I buried another Firefighter today - Why it's time to stop killing our First Responders.

The church was majestic.  Organ pipes adorned the walls behind the stage, rising like dawn sunbeams toward the heavens.  The acoustics of the room were such that every sniffle and suppressed cry could be heard.  The screen behind the pulpit showed a muscular man in bunker gear, the kind of firefighter you imagine when thinking of a man in our profession.  One of our brothers in the honor guard stood in front of the shining bell and rang it three times.  Then, as I’d heard so many times in my career, the “Last Call” came through the speakers, calling for my brother firefighter Jim.  After the final call, the dispatcher announced that he had not responded and that this was his last call.  I have never been able to stop the tears from betraying my true emotions, and this was no different.
 
Lt. Jim Dorminy was a lieutenant at my station and was 2017 line of duty death number 38.  Jim had a medical emergency after coming off shift.  He was doing what he loved, exercising, knowing that it was vital to being able to perform at the highest level as a firefighter.  Earlier that week we had fought a training burn and worked a code together.  Jim had been a lifelong martial artist, teaching at his own studio and when not working at the station, Jim worked on his farm.  But now we stood side by side with brothers and sisters from all over the state to say goodbye to our brother firefighter.  There is no more heart wrenching sight than to watch a folded flag being given to a grieving family.
 
In the last five short years, I have lost eight firefighters that I personally worked alongside and many more in neighboring departments.  The causes of death weren’t building collapse, backdraft, exploding grain silos or raging wildfires.  Cancer killed six of my close firefighter brothers, an aneurism took another, and cardiac arrest took several more.  The affliction extends to mental health where accidental overdose and suicide claimed even more of my brothers and sisters lives.  The sad thing is that this statistic seems to be viewed at as the “price of doing business”, which illustrates my point.  Protecting your community is not a business and the men and women who sign up for this position are not expendable like some out of date stock in the back of a warehouse.
 
Computer science professor Randy Pausch once said “If there’s an elephant in the room, introduce him!”  And let me say that that elephant has been in the room for a really long time and should have been paying rent for years.  We have been battling factors that kill us for decades and have a lot to thank our forefathers for.  Whether it is firefighter’s bunker gear and SCBAs or ballistic vests and tasers, advocates have fought tirelessly to keep first responders safe.  The buildings are being made safer to protect the occupants from fire.  Cars have been developed so well that a crew responding to a seemingly fatal wreck will be met with unscathed passengers.  Men like Keith Tyson have educated us on the dangers of carcinogens advocating cleaning bunker gear, removing exhaust from bays and aggressive post fire decon.  Sadly, just like Randy Pausch, who died from Pancreatic, this disease still takes an unacceptable amount of first responders every year.  Keith Tyson also underlined that cancer often manifests after retirement and the current statistics are just the tip of the iceberg. 
 
 

The question that needs to be asked is why are so many first responders dying despite increased education on fitness, decon and safety?  The answer is so simple it is almost comical, although there is nothing funny about the deadly results.  According to the Organization of Economic Co-operation and Development (OECD), the average American work week is 34.4 hours.  The average firefighter work week ranges from 48 to 56 hours.  This is the bare minimum, not factoring that many departments will continuously force their firefighters to stay additional shifts to cover staffing shortages.  This can put the average work week well in excess of 80 hours.  Imagine for a moment if you told a candidate for an office job that they would probably be forced to work 80 plus hours a week.  I’m pretty sure you would have an empty office.  Now don’t misunderstand me.  We all have to band together on the odd occasion when all hands are required.  Every department will have incidents where they will need extra manning.  The problem is when this requirement becomes a weekly event.
 
The shift schedule has always been sold as if it’s some heavenly secret, hidden from the public.  “One day on, two days off” sounds like an amazing pseudo retirement arrangement.  The reality is that by the time you get off shift, you have already worked an eight hour day, rendering the “two days off” null and void.  When you factor in that those eight hours were when you were supposed to be sleeping, you introduce the true elephant in the room; sleep deprivation.  
 
