Speaking of Fire
NAVIGATING THE IMPACTS OF
Extreme Events
Me nta l H ealt h Glo bal Pa nde mic Sleep Disord ers E xtreme Wildfire
h D t omest ic Terr o l a e H l r a o i v a Beh rism N s a s tural Disa e r t S r e t h g sters Fir efi
Photo by Louise Bradt
In This Issue ARTICLES Introduction: Protecting our Communities by Chief Dennis Compton.................................................................................... 2 Stress and Mental Health: Take Care of You by Maria Koeppel, Ph.D. and Sara Jahnke, Ph.D.................................................. 4
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A Full Toolbox by Joel Billings, Ph.D. and Allison Kwesell, Ph.D.................................................. 7 Preparing for the Extreme and Unexpected by Chief Bill Tensfeld......................................................................................... 11 Bridging the Gap Between Community and Government Assistance by the IAFF............................................................................................... 14 For the Love of the Job by Brittany Hollerback, Ph.D.............................................................................16
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Dear Reader by IFSTA Executive Director Mike Wieder...........................................................20 Mental Health Resources .....................................................................21
page 16 Fire Protection Publications | Oklahoma State University | 930 N. Willis St., Stillwater, OK 74078-8045 +1 (800) 654-4055 | ifsta.org Director: Craig Hannan | Associate Director and IFSTA Executive Director: Mike Wieder Managing Editor: Colby Cagle | Copy Editors: Peyton Haley, Erin Portman, Jason Sharps Layout & Design: Ben Brock Comments or Questions? Contact Colby Cagle by email: caglecw@osufpp.org. The views acknowledged in Speaking of Fire do not necessarily reflect those of Fire Protection Publications or the International Fire Service Training Association. FPP is an extension unit in the College of Engineering, Architecture and Technology at Oklahoma State University, and operates as headquarters for IFSTA. Copyright © 2021 Fire Protection Publications. This material may not be reproduced without the express permission of the publisher.
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Introduction: Protecting Our Communities by Chief Dennis Compton
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hen I began my fire service career in Phoenix, Arizona, more than 50 years ago, fire departments played a critical role in protecting communities throughout the nation – but the mission was more narrow then than it is today. As far as emergency response was concerned, the mission focused primarily on responding to fires, first aid calls and special duty calls. The training for firefighters was limited, and the Personal Protective Equipment (PPE) was poorly engineered, or in some cases, non-existent. Firefighters learned basic fire suppression and rescue at the entry level, Red Cross first aid training – which took a total of 8 hours, and the only special duty training we received was using a Geiger Counter to search for radiation. During the 1960s and 1970s, more than 12,000 people died in fires each year in the United States and hundreds of thousands were injured. It was common to experience upwards of 250+ firefighter line-of-duty deaths each year as well. Whether career or volunteer, being a firefighter was the greatest job I ever had. The people I began my career with were incredible and they were as committed to their work as firefighters have ever been. We performed the mission we were assigned and did it well, using the training, equipment and safety gear to the best of our ability. The camaraderie within the department was off the charts and for the most part, the public appreciated their firefighters. When dispatched, we went to the scene and gave it our all. When dispatched on another run, we went out and did it again – and again – with little regard from fire administrators or anyone else for the toll that intensity of work might be taking on firefighters. Basically, as a fire department, we took better care of our fire apparatus than our firefighters. I don’t mean that as a dig on the past because until the 1980s or so, firefighter safety and wellness just wasn’t a front-burner issue. Changes in the fire service mission have been significant, including the types and frequency of responses firefighters might make during a shift. These changes, along with the performance expectations the public has of fire departments and firefighters, didn’t come all at once. They occurred incrementally over time and resulted in the fire service becoming recognized as literally an all-hazards fire and life safety emergency service delivery system. Among these expectations has been the evolution of the fire service role in dealing with disasters (natural and human caused) and other extreme events. We essentially try our best to prevent harm – period – and address harm whenever it occurs. As IFSTA’s Speaking of Fire has done in the past, this edition looks at current response issues in general and focuses specifically on those issues that will certainly continue to challenge us in the future. The topics in this issue of Speaking of Fire are not limited to emergency response’s responsibilities on the scene, but include the cumulative impact of the modern-day mission on firefighters – physically, emotion-
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ally and psychologically. During my career, I have responded to more than my share of what most would consider significant emergency incidents, including deadly high-rise hotel fires, major earthquakes, domestic terrorism in Oklahoma City, devastating hurricanes, terrorist attacks at the Pentagon and the World Trade Center, and a full range of emergency incidents throughout the Phoenix and Mesa Metropolitan Areas in Arizona. The key to success throughout past years has revolved around training and this remains true today. You simply can’t outperform your people. With that as the reality, I strongly believe the programs that need to be in place to maintain our firefighters’ health and well-being, as well as the training it takes to make those programs successful, is more important and complex today than ever before. Consider just the past few years, as fire departments have assumed and/or been delegated responsibility for the pre-hospital care of patients during the global COVID-19 pandemic. Additionally, due to issues surrounding the urban/wildland interface, zoning and construction practices, and changes in our climate, we are responding to frequent incidents of extreme wildfire behavior. Our human resources are on the scenes of acts of terrorism, active shooter situations and incidents arising from political and social uprise. Natural disasters seem to have increased in frequency and are more volatile than what has been the norm. These and similar challenges will continue in some form for years to come. As the fire service, we will only be effective in meeting these and other mission challenges over the long haul if we maintain our human resources to the best of our ability. I am thrilled that Speaking of Fire will focus this edition on the types of programs and interventions that will accomplish that goal. These include, but are certainly not limited to, mental and behavioral health, stress, PTSD, and disorders such as sleep, and recovery from disasters and other events that meets not only the needs of the community, but the firefighters/first responders as well. Enjoy exploring this state-of-the-art information, because it will make fire departments more effective and their members safer, healthier and better prepared. About the Author Chief Dennis Compton has been a firefighter, fire officer, and fire chief, as well as held leadership positions in several national fire service organizations for more than 50 years. During that time, he is humbled to have been the recipient of many prestigious national awards and recognitions. Chief Compton has been a member (and past chair) of the IFSTA Executive Board since 1983.
