Abstract
This chapter outlines the key issues that face firefighters, including prevalence of trauma-related mental health issues, the differing impact of disaster response, violence, fatalities, and cumulative stress. The risk factors for post-traumatic stress disorder are explained, with attention to fixed and variable factors. Stigma and barriers to help-seeking are explored with consideration of issues specific to firefighters, and an overview of how to influence protective factors is provided. There are other aspects of firefighting other than trauma exposure that impact wellbeing; the impact of shift work, sleep disruption, alcohol use, and relationship stress are outlined. Finally, this chapter discusses the impact of firefighting on partners and families.
TopIntroduction
Firefighters work in extreme conditions impacting physical, psychological, and emotional stress in the scope of their day-to-day work—a job that is characterized by running toward hazards as others flee. This was starkly observed in the aftermath of the September 11 attacks, as 412 emergency workers (343 of whom were firefighters) perished trying to rescue survivors in the World Trade Center. Hundreds of families and firehouses were bereaved in a single day. In popular culture, firefighters are branded as heroes who will always come to the rescue, while the crushing weight of responsibility that comes with the job remains hidden. Firefighters are never ‘off duty’ and face daily mental and physical stressors. Their families are not exempt from this job stress, as they also bear the hidden pressure of constant danger and risk of death or injury to their loved ones.
Firefighters respond to a range of emergencies such as fires, medical emergencies, hazardous chemicals, explosions, search-and-rescue operations, natural disasters, and other situations that may result in physical or psychological injury, including post-traumatic stress disorder (PTSD). Firefighting has been declared the most dangerous occupation in the United States by the National Commission on Fire Prevention and Control and in the International Association of Fire Fighters Annual Death and Injury Survey (IAFF, 1995). This chapter will outline the risk and protective factors for PTSD, considering what factors might be influenced to potentially change mental health and wellbeing outcomes in this high-risk profession. Finally, this chapter will discuss other known quality of life challenges associated with firefighting and the potential impact these have on partners and families.
Chapter Objectives
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Demonstrate an understanding of common mental health issues following trauma exposure.
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Describe the range of stressors associated with firefighting and their associated impacts on wellbeing.
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Recognize the risk and protective factors associated with PTSD.
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Understand the impact of firefighting on partners and families of firefighters.
Background
Firefighters are at increased risk of PTSD and other mental health problems because of the repeated trauma exposures that are a part of fire and emergency work. Some trauma exposures are highly visible and well publicized, such as major bushfires/wildfires or other natural disasters. However, the daily stress of firefighting is invisible to most, and the stigma of mental health issues that exists within fire services creates invisible pressure on firefighters to remain silent when they are struggling mentally or emotionally. This section will provide an overview of trauma and mental health issues within fire and emergency services, with reference to different types of trauma and the varying impacts on firefighter mental health and wellbeing.
Key Terms in this Chapter
Protective Factors: Factors that might boost resilience, or otherwise protect an individual from psychological harm following a trauma exposure.
Potentially Traumatic Event (PTE): An event that meets the diagnostic definition of a “trauma,” as defined by the Diagnostic and Statistical Manual for Mental Disorders (5 th Edition). For example, natural disaster, car accident, war/combat, sexual violence, or serious injury.
Acute Stress Disorder: A psychological disorder that occurs within 4 weeks of being exposed to a traumatic event.
Impression Management: The attempt to influence the perceptions of others. In this chapter, impression management referred to attempts to make firefighting work appear less stressful than it is, to avoid talking about major incidents, or minimize symptoms of stress.
Variable Risk Factors: A set of risk factors that may change with time and can be altered by intervention.
Self-Esteem: A person’s general sense of personal value.
Belongingness: A sense of fitting in, being valued and respected.
Ambiguous Loss: A potential loss, or loss without closure, such as when a firefighter is attending a significant disaster and family cannot confirm their physical wellbeing. For example, when firefighters were attending to the 9/11 disaster.
Burnout: A sense of exhaustion and cynicism resulting from chronic and prolonged job stress.
Post-Traumatic Stress Disorder (PTSD): A psychological disorder that may occur in people who have been exposed to trauma.
Peri-Traumatic Arousal: Physical arousal during a potentially traumatic experience.
Adaptive Denial: Using denial to improve or maintain wellbeing. For example, consciously or subconsciously directing attention away from stressful aspects of firefighting and focusing on rewarding aspects of the job.
Cumulative Stress: A buildup of various stressors, leading to agitation, difficulty coping, and inability to relax. Cumulative stress may occur in high-risk professions such as firefighting, but may also occur during periods of prolonged life stress (e.g., relationship breakdown, serious illness of a family member).
Fixed Risk Factors: A set of risk factors that cannot be changed.