Instead of well rested first responders making life or death decisions, the reality is that these men and women are worn thin and running on fumes.  Whilst the person bagging your groceries or grooming your pet most likely had a good night’s sleep, the driver of a 50,000lbs ladder truck going code three, opposing traffic, may not have slept for two days.  Green Beret, West Point Psychology Professor and author of “On Killing”; Lt. Col. Dave Grossman, stated that there was no doubt that sleep deprivation was killing first responders.  Lt. Col. Grossman has seen this in military, law enforcement, fire and EMS, and also cites it as one of the underlying causes of the school shootings seen around the globe.  He also pointed out that commercial truck drivers and pilots were required to have a full night’s sleep yet there were no standards for first responders.  
 
Dr Kirk Parsley, Navy SEAL turned doctor for the west coast SEAL teams has become one of the faces of sleep medicine.  Dr Parsley saw ill health amongst his uber athlete soldiers and was able to reverse many of their issues once sleep was restored.  Dr Parsley postulates that driving home after a hour shift with no sleep is neurologically the same as driving with a blood alcohol level of 0.08.  First responders live an average of twelve years less than their civilian counterparts and are anywhere from 1.2 to 2.1 times as likely to develop cancer.  Dr Parsley cites that the disruption of the circadian rhythm can cause a cascade of physiological effects from limiting testosterone production to inhibiting insulin production.  If the body cannot switch to the parasympathetic state that sleep allows, it cannot repair itself.
 
 

So what is the answer?  Shift patterns have been contested for decades.  Two 12s ?  10s and 14s?  48:96?  The rainman-like algebra goes on and on.  The problem is you can try and divide 56 hours in a million different ways but at the end of the day it still adds up to 56 hours.  We are never going to fix the underlying issues that are killing our first responders until we address the work week.  There is no denying that we need to protect our communities at night.  A majority of fires and criminal activities occur outside of office hours and we need to be ready to respond.  The answer to this is not to chop up the day into bite sized pieces.  Lt. Col. Grossman called the split shift, often used by law enforcement, as the worst shift schedule out there.
 
The answer is to give our first responders time to recover from the shifts they work.  In the fire department, the 24:72 shift pattern would be the best configuration.  This would mean that a firefighter would truly have two full days to recover from twenty four hours without sleep.  This also means that in a circumstance where the firefighter is forced to stay additional hours, there would still be time to recover before the next shift.  When you do the math, this still adds up to a 42 hour week, well above the average American’s.  So ask yourself this.  Would you want the Paramedic fighting to save your child’s life to be sleep deprived?  Would you want the armed police officer that pulled over your teenaged son to be running on fumes?  Would you want the firefighter cutting your mother out of a car with power tools to be fighting to stay awake?  Obviously the answer is a resounding no!  So let’s start changing this profession that we love so much.
 
We have the power to save lives.  Save lives in our profession and also the lives of those we serve.  Sleep deprivation has undoubtedly contributed to many deaths.  Whether it was a poor decision by a police officer, a missed medication by a paramedic or a missed victim in a primary search, lack of sleep affects every aspect of our job.  This same affliction is also claiming the lives of countless first responders on shift, off shift and after retirement.  Delta force operator Pat McNamara stated that the special forces had been referred to as “disposable heroes”.  I think that is how first responders have been viewed for a long time as well.  We need to address both the work week and the recovery from the high stress shifts our profession endures.  I hope this essay will sow some seeds in this profession I love so much.  “It’s how we’ve always done it” has never been an acceptable answer.  Our forefathers paved the way with bunker gear, SCBAs, air monitors and a multitude of other progressive innovation.  We need to be the generation that carries on this tradition with the health of our peers.
 
I’m tired of hearing the “Last call”.  I know it is going to keep happening but we truly have the power to reduce the number of deaths caused by this calling we love.  This choice is completely in our power although, as with every other change, there will be resistance.  I hope that the young firefighters in the future will look back and thank us for having the courage to change the very thing that is killing us.  Tears will be shed, bells will be rung and flags will be folded.  How many though, is entirely in our hands.
 
To hear my interviews with Lt. Col. Grossman, Dr Kirk Parsley, Pat McNamara and the other amazing guests, listen to the Behind the Shield Podcast.
 

Let food be thy medicine, not thy poison - How our food is killing first responders....and everyone else.

