by Dave Papandrea, LLC, NCC

Dave Papandrea is a Limited Licensed Counselor (LLC) in private practice at Trinity Family Counseling Center. Dave’s personal counseling philosophy is that he is a traveler on YOUR journey.  He believes YOU are the expert of you, and that the power of change is already within you.  It is his goal to walk with you on your journey to wellness, allowing you to lead at your own pace, hoping to point out items in your blind spots along the way.

For a young firefighter, the senior man with their sooted gear and burned up helmet was the ultimate symbol of experience.  Trial by fire quite literally.  But as firefighters learned more about cancer rates, they realized these public displays of heroism were feeding cancer cells in their bodies and cutting retirements short.  They keep their gear cleaner now to avoid the deadly disease.  
 
Like the sooty gear, trauma experiences have replaced the visual display of experiences obtained throughout the years.  Speaking openly and candidly about critical incidents and associated mental trauma is becoming more commonplace.  
 
But humans, before becoming superheroes, have a life story.  Some stories are wealthy in rich experiences involving a loving, supportive family with normal attachments having achieved normal developmental milestones.  While others have a darker tale.  
 
Frequently, a professional rescuer’s trauma history does not begin on graduation day from the academy.  They carry complex experiences with them which can act as a detonator to the powder keg of emotional responses that rescuers experience following traumatic scenes.  
 
It is widely known that many counselors are drawn to the counseling profession because of life experiences that contributed to their own mental health journey.  Perhaps they are wanting to be the professional they lacked or perhaps they want to emulate an impactful counselor.  The same holds true of many rescuers.  
 
A prime example of personal experiences positively impacting professional experiences is a rescuer’s connection to children.  Their professional experiences with children radically change when they have a close connection with a child.  They become more adept at handling children, they begin to understand children’s ways of communicating, they may develop a greater sense of calm, and they become better at evaluating the seriousness of a situation.  They also fight back a profound sense of sadness because of the empathy developed for other parents, or the love they have for that special child in their lives.  
 
Conversely, applying the impact a scene carries where a rescuer has a negative personal connection brings about complex responses to the incident.  How these scenes resonate, or how a rescuer responds to an incident they have a personal negative experience to, may compound the mental trauma they experience.  Overdoses are difficult scenes to manage.  Overdose scenes that connect to a rescuer because of a personal history can have increased severity of traumatic responses, and the responder may be more likely symptomatic.  
 
Discussing our “PTSD” from heroic acts is becoming a badge of courage but discussing the compounding trauma from a complex life history is not.  Rescuers live and work next to people who keep their private lives out of public view.  On the one hand, discussing our “PTSD” or traumatic incidents helps us process and create meaning from our experiences.  But the code of silence related to their personal lives is the equivalent to allowing a cancerous tumor to fester.  A young rescuer whose personal trauma history has gone undetected and who doesn’t know any better may believe their lived experience is typical.
 
Rescuers work as part of teams.  Sharing personal life experiences with trusted others and receiving feedback is a great way to mitigate or resolve personal trauma that began before the career began.  Perhaps the trusted other can relate to a shared experience and can provide comfort.  Other times, a partner or teammate can be the encouragement someone needs to begin a personal counseling journey.  
 
Before the badge is pinned, to maximize a professional rescuer’s mental resilience, personal trauma endured should be processed with a professional.  Effective coping strategies for a long career in emergency services are essential.
 
If you, or someone you know, could benefit from the opportunity to work through past experiences that are currently impacting your work in emergency services, please consider reaching out to a professional counselor today. 

by Dave Papandrea, LLC, NCC

Firefighters are developing awareness about the toxins that raise our risk of developing cancer. I never thought I would see the day where we did not gear up before leaving the firehouse for a fire, but clean cab initiatives are in place to keep these toxins out of the passenger compartment of apparatus. Some departments are monitoring for Hydrogen Cyanide post fire, and members are wearing masks during overhaul, aware that off gassing is raising the cancer threat level. Charcoal soap is becoming more prevalent in showers to aid in the detox process after incidents. There is even a video circulating of a European firefighter that doffs his gear right down to his shorts, on scene, like a HazMat decon.
 
Equally as toxic to our bodies are the traumatic scenes that play out daily throughout our career. The average American will see four or five traumatic incidents in a lifetime. Firefighters working in busier communities could see that in a bad shift. Here are five practical steps that firefighters can take to build resilience and defend themselves against Post Traumatic Stress Disorder in 2023.
 