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Stress and Mental Health: Take Care of You by Maria D. H. Koeppel, Ph.D. and Sara A. Jahnke, Ph.D. Center for Fire, Rescue, and EMS Health Research, NDRI-USA, Inc.
T
he inherent stress associated with firefighting is well known, widespread and comprehensive. It’s the physical stress of working in extreme conditions in heavy gear. It’s the emotional response to witnessing trauma and human suffering. It’s the mental grind of middle of the night calls and lifesaving responsibilities. Rookies and new recruits know it comes with the territory, similar to the bunker gear issued to them at the start of their careers. Veterans know it’s responsible for the overabundance of gray hair. All of them prepared to face it head on–like opening the front door to a burning house. Stress, unlike a fire, isn’t easily contained with water and proper venting. It is much more similar to carbon monoxide, a silent toxin spreading everywhere in the life of the firefighter–unknown until it begins to cause damage. Damage such as interrupting sleep, settling on waistlines, increasing substance use, fracturing marriages, and truncating lives. While once a taboo subject in the fire house, stress and its toll on mental health is slowly becoming a topic of conversation, especially as more about the topic is being understood. Firefighters are up to five times more likely to suffer from depression and PTSD.3 In 2017, more firefighters died by suicide than in the line of duty.3 Repeated exposure to trauma affects personal and family relationships as firefighters become more cynical and negative.4 These effects make a lasting impression, and highlighting the impact of extreme events on firefighters is important as they add additional stress. Natural disasters, pandemics and epidemics, and man-made tragedies add a layer of uncertainty for those already in a career filled by the unknown. Stress associated with these unanticipated, wide-spread events impact firefighters in previously unconsidered ways and tax an already overwhelmed nervous system. Firefighters on duty during natural disasters (hurricanes, tornados, floods and derechos) must respond to an influx of calls as the public requires assistance while trying to determine if their own family and friends are safe, creating an internal struggle between service to community and service to family. The stress of increased workloads, intense debris clean up and drawn out community rebuilding results in increased rates of both substance use and depression.6,7 Working during the COVID-19 pandemic led to a heightened fear of contracting and spreading the virus, a fear that greatly impacted families as spouses and children stayed away from firefighters to ensure their own health.8 Increased stress levels coincide with epidemics, including AIDS and H1N1; however, the effects during the COVID-19 pandemic have reached epic proportions. Sleep disorders have developed as the brain tries to process the increased number of patients related to the virus.8 Post-traumatic stress associated with COVID-19 has become a specific reason for first responder suicide.2
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Perhaps the most horrific extreme events are man-made tragedies, given their intentional nature. Personnel working during events like active-shooter incidents or tragedies like 9/11 experience the most extreme form of stress as they fear for their lives and juggle their own life safety while tending to patients. Sleep is often interrupted with horrific images of victims, making it even more difficult to process and heal from the experience. Firefighters who are parents often project their children’s faces onto young victims, making sleep even more elusive. Job burnout, substance use, depression and PTSD all increase as a result. Privacy to cope is often scarce as constant media attention regarding these events magnifies the emotional toll, making it difficult for firefighters to escape trigger points.1 These mental health outcomes are examples of the damage caused by unchecked extreme stress. While it may be simple enough for firefighters to brush the mental strain off as part of the job, too many brothers and sisters have experienced declining mental and physical health, and have lost relationships and lives to the silent toxin. Firefighters recommend homes have a carbon monoxide detector to ensure the safety of the residents before the gas has caused damage. The need for a stress detector to ensure the mental wellbeing of firefighters is proving to be just as necessary. The impact of social support cannot be overstated, especially during times of social distancing.5 Firefighting is the ultimate team environment. The job can’t be done alone. Healing from the job can’t be done alone either. About the Authors Maria D.H. Koeppel, Ph.D. is a postdoctoral fellow at NDRI-USA. Maria's graduate work was in Criminal Justice, completed while studying at Sam Houston State University. Previous areas of research included gender and crime, queer criminology, and victimization. Prior to joining NDRI-USA, Maria was a firefighter. Sara Jahnke, Ph.D. is the director and a senior scientist of the Center for Fire, Rescue & EMS Health Research at the National Development & Research Institutes - USA. With over a decade of research experience on firefighter health, she has been the principal investigator on ten national studies as well as dozens of studies as a co-investigator. Her work has focused on a range of health concerns including the health of women firefighters, behavioral health, risk of injury, cancer, cardiovascular risk factors, and substance use with funding from the Assistance to Firefighters Grant R&D Program, the National Institutes of Health and other foundations. She has more than 100 publications in the peer reviewed medical literature. References 1. DeMarco, H. (2018, July 4). The other victims: First responders to violent disasters often suffer alone. Retrieved January 28, 2021. 2. Edelman, S. (2020, June 20). FDNY EMS lieutenant dead in apparent suicide may be due to coronavirus PTSD: Union. Retrieved January 28, 2021. Speaking of Fire
