“The Next Few Weeks are Gonna Suck:” Acute Stress Disorder in Firefighters

By Hersch Wilson

Photo courtesy of Lauralee Veitch

We were sitting at a table at our station. The table had stained coffee cups and a few water bottles strewn across it. A dozen firefighters were sitting around the table, most with their heads down. It was the morning after a multiple-fatality crash — three of the fatalities had been little kids.

The room was quiet, but finally, a paramedic spoke: “The next few weeks are gonna suck.”

And they did.

In a previous article, I wrote about Post Traumatic Stress Disorder (PTSD) and the rural volunteer fire department. The gist of that article was that as officers, we need a game plan for dealing with individuals in our departments who develop PTSD.

During the research for that article, I came across another condition that I thought deserved exploration and understanding by firefighters called Acute Stress Disorder (ASD).

Acute Stress Disorder: A severe stress reaction to a traumatic event that temporarily disorders your personal and work life.

Acute Stress Disorder has many of the signs and symptoms of PTSD. The main difference is ASD lasts from three days to one month. PTSD can emerge later with long-lasting effects.

Here is an analogy. If you’ve ever had a concussion, immediately after you get hit, you often don’t remember where you are, who you are, and what you’re doing. After a few hours (or days) you recover. However, as we are discovering, there can be long-term effects of a concussion that can cause health problems later on in life. Not everyone who gets a concussion will deal with chronic mental health problems, but some will.

In the same way, ASD is a severe but usually temporary response to a traumatic event. Most recover, but some go on to develop longer lasting PTSD.

What Causes ASD: The “Emotionally-Charged” Scene

As firefighters and EMTs, we attend all sorts of scenes that are tragic for someone, and yet the majority of those don’t affect us (although year-after-year of exposure to tragedy can cause stress). Then, every once and a while, there is a scene that pierces all our defenses. Those scenes we call “emotionally charged.”

A couple of points are important to remember. First, what emotionally charges a call for me might not for you; for example, if the victims were kids the same age as mine, or I felt helpless during the scene while you felt competent, or I knew the patient in cardiac arrest.

It isn’t a cardiac arrest that causes my response with symptoms of ASD; it’s the emotional charge that scene has for me. ASD (and PTSD) are thus very personal responses to traumatic events. An entire department might be okay, and acting and thinking appropriately after a tragic fire, but that one firefighter who felt that he “screwed up” might be on the cusp of ASD symptoms.

Symptoms of ASD

Symptoms of ASD include intrusive thoughts — you begin thinking about “that call” almost involuntarily, or you have nightmares and dreams. Your general mood can turn negative; you have difficulty experiencing positive feelings, happiness, or connections to others. You avoid talking about the call or go out of the way to avoid driving by the location of the scene. There can be a sense of emotional numbing after a bad call, where you just don’t feel anything (also known as compassion fatigue), or you may have an amnesia-type of experience when you don’t remember some or all of what happened. Finally, you may have problems concentrating, you may be irritable, and have difficulty sleeping.

All this can be mild, but in its most severe form it will interfere with work, with relationships, and even with your desire and ability to get help: it will “disorder” your life.

Who is At Risk for ASD

As we sat in the station that morning, it would have been difficult to predict who was more vulnerable to ASD.  On the one hand, the research points out that the young and single are more likely to develop ASD, which makes sense. They don’t have a lot of experience with trauma and they don’t necessarily have a robust support system. Also at risk are those who have had ASD episodes or PTSD in the past. Again, that makes sense; bad calls can bring back memories of other bad calls and the cycle continues.

A little more counter-intuitive is that long careers also seem to be a risk factor. Experience does help build an immunity to all but the worst calls, and yet experience is a double-edged sword. Stress is cumulative; it can develop over time. I’ve also been around long enough to know that even the most experienced, stoic veterans — the folks who are the rocks of the department — are not immune.

ASD and Volunteers

For volunteers, there are other risk factors. First is the suddenness of some calls. Unlike career firefighters, who go on shift and are somewhat prepared, volunteers can go from a Sunday brunch to a dreadful call in minutes. Sometimes we end up on a scene before our emotional “shields” are up. Next, because of the differences in training and experience of firefighters in volunteer departments, a firefighter might not have the training or the skills to deal with a terrible scene. That can lead to crushing guilt.

Getting Better

For many who have their own support systems — family and departments —they can resolve the symptoms on their own. But if the symptoms are severe, that might not be the best plan. It is vital to get help before ASD gets worse. (One source stated that 80 percent of individuals reporting ASD had PTSD six months later. Another claimed that the relationship was not that clear and ASD was not that great a predictor of PTSD. I would err on the side of getting help.)

My three-step plan is as follows:

  1. If you have a supportive department, contact an officer and let them know you are having symptoms of ASD.
  2. If that is not an option, contact your county or state peer counseling hotline. They are confidential and can point you to the right kind of resources.
  3. If both those options are not available, contact the National Volunteer Firefighter Council/American Addiction Centers Fire/EMS Helpline — it is confidential and staffed by firefighters who have “been there.” The Fire/EMS Helpline is a 24/7 support line that is also available for family and spouses. That number is 1-888-731-FIRE (3473).

Sucking it Up   

A few weeks ago, I received an email from a retired firefighter who had suffered from PTSD and sought help. But one therapist told him that because he was a firefighter, he should just “suck it up.” I thought that was stunning. My point here is that every firefighter I know “sucks it up” every day on the job. They respond day in and day out to the tragedies of others, seeing things, as one researcher wrote, ”that are horrific events beyond the scope of normal human experience.”

The vocation requires us to suck it up on scenes. But the vocation can punish us afterward.

Sitting around in the station that morning, I remembered how these men and women had done their jobs the night before with urgency, skill, and kindness — they had sucked it up. You’d wish them nothing more than to be able to quickly get on with their lives and continue the work that they all loved. But sometimes it doesn’t work out that way.

When it doesn’t work out, when a fellow firefighter — or yourself — is suffering, that is not the time to “suck it up.” That is the time to get help. It is not a sign of weakness or lack of character. Asking for help, knowing when you need help, is a sign of resilience.

Over a career as a volunteer firefighter, we all most likely will have episodes of Acute Stress Disorder. The ability to ask for help in those situations is as important a tool as the hydrant wrenches we carry on the trucks. We might not use them everyday, but when we need them, we need them!

Ask for help when you need it. Offer help when you see the need.

Be Brave. Be Kind. Fight fires!

Hersch Wilson is the medical captain with Hondo Volunteer Fire and Rescue in Santa Fe County, NM. He has been with the department since 1986. In his “other life” he is a writer and a soccer coach. Visit him at Herschwilson.com or on Facebook at ‘Hersch Wilson-Author.’