Progressive Paramedicine: 3 reasons to never stop learning

Progressive Paramedicine: 3 reasons to never stop learning

Increasing suicide rates among first responders spark concern

A survey of more than 4,000 first responders found that 6.6 percent had attempted suicide, which is more than 10 times the rate in the general population


By Wes Venteicher
The Pittsburgh Tribune-Review

PHILADELPHIA — Paramedic George Redner III started to grow angry and distant after he failed to revive a 2-year-old who had drowned.

But not even his parents saw how deeply his work affected him until he took his life seven years later.

"My son was a classic case of 'I'm never going to tell anybody; if I tell them, they'll think I'm weak,'" said Redner's mother, Jacqui Redner, 48, of Levittown, outside Philadelphia.

Like many first responders dedicated to saving lives, Redner, who was 27, never talked about his struggles, she said.

Her son, who went by "Georgie," threw himself in front of an Amtrak Acela train the morning of Aug. 1, 2015, at a station near the family's home.

Suicides among first responders, often driven by emotional strain in a culture that long has discouraged showing weakness, are too common, according to organizations that track the deaths.

Little high-quality data are available on first-responder suicides, but rising awareness has prompted several groups to start looking more closely at the deaths in recent years.

A survey of more than 4,000 first responders found that 6.6 percent had attempted suicide, which is more than 10 times the rate in the general population, according to a 2015 article published in the Journal of Emergency Medical Services.

Friends, family and coworkers reported 132 first-responder suicides nationwide in 2016 to the Firefighter Behavioral Health Alliance, an Arizona-based nonprofit that promotes better mental health support for first responders. The voluntary reports are some of the only data available on the deaths and likely capture only about 40 percent of them, said Jeff Dill, the organization's founder and CEO.

Dill said he validated 16 suicides — 10 firefighters and six emergency medical services providers — for the year in Pennsylvania.

First-responder suicides are sometimes compared to those among military veterans, many of whom have been diagnosed with post-traumatic stress disorder. Military veterans deployed from 2001 to 2007 had a 41 percent higher suicide risk than the general population, according to the Department of Veterans Affairs.

But the first-responder deaths have received less attention, said Ann Marie Farina, director of the Code Green Campaign, a Washington-based nonprofit that tracks suicides and provides an online forum for first responders to share anonymous stories. The group counted 13 suicides in Western Pennsylvania from 2014 to 2016."We're still kind of in the stage where a lot of people don't know or don't realize that PTSD is a widespread problem among first responders," Farina said.

First-responder training doesn't prepare trainees for the mental impact of what they see, said Dill, a former Chicago-area fire chief who started to focus on mental health after seeing the struggles of coworkers who had responded to Hurricane Katrina.

"They never told us all the things we'll keep in our minds — the images, the brain deprivation, that cultural brainwash of being strong, keep things to yourself, don't ask for help," he said.

Georgie Redner started volunteering at a fire company when he was 15, said Jacqui Redner. At 19, he got a job as a full-time firefighter in South Carolina. He called home one day to talk to his father, firefighter George Redner Jr., about a bad call.

He had picked up a 2-year-old girl who had fallen into a pool. He tried to revive her during a trip to an emergency department, but the girl died. Eight hours later, he responded to a drug overdose in which the drug naloxone revived an unconscious addict. He returned home a month later and started questioning his faith.

"He said, 'You explain to me how God killed a 2-year-old but let a drug addict live,'" Jacqui Redner said.

He changed, she said, reacting with anger to jokes and minor provocations. A fight between his Dalmation, named Lucky, and the family's German Shepherd led the 6-foot-3, 280-pound man to pick up and throw his smaller brother into a wall, leaving a mark in the plaster. Georgie grabbed Lucky and left, not talking with the family for a month.

"Those instances where stupid things just kind of threw him right over the edge, that's where we knew," she said.

His father suggested anger-management classes, but Georgie said he was fine, she said.

The fire jackets of Georgie Redner sit on display inside of his parents' home. Photo by Nate Smallwood

Depending on how they process what they see, first responders can develop a sort of "tunnel vision" that makes them feel like they have no other options but to kill themselves, said Sheila Roth, a therapist who counsels first responders in Pittsburgh.

Sensory details from bad experiences can stick with first responders, triggering emotional responses at unexpected times, Roth said. The smell from a backyard grill, for example, could bring to mind a recent call in which someone died. The firefighter might experience emotional swings based on the triggers without even recognizing the changes.

Roth counsels first responders to acknowledge and process those memories, which helps manage them. But social settings don't always permit first responders to take time to process the emotions, and they can be tamped down or ignored, building up over time. Firefighters then might shut down emotionally or develop what Roth calls compassion fatigue. That can erode a person's ability to relate to others or communicate, which can in turn worsen their relationships.

Child deaths are the most troubling calls for first responders she talks to, followed by the deaths of coworkers who die in the line of duty, Roth said. Also difficult are calls in which they help someone who reminds them of someone they know, Roth said.