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3. Heyman, M., Dill, J., & Douglas, R. (2018). The Ruderman white paper on mental health and suicide of first responders. Ruderman Family Foundation. . 4. Jahnke, S., Poston, W., Haddock, C., & Murphy, B. (2016). Firefighting and mental health: Experiences of repeated exposure to trauma. Work, 53, 737-744. 5. Lamplugh, M. (2020, July 10). Covid-19 and its psychological effects on firefighters and first responders. Retrieved January 27, 2021. 6. Mohney, G. (2016, October 13). Natural disasters may increase substance abuse risk, study finds. Retrieved January 27, 2021. 7. Osofsky, H., Osofsky, J., Arey, J., Kronenberg, M., Hasel, T., & Many, M. (2011). Hurricane Katrina’s first responders: the struggle to protect and serve in the aftermath of the disaster. Disaster medicine and public health preparedness, 5 Suppl 2, S214–S219. 8. Wang, H. (2020, April 23). ‘I Hear The Agony’: Coronavirus Crisis Takes Toll On NYC’s First Responders. Retrieved January 28, 2021.
Training Solutions for Every Need Public Information Officer, 2nd Edition
The second edition of Fire Protection Publications’ Public Information Officer is a complete revision of our previous manual, intended to provide basic skills and awareness training for fire department PIOs. This manual has been constructed to meet NFPA 1035 guidelines and practices in the field, and features an overview of the skills and knowledge a PIO needs to perform the diverse and demanding tasks associated with the position.
Item Number: 36347 Introduction to Active Shooter/Hostile Event Response This first edition of Fire Protection Publications’ Introduction to Active Shooter/Hostile Event Response defines how to establish an ASHER training program on the local level, how to conduct threat assessment of your community, how to coordinate response with other responders and how to recover from an ASHE. Ours is the only fire service training manual available on this topic. The manual addresses NFPA 3000™, Standard for an Active Shooter/Hostile Event Response (ASHER) Program.
Item Number: 36190
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Speaking of Fire
A Full Toolbox by Joel M. Billings, Ph.D. and Allison Kwesell, Ph.D.
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ithin the last 10 years, an emergence of research exploring firefighter sleep has indicated that most firefighters experience inadequate sleep. Firefighters in Finland report sleep disturbances after working more than 50 hours in a week1. Mehrdad and colleges found 69.9% of firefighters report poor sleep quality2 compared to 37% of the general adult population in Tehran.3 A study of South Korean firefighters found 51.6% of shiftwork firefighters suffer poor sleep quality compared with 38.5% of non-shiftwork firefighters.4 Researchers found 59.3% of Iranian firefighters report poor sleep quality.5 Among six fire departments in the South-Central US, 73% of firefighters report poor sleep quality.6 It is generally understood that anticipating and responding to emergencies during the night disrupts sleep duration and sleep quality (Figure 1) compared to non-work nights. While responders may recover sleep at home, the continual “all-nighter” creates a greater risk for adverse outcomes. Research consistently associates poor sleep with acute and Figure 1: Firefighter Actigraphy chronic health impairments, which would ultimately decrease firefighter performance. It makes sense why sleep has been labeled the fourth pillar of health7 accompanied by a healthy diet, physical activity and mental wellbeing. The concessions to normal safety rules assume fire and emergency responders have a high level of alertness and performance. While working during the night reduces sleep opportunity and disrupts circadian rhythm, it may be possible to improve the quality of sleep one receives. Figure 2 illustrates the relationship of sleep to organizational characteristics, sleep environments (home and work), individual behaviors, mental health, physical health, physical performance and cognitive performance. Individual Behaviors
Mental Health Acute Stress
Anxiety
PTSD
Alcohol
Drugs
Physical Health Diet
Immune Function
Obesity
Cardiovascular System
Sleeping Environments (home and work)
Organizational Characteristics Individual Call Volume
Shift Schedule
SLEEP
Shift Start Time
Temperature
Odor
Sound
Physical Performance Muscular Strength
Endurance
Light
Comfort
Cognitive Performance Reaction Time
Memory Recall
Alertness
Figure 2: Relationships of Sleep
