They’re scenes that are hard to read about in the paper, but even harder to witness in person: Gathering a child from the pavement after they’ve been struck by a vehicle; trying to revive someone who has attempted to take their own life; sifting through the rubble of a fire in search of a body.
Most firefighters can recall with ease at least three horrific emergency calls that replay in their mind.
Long after the adrenaline has subsided, these memories remain — and years of witnessing heart-stopping scenes takes its toll. Studies show that firefighters’ prolonged exposure to traumatic events is triggering post-traumatic stress disorder at rates similar to those found in service members returning from combat. Agencies around Clark County have different ways of addressing this frightening trend, while legislators work to make it easier for first responders to seek the mental health treatment they need.
Backpack of trauma
When the Vancouver Fire Department looked for a way to address post-traumatic stress in firefighters, it turned to an expert just south of the Columbia River.
Tim Dietz was a firefighter in Oregon for 22 years. During that time, his 2-year-old son drowned at a babysitter’s house. To cope with the tragedy, he sought help from the employee assistance program but didn’t appreciate his experience with the counselors he encountered.
“They didn’t know how to handle the emergency worker’s side of it,” he said. “They told me, ‘You should quit your job.’ That’s not what I wanted to hear; I loved my job.”
The experience motivated Dietz to take a position as a behavioral health specialist at Tualatin Valley Fire & Rescue and go back to school to get his master’s in counseling. After retiring as a firefighter, Dietz founded Behavioral Wellness Resources, which aims to help emergency responders and the organizations they work for deal with trauma and the stress that inevitably follows.
“We keep putting ourselves out there to the risk of ourselves and our families because it’s the way that we’re wired,” he said. “We are wired to help people to our detriment. … We’re not wired to receive help.”
While local numbers are hard to find, the International Association of Fire Fighters reports that about 20 percent of firefighters and paramedics have experienced PTSD.
And that can have tragic results.
The National Fallen Firefighters Foundation estimates that suicide is three times more likely to happen among fire personnel than a line-of-duty death. Nearly half of firefighters (46.8 percent) have thought about suicide, 19.2 percent had suicide plans, and 15.5 percent had made attempts, according to the IAFF.
Part of the problem, Dietz said, is that the atmosphere of most fire stations doesn’t easily allow for a mental or emotional breakdown.
“The traditional culture of fire service is that it’s a sign you’re broken, it’s a sign of weakness,” he said. “It’s not a sign of weakness, it’s not a sign you’re broken, it’s not a sign you chose the wrong career. It’s a sign you’re a human being and you just went out on something horrible.”
Dietz often explains how firefighters deal with trauma with a backpack metaphor: Each traumatic event adds a rock to the pack.
“Eventually your backpack can get full of big rocks and little rocks. The stuffing stuff down in a backpack works until it doesn’t work anymore,” he said. “It’s called maladaptive coping mechanisms, and firefighters are the masters of that.”
Once it’s recognized, Dietz said, PTSD is very treatable.
“I can’t make you forget the event,” he said. However, “trauma is very treatable. … It takes the energy that the event still carries and it takes that away. It takes the rock out of the backpack.”
Dietz said he advocates for a peer support team model within fire organizations, but ultimately he wants first responders to be able to identify the stress of trauma and learn to take care of their mental health. That way, the stress of those traumatic experiences never becomes PTSD, he said.
Peer support team
Dietz began officially working with the Vancouver Fire Department about 15 years ago, when the agency was forced to face the mental risks that the job posed. In the span of about two years, the agency experienced four deaths of former and current firefighters. Two were suicides.
“It really rocked us,” fire Capt. Eric Giacchino said.
At the time, the agency addressed traumatic events, including deaths of co-workers, by holding critical incident stress debriefings, which involved bringing in a psychologist to talk to crew members in a group setting. Giacchino said they were formal and stuffy and not the intimate atmosphere required for divulging something personal.
“Somebody you don’t even know is going to come in and try to talk to you about your feelings and emotions; that’s just not going to fly with a group of firefighters,” Giacchino said. “Firefighters are a pretty tight group, and they don’t want to open up to just anybody off the street.”
So Dietz helped the agency form a peer support team — a group of six firefighters and one battalion chief who have received some specialized training on how to offer mental and emotional support to their co-workers.
Part of the reason the team works, Giacchino said, is that its members were chosen by their peers.
“We surveyed everybody in our fire department and asked: If you were having a problem and you wanted to chat with somebody about your problem, who would you select? Names just kind of rose to the top,” he said. “These are people who are good at establishing a relationship with somebody whether they know them or not. They’re good at talking to somebody and listening to them. They’re trustworthy, they’re not just somebody off the street.”
Giacchino said he was honored to be chosen to be part of the peer support team. After hearing of a particularly bad call, he or any of five other firefighters stop by to check on the crews. Sometimes, if it’s needed, peer support team members relay to management that a firefighter needs to go home. They’re not clinicians, Giacchino said, they’re friends.
“Our peer support team is just a more relaxed, more friendly, more personal way to engage with people,” Giacchino said. “It’s taken the stuffiness and the formality out of it.”
