A working paper designed to address Post Traumatic Stress as it relates to the emergent field surrounding the professional Fire Fighter.

Gaining knowledge of what exactly post traumatic stress is and how it affects the fire fighter has become a goal that achievable given the proper background and insight as to how a fire fighter thinks and operates. As information is culled from the profession it will need to be updated. As additional data is made available and brought to the front lines for use by fire fighters the treatment of those under stress of the disorder should become more socially accepted within the culture of the profession itself. The knowledge gained can be transferred and is no different than that which is shared and taught to the Rookie/Probationary candidate when they attend fire school and learn about the use of various tools and equipment.

In the cultural past and into the present, fire fighters have presented themselves within the male dominated belief that as men, they have to “suck it up” and brave the perils of their profession to the public they are to serve. Privately, within the domain of their own culture, there is a different view. After the events of 9/11, the public wanted to know more about the people who risked life and limb to be there during such a catastrophic event which had so changed and altered our world.

In opening a general discussion on P.T.S.D a few observations can be reviewed.

One should ask what post trauma stress is not. For the average, if there can be an average person, the norm or abnormal description lays in the pages of the D.S.M.IV. or Diagnostic and Statistical Manual revision for used by professionals to define Post Trauma Stress.

P.S.T.D comes in two types. Type I encompasses exposure to events or the witnessing of events that are extreme and/or life threatening. Traumatic exposure may be brief in duration or involve prolonged, repeated exposure. Type 2 P.T.S.D. is type involving repeated long term exposure (*Meichenbaum, 1994)

P.T.S.D. is not funny nor it is a “happy event” designed to allow the fire fighter who is experiencing its signs to evade working in his/ her profession.

P.T.S.D. is not for faint of heart. It has real consequences for the individual and their family and those the fire fighter works with.

P.T.S.D. can, with education, be understood. It requires maturity and wisdom to begin to understand how it effects the individual. It requires a level of time, energy and commitment in order to understand it.

P.T.S.D. statistic: Approximately 50% of individuals who have developed the disorder continue to suffer from its effects decades later without treatment. (*Meichenbaum, 1994) There is remission for Type 2 but, the effect of P.T.S.D. remains for the balance of the individuals lifetime once it has been detected and actually determined that the individual has it.

P.T.S.D. is a psychological disorder. It has such overwhelming impact on the individual that serious medical complications can and do result. These include diabetes, heart related problems, suicide (the silent killer), drug abuse and family abuse to name a few.

P.T.S.D. is not about drug therapy or drug intervention. It is about the use of drugs to provide temporary short term relief from the effects of the disorder.

P.T.S.D. require testing in the clinical determination phase using recognized methods by a properly trained individual.

P.T.S.D., narrowed to the effect it has on the profession of fire fighting, has not been the primary focus of care givers or clinicians prior to the events of 9/11. For the front line fire fighter, there is no other source of comparison for the definition of the disorder until the writing of the paper. Prior to that, all fire fighters have been collectively placed into the general population and the definition found in the manual.

Fire Fighter Traumatic Stress Disorder (F.T.S.D.): the generic name given to include the D.S.M.IV definition is not currently in the D.S.M.IV manual. The manual itself is being updated and is scheduled for released sometime in the next few years. The term belongs to, and is the intellectual property of, Shannon H. Pennington of FireWorks Consulting (World copy right reserved). Until its writing, there is no other published documents relating to Fire Fighter Traumatic Stress Disorder (F.T.S.D). There is mention of a parallel under the title, “cop shock”, written to cover the description of stress and its effect on the police profession.

P.T.S.D. is survivable given the tools and methods of understanding when coupled with the correct approach to the care of the individual who are effected by its assault on the inner kingdom of self where the processing of traumatic stress takes place.

P.T.S.D. symptoms often co-occur with other psychiatric conditions. This is referred to as co-morbidity (e.g. substance abuse, depression, personality disorders). It is important to assess for co-morbid (in other words “others”) disorders when seeing a patient who presents with trauma induced symptoms (*Traumatic Stress: An overview by Joseph S. Volpe, PhD).

F.T.S.D. (Fire Fighter Traumatic Stress Disorder) is currently the co-emergent number one disease of fire fighters who serve on the nations front lines. It ranks beside cancer, heart attacks and lung disease (Approximate figures show that in the United States of America there are some 1.1 million fire fighters on the front lines and at risk.). As an additional note, not every fire fighter will experience F.T.S.D. but everyone has the potential to fall victim to the disorder.

There are many reasons that the disorder is not being addressed, or assessed at the level it should be. The literature needs to be generic in content to the profession and speak to the core issues that are emergent from a properly assessed study of the problem as it relates to its professional attachment to all aspects of fire fighting but, more specifically to the "emergent needs of the front line fire fighting individual". In many, if not all cases, the individual works in a crew/team-like setting but is treated in a individual manner. This adds to the separation anxiety and stress that has provided the link for safe networking which the injured person needs in order to assist in understanding the event as it is happening to them. In the last century, many of the support networking systems for the fire service are simply non-existent or stress rooted using old behaviour models that are no longer relevant given the increase in the requirement for a broader based service delivery which includes medical, fire, hazardous materials and, now current to the new reality, terrorist events.

It will require many of those fire fighters who are exposed to the disorder to reach for the necessary tools to aid them in gaining an understanding. It will take massive amounts of courage and resources to give those who need it, a step up the ladder of recovery.

It stars with the "FIRST STEP" acronym developed by the writer:

Fire Fighter
Initial
Response to
Stressful
Trauma

Sound Off
Tell a Friend or Co worker, someone you trust
Employ all available means of assistance including competent
Psychological help from someone trained in stress / asd / ptsd assesment treatment.

Have
Options
Prior to
Engaging in process or Exiting the Profession.

If the care givers and clinical professionals begin to take the steps toward helping those, within the time-honoured profession of "Fire Fighting", who are suffering needlessly when there is help at hand, then the future will have truly been embraced. The challenge is there, the need is great, and the clock is ticking. The front lines in the new reality remain whole for the time being.

On a final note:

It is natural evolution for those who serve the front line to reach out the "new reality" of the 21st century (including post 9/11) instead of looking back into the early years of the profession, when muscle and sweat and raw determination were the primary characteristics that made the individual effective.

The common denominator of courage that binds the old with the new will allow the lay person and medical community to begin to understand that there is great pain, and injury from that pain, that needs to be addressed if the individual fire fighter is to lead a healthy life beyond the profession and into the privacy of his/her own family as well as a sense of well being.

It is the very least that the public begins to understand the professional and volunteer fire fighter. In doing so, the community the fire fighter serves will be rewarded with a longer serving, healthier and capable individual who deserves and has earned the right to be heard from. It makes sense to care for the care givers in our community and nations. Not just in the myth that has been built up from the public imagination of who or what the profession does for a living but, for the reality that is.

The acronym: "FIRST STEP and HOPE" are the intellectual property of Shannon H. Pennington of FireWorks Consulting (World copy right reserved). Permission to reprint this article is given by the author.

Shannon H. Pennington is a retired, 26 year, career fire fighter veteran. He is a member of the International Critical Incident Stress Foundation, a past member of the American Academy of Experts in Traumatic Stress. He is also a retired Warrant Officer in the Canadian Armed Forces (Regular and Reserve component) and a former Military Engineer. He is currently a Senior Chief with the North American Fire Fighter Veterans Network, assisting fire fighter veterans in Canada and the United States. He can be contacted by e-mail at the following address: firefighterveteran@hotmail.com or by telephone at (250) 812-3737.