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While certain indicators may directly affect sleep duration and quality, some factors in mental health, physical health and individual behaviors may be bidirectional, meaning one can influence the other and vice versa. Fire and emergency services is a high-risk occupation. Members within this profession do not always operate in protected environments, so it is likely many are exposed to varying degrees of stressors throughout their career. Each shift, they face an uncertain level of harm, from the routine public assist to the mass casualty incident. Thus, in addition to medical skills, fire/EMS, police and other emergency responders need a tool chest of psychological skills.8-9 Such continued and cyclical experienced trauma can result in ongoing PTSD, or what academics term persistent PTSD.10 Those facing ambiguity cope by 1.) focusing on alleviating a direct issue, or 2.) trying to find meaning for an event that occurred. The latter, termed pervasive ambiguity, may lead to searches of “why” something happened.11 Persistent PTSD has been found to result in: ongoing posttraumatic symptoms (increased anxiety, hypervigilance and numbing),10, 12-13 behavioral conditions (avoidance activities like overuse of drugs and alcohol and loss of sleep),14-15 and health conditions (obesity, autoimmune and cardiovascular disease).16-17 PTSD can result in rumination and insomnia, which can eventually snowball into more severe adverse impacts. In addition, the cyclical nature of the profession may repeatedly expose responders to trauma. If left unaddressed, the trauma effects may be more difficult to mitigate18-20 placing firefighters, their co-workers and the community at risk. While such trauma may adversely affect responders, experiences may also prepare them to be better at their jobs. People experiencing persistent PTSD can have enhanced self-determination and may positively impact their communities.21-22 When not completely overwhelmed by an experienced trauma, responders can learn from their experiences to prepare for future situations. Essentially, the more tools they have, the better. Sleep is the central connection in the web of human functions. It relates to physical and mental health, but is often overlooked. Sleep should become a priority for responders and organizations because with improved sleep, diet, physical activity and mental wellbeing, fire and emergency services responders will be better prepared to perform tasks, process exposures and recover from shiftwork – improving their resilience for future events. About the Authors Joel M. Billings, Ph.D. is an Assistant Professor of Security and Emergency Services at Embry-Riddle Aeronautical University. He is interested in building the body of knowledge in fire and emergency services to prevent loss in health and safety. He wants to help bring together research and practice to influence evidence-based decision making. Billings’ current research focuses on firefighter sleep quality, fire department shift schedules and fire station alerting systems. 8
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Allison Kwesell, Ph.D. is an Assistant Professor of Communication at Embry-Riddle Aeronautical University. Her research interests include implications of collective trauma, visual narration as a tool to cope with post-trauma, effects of media photographs and socio-psychological aspects of sustainable recovery. Kwesell worked as a photojournalist for over a decade, covering public health, disaster, conflict and post-conflict for international media outlets.
References 1. Lusa, Sirpa, Marketta Häkkänen, Ritva Luukkonen and Eira Viikari-Juntura. (2002). Perceived physical work capacity, stress, sleep disturbance and occupational accidents among firefighters working during a strike. Work & Stress, 16(3):264-274. 2. Mehrdad, Ramin, Khosro Sadeghniiat Haghighi and Amir Hossein Naseri Esfahani. (2013). Sleep quality of professional firefighters. International journal of preventive medicine, 4(9):1095. 3. Asghari, Alimohamad, Mohammad Farhadi, Seyed Kamran Kamrava and Babak Ghalehbaghi. 2012. Subjective sleep quality in urban population. Archives of Iranian medicine 15(2):95. 4. Lim, D. K., K. O. Baek, I. S. Chung and M. Y. Lee. (2014). Factors related to sleep disorders among male firefighters. Ann Occup Environ Med, 26(1):1-8. 5. Abbasi, Mahnaz, Majid Rajabi, Zohreh Yazdi and Ali Akbar Shafikhani. 2018. Factors affecting sleep quality in firefighters. Sleep and Hypnosis, 20(4):283-289. 6. Billings, Joel and Will Focht. 2016. Firefighter shift schedules affect sleep quality. Journal of Occupational and Environmental Medicine, 58(3):294-298. 7. Duncan, Dustin T, Ichiro Kawachi and Susan Redline. The social epidemiology of sleep. In, edited by: Oxford University Press, 2019. 8. Steadman, H. J., Deane, M. W., Borum, R., & Morrissey, J. P. (2000). Comparing outcomes of major models of police responses to mental health emergencies. Psychiatric Services, 51(5):645–649. 9. World Health Organization. (2009). Preventing Suicide: A resource for police, firefighters and other first line responders. 10. Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4):319–345. 11. Ball-Rokeach, S. J. (1973). From Pervasive Ambiguity to a Definition of the Situation. Sociometry, 36(3):378–389. 12. Friedman, M. J. (2007). PTSD history and overview. United States Department of Veterans Affair [Available Online]. 13. Thabet, A. A., Tawahina, A. A., El Sarraj, E., & Vostanis, P. (2008). Exposure to war trauma and PTSD among parents and children in the Gaza strip. European Child & Adolescent Psychiatry, 17(4):191–199. 14. Sestito, S. F., Rodriguez, K. L., Saba, S. K., Conley, J. W., Mitchell, M. A., & Gordon, A. J. (2017). Homeless veterans’ experiences with substance use, recovery, and treatment through photo elicitation. Substance Abuse, 38(4):422– 431.