In Bath, a beautiful Roman City surrounded by the rolling hills of the English countryside, there is a park.  When I was a young boy, this park was the closest thing any child growing up in rural Somerset would ever get to Disney World.  The park was adorned with wooden structures, swings, ropes and even a crude zip line.  Parents would bring their munchkins and set them free, hoping to use up just a fraction of the seemingly infinite energy a young child has.  Despite the complexity of some of the equipment, the traditional seesaw was usually one of the most popular play areas.  A simple plank of wood balanced over a fulcrum allowed two riders to launch each other into the air.  The most comical moments would be when a mismatched couple would jump on and the lighter of the two was stuck in the air, helpless whilst the onlookers laughed.

“What’s with the childhood story?” I hear you ask.  Let me tell you another one, not quite so uplifting this time.  The man lays supine, near lifeless eyes stare into mine, seeming to beg us to save him from his seemingly inevitable death.  Due to being morbidly obese, it had taken several of us to pull him from his car, where he had the initial cardiac arrest.  Effective compressions were challenging as his body was riddled with both subcutaneous and visceral fat, strangulating every organ and blood vessel.  IV access was nearly impossible as his body had become so deconditioned that his veins were atrophied and buried deep under his cutaneous layers.  I fought to get an airway but his stomach had other ideas and sent an unending flow of gastric contents, overriding his epiglottis and violating his airway.  My partner searched for a landmark to drill an IO, a challenging task in legs that are swollen, seeming ready to burst from the fluid his failing heart had been unable to move.

It was a strange feeling, working a code knowing damn well the person has no chance of surviving.  With an airway full of emesis and asystole on the monitor, the chance of moving oxygenated blood around the body becomes close to zero.  We continued our efforts as there is always that crazy miracle story giving a minute amount of hope.  The man’s wife was screaming, although it was barely palpable in our focused state.  Our Lieutenant tried to calm the woman and tease out the patient’s medical history.  She began to list a seemingly endless monologue of medical history and medications.  Our local protocols called for twenty minutes working an asystole code before calling it if all of the criteria are met.  As the last minute concluded, we I made the decision to call it, another feeling I’ll never get used to.  We then step back, leaving every intervention in place for the Medical Examiner.  As we begin to pick up our equipment, I happen to glance at the giant bag of medications the patient’s wife had been describing.  It suddenly dawned on me that none of them had worked.  This man had thousands of dollars worth of the latest and greatest and he had died a horrible death anyway.

“So what the hell does this have to do with seesaws?”  I hear you cry once again.  Well it really comes down to homeostasis.  The human body has an innate desire to be in balance, a place of equilibrium where both kids on the seesaw would be suspended above the ground.  When this balance is upset for a long period of time, the body begins to fail.  The man in this story is just one of millions across the globe that have fallen prey to this abandonment of the body’s natural balance.  The equation is painfully simple but application seems to elude many.  Energy in versus energy out pretty much sums up the key to good health.  Of course there are nutrients that we all need but scurvy and rickets are not our primary killers in the overfed west.  That being said, there is a haunting irony to the fact that many people are overfed yet malnourished.

There are 168 hours in a week.  The most dedicated athlete will train for 3 or 4 hours a day, with the average active person training 3 to 4 hours per week.  I’m no Rain Man but that leaves around 164 hours of low activity, especially in those with sedentary jobs.  As much as first responders like to believe we are kicking in doors 24/7, the reality is that driving emergency vehicles and computer work takes up a large part of our shift.  What this means is that one side of the seesaw is going to have a very skinny child on it.  If your energy in, ie the refined calories you consume, far outweigh the energy used in a week, the thin kid continues to get stuck in the air.  As time goes on, the systems in the body that work optimally in a state of homeostasis begin to develop disease.  Blood vessels become inflamed and narrowed.  The pancreas’ ability to produce insulin diminishes.  Sex hormones become suppressed, further exasperating the global degeneration in the body.

