When Durango firefighters and paramedics pass through the city, they are reminded of past calls, like echoes in time – a crash at that intersection, a bodily trauma call in that house, the loss of a loved one for that family.
“It’s like going down Main Street being like, I’ve seen a dead person there,” said an engineer in the department, who asked not to be named to maintain his privacy.
Nationally, emergency services are fighting for the long-term mental health of their personnel. Now, Durango Fire Protection District and other regional fire districts are developing a new tool to expand and reinforce existing support: each other.
In January 2018, Durango Fire and Rescue began building a peer support team where emergency responders, backed by mental health training, provide confidential support for their peers. In May, the Colorado Legislature funded a statewide peer health assistance for emergency medical service providers. In June, Mile-High Regional Emergency Medical and Trauma Advisory Council released regional surveys evaluating mental health support in Colorado’s emergency response agencies. The emergency services have higher-than-average rates of post-traumatic stress disorder and suicide, and the peer program is part of a national movement for change.
“The peer support team members, they’re just there to listen and validate people and make them understand that they’re not alone,” said Chelsea Gardner, the firefighter and emergency medical technician leading the peer support team. “They have someone on their team no matter what they’re going through.”
The support team has 10 to 12 members available 24/7 to assist 180 volunteer and full-time firefighters. They’re trained to recognize common indicators of depression, PTSD, suicidal ideation, substance abuse and other health challenges.
Peer support teams are part of an established system of support within agencies: structured debriefings, chaplaincy programs, behavioral health resources and treatment programs. There are also national resources like the Code Green Campaign, a mental health advocacy nonprofit.
In Colorado, support systems are varied and service gaps are “widespread,” according to a Mile High RETAC report. Two RETAC surveys analyzed employee assistance programs, finding that emergency responders want stress-management, mental health and peer support services but don’t always have access to the specialized services they need.
Other agencies in the Durango area, like the Los Pinos Fire Protection District, are interested in developing a similar peer program. Some have already started – the Upper Pine River Fire Protection District began building its program in 2018 and has one fully trained team member.
Nationally, the fire service industry has some of the highest rates of PTSD and deaths by suicide. Several studies found that 20% to 22% of firefighters around the world experience post-traumatic stress disorder symptoms in their lifetimes. The U.S. lifetime prevalence is estimated at 7% to 8%, according to the International Association of Fire Chiefs 2017 Yellow Ribbon Report.
In a 2015 study, current and retired firefighters showed rates of suicidal thoughts (46.8%), planning (19.2%) and attempts (15.5%). In 1999, 13.5% of U.S. adults had suicidal thoughts, 3.9% made a plan and 4.6% attempted suicide, according to the 2017 report.
“It’s critically important for people who run fire service agencies to understand that you don’t have 180 stainless steel objects working for you,” said Durango Fire Chief Hal Doughty. “You’ve got 180 human beings who’ve experienced horrible things.”
‘A bad run’Firefighters and EMTs are trained to handle crisis situations, and they usually have healthy ways to cope. But the job requires meeting others on the worst day of their lives – over and over again.
In a small town, they might answer calls where they know the person. They see human bodies that are unrecognizable. They can see no suicides for a year and then three in one month.
“I would say half of the stuff they’ve seen, if a non-fire personnel saw it, it would be one that they would never forget,” said Nate Baier, captain with Durango Fire.
Then there are the days that the emergency responders never forget.
Before she worked in Durango, Gardner’s friend died in an avalanche, and she was one of the responders. The loss sent Gardner into depression and PTSD that she didn’t recognize at first. It was through interactive therapy techniques that she found her way, she said.
“You still lost someone important, but it’s palatable for me now,” she said. “I’ve recognized that I can process, and I can cope with it.”
The engineer and a firefighter-paramedic with Durango Fire, both of whom have children, remembered answering a call for a 9-month-old girl with a closed-head injury that caused permanent damage. The next week, they went to a car wreck that was fatal for a 3-year-old boy. (The firefighter-paramedic also asked not to be named to avoid public attention.)
“We had a bad run,” the firefighter-paramedic said. “We don’t run into burning buildings every day; we don’t see dead people every day. But, with a certain frequency of those kinds of things, the stress it creates is cumulative.”
This cumulative stress overload, and its emotional toll, can lead to behavioral health issues – like anger, avoidance, substance abuse, addiction and suicide – at times beyond the understanding of the person affected, according to the 2017 report.
Changing cultureBy definition, emergency responders have to continue even when they are having a bad run, but cumulative serious calls and a culture that says “suck it up” can be a dangerous combination.
“For a great part of our history, there’s been a stigma about needing to be tough and not showing your emotions,” said Doughty. “It set fire departments on a path for disaster.”
Emergency responders might fear being ostracized or teased by their colleagues if they say they’re struggling with a call. They fear they’ll be deemed unfit for service, or they don’t want to show signs of weakness, the Yellow Ribbon Report said.
It’s the idea that boys don’t cry, that the armed forces are always tough and that we’re not supposed to talk about struggles, the engineer said.
Although Durango Fire emergency responders still hear “toughen up,” or “get a better attitude” at times, the five Durango fire and three Upper Pine River personnel interviewed for this story said the departments’ cultures made it easy to ask for help if they needed it.
“I think it’s good that we’re having the conversation. It’s out there; it’s open. We’re trying to break down those barriers,” the engineer said.
Your second familyFirefighters and emergency responders already depend on each other for support, but the peer support program helps them listen with actual mental health training.
“We’ve always had a peer support group,” Baier said. Emergency responders cook, train, work and live together. They give each other a hard time, but they also support each other.
“It’s your second family,” the firefighter-paramedic said.
The peer support team is a way of formalizing the system that already exists in many agencies. Fire personnel used to have to seek help themselves; now a team member might reach out to him or her. Emergency responders can also ask team members to check in on someone they’re worried about, supporting those who might be ignoring or silently struggling with an issue.
Even if not everyone uses it or needs to use it, the emergency responders said they think it is a valuable tool in the system of mental health support.
“I just hope that it becomes so common in the work culture that people aren’t afraid to seek the help,” the engineer said. “Just that they know that there’s no shame. They don’t need to hide it; just go deal with whatever you need to deal with, and come back.”