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15. Ueda, Y., Yabe, H., Maeda, M., Ohira, T., Fujii, S., Niwa, S., Ohtsuru, A., Mashiko, H., Harigane, M., Yasumura, S., & the Fukushima Health Management Survey Group. (2016). Drinking behavior and mental illness among evacuees in Fukushima following the great east Japan earthquake: The Fukushima health management durvey. Alcoholism: Clinical and Experimental Research, 40(3):623– 630. 16. Bookwalter, D. B., Roenfeldt, K. A., LeardMann, C. A., Kong, S. Y., Riddle, M. S., & Rull, R. P. (2020). Posttraumatic stress disorder and risk of selected autoimmune diseases among US military personnel. BMC Psychiatry, 20(1):1–8. 17. Ryder, A. L., Azcarate, P. M., & Cohen, B. E. (2018). PTSD and physical health. Current Psychiatry Reports, 20(12):1–8. 18. Back, S. E., Flanagan, J. C., Jones, J. L., Augur, I., Peterson, A. L., YoungMcCaughan, S., Shirley, D. W., Henschel, A., Joseph, J. E., & Litz, B. T. (2018). Doxazosin for the treatment of co-occurring PTSD and alcohol use disorder: Design and methodology of a randomized controlled trial in military veterans. Contemporary Clinical Trials 73:8–15. 19. Brazil, A. (2017). Exploring critical incidents and postexposure management in a volunteer fire service. Journal of Aggression, Maltreatment & Trauma, 26(3):244– 257. 20. Flannery, R. B. (2020). Psychological trauma and the trauma surgeon. Psychiatric Quarterly, 1–7. 21. Bonanno, G. A., Brewin, C. R., Kaniasty, K., & Greca, A. M. L. (2010). Weighing the costs of disaster: consequences, risks, and resilience in individuals, families, and communities. Psychological Science in the Public Interest, 11(1):1–49. 22. Calhoun, L. G., & Tedeschi, R. G. (1998). Posttraumatic growth: Future directions. In Posttraumatic growth (pp. 217–240). Routledge.
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Speaking of Fire
Preparing for the Extreme and Unexpected by Chief Bill Tensfeld Director of Whitman County Emergency Management
H
ow far outside your comfort zone are you going to have to call for resources? What if an extreme disaster comes and you need resources three counties away, but never had a conversation with those chiefs?
Extreme Events Whitman County lies in eastern Washington State and is the number one wheat producing county in the nation. Area farmers were wrapping up the 2020 harvest of a bumper wheat crop, accompanied by dry conditions and erratic wind. Whitman County is mostly protected by volunteer departments (districts), with full-time crews in our larger cities, Pullman and Colfax, all bound together by mutual aid agreements. A typical harvest or wildland fire response includes the home district and a few others, however due to 2020s abnormal conditions, we added a couple of additional districts. For years, I have stressed to my own volunteers and to the county chiefs to “call for adequate help early on.” The National Weather Service issued a Red Flag Warning for September 7, 2020. The Colfax Emergency Management office was preparing a morning COVID press release when the Colfax Fire Department was paged to the first wildland fire of the day–in the middle of a residential area. As the wind picked up, another wildland fire was spotted five miles outside of Colfax in Green Hollow–within ten minutes, we went from one fire on a Red Flag day to two, stretching our resources and limiting our response. While dispatch requested resources from all the county districts, I called the area coordinator for air support; however, due to the winds, nothing was safe to fly. The county was tapped for resources, so I asked for State Mobilization. Walla Walla, the closest state resource center, was three hours away. I called Spokane County asking for aid, and they responded with singular strike teams of structural engines and wildland engines, but Courtesy of Chris Mickal/District Chief, New Orleans (LA) Fire Department Photo Unit were an hour away. From the Moscow, Idaho, Fire Department, we received and accepted an offer, since Moscow is only thirty minutes away. A Colfax residence and a large shop were both consumed by this point and the Green Hollow Fire threatened residences. Speaking of Fire
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An hour in, crews were managing the Colfax Fire and multiple requests were coming in – when a tone went out. A third wildfire had developed in Spokane County, a half mile from the county line. An automatic aid response was needed from my district. With the north wind, I knew it could wind up in my district. Monitoring the call, we rushed to develop a plan for the first two fires. My phone blew up! The fire was running fast in the timber and was heading directly towards the town of Malden. Evacuations were being ordered. I raced the 37 miles to Malden and was speaking to the county sheriff. Cresting the hill out of Colfax, a pyrocumulus cloud came into view–we had never experienced one before in Whitman County. Our hands were full. The fire blazed through Malden and destroyed about 80% of the town’s structures, continued south and decimated the community of Pine City, and continued southwest until it finally ran out of the timber and area farmers were able to catch it with tractors and disks.
Recovery Begins By sunup Tuesday morning, the Colfax Fire had consumed 10 acres, destroyed two homes and a large shop. The Green Hollow Road Fire had consumed 3,000 acres and destroyed two homes. The Babb Road/Malden Fire consumed just over 15,000 acres, destroyed 120 homes and 93 outbuildings. There were no fatalities. Courtesy of Chris Mickal/District Chief, New Orleans (LA) Fire
Days after the fire, a Type 3 Incident Department Photo Unit Management Team arrived. Four days after the fire, a Washington State Emergency Management Team arrived and completed a preliminary damage assessment for a Presidential Disaster Declaration. Nine days after the fire, a request for Public and Individual Assistance was submitted to FEMA. As the community came to grips with what had happened, donations started to pour in. Within a few days, local churches and community centers were overflowing with donated items. We requested help from the United Way of Whitman County for assistance with the monetary donations. The community attitude was upbeat, considering they had just survived a catastrophic event. Donations from across the nation were coming in and a FEMA declaration was pending. However, days turned to weeks with no word on the declaration. No explicit reason was ever given for our lack of an official Presidential Disaster Declaration. While we waited, the Washington State Department of Ecology performed asbestos assessments on the majority of the properties, Washington State Emergency Management secured a contract to clean up the uninsured and underinsured properties, and the community created a Long Term Recovery Group to assist the survivors.
