAUMA.”
KATHLEEN CHARD, PhD
The Rural Volunteer and PTSD
After a particularly bad mutual-aid call, a friend of mine who is a career paramedic said that the conversation at their station that evening was, “how do volunteers cope with these calls?”
Her point was that a career crew went back to their station together and they talked about the call. The city department had infrastructure for these situations, they had a wellness officer, insurance, health benefits, and the union.
But what does the average, rural volunteer department have?
Probably very little.
And yet, volunteers are in many ways more at risk for PTSD. When you’re a career firefighter, you show up for your shift and you mentally “get in the game.” There is some psychological protection there. But for volunteers, especially the small departments who are “on” 24/7, you never know when the pager is going to tone out and what you’re going to find. We often go from “civilian” to dealing with mass casualties in the space of a few minutes.
Finally, the essence of being a volunteer is that we work in our community, we are there for our friends and neighbors. The cardiac arrest call at 1:00am could well be your neighbors. The DUI crash fatality might be the best friend of your son’s.
The Game Plan
1. Educate, educate!
The most important action we can take is to educate our departments. Just as we are trained on infectious diseases we also need to be trained in PTSD, what it is, what the symptoms are and what help is available. PTSD training needs to be part of our annual curriculum. The National Volunteer Fire Council (NFVC) has virtual courses on both Behavioral Health and Suicide Prevention that can be used and adapted for any fire department.
Our task as leaders is to “be the change we want to create.” With PTSD, we need to be open about it, talk about it and be clear that, like having the flu, there is no stigma attached; it can happen to anyone, including you.
3. Know your people
As leaders, we need to know our people. How do individuals normally respond in crisis? What does it look like when it’s “not normal?” When Ellen, the steady, every-call Firefighter-EMT stops showing up, do you know why? When Bill, the ebullient guy always with a joke, clams up, is it because he’s just tired or is he playing the movie-in-his-mind about extricating the dead mom?
4. Sobriety and Sleep!
Believe it or not, one of the most simple and effective ways we can help is to make sure that firefighters involved in an incident are getting sleep and staying sober.
5. Know Your Resources
There are several ways to help depending on the individuals, the severity of the trauma they’ve experienced and the symptoms presenting.
On our department, we often start with just talking about it among ourselves or talking to firefighters individually. These sessions are mostly about officers listening, rather than sharing war-stories.
If anyone on the department believes it is warranted, our next step is a Voluntary Critical Incident Stress Debriefing. It is crucial that it’s voluntary. For some individuals, sitting around and reliving the scene with a group will just make the symptoms worse.
Next, the National Volunteer Fire Council has a 24/7 helpline for firefighters and families of firefighters. (1-888-731-FIRE (3473). They can point you towards a variety of resources to help.
Finally, there are a variety of emerging therapies and clinicians who deal specifically with PTSD. It’s a good idea to have a couple of phone numbers of specialists who can help in a crisis, especially concerning substance abuse and suicide prevention.
A wise ex-chief once lectured our department, “If you want to be 100% safe, turn off your pager.” Being a firefighter, even in a small town, carries inherent risks, which we all accept as part of the vocation. On the other hand, as officers, our number one responsibility is to keep our people safe. We focus on physical safety every day; keeping a watchful eye whether our team is on the highway at midnight or at a wildfire in the midday sun. But we also have a moral imperative to keep our firefighters safe from the effects of emotional trauma.
We have a moral imperative to keep our firefighters safe from the effects of emotional trauma.
It is not a simple thing to be a volunteer fire department officer. But we must never let anything get in the way of our first duty, to keep our folks healthy, physically and mentally, and to make sure they get safely home after every call.
Know the science about PTSD. Have a game plan. Take care of yourself and your department. Be Brave! Be kind! Be safe!Photo courtesy of Lauralee Veitch. Amazing Art courtesy of Daniel Sundahl. (Dansun.com)
Earlier this month I introduced Who We Are, a series of videos in which I interview firefighters about their experiences. It’s a cause close to my heart.
My most recent video is an interview with Jean Moya, the chief of theGalisteo Fire & Rescue Division. When Jean realized there was no department in her area, she started one:
Just like that.
Just like us, he was in his thirties, with a young family.
Our patient stared stoically at the sky.
We shaded his eyes and gave him sips of water. We, the firefighters, kept looking at each other. We had the sinking feeling that nothing we or the trauma team could do would change the outcome.
At the trailhead, we transferred him to our Med Unit and began the slow drive over rutted roads to the hospital. Our paramedic drew a line on his belly that demarcated the parts of his body where he had sensation and where sensation stopped. She wrote the date and the time by the line.
Later that evening, two of us went to visit him in the intensive care unit. The neurologist, who was a friend, confirmed our fears: She told us that he had severed his spinal cord and was now a paraplegic. We went into his room. He was flat on the bed with a big halo head stabilizer holding his head steady. He was staring at the ceiling — there was not much else he could do. He moved his eyes as we came in. Seeing us, he whispered, “Just kill me.” Dan and I looked at each other. We talked for a while and as we left Dan whispered, “This sucks.”
“Traumatic injury. Man fell off bike.”
My heart leapt to my throat. I was only a block or so away. I sped to the scene. As I slid into the driveway, another car came in right behind me.There was a man down on the driveway, bike next to him. He had a helmet on, but he was still. Before I could reach him, his 4-year-old daughter ran by me and jumped into his arms. Startled, he sat up. I watched — in one of those moments when time itself slows down — as his arms came up to hug her.