The point I am trying to make it that although I am a huge proponent of exercise, no matter what the lycra clad orange guy on QVC tells you, it is only a small, albeit important part of overall health.  What we eat truly dictates a large portion of how the body functions.  I recently heard a doctor say “Don’t wait for science to prove what you already know is true.”  Despite the spectrum of wellness arenas, this simple concept has held true although the quality of the food we ingest has only recently been brought back to the forefront.  If you consume more energy than you can burn, it will be stored in your body.  This is nature’s way of preparing for periods where food may not have been as available.  As a species, we most likely were not getting three square meals a day back in primitive times.  The would have been periods of feasting and others of famine.  The body’s defense is to allow this food to be stored as fat, to avoid death in times where food was sparse.  

In today’s society, this protection mechanism has become our own worst enemy.  Our food is ground to dust and many of the nutrients long lost in the factory process.  The digestive tract is designed to break down whole food, in the form if was plucked from the ground or tree.  This allows the body to absorb the calories at a steady state.  On the contrary, processed foods are often refined to a powder where even starches are basically pure sugar.  This highly ground form of carbohydrate is rapidly absorbed by the body and creates a huge insulin spike, resulting in enormous stress to the pancreas.  The sheer enormity of calories consumed also overwhelm the body and it is forced to convert the sugars to fat.  This is then piled onto organs and under the skin in the same way sludge builds up in a car’s engine.  This vicious circle compounds as the organ systems begin to fail in a synchronistic manner.

“So what is the extremely complex and complicated answer to this epidemic?”  I hear you ask your third and final question.  Well, I hate to disappoint but the answer is really bloody simple.  Eat how your great grandparents ate.  Of course there are some habits they may have had that might have upset the balance a bit, but the fundamental message remains true.  A hundred years ago, food was grown without chemicals and its DNA had not been messed with, so the body still recognised it as a member of the plant family.  Livestock roamed in paddocks, eating the food that they actually wanted to eat.  Cows ate grass, chickens pecked at seeds and insects and pigs foraged for acorns and roots.  There were no antibiotics or hormones needed as these animals weren’t crammed in industrial warehouses, being fed ground animals whilst their peers lay dead and rotting at their feet.

Winston Churchill once said “Healthy citizens are the greatest asset any country can have.”  Industrialization of our food has been the single most contributor to ill health in the western world.  Turning food into food like products with no nutritional value has created an epidemic of ill health in western countries, killing more people than all wars combined.  This food is being fed to our children in schools, grooming them to follow the same road to disease that their modern forefathers are currently on.  The fruit and vegetables are poisoned with chemicals, sprayed by men wearing level B hazmat suits.  The meat is from animals so sick that they are pumped with antibiotics just to keep them alive long enough to slaughter.  Milk comes from cows loaded with hormones to keep them constantly lactating, with any remaining nutrition destroyed during pasteurization.  Let’s not forget the corporations genetically engineering seeds, which are seen as foreign bodies, invaders, by the human body.
It is time that we took control of our food and therefore our family’s health.  Buying food from local farmers that subscribe to the traditional organic farming methods is not only cheaper but greatly reduces the carbon footprint.  Why drive food 2500 miles when it can be grown in your own County?  We vote with our money and if we, the people, demand quality food at the community level, we can truly change the health of our loved ones and our neighbours too.  Visit your local farmer’s market and buy food that has never been in a box or bag.  These markets are usually cheaper than the pesticide laden imported foods at the stores.  Learn to cook.  The process of cooking alone creates a greater appreciation of food and a lessened chance of gorging.  Turn off the electronics, sit around a dinner table and talk, the way firefighters have for decades.  This will not only nourish the body but also the soul.  

As Hypocrites said “Let food be thy medicine and medicine be thy food.”  What you put in your mouth will either heal you or hurt you.  You and you alone get to make that decision and the more of us that choose health, the more available this type of food will become.  We focus on terrorism whilst our fellow citizens are dying in genocidal numbers.  It’s time we start a new revolution, reclaiming our nation’s health and carving a healthier future for our children.  As my Podcast guest Joel Salatin once said “If you think organic food is expensive, have you priced cancer lately?”  Invest wisely!

It breaks my heart as a firefighter/paramedic to see people die from completely preventable diseases. I hope I won’t be staring into your eyes next.  Be safe out there.

James

For more on these topics, listen to my Behind the Shield Podcast guests Joel Salatin, Rip Esselstyn and Dr Eric Goodman among many others.  You can find the show on Soundcloud, itunes, Stitcher and Pocketcast.