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The recovery process is challenging even when things are going good. We should have had a Presidential Declaration four months sooner than we did. Those four months of not knowing were a disaster in itself as we tried to develop plans and contingency plans, not knowing if aid would be ever approved.
Lessons Learned • Call for adequate help early on–the quick response to Colfax saved numerous homes. • The call for State Resources put us in the queue early for an Incident Management Team, a limited resource that might not have been available if we had waited. • Understand the avenues of all types of resources. Volunteer resources such as farmers and tractors can be a huge asset to your response, but that, too, comes with issues like managing resources, safety risks and communication problems. • Review your mutual aid agreements - make sure they are inclusive for your everyday needs and will cover even the most unexpected days. • Extreme events can happen to any of us as any time and come in any form. Preparation and learning from others’ experiences can help lessen the blow of these events when it is your agency’s turn to respond. About the Author Chief Bill Tensfeld is the Director of Emergency Management for Whitman County, Washington. Tensfeld has been a volunteer firefighter/EMT with Whitman County Fire District #7 in Rosalia, Washington, for the past 38 years, serving as chief for the last 21 years.
TAKE YOUR TRAINING TO THE NEXT LEVEL
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Bridging the Gap Between Community and Government Assistance
D
uring crises, emergency personnel place their community’s safety and health before their own. Firefighters and emergency medical service (EMS) personnel are forced to work days, and sometimes weeks, to protect and serve their communities. Working consecutive days without a break, while away from their families and not knowing if their own homes are damaged, can pose significant long-term physical and behavioral health concerns for these individuals on the frontlines. When disaster strikes, the International Association of Fire Fighters (IAFF) is there to support our members and help local governments keep their communities safe. The IAFF, through union benefits and the disaster relief fund, helps to bridge the gap between local, state and federal assistance supporting emergency personal, enabling emergency responders to continue serving their communities.
Every division within the IAFF is involved in our union’s response to member needs. At the first indication disaster, the technical assistance division uses its Geographical Information System (GIS) mapping technology to identify members in the path of a storm, wildland fire, or other disaster area, allowing for a rapid triage of members needing the most assistance. GIS mapping also assists in identifying a safe and strategic location for centralized IAFF disaster relief operations. This command center is set up and operated by the IAFF Disaster Relief Go-Team, which consists of a five-member group of firefighters and EMS personnel from across the country who specialize in disaster response. The Go-Team evaluates and prioritizes the needs of members affected by the disaster, secures and deploys the resources necessary to respond, and oversees IAFF members who are helping provide assistance to their fellow fire fighters and EMS workers. Our communications team monitors the latest disaster-related information to provide timely updates on members in the affected area and the work of our Disaster Relief Go-Team. Further, the IAFF Health and Safety Division has a group of 6,000 trained peer support providers ready to help members and their families process the emotional toll of 14
Speaking of Fire
these catastrophic events. These mental health advocates meet first responders on the frontlines to listen and talk about what they are experiencing and how it is impacting them, and to provide the tools for addressing behavioral health issues and remaining resilient during difficult times. However, behavioral health assistance extends beyond natural disasters to include peer support services following an active shooter event, a serious injury or fire fighter line-of-duty death, as well as other significant incidents affecting firefighters’ or EMS personnel’s behavioral health. IAFF disaster relief efforts have grown in scope and sophistication by identifying types of resources and making plans to mobilize these resources in a timely and effective manner. The IAFF’s ability to quickly have teams on the ground to provide home repairs, deliver critical supplies and offer behavioral health services allows first responders to stay focused on the job at hand, keeping their communities safe, while advocating and recognizing the human nature of emergency responders. For more information on the IAFF disaster relief program, visit the IAFF Foundation website at: foundation.iaff.org
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IFSTA.ORG | 800.654.4055 Speaking of Fire
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For the Love of the Job by Brittany S. Hollerbach, Ph.D.