1.  Establish Relationships: Firefighters need the ability to unload trauma and we cannot always bring the subject or material into our living rooms. We acknowledge that exclusively unpacking our experiences with our spouses and partners is not practical or healthy for the relationship. Having that person, or group, who we can call after a traumatic incident is valuable. Have an agreement in place including a verbal cue that signals to others you need to process what you just experienced. 
2. Keep a Counselor on Speed Dial: Of vital importance is having and maintaining a relationship with a counselor that speaks “fireman.” Counselors are a lot like boots. Some fit great and we keep them. Others are uncomfortable and we need to shelf them. But we need a good pair of fire boots to survive this job, similar to needing a good counselor who understands us. Entering a crisis is the wrong time to look for a counselor hoping to find a good fit. The American mental health care system is insufficient, and it may be common to find waitlists for counselors. The International Association of Firefighters Center of Excellence can help with vetted lists, as may state unions. 
3. Practice Meditation and Yoga: I have studied and found there are two effective interventions for managing job related stress and trauma. EMDR (Eye Movement Desensitization and Reprocessing) has great efficacy for PTSD. Building a practice based on Eastern philosophies of meditation and movement is the other one. EMDR requires a specialized counselor whereas Yoga and meditation practices need only you and a quiet space. Recently, mindfulness meditation went head-to-head in a study with popular anxiolytics (anti-anxiety medication), and was shown to be as effective or more. Disciplines like Yoga and Tai Chi help us to connect to our bodies which may be difficult after years of trauma and job stress. I hear the groans from here. I know we all have ADHD which is why we can’t sit still, hence the reason we entered the fire service in the first place. Rome wasn’t built in a day, and a marathon begins with one mile. Try ten minutes of meditation per day, and see what happens after a month. There are great resources on YouTube to get you started. Search “mindfulness meditation” and see where it takes you. 
4. Exercise: We all know the associated physical health benefits of exercise, but did you know daily exercise helps to build mental resilience as well? The good news is you don’t have to be a CrossFit athlete or powerlifter to enjoy the mental health benefits. Brisk walking has been shown in studies to help reduce stress and anxiety. Grab your truck radio and set up a course around quarters. Consider taking the entire company to a serene location in your first due and walk in the view of the public. Even a course inside of the station can serve as a track for brisk walking. Just get up and establish a daily routine, and notice the reduction in stress with a side of cardiovascular improvement. 
5. Tend Your Garden: It would be reasonable to think that if your personal life was stressful, it would complicate traumatic stress experienced on the job. The cumulative nature of stress across all areas of life is a threat. Working to manage the amount of stress you experience away from the job will provide a resilient layer against PTSD. Work to iron out marital conflicts and maintain healthy relationships. Many firefighters work copious amounts of overtime and / or second jobs. Create a healthy work-life balance and establish intentional and regularly scheduled recreational periods everyday. 
6. Know Your Enemy: Every year I receive OSHA mandated Communicable Disease Training despite never having met anyone in the fire service who has had a disease communicated to them on the job. Perhaps this proves the effectiveness of the annual training. If our departments will not mandate healthy awareness of the fastest growing threat to our brothers and sisters, we must take the time to study and understand the subject. Understanding the signs and symptoms of acute stress and post-traumatic stress are as valuable as recognizing the signs of flashover. If we don’t have a healthy awareness, both could really burn us in the end. Understanding the signs of PTSD keeps us safe and keeps our brothers and sisters safe as well.

 
During the course of a career in the fire service, members will experience traumatic events. We should begin training our members on how to protect against PTSD the day we hand out the helmets and boots in the academy. With under reporting of suicide by fire service members, it stands to argue we lose way more firefighters to suicide than flashovers. If we spend an hour in a flashover simulator, how much time do you think we should spend understanding PTSD and building resilience?

A professional counselor that works with first responders at Trinity Family Counseling can help you unload the stress associated with trauma events and maintain your mental health and resilience.

by Dave Papandrea, LLC, NCC

Returning a fire company to service following a difficult call takes many different forms throughout the fire service.  In some areas, it may mean clearing to go to the next emergency.  Other jurisdictions offer tailboard defusing in the form of, “...you good?”  This typically prompts the auto response, “Yeah I am good.  You good?”  Repeat said process, and we check the box of crews defusing before returning to service.  It has escaped me for years how firefighters can work tirelessly one minute with life hanging in the balance, and transition seamlessly back to the kitchen table to finish a lukewarm meal.  But after a deep dive into the subject, I have realized that this oddity is not without a cost.  A debt we often pay and share with the people we love the most.

Have you ever approached the firehouse for your shift, and before entering the bay you knew the prior crew had a good fire?  We are not part bloodhound, so what is happening?  Our bodies are becoming hyper alert or hypervigilant.  We are about to spend the next 24 hours in our uniform, in the station, never far from the apparatus, and with a heightened sense of readiness for whatever is toned out for us.  This hypervigilance is comparable to fight or flight, but knowing firefighters, we are all fight!  For the next 24 hours, the part of our brains that control fight or flight (the amygdala and hypothalamus) will remain out of neurochemical balance with peaks and spikes when critical calls tone out, only partially reducing before tones drop again for the next call.  Each call, regardless of whose company is responding, helps to thrust those levels of neurotransmitters in the brain (cortisol) further out of balance.  Our levels rise and fall but never quite return to baseline, and never return to where a “normal” brain functions.  So, what’s a firefighter to do?  The brain dislikes imbalance, so how do we restore balance while on duty?  