Jeff Dill, who founded Firefighter Behavioral Health Alliance in 2011, talks with first responders around the country and said he tells them, "If you don't think you've changed, you're absolutely wrong."

He consults fire chiefs, family members and medical reports to try to categorize the suicides. The top category is unknown, he said, followed by marital and family relationships, depression, addiction, mental health and PTSD. He has counted 46 homicide-suicides in which a firefighter killed someone else along with themselves.

Dill founded the alliance after learning that the Centers for Disease Control and Prevention, the Occupational Safety and Health Administration and other agencies fail to keeps data on the deaths. He collects reports of deaths from as far back as the 1880s and had recorded 978 reports as of Wednesday.

Code Green Campaign was started about three years ago when a group of first responders in Washington decided to repost on social media anonymous stories from first responders about their personal struggles. Posting the stories helped the storytellers circumvent the "macho, tough culture" that Farina, Code Green's director, said prevents many from talking about personal matters with coworkers.

The original posts blew up on social media, Farina said. The group decided to create a nonprofit, and the organization now posts about three anonymous stories per week on its website, codegreencampaign.com.

"This is a bigger problem than we thought; we weren't misunderstanding that there was a need for something," she said.

Each first responder processes his or her experiences differently, said Roth. Some of the most resilient are able to reframe the bad calls, telling themselves that they were there because they had training and skills that might have helped. They are able to learn from their experiences without tormenting themselves with questions about what they could have done differently, she said.

George Redner Jr., 50, Georgie's father, said that in 32 years as a firefighter, he had been able to compartmentalize his experiences, preserving mental stability. The incidents he struggled with most were the deaths of two coworkers during responses. But after his son's death, he stopped responding to calls for a year.

Jacqui Redner thinks sleep deprivation from back-to-back shifts, fears that his younger brother might have been on the other end of a heroin overdose call and the pressure of a new job offer might have contributed to her son's mental condition on the day of his death.

Georgie worked full time as a firefighter at Six Flags Great Adventure while volunteering for Edgely Fire Company and three local rescue squads. Sometimes he volunteered through the nights and went to work in the morning, Jacqui Redner said. He would eat and fall asleep on the couch in her home until he had to return to work, she said.

He was an EMT and had just finished paramedic school. He had received a letter from the Philadelphia Fire Department accepting him as a full-time employee, his dream job.

He was upset about having broken up with his girlfriend and threatening to kill himself the night before Aug. 1. Local fire, police and EMS authorities tracked him down at a bar. They took him to Lower Bucks Hospital, where he had been treated for mental health issues before. Jacqui Redner said the hospital released him, and he talked with several friends during the night.

George Redner Jr. got a call the next morning that his son had killed himself.

"What haunts us to this day is that the train station is so close, you could hear the trains going by slow," Jacqui Redner said.

She and her husband now spend much of their time fighting the stigma they say kept their son and others like him from asking for help. They say changes are needed to support people who fill critical roles in communities, often in volunteer positions.

"They show up, for little to no money, to take care of you. Why can't we take care of them?" Jacqui Redner said.

The Journal of Emergency Medical Services survey found that first responders who felt supported and encouraged at work were less likely to contemplate suicide.

Responders who didn't feel supported wrote things in the survey responses such as, "I asked for help and ended up losing my 22-year career" and "(I) asked for help and was laughed at," according to the article.

Rep. Frank Farry, R-Langhorne, Bucks County, who is a volunteer firefighter, said he is exploring legislative changes that might be able to help.

Farry said that volunteer firefighters are covered only by workers' compensation insurance, which doesn't treat mental health issues as work-related injuries. Some states and countries have changed laws to expand workers' compensation coverage, he said. Pennsylvania is just starting to look at options, he said.

"I would say that there's not a system in place to take care of these responders," Farry said.

A group has set up a help line for them in Bucks County, he said. All the groups involved in first responder suicides agree more education is needed to encourage people to seek help when they need it.

Roth is co-chairwoman of the Change the Culture Committee, a grassroots group that started meeting last year at the Emergency Medical Services Institute in Pittsburgh. The group is preparing to survey first responders about what resources might help prevent suicides.

Pittsburgh EMS Chief Robert Farrow said there have been no suicides in the city squad in the 41 years he has been a part of it, but he said he takes the risk seriously.

"That can change overnight, and that's what we want to prevent," Farrow said.

The squad is focused on expanding its peer-support program, based on observations that responders are more likely to open up to one another than to a superior or someone from outside the squad, he said.

The Redners keep three of Georgie's uniforms in a game room in their home. Posters with photos of him line the walls, given to the family by the squads he worked with.

George Redner Jr. talks with any first responder who calls him at any hour about whatever they are struggling with.

Jacqui Redner said she misses her son every day and is fighting to save other mothers' children, including working to change state and federal laws.

"These are the people who we call when someone in our family is hurt or dying or having a heart attack," she said. "These are the people who save us ... and we can't as a country take care of them?"

Copyright 2017 The Pittsburgh Tribune-Review

McClatchy-Tribune News Service

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