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irefighters want to do their job because they love the job. But sometimes, over the course of a career, things creep up and make the job more challenging. Firefighters know they work in a dangerous occupation, but the majority of fire service research has focused primarily on fireground related injuries and fatalities. Recently, there has been a shift towards focusing on other aspects of firefighter health and wellness, including cardiovascular health and cancer. In fact, firefighters are bombarded by a number of adverse health risks including disrupted sleep, horrific calls, inadequate physical activity, high levels of alcohol consumption, a unique food environment and strenuous work in toxic environments. While these issues point towards firefighting being unhealthy, many of these are modifiable risk factors. Just as progressive fire prevention strategy is essential for community risk reducCourtesy of Chris Mickal/District Chief, New Orleans (LA) Fire tion, so too is a prevention strategy Department Photo Unit for individual firefighter health. Large-scale disasters and recent events like the Oklahoma City bombing, Hurricane Katrina, 9/11 and, most recently, the COVID-19 pandemic have shifted the focus toward firefighters’ mental and behavioral health. Though incredibly resilient, first responders suffer from elevated rates of depression, anxiety, and post-traumatic stress disorder (PTSD).1 There is growing concern about behavioral health issues and their significant impact on firefighter wellness, as well. The stress faced by firefighters and other first responders throughout their careers–incidents involving children, domestic violence, death or injury of a coworker, and other potentially traumatic events–can have a cumulative impact on mental health and well-being.2 Recent work by Jahnke and colleagues found there is a cumulative psychological toll of repeated exposure to traumatic events including desensitization, flashbacks and irritability.2 According to the Firefighter Behavioral Health Alliance (FFBHA), 120 firefighters and 21 emergency medical technicians (EMTs) and paramedics died as the result of suicide in 2019,3 which is more than double the firefighter line of duty deaths reported that year.4 Large metro departments have also seen a spike in clustered firefighter suicides in recent years.5 The impacts of mental health issues among firefighters manifest into behavioral health concerns such as substance abuse, increased caloric intake, weight gain and obesity, and increased injury rates. For example, on average, firefighters drink more
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frequently and in larger quantities than the general population.6,7,8 Alcohol use disorders were rampant among firefighters who responded to the Oklahoma City bombing and using alcohol as a coping mechanism resulted in poorer functioning.9,10 Recent research found that alcohol dependence was associated with depression and posttraumatic stress, as well as suicide risk.11 Firefighters struggle with low fitness levels and increasing rates of overweight and obesity,12 likely due to the nature of the job and fire service culture.13 Firefighting is a stressful career and it has been characterized as a high demand, low control profession.14 A number of studies have found positive associations between job strain/stress and body mass index (BMI).14,15 Recent work with women firefighters found correlations between depression, anxiety and PTSD, and the likelihood of sustaining an injury. While the study could not determine causation, job satisfaction and improved mental health may be protective factors associated with injury risk suggesting the added benefit of the camaraderie so often touted by those in the fire service. Volunteer and minority firefighters may be at an even greater risk of mental health issues.16,17 Recent research found volunteer firefighters reported significantly elevated levels of depression, posttraumatic stress and suicidal symptoms compared to career firefighters.16 Volunteers may also have less access to behavioral and mental health resources than their career peers. With a rise in behavioral health issues amongst firefighters, the fire service is trying to address these issues through national standards, behavioral health programs, peer support and research focused on these issues. Many programs exist to support firefighters and their families struggling with behavioral health issues including the National Volunteer Fire Council Share the Load program, which connects individuals with resources and providers. The International Association of Firefighters Behavioral Health Program is a free resource that provides an overview of behavioral health issues and their impact on firefighters. Yet, often, firefighter behavioral health research is not translated into fire service training nor reflected in policies and procedures. Although NFPA 1500: Standard on Fire Department Occupational Safety, Health, and Wellness Programs requires access to a behavioral health program that proposes assessment, counseling and treatment for such issues as stress, anxiety and depression,18 many departments lack the resources to adequately implement such programs. Recognizing that firefighting, mental, and behavioral health are not separate issues, but integrated ones that tell the whole story of a firefighter is the first step toward assessing the full picture of a firefighter’s health.
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About the Author Brittany Hollerbach, Ph.D. is a postdoctoral research fellow at NDRI-USA, Inc. She received her Ph.D. in Kinesiology from Kansas State University. Dr. Hollerbach has extensive experience working with the fire service on a number of federally funded firefighter studies conducted by the Center for Fire, Rescue & EMS Health Research. She has an interest in firefighter health in general and female firefighter health specifically, given her background as a former firefighter. She also has experience teaching at the fire academy and is well-connected to the fire service community in Kansas City. References 1. Heyman M, Dill J, Douglas R. The Ruderman White Paper on Mental Health and Suicide of First Responders.; 2018. 2. Jahnke S, Poston W, Haddock C, Murphy B. Firefighting and mental health: Experiences of repeated exposures to trauma. Work. 2016;53:737-744. 3. Firefighter Behavioral Health Alliance. Who We Are. Published 2020. 