If you stand for nothing then what will you fall for? - Being worthy of the badge.

The alarm goes off.  An obnoxious sound that creates a cringeworthy response from a comfortable deep sleep.  The time is 5:00am, only seven hours since I was able to lay down in my own bed.  As my brain bullies me into semi consciousness, it begins the Einstein like equations.  How long did I sleep?  What do I have to do today?  What is the dose of Magnesium Sulphate on an Eclampsia patient?  Random thoughts insult my weary mind as I stand motionless in the shower.  The thoughts then change to how easy life might be if I turned to a 9 to 5 desk job, getting to come home every night and be with my family, sleeping in my own bed.  Then I laugh and remind myself that I would have killed someone by the end of my first day in a cubicle.

I creep around trying not to wake my family as I pack the multiple bags required for a 24 hour shift.  My german shepherd’s tag clinks as her feet tap on the wooden floor, negating my efforts at stealth.  I need to pack multiple changes of uniform in case I get vomited on by a GI bleed, climb down an elevator shaft or have to load soot covered hose back onto the engine.  PT gear needs to be packed to make sure I get the all important workout done.  Computer bag is next, ensuring I have all of the hardware and books to accompany the never ending education or a modern day firefighter/paramedic.  Finally, bags of food need to be prepared to cover 24 hours, with the potential of being forced to hold over for the next shift.  I quietly open my son’s bedroom door and say a silent blessing before gently closing the door.  I make sure I kiss my wife goodbye and tell her I love her, not knowing if this will be the last time I ever get to say those words.

My commute to the station is 75 minutes exactly if there is no traffic.  I listen to a Podcast to educate myself and make the most of the extended journey.  In my mind, my goal is to arrive at the station more intelligent than I left my home.  I pay multiple tolls to get to my fire station, spending an average of fifteen dollars in gas every time I drive to and from my second home.  I get to the station half an hour early to ensure my brother or sister firefighter can avoid a last minute call and get home to their family.  Then the day begins, checking out gear, running tools and inventorying medical equipment, trying to prepare for whatever the universe may throw at us today.  

To some, the badge on our chest is a piece of metal that is given to you when you are hired by a department.  To the rest of us, it represents the honour of protecting your community.  It is a symbol of sacrifice for the wearer and respect to the citizens that we serve.  This respect is not handed out like some flyer for a new restaurant in a busy high street.  The role of a first responder is that of a pledge; to be the best version of yourself to protect the men and women in your first due.  There are t shirts out there that spew the most narcissistic rhetoric.  “We fight what you fear” or “First in Last out” are some of the vomit inducing phrases that adorn attire aimed at letting the public know what a damn hero you are.  These same men and women are the first to post selfies on 9/11, reminding us all that they are part of the same profession as the 343 brave men that lost their lives in the World Trade Center.

So the question begs; “What is your why?”  Why do you wake up in the morning?  What do you hope to have achieved by the time your head hits the pillow at the end of the day?  These are very powerful questions in a world where a day can be comprised of Facebook and Call of Duty.  Knowing your why is fundamental to excelling in every aspect of your life.  What kind of life do you want to live and what impact do you want to have on the world?  As a first responder, what was the fire that was burning inside when you made the decision to apply to fire academy, police academy or EMT/Paramedic school?  What did you dream of doing once you passed the state test and were finally wearing the uniform you’d envisioned yourself wearing?

This burning desire is what gets me up at 5am, tears me away from my family for a relatively small salary.  My desire has always been to serve my community, being there when people are having their worst day ever.  There seems to be a delusion that a country is made great by it’s leaders. Forgive me if I disagree but I believe it’s the men and women who serve their communities that are the backbone of countries around the world.  The common denominator in all of the religious scriptures is to serve others with kindness and compassion.  This basic human desire to help our fellow man has been demonstrated time and time again.  From the New Yorkers of 9/11 to the Londoners of 7/5, people have found incredible compassion and courage in times of tragedy.