When I started the job there were a lot of common practices that we have removed from our culture. If we went back in time to visit the 1950’s firefighter, having a beer with dinner was commonplace.  As a young firefighter in the late ‘90s they were just removing the taps.  Alcohol still remains culturally significant in the fire service, and it is a part of every tradition and party from probation to promotion.  But there was pathology behind what seemed like a social club mentality.  Drugs and alcohol are threats to firefighters for obvious reasons, but a silent threat they play is the role of activator for the brain's pleasure pathway.  Remember, after activation of the amygdala and hypothalamus the brain experiences imbalanced levels of cortisol and is working hard to return to homeostasis or balance.  If there is no “dump,” then one way to level the playing field is increasing dopamine, or the happy sauce.  One way dopamine is released is consuming alcohol.  Alcohol is a way for the brain to maladaptively cope with the stress it was under.  But it isn’t the only way to cope, and firefighters are extremely resilient at solving problems.  Stacks of pornography collected in firehouse bathrooms for decades not because the fire service was a male dominated chauvinist club.  Sex and pornography also served as maladaptive coping strategies for releasing dopamine and restoring balance.

Also central to firehouse culture and lore is our ability to cook… and eat!  This coping strategy may be the most devastating of all.  How many firefighters began their career looking like a CrossFit athlete and ended their careers unable to pass the fitness exam that earned their spot in their department?  In that vein, we still experience a high rate of cardiovascular emergencies on scene.  We love cooking meals loaded in fats, salts, and sugar!  We crave ice cream! Overtime guys usually had to throw in extra for dessert, and each day there were snacks of cookies and brownies on the table.  Again, this was more brain based than sweet tooth based.  It served a function in our recovery, and thus earned a place at our cultural table.  This may add new and literal meaning to the phrase, “comfort food’ and “stress eating.”  Think about the times on duty or coming off when you find yourself famished or experiencing cravings.  Dopamine releases resulting from food and sex serve a very important primal role for survival.  But as our brains try to survive the trauma that accompanies the job of firefighter, we often struggle personally with addiction and dependency, and our loved ones and families are footing the bill right along with us.  

Just as important as reporting for duty mentally fit, is making sure we return home to our families in good mental condition!  Understanding that our agitation and difficulty relaxing upon our return to the home is a bi-product of our fight or flight status, and acknowledging there isn’t an off switch, is a step in the right direction.  Helping our families realize what is happening is also very helpful, but that is difficult if we haven’t done our own personal work and possess a healthy self-awareness.  Enter in the importance of defusing and debriefing our critical incidents.  When you see peer support approaching, don’t run and hide in closets or under the bed!  Isn’t that what we teach kids about fires?  Do your part.  If not for yourself, do it for your family that doesn’t understand your aggressiveness, but knows to keep some distance after you get home from a shift.  Firefighters are willing to put the time in at the gym with weights and cardio routines.  We love doing RIT drills, and we train for every possible obstacle when extracting victims.  But we rarely step foot in a counselor’s office, dare I ask if we even have a relationship with one should we enter dire straits.  We keep pushing through our RIT drills despite the evidence that suggests we are losing more firefighters to suicide then collapse.  We pride ourselves with readiness, yet we are frequently surprised and ill prepared when a mental health crisis arises.  It is time we are champions of our own mental health by engaging in debriefings, defusing, and individual counseling sessions.  It is time to change the culture making the aforementioned as normal as physical fitness.

Not every call requires defusing or debriefing from peer support services.  But a healthy awareness of what each difficult call (from which we proclaim our “good-ness”) is doing to our psyche is valuable.  Excluding the occasional stubbed toe emergency, we need to visualize stress inducing calls as a piece of straw that is handed to you at the end of every shift.  Some shifts you only have a single piece; other shifts may have 10 or 20 pieces of straw.  None of this seems like much, but you never actually put the straw away.  You carry it with you.  Compound the straw by the number of years you spend serving in your communities, and if you have ever driven across northern rural Michigan in late summer, you will see huge rounded hay bales that could crush a man under its weight.  Each bale is made up of individual straws.  That is what a career of critical incidents brings each firefighter.  It is a lot to carry around, and it can feel crushing at times.

A professional counselor that works with first responders at Trinity Family Counseling can help you recognize the need for mental fitness and how to maintain a healthy self-awareness.