Calif. Firefighters Open Up About PTSD

Daily Press, Victorville, Calif.

Sept. 23—Frank Lima still remembers, with a disturbing amount of clarity, some of the images he saw as part of the group of firefighters who responded to the World Trade Center terrorist attacks on 9/11.

"I have a noise—a horrific noise, a scream, from someone trapped inside—I can still hear it in my head, years later. It was just too late to save them," Lima said.

Lima, vice president for the International Association of Fire Firefighters (IAFF)'s 10th District, which covers large areas of the West Coast, has been in the firefighting world for almost 30 years. In that time, he's covered deadly house fires, the WTC attacks, drive-by shootings and much more.

It becomes normal in a way, Lima says. Firefighters are often used to jumping from call to call, patient to patient, incident to incident, often without taking much of a breath or giving a passing thought to what they just experienced.

But much like the layer of soot and ash that tends to permeate all firefighters' uniforms and gear, some incidents stick around much longer than intended.

"I still get nightmares from time to time," Lima said. "I'll go for months at a time where I don't get them, then all of a sudden they start again."

It's a scenario that's heartbreakingly familiar to anyone who's spent time in the fire service, a world where bravery, pride, and the overwhelming need to help others can often overshadow the inherent trauma that comes with it.

"Everyone knows we go to fires, but we respond to every single emergency there is," Lima said. "We actually touch those hurt and dead patients. And it wears on you."

The IAFF has been at the forefront of raising awareness of the high rates of post-traumatic stress disorder (PTSD) in firefighters, especially as suicides continue to increase.

A study commissioned by the Ruderman Family Foundation in 2017 found that first responders, including firefighters, are more likely to die by suicide than in the line of duty. Last year, there were at least 103 firefighter suicides, compared to 93 line-of-duty deaths.

PTSD and depression rates among firefighters also have been found to be as much as five times higher than the rates among civilians, according to the study.

"To me, that's job-related," Barstow Fire Protection District Capt. Travis Espinoza said. "We can tie that back to the things we do and see."

The symptoms of PTSD and depression can be quite varied, especially from person to person. But authorities say they tend to fall into one of three categories: intrusive memories, avoidance or emotional numbing, and anxiety and increased emotional arousal.

Some of the more common symptoms are sleep or eating disorders, depression, irritability and isolation. This can lead firefighters to self-sabotaging behaviors, such as substance abuse, in an effort to cope.

"The more you drink, the more exhausted you get and you'll pass out and won't get the nightmares," Lima said, offering an example.

But it can sometimes be as innocuous as a firefighter getting "a little too quiet after a call," as Espinoza put it. He's strived to lead by example, making sure his crew always knows they have someone to turn to.

"I try to keep my guys talking. I'm sitting here at the station having this conversation around all the guys right now," Espinoza said. "I try to always stay available if they need to talk. It's hard for firefighters to just reach out."

This stigma can be a powerful barrier to seeking help. Many will instead turn to other coping mechanisms, both positive and negative. But authorities are now slowly realizing that the issue needs to be addressed head-on.

"I'm glad this is starting to get out. It's always been there, kind of like this dark secret," Lima said. "Just no one wanted to talk about it."

Espinoza and Lima both said the stigma associated with seeking help for trauma was a major factor in keeping PTSD among firefighters in the shadows.

"Back then it was just 'keep your mouth shut, suck it up.' You'd come back to the station and the senior firefighters were just laughing at the stuff they'd seen," Lima said. "That's how they dealt with it."

Espinoza categorized it as a "generational gap" between veteran firefighters and newer recruits, a gap that can still be difficult to effectively bridge.

"We have a hard time reaching the older guys sometimes—they're still very much into the mindset of 'we're bad, we can handle this,'" Espinoza said.

One way to get through the storm is to simply become more aware of the signs that it's building. As such, fire departments around the nation are tackling the issue from the very beginning, starting with fresh recruits.

Lima said the IAFF is "aggressively training" union members to become what they call "behavioral health peers," firefighters trained to look for signs of PTSD and provide some counseling if needed.

"We've found that firefighters would rather talk to their own people, at least as a first buffer, to eventually getting help," Lima said.

San Bernardino County Fire Department spokeswoman Tracey Martinez said the department has an internal peer support group, along with contracting with Counseling Team International, which specializes in helping public safety personnel, to provide needed services.

"After any major incident or any incident that has the potential to be traumatizing, we have a debriefing that will include members from the support group or the counselors, depending on the need," Martinez said.

New recruits going through the Fire Academy also go through training, along with their families, to talk about PTSD in the fire service, "what they can expect and what they should be looking for."

"Many times firefighters might not know they're going through PTSD," Martinez said. "And it can hit you days, even years, after the incident. So we're trying to train to look for the signs."

The IAFF opened up an innovative "Recovery Center" last year for firefighters going through PTSD or depression. Located in Maryland, the 15-acre facility, designed to look and feel like a firehouse, boasts a full gym, pool, and a range of experts ready to help.

"It's a first for firefighters—it's built for them," Lima said. "It's one of the first places to offer dual help, in addressing behavioral health and the symptoms and coping mechanisms that can come with them, such as drinking or substance abuse."

The IAFF is looking to open a second location in the West Coast to be able to treat more firefighters around the country, along with spreading awareness on the issue.

"It's the way of the future—we have to prepare our firefighters earlier," Lima said. "Let them know it's OK to reach out if you see something that gets to you, and you will. We have to let them know that, instead of having them figure it out on their own after the fact."

Visit https://www.iaffrecoverycenter.com/center/ for more information on the recovery center and for further resources on PTSD and what signs to look out for.