The “why” also drives all other aspects of our life.  If you have a passion to serve, then there is also a desire to be the best damn firefighter, police officer or EMT you can possibly be.  This involves training both your body and mind.  This passion is what gets you off your arse and into the gym, forging the body into an efficient machine.  The average first responder’s career will span 20 - 30 years and there is no excuse for not being able to do the job right up until the last day.  The fifty year old veteran should be a leader both physically and mentally, ready to teach the rookie how to stay alive in this dangerous profession.  

The same aggressive attitude must be applied to the skills we are responsible for.  Whether subduing a combative felon, cutting a trench on a five story apartment complex or suctioning a newborn’s airway, these skills need to be drilled.  To quote Navy SEAL Richard Marcinko, “The more you sweat in training, the less you bleed in combat”.  This rigorous training mentality must be applied to all aspects of your job.  The question I always ask is “How would you feel if your family died because the rescuer hadn’t trained?”  This is not a profession where complacency is acceptable.

To perform at a high level as a first responder, we have to view ourselves as athletes; tactical athletes.  We need a team the same way an MMA fighter or ice hockey player does.  Most of us are required to work through the night when the average citizen is sleeping.  This constant sleep deprivation means that we have to strengthen the pillars of health that are in our control to offset the damage from shift work.  Nutrition is an area that can make or break us, creating a strong base or an unstable structure just ready to collapse.  Stress levels have to be controlled through some sort of mindfulness practice, whether meditation, art or fishing.  Clearing the mind of the white noise of everyday life creates a clam that resets the stress level.  The scenes we are exposed to can crush the mind if these areas are not reinforced.  

Physical training is where the “why“ truly comes into place.  It takes a lot of self discipline and motivation to push yourself to the edge in your training.  We have to be able to keep going when the average person would have thrown in the towel.  Mental toughness is imperative when lives are at stake.  Stress inoculation is the other element of training, creating physically exhausting scenarios that test us mentally to ensure we can perform when we are needed the most.  The person you are training to save doesn’t care if you are tired., hot or bleeding.  There are two outcomes; success and failure and the latter is not an option.  Reminding ourselves of why we chose this profession is what drives us through the pain cave, the unbearable pain of the red line.  

Bullfighter Juan Belmonte was quoted saying “No life worthy of the name consists of anything more than the continual series of struggles to develop one’s character through the medium of what everyone has chosen as a career”.  We have been blessed with the amazing opportunity to wear the badge, tasked with protecting and rescuing those who are unable to do so themselves.  I have been charged with coming home to the family I love with all of my heart and my crazy german shepherd.  They are my “Why”.  What is yours?

James

Don’t forget to listen to my amazing guests on the Behind The Shield Podcast on itunes, stitcher or soundcloud.

The Tried to bury us. They didn't know that we were seeds. - Removing the "Disorder" from PTSD.

It came in like any other fender bender.  A one car collision on the off ramp of a local freeway; “Truck response”.  As we began the journey to the intersection in question, the dispatcher began to feed more information through the radio.  The Engine was already on scene and had called for us for extrication.  Driving the back of the Tiller Truck, I had the vantage point of the scene as we pulled up.  The passenger side had taken a huge hit, with massive intrusion into the passenger compartment.  The person in the front passenger side was clearly deceased, folded over in a way that defied classical anatomical teachings.  The Engine medic was assessing the driver of the vehicle, who appeared completely unhurt after the incident.  

I climbed out of the tiller doghouse and walked over to the Engine Captain.  There was a different air to his demeanour and I had a sense of foreboding that I didn’t usually feel, even on the more tragic calls.  As I neared the car, I noticed a cream woolen blanket covering something in the back seat, but thought nothing of it as people often had clutter in the back of their cars.  I finally reached the Captain, a gentle giant that usually had a huge smile on his face at all times of the day.  I could see the pain in his eyes as he began to tell the story of the incident we had arrived at. He told me that the car had lost control on the off-ramp and struck a huge steel post on the passenger side.  My son had just turned 14 months old at the time of this incident and had graduated from the baby seat to the upright version.  I had installed his seat on the passenger side of my car so I could see him when I drove.  