4. Fahy R, Petrillo J, Molis J. Firefighter Fatalities in the US - 2019.; 2020. 5. Gist R, Taylor V, Raak S. Suicide Surveillance, Prevention, and Intervention Measures for the US Fire Service: Findings and Recommendations for the Suicide and Depression Summit. National Fallen Firefighters Foundation; 2011. 6. Haddock CK, Jahnke SA, Poston WSC, et al. Alcohol use among firefighters in the Central United States. Occup Med Oxf Engl. 2012;62(8):661-664. doi:10.1093/occmed/kqs162 7. Haddock CK, Day S, Poston W, Jahnke SA, Jitnarin N. Alcohol Use and Caloric Intake From Alcohol in a National Cohort of U.S. Career Firefighters. J Stud Alcohol Drugs. 2015;76(3):360-366. 8. Haddock CK, Poston WS, Jahnke SA, Jitnarin N. Alcohol use and problem drinking among women firefighters. Womens Health Issues. 2017;27(6):632-638. 9. North C, Tivis L, McMillen J, et al. Coping, functioning, and adjustment of rescue workers after the Oklahoma City bombing. J Trauma Stress. 2002;15(3):171-175. 10. North C, Tivis L, McMillen J, et al. Psychiatric disorders in rescue workers after the Oklahoma City bombing. Am J Psychiatry. 2002;159(5):857-859. 11. Martin C, Vujanovic A, Paulus D, Bartlett B, Gallagher M, Tran J. Alcohol use and suicidality in firefighters: Associations with depressive symptoms and posttraumatic stress. Compr Psychiatry. 2017;74:44-52. 12. Poston WS, Haddock C, Jahnke S, Jitnarin N, Tuley B, Kales S. The Prevalence of Overweight, Obesity, and Substandard Fitness in a Population-Based Firefighter Cohort. J Occup Environ Med. 2011;53(3):266-273. doi:10.1097/JOM.0b013e31820af362 13. Poston WSC, Jitnarin N, Haddock CK, Jahnke SA, Tuley BC. Obesity and Injury-Related Absenteeism in a Population-Based Firefighter Cohort. Obesity. 2011;19(10):2076-2081. doi:10.1038/oby.2011.147
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14. Kales S, Tsismenakis A, Zhang C, Soteriades E. Blood pressure in firefighters, police officers, and other emergency responders. Am J Hypertens. 2009;22:11-20. 15. Schulte P, Wagner G, Ostry A, et al. Work, obesity, and occupational safety and health. Am J Public Health. 2007;97:428-436. 16. Stanley I, Boffa J, Hom M, Kimbrel N, Joiner T. Differences in psychiatric symptoms and barriers to mental health care between volunteer and career firefighters. Psychiatry Res. 2017;247:236-242. 17. Poston W, Haddock C, Jahnke S, Jitnarin N, Day R, Daniels I. Health Disparities Among Racial and Ethnic Minority Firefighters. J Health Dispar Res Pract. 2014;7(5):105-129. 18. National Fire Protection Association. NFPA 1500: Standard on Fire Department Occupational Safety, Health, and Wellness Program.; 2021.
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Dear Reader
T
hrough the evolution of the fire and emergency services, much focus has been placed on improving equipment, modernizing strategies and tactics, improving incident management, and improving responders’ physical health and safety. Certainly, this is justifiable and significant gains have been made in respect to these areas. More recently, however, we have become more aware of the need to focus attention on and make improvements to our profession regarding the mental and emotional well-being of our responders. Some of the reasons for this new focus include: • Increased call volumes that tax responders' mental and physical well-being • Drastically declining numbers of responders in the volunteer fire service that place greater demands on those who remain • The evolution of the COVID-19 pandemic that has required us to change the way we operate and interact with each other and the public we serve • Increasing acts of terrorism that senselessly harm innocent members of the public and responders • Rising divorce rates within the responder ranks The increase in recent years of the number of firefighters, EMS personnel, and law enforcement officers suffering from serious stress-related illnesses and dying by suicide, is tragic and something that must be addressed NOW. We owe it to our personnel not only to ensure their physical well-being, but their mental and emotional state, as well. In this edition of Speaking of Fire, we look at several aspects of the important work that is being done to address this issue. IFSTA and Fire Protection Publications are dedicated to the total health and wellness of the responders that we serve and who serve us. We hope that you find the information that we are providing from some of the leading authorities on this topic useful and thought-provoking. We are doing this for you. Stay safe out there!
Mike Wieder Executive Director, IFSTA Associate Director, Fire Protection Publications
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Mental Health Resources According to the Centers for Disease Control and Prevention, 1 in 5 Americans will experience a mental illness in a given year and more than 50% of people in the United States will be diagnosed with a mental illness or disorder at some point in their lifetime. We want you to know that you are not alone. If you are feeling overwhelmed, lonely, depressed or exhausted, we encourage you to take advantage of the resources available to you.
United States of America If you need immediate support, the National Suicide Prevention Lifeline (suicidepreventionlifeline.org) is available at (800) 273-8255 or go to the website for chat, and the Crisis Text Line (www.crisistextline.org/ text-us) is available by texting HOME to 741741. For assistance finding counseling and/or therapy, visit beingseen.org or openpathcollective.org
Canada If you need immediate support, Crisis Services Canada (www. crisisservicescanada.ca) is available at (833) 456-4566 and the Crisis Text Line (www.crisistextline.org/text-us/) is available by texting HOME to 741741. For assistance finding counseling and/or therapy, visit www. goodtherapy.org/therapists/canada
Mexico If you need immediate support, use the suicide prevention hotline (525) 510-2550 or go to SAPTEL (www.saptel.org.mx) and their help line (555) 259-8121. For assistance finding counseling and/or therapy, visit www. therapyroute.com/therapists/mexico/1
More Resources The IAFC’s Yellow Ribbon Report, Under the Helmet: Performing an Internal Size-Up, A Proactive Approach to Ensuring Mental Wellness at: www.iafc.org/docs/default-source/1VCOS/vcosyellowribbon. pdf?sfvrsn=5204ba0d_4 The NVFC’s Share the Load Program at: www.nvfc.org/programs/sharethe-load-program UNC’s Heroes Health App at: www.heroeshealth.unc.edu
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Speaking of Fire
