This document discusses the triggers and symptoms of trauma, stress, and mental health issues among firefighters and EMTs, such as depression, suicidal thoughts, substance abuse, and bullying. It notes that 57 firefighters died by suicide in 2013 and 2014, and a survey found 36% had thoughts of suicide and 6% attempted. It provides recommendations for what to do if someone exhibits signs of suicide risk, such as getting help from medical professionals or a crisis hotline. The document advocates for employee assistance programs, critical incident stress debriefing, and rehabilitation programs to help those struggling with mental health issues stemming from their work in emergency services.

2. What we see

3. Then this

4. Now what?

5. Triggers
• Can be anything- complex on emotional status
and prior well-being
• One event or several events over a career
• Death- especially unexpected
• You know the patient
• Multiple fatalities
• Children-senseless tragedy
• The negative change in our practice
• End of career issues
• Sleep deprivation- all in lifestyle

7. Ongoing emotional pain
• Thoughts of suicide
• Addiction
• Bullying-outward anger

8. How big is the problem?
• 57 suicides in fire/ems in 2013 and again in
2014- we know this is under-reported
• JEMS Survey- 36% had thoughts 6%
attempted
• Depression, helplessness, suicidal thoughts
are much more common.
– Stop signing up for call
– Personality changes
– Become unsure of skills on calls
– Feel inadequate

9. Some will look to substances to mask
the pain
• Addiction is on the rise in America and
fire/EMS is not immune
• Punishment for addiction, especially with
drugs remains strong in our culture
• Addicts need help, not felonies, loss of job or
incarceration
• Alcohol most common in Fire Service

10. In the month before their death by suicide:
•Half saw a general practitioner
•30% saw a mental health professional
In the 60 days before their death by suicide:
•10% were seen in an emergency department
People At Risk For Suicide Are Falling
Through the Cracks in Our Health Care
System

11. You may be the person to identify the
risk of suicide or self harm
• Despondent
• Talking about death
• Getting life in order-will, visiting family etc.
• Sudden calm demeanor
• Increased use of drugs or alcohol.
• Buying a firearm

12. Some will become angry
• Bully others to hide the pain
• Behave this way to cover own feelings of
inadequacy
• Constant complaining and anger on the job
• Hating to come to work

13. What to do?
• Do not leave person alone- get family and
other friends involved
• Get friend to a doctor- ER if necessary
• Make effort to remove medications and
weapons from the home
• Non-judgmental, loving, caring, genuine.
• Crisis intervention
• Suicide prevention help line

14. Some reach for substances
• Alcohol by far the most common
• Some will become addicted to opioids
– By initial prescribed medications
– By using and diverting to cover emotional pain

15. What should we do when something
happens?
• Open lines of communication encouraged
• It is not a weakness to be human
• Allow and encourage fellow members to be
open with struggles without fear of
punishment
• Have a plan in place to implement when a
member needs help
• Be vigilant- act on suspicion.

16. CISD
• Should be done ASAP after event. Should be
within 72 hours for sure. 24 hrs optimal.
• Needs to be done by trained individuals.
• 63% of EMS surveyed say this helps
significantly

17. EAP
• Your service should arrange to have an
Employee Assistance Program in place.
• This is for those continuing to struggle after
CIDS. 58% say this is helpful.

18. Florian Program at Rosecrans
• Started by Chicago FD Batallion Chief
• Specific in-patient program for Fire or EMS
personnel dealing with PTSD, suicidal
thoughts, addiction etc due to stress of the
job.
• In-patient stay. In Rockford, so close.

19. My personal take after 40 years
• We respond to situations routinely that are
painful and make no sense
• We live in a fallen/broken world
• Humans are wonderful and beautiful creations
that mess up constantly.
• Evil is alive and well in the world
• The further we exclude God from our society
and personal lives, the worse things will be

20. • What we do takes a special skill set.
• We were created to do this job.
• It is a PRIVILEGE to care for others at their
worst possible moments.
• We have wonderful opportunity to help and
change the world one patient at a time.
• This task is increasingly difficult-we must take
care of our own.

21. BEST ANSWER
• G R A C E !