Information About Issues - See Below for More Information
Suicide
Post Traumatic Stress Disorder (PTSD)
Substance Use Disorder (SUD)
Suicide in the fire service has reached alarming proportions, surpassing line of duty deaths (LODD) in firefighters. According to the National Fire Protection Association (NFPA), there were 60 firefighter LODD in 2017. Compare this to 91 firefighter suicides.
Substance Use Disorder (SUD)
Post Traumatic Stress Disorder (PTSD)
Substance Use Disorder (SUD)
SUD is a common issue within the first responder community. Current research suggests that those in fire service engage in binge drinking at almost double the rate of the general public.
Post Traumatic Stress Disorder (PTSD)
Post Traumatic Stress Disorder (PTSD)
Post Traumatic Stress Disorder (PTSD)
PTSD has reached epidemic proportions in the fire service. Symptoms include intrusion, avoidance, negative cognition and mood, and alteration in arousal response.
Depression
Sleep Disorders
Post Traumatic Stress Disorder (PTSD)
Firefighters experience depressive disorders at more that twice the rate of the general public (17% vs 7%). Resources are available to help.
Family Issues
Sleep Disorders
Sleep Disorders
The firefighter is not the only one affected by the job. Spouses, partners, significant others, children and even parents can all face challenges.
Sleep Disorders
Sleep Disorders
Sleep Disorders
Ask mental health professionals and they will tell you that everything is related to sleep. Many mental health (and physical) issues can be affected by poor sleep.
Suicide in the Fire Service
The Problem
Suicide has grown into a serious problem in the American fire service.
Prevalence of Suicide vs. Line of Duty Death (LODD) Firefighters
According to the National Fire Protection Association (NFPA), the number of suicides among firefighters is much higher than the LODD rate.
2019: 48 LODD, 119 Suicide
2018: 64 LODD, 82 Suicides
2017: 60 LODD, 91 Suicides
2016: 69 LODD, 99 Suicides
2015: 68 LODD, 94 Suicides
The Special Problem of Emergency Medical Services
According to the International Critical Incident Stress Foundation (ICISF), EMS practitioners have a suicide rate that is 12x the national average.
Ideation (thinking about suicide)
5-13% of the general population.
21% of the firefighter population.
Planning (actually having a plan)
5% of the general population.
7-12% of the firefighter population.
Important
Studies show that 90% of all completed suicides show some sign before they occur. Know the signs!
Some Signs (not all inclusive list, there are others)
Expressing feeling that the world would be better off without them
Hopelessness/purposeless
Withdrawal
Giving away possessions
Anxious, reckless behavior
Extreme mood swings
Substance Use Disorder (SUD)/Addiction
Alcohol
Blood Alcohol Concentration (BAC) is measured as a percentage and is directly related to certain behavioral effects.
0.05% - Lowered alertness, good feeling, reduced inhibitions
0.08% - The relative risk of being involved in a fatal crash is 3x that of a sober driver
0.10% - Slower reaction times
0.15% - Large, consistent increases in reaction time
0.20% - Marked depression in sensory and motor capacity
0.25% - Severe motor disturbance, great impairment
0.30% - Stupor, no comprehension of events
0.35% - Used in the past for surgical anesthesia. May cause death
0.40% - 50% mortality rate
Hart & Ksir, 2018
Alcohol Toxicity
The Centers for Disease Control and Prevention (CDC) estimates that 2,200 people die each year due to alcohol toxicity.
Binge Drinking/Alcohol Use Disorder (AUD)
Studies show that the rate of firefighter binge drinking is near double that of the general population.
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) describes the conditions that must be present to diagnose AUD. Two must be present within a 12-month month period and this MUST be diagnosed by a licensed clinician.
1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol,
or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work,
school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or exacerbated
by alcohol.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of
the criteria set for alcohol withdrawal, pp. 499-500).
b. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to
relieve or avoid withdrawal symptoms.
Drug Use
Like the general population, firefighters are at risk for abuse of both illicit and over the counter (OTC) drugs. Categories include:
Stimulants
Depressants
Psychedelics
Opioids
Performance-enhancing drugs
Tobacco
Tobacco is recognized as the most dangerous public health threat related to substances, greater than all other drug substances combined, including alcohol (Hart & Ksir, 2018). Tobacco may be considered a drug because it acts as the delivery mechanism for nicotine - a psychoactive substance (Hart & Ksir, 2018).
According to the World Health Organization (WHO), smoking is responsible for 5 million deaths annually.
Nicotine is one of the most toxic drugs known. 60 mg is a lethal dose. One cigar contains two lethal doses (Hart & Ksir, 2018).
Smokeless tobacco is not a safe alternative to cigarettes. It carries with it an increased risk of cancer of the mouth, pharynx, and esophagus (Hart & Ksir, 2018).
High Risk Behavior
High risk behavior may be addictive as well.
Post Traumatic Stress Disorder (PTSD)
Prevalence Nation-wide
Most Americans will suffer some sort of traumatic event in their lifetime. Depending on the consulting resource, prevalence ranges from 50-90%. Only 8% will be afflicted with PTSD, however. Two main reasons for this, presumably, are resilience and support. Resilience relates to "bouncing back" from the traumatic event by employing effective coping strategies. Support refers to the availability of interpersonal communication.
Prevalence in Firefighters
The rate of PTSD in the Urban Fire Service is between 13 - 30%.
Signs/Symptoms
PTSD must be diagnosed by a licensed clinician and be the result of one or more traumatic events.
Signs and symptoms of PTSD include intrusion, avoidance, alterations in cognition or mood, and alterations in arousal.
Intrusion: Flashbacks, unwanted memories of the event, or nightmares
Avoidance: Staying away from people, events, or places that remind of the event
Alterations in cognition or mood: Consistent negativity, irritability, and self-blame
Alterations in arousal: Hypervigelance, exaggerated startle response
Family Issues
Who is Affected
We know that the firefighter is not the only one in the family that is affected by the job. Spouse/significant other/partner, children, friends, and even parents may be affected.
What Happens at Home is Important
Sometimes, firefighters do not want to discuss work issues or critical incidents at home. Observable signs may be present, however. Often, the first signs of trouble present themselves at home.
Psychological First Aid (PFA)
One of the most important things you can do is learn psychological first aid, particularly how to recognize signs of trouble. Early recognition and intervention are critical.
Sleep Disorders
Prevalence
20% of the general population.
37% of the firefighter population.
Associated Illnesses/Conditions
Risk of the following conditions increases with inadequate sleep.
Cancer
Cardiovascular
Obesity
Diabetes
Talk to your doctor if you think you may have an issue.
Divorce
Divorce Rates
According to a recent study, as much as 25% of those over the age of 18 have experienced divorce. Male firefighters have a similar incidence of divorce as the general public. Females, however are 3x more likely to divorce than their male counterparts.
Pre-Divorce Support
The JFPSG is here for you. If you just need to vent or require structured couples or individual therapy, we can help. Our clinicians are experts in the field of marriage and family counseling. Please give us a call.
Post Divorce Support
Post-divorce, the need for support is heightened. We are here for you in these times as well. Our peer supporters are here to listen and our clinicians are here to treat divorce-related issues. Please give us a call.