Employees at the Vancouver Fire Department who have something bothering them or are noticing a problem with a co-worker can call a peer support team member and get advice on dealing with the situation. Team members check back a few days later. If the advice doesn’t help, Giacchino said, the peer support team has a list of professionals who are used to working with firefighters — ones considered “culturally competent” and who won’t steer them away from the career.
Triggers are different for everyone, Giacchino said, so he says all firefighters are really supports for each other.
“I want to be happy and I want my co-workers to be happy. I love going to work, going on calls,” he said. “Unfortunately, when we go on calls, bad things happen.”
Fire Chief Joe Molina said it’s hard to evaluate the team’s success, since the team is union-run and management stays out of it. When managers are told someone needs to leave work, they accommodate.
“We don’t question them. The worst thing you can do is question it,” he said. “In this area, it feels like the right thing to do. … My sense is it is working. People are accessing it and hopefully benefiting.”
Ultimately, Giacchino said, he believes the group is working because he’s seen it accomplishing a big goal: changing the “macho” culture of firefighting by making it OK to open up about feelings.
“What we’re trying to do at the fire department with our peer support team is remove that culture of ‘I’m a tough firefighter, these things don’t bother me,’ ” Giacchino said. “After a 20- or 30-year career, we find that they do bother them. It’ll impact everybody — nobody gets out clean.”
Chaplains on call
While the peer support team model appears to be gaining popularity — Clark County Fire District 6 is committed to implementing something similar — other local agencies are using a resource also offered to victims or bystanders: the County-Wide Chaplaincy.
The organization’s story began in 1982 when Landis Epp, who at the time was a pastor at Battle Ground Baptist Church, made an off-the-cuff offer to the city’s police and fire chiefs to help. At first they both said no, but the next day they called him to ask what he meant.
Epp told them, “I just thought, you might be doing CPR on grandpa and the rest of the family’s standing around and not sure what to do and what’s going on,” he said. “Maybe I could just be there to help support them.”
They took him up on his offer, and what started as Epp, another chaplain and a pager evolved into a full-time job. He formed a nonprofit that has grown to now include about 12 chaplains, most of whom volunteer their time to be on call and respond to the scene of traumatic events alongside first responders.
Though the idea began as a support system for families going through trauma, Epp said that the chaplains naturally became a support to the firefighters.
After helping the victims and involved family through the initial shock, Epp began to stop by the fire station to hang out with crew members who dealt with the incident.
“Sometimes they come back to the station and think, ‘What could I have done different? What could I have done better? Or if only I had done this,’ ” Epp said. “One of the things we try to do is let them know that you were the last hope that they had. You did everything you possibly could have.”
Epp said that he tried to make sure the firefighters not only understand it, but feel it. He knows if they’re not in a good head space, they won’t be of help to anyone on the next call.
“We become the product of everything we see or are involved in,” he said. “There’s an interesting truth that you can’t pull somebody out of a hole if you’re falling in a hole yourself.”
Epp retired about a year and a half ago, and he said it was hard to leave the work. He found satisfaction in helping the people left in the wake of traumatic events, which includes those in uniform.
“It’s hard for a cop to cry; it’s hard for a firefighter to shed tears and to say this hurts like crazy,” he said. “They’re working to save lives and property and yet … (the chaplains) want to be a friend, to be able to help and support you so you can go to the next call without carrying a load on your shoulders that you failed at the last one.”
Helping the helpers
Before he became a state representative, John Lovick, D-Mill Creek, worked as a trooper with the Washington State Patrol for 31 years. He said he has firsthand experience of witnessing trauma and its impacts.
“The fatalities, school shootings, all of those things they have to respond to day in and day out,” Lovick said. “I saw that every day.”
He remembers working a full graveyard shift, getting home and going to bed at 8 a.m. on May 18, 1980, when he was called back to work to help respond to the eruption of Mount St. Helens.
“I know the strain and stress it put on me,” he said. “And who did I see there every day? Police officers and firefighters. Most people are getting out of the scene, fleeing danger, but they’re the ones going toward the danger.”
Those are the types of things Lovick said he thought about when he sponsored House Bill 1655, which would more easily allow first responders to make workers’ compensation claims for treatment of repeated exposure to traumatic events. It also adds PTSD as a presumptive occupational disease for those jobs.
After studies showed that firefighters were at an increased risk for certain cancers due to the exposure to toxins and carcinogens, most states evolved their laws to included those cancers to presumptive disability laws for firefighters. However, only one state — Oregon — has added PTSD and other mental health disorders to the list of occupationally related diseases in first responders.
Lovick is trying to make sure that Washington joins Oregon.
While firefighters at the Vancouver Fire Department can currently use sick leave or paid time off for post-traumatic stress, employees can’t easily get treatment and paid time off reimbursed through a compensation claim. This bill would open up those benefits for PTSD and provide the recognition that the illness is because of the job.
“It’s just an outdated law,” he said.
Though it’s too early to know the bill’s fate, Lovick said if it doesn’t pass, he won’t give up.
“I’ll work at it the next year and the next year and the next year until we get it passed,” he said. “These brave men and women are standing up for us every day. It’s time for us to stand up for them.”