Treating first responder mental health, addiction, PTSD and suicide
A new fire/EMS-specific treatment facility caters to specific job-related trauma while making first responders feel at home
By Daniel Martynowicz, EMS1 Contributor
Most in the fire/EMS community have a harrowing story of death, destruction and despair. These stories usually involve heartbreak and pain – not just for the victims involved, but also for the first responders tasked with restoring order to the chaos, perfusion to the pulseless, and hope to the destitute.
None take the responsibility lightly, and the cost of accepting such a burden can be seen in every fire station, ambulance shop and volunteer garage in the world. The ever-present issues of PTSD, addiction, mental health and suicide in the firefighter and EMS communities have taken center stage in recent years.
According to a 2015 article published in the “Journal of Emergency Medical Services,” 37 percent of EMS workers have contemplated suicide, as compared to 4 percent of the general population. Likewise, nearly 7 percent have actually attempted suicide, as compared to half a percent of the general population.
While treatment facilities and therapist couches are readily available for those who would seek them, the United States has never had a treatment facility dedicated to the unique needs of fire and EMS personnel – until now.
Making first responders feel at home
While some facilities have a wing dedicated to first responders, often it includes police, dispatchers, veterans, etc. The IAFF Center for Excellence, Behavioral Health and Recovery is the first to focus on career firefighters and EMS providers, says Dr. Abby Morris, a psychiatrist and the center’s medical director.
“I really do think as attention has turned to PTSD and TBI from the conflicts in Iraq and Afghanistan, it’s turned the microscope to the medical community and asked the question, ‘What are you going to do about this?’” Morris said.
In part, the IAFF Center for Excellence is the medical community’s response to that question.
The 64-bed facility, which caters to mental health as well as addiction, opened in March 2017. Located in Maryland just outside the nation’s capital, the campus sprawls over 15 wooded acres with two miles of walking paths, a pool, basketball court, gym and volleyball court. Built to resemble a station house, the facility has been designed to be as fire-friendly as possible.
Every staff member is required to complete Fire-Ops 101 and do ride-alongs with the local fire and EMS crews in order to better understand the firefighters and medics who come to them for help.
“It gives us a really good sense of the culture,” Morris said. “It’s a small microcosm of your life – one day, one shift – but really good for our doctors and nurses to spend the time to see you in action.”
Clinical director Dr. O’Tilia Hunter said the Fire-Ops 101 experience in particular is eye-opening for staff and helps to avoid the awkward, “So, what’s it like?” question, which could trigger a patient.
“With the ride-alongs, you realize it’s an all-day adrenaline rush. All day, every day, they’re riding that high,” Hunter said. “I think for civilians, you have this very unrealistic view of what EMTs and firefighters go through every day.”
Dealing with past trauma and coping with the future
While both Morris and Hunter have worked with combat veterans in the past and apply a great deal of what they learned to treating fire and EMS personnel, the key difference is that with veterans, the trauma is over. The task is to mitigate damage done months or years prior and focus on returning to civilian life.
For firefighters and paramedics, it’s an ongoing struggle. Most of the patients at the IAFF Center for Excellence are career firefighters and paramedics who plan to return to their careers after treatment. Hunter said the center currently has several patients who are reminded of their traumas daily.
“They can’t get away from it,” Hunter said. “Most (military) veterans do one deployment. These people do it every day and are reminded of it constantly because they live in the community in which they work.”
As such, treatment must rely on both dealing with past trauma and teaching coping mechanisms to deal with the certainty of future trauma.
To do this, the center relies on standard group and individual therapy, and, when needed, medication. However, unlike most current PTSD treatments, which rely heavily on sedatives and anti-psychotic medication, the center’s staff must be mindful that when their patients return to work, they must be clear-headed and able to pass a random drug test.
For example, Morris said that for sudden anxiety, she prescribes antihistamines – allergy drugs that can have a calming effect – rather than much more potent benzodiazepines, which can slow the brain’s activity. For help dealing with painful memories causing a fight-or-flight response, she prescribes beta-blockers, which block adrenaline, rather than anti-psychotics, which can cause drowsiness and dizziness.
In addition, the center uses biofeedback sessions to help patients better recognize their own sympathetic nervous system response. Once patients are able to recognize that they are getting into that fight-or-flight mode, staff can teach techniques for slowing heart rate and respirations, lowering blood pressure and reversing the process to prevent further trauma.
“We do a lot of work on resilience. We can’t just process your top three traumas – we need to get you ready to get right back into it,” Morris said. “A lot of veterans come home and deal with what’s been done. In some respects, we’re sending you back out into combat.”
Measuring mental health gains
As the center has been open for less than a year, statistics are difficult to come by. That said, Morris and Hunter said they are extremely happy with the results they’ve seen so far.
“I have a patient who hasn’t been able to sleep through the night for years because the nightmares are so bad,” Hunter said. “Most people count days without alcohol. He’s counting nights without nightmares, and as of this morning, he’s on his twelfth night without a nightmare. Can you imagine? Years and years without sleeping through the night, and he’s almost two weeks without nightmares. It’s things like that that tell us we’re making a difference.”
As far as those who are still suffering and unsure of what to do or where to turn, Morris said they deserve to feel better and to know it is possible to feel better.
“Unless you’re healthy, you can’t take care of other people, no matter how much you try,” Morris said. “Getting help is a form of helping others.”
For information on the IAFF Center for Excellence, Behavioral Health and Recovery, call 877-837-4346 or visit www.iaffrecoverycenter.com.
About the author
Daniel "Moose" Martynowicz is a paramedic for two agencies in Western Montana. He and his wife are expecting their first child, who, no doubt, will be a professional stretcher-fetcher in no time! Reach him at firstname.lastname@example.org.