“Daddy, daddy,” the girl cried. “Are you okay?”
“I’m fine,” he said, “I guess I was just scared.”
And he started to cry. The little girl cried. As did I.
Our Med Unit pulled in and we treated the dad as if he were the most fragile patient we’d ever had. I kept asking him to move his hands and feet. He would smile, comply and tell me he was fine. At the ED, they took an X-ray of his neck and declared him fracture free. He’d just had a concussion.
“Chance happeneth to them all”
It’s written in Ecclesiastes that “. . . chance happeneth to them all.” But we don’t believe that, not deep in our bellies. We think there is order and reason in our lives. We think we are in control. At the same time we pray, we have Saint Christopher medals and totems to protect us, we trust our superstitions.
But we are only clever apes, standing on this spinning rocky ball in a universe that has rules we don’t understand, mysteries we cannot yet grasp. But chaos is everywhere. Chance is baked into the cosmos. (One father a paraplegic, another holding his daughter and weeping in relief.)
We can’t always grasp this because our sense of time and space is so fractional, so limited. We live in the interludes between chaos and think this is how the universe works. And then something happens. Something “out of the blue.” (I have no feeling in my legs. A terrified child running to you.) And for an instant we glimpse the implacable face of the universe as it really is.
What can we do? Only this: ten of us carefully carry another over the rocks. A little girl, at the speed of light, leaps into father’s loving — and moving — arms. We carry each other. We jump into the arms of those we love.
A few years ago, I decided to talk to the other volunteers in my firefighting department about their experiences. Why did they become volunteers? How did firefighting change them? What did volunteering mean to them?
I’m sharing some of the videos now as part of a series I’m calling Firefighters: Who We Are. You may have seen some of them on my Facebook page. Some have also been shared by the National Volunteer Firefighter Council.
Now I’m sharing some of them on this blog.
This first interview is with my friend and mentor Sheila Beuler. Sheila was a volunteer with the Hondo fire district, my department, before she was hired by the Santa Fe City Fire Department as a career firefighter and paramedic. She recently retired as a Captain after 20 years.
In this video, Sheila talks about a call early in her career that dramatically changed her view of life.
”How do you defeat terrorism? Don’t be terrorized.” – Salman Rushdie
Thoughts on Fear, Facts, and Leaders
Two 60-plus-years-old, 30-year veteran firefighters worried about driving.
The odds of being killed in a crash in New Mexico hadn’t changed, but for both of us a switch had flipped in our brains that made it feel like we could be next.
In our normal day-to-day lives, we are not great at assessing probability. Add fear, sprinkle in a little shock and we truly suck at it. That simple fact has allowed demagogues to manipulate populations since the beginning of humankind.
A highly charged and terrifying scene had hijacked my mind.
Assessing the Odds
From an evolutionary point of view it makes sense that we don’t think probabilistically. We evolved to make quick decisions that kept us alive. While the rest of the tribe bolted for the hills, the early Homo sapiens who paused and wondered, “Huh, what is the probability of that noise being a leopard?” did not survive to pass on his or her Spock-like genes.
In our more complicated and nuanced world, the inability to understand risk not only leads to bad decisions – it makes us easily manipulated.
But driving home from that crash probability went out the window. Why? Because I was afraid. When we’re afraid, our already tenuous grasp on what is a threat and what is not evaporates. When we are afraid, we are the tribe bolting for the hills in fear of the leopard. When we are afraid, it makes sense to intern Japanese-Americans. When we are afraid, there are Communists in every classroom. When we are afraid, it’s easy to convince us that terrorists are lurking in malls.
And I confess that on that night, after observing that fatal, alcohol-induced crash, I was afraid. I saw those lights coming at me and I was sure it was another drunk driver on my side of the road.
On Fear and Manipulation
Their task today is made easier by media sources that 24/7 inundate us with images and stories that cause the same kind of anxiety I felt that night. They show the image of a woman killed by an illegal immigrant, powerful and tragic, and the message is that this could — no, probably will — happen to you. Or endless looping images of a terrorist bombing and shooting in France and the not-too-subtle message that this will soon be happening here. Nowhere in these stories is the contravening data: “The chance of an American being murdered in a terrorist attack caused by a refugee is 1 in 3.64 billion per year while the chance of being murdered in an attack committed by an illegal immigrant is an astronomical 1 in 10.9 billion per year.” (Terror and Immigration: A Risk Analysis, Alex Nowrasteh The Cato Institute, 9/13/17. Issue #798)
Although I’m not sure that information streaming across a screen would help. Data and numbers (also known as facts) seem overwhelmed in the brain by images, be they of a terrible car crash or the aftermath of a terrorist bombing.
We Can Help Each Other Through Fear
As a country, we need leadership. But note that there are two kinds of leaders.
There are leaders who tell us to be afraid. And there are leaders who call on us be to brave.
Finally, there was Franklin Delano Roosevelt, who spoke to Americans during another dark time, deep in the Great Depression, when unemployment was near 30 percent and there was terrible unrest domestically and in Europe. At his inauguration in 1933, he not only called out fear, he named it: “First of all, let me assert my firm belief that the only thing we have to fear is — fear itself — nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.
Nameless, unreasoning and unjustified terror.
We will always have moments that will terrify us. It is a cost of being human. But we must work hard to not let terror paralyze us, whether it is the fear of drunk drivers stopping us from driving or the fear of the stranger causing us to hate. We don’t have to live in fear and we must fight being governed by terror.