After listening to the tragic tale of the scene that had unfolded before me, I walked up to the crumpled passenger side of the sedan.  There was a three year old girl in the back of the vehicle, sitting in the same kind of seat my son had, installed in the same seat location. The blanket I had noticed earlier covered what was once her head.  The blanket wasn’t long enough to cover her whole body.  Red and white striped stockings and blue sneakers covered the little girl’s lower legs.  My mind would not stop asking the question “If she had been sitting on the other side, would she have been as unscathed as her mother?”  It made me completely rethink the position of my son’s car seat from that day on.  I often wonder why I get so angry when I see someone drive aggressively, then I’m reminded that I have seen the tragic results of the inconsiderate driver.

As this became a body recovery, we were sent back to the station for a while and then dispatched to return to remove the bodies.  My partner and I were getting on the truck when my Captain ordered us to stay at the station.  We both told him that we were fine and had no problem carrying out the extrication; which was true.  He replied with “You’re a new father.  You’re going to see enough images to fill your album in your career, there’s no sense in adding this one”.  He was right.  Both my Captain and Engineer were close to retiring and knew this would be one of the last times they would have to cut a dead child out of a car.  As young firefighters, we still had twenty plus years of images to collect, victims the same age as our children as they grew up.

“So did this crush you?” I hear you ask.  No is my short answer.  This became just one of hundreds of deaths in my twelve year career.  Some met a violent and tragic end whilst some passed away peacefully in their sleep.  Some died right in front of me whilst we fought tooth and nail to save them, whilst others had been dead for days before we found what was left of them.  Some codes went well, hitting every benchmark at exactly the right time whilst others were a futile attempt at gaining an airway whilst the body dispatched a non-stop flow of bodily fluids the wrong way down their trachea.  Regardless, none of them made it.  I have never saved a person from a full code.  The futility of doing everything you are trained to do but not being able to save a life is also one of the worst feelings a First Responder can encounter.

These calls have become a part of me.  This is not a “Disorder” the same way I did not have a back disorder when three ligaments tore lifting a patient.  This was the result of years of wear and tear.  Physical wear and tear resulted in a catastrophic back injury that was completely unforeseen.  This happens with the mind both physiologically and emotionally.  Each of these calls is an injury to the psyche.  As a compassionate human being that chose to serve others as a profession, each tragic incident, be it death, injury or loss of a person’s most cherished memories in a fire, these leave physical and emotional scars.  Seeing complete strangers’ lives torn apart by a lapse or concentration or murderous intent chips away at the childhood innocence we were all born with.

I am reminded of Michael Clarke Duncan’s character John Coffey in “The Green Mile”.  In this amazing story, although he is accused of a crime he did not commit, he takes the pain and suffering from people he meets and carries it himself.  One day, the burden becomes too big to carry on his own. In his speech to Tom Hanks’ character, the warden, he says: “I’m tired boss…..Mostly, I’m tired of people being ugly to each other.  I’m tired of all the pain I hear and feel in the world, every day.  There’s too much of it.  It’s like pieces of glass in my head, all the time...can you understand?”  I think this is the perfect analogy for a public servant.  We volunteer to be there on people’s worst days, day in day out.  Hoping to save a life or at least be the compassionate soul who holds them up after they lost their loved one.

I think it is time to redefine the mental burden of the tragic events that First Responders witness on a daily basis.  PTSD has acquired a negative stigma, an image of some mental abnormality, viewed as some sort of weakness.  This couldn’t be further from the truth, but I think this image is so embedded, and needs to be redefined.  This is not a disorder, disease, tumor or stenosis.  This is the load that the Firefighter, Cop, Paramedic, Dispatcher, Medical Examiner, ER Nurse and all associated professions carries from the pain they see.  To ignore or negate this is the recipe for tragedy, the catastrophic failure of the mind where the only escape is death.

PTS, Post Traumatic Stress, occurs from all of these incidents and accumulates the way a retiree carries visible scars from a lifetime of physical trauma.  From childhood scrapes to adolescent streetfights, the body tells a story and the mind is no different.  The trauma we see creates trauma in the depths of our minds.  The dark side, the shadow self is an ever present part of each and every one of us.  How this manifests is the result of three factors.  The first one is basic mathematics.  As time goes on, the images stack up like some precarious game of Jenga.  The longer the career, the more baggage is accumulated.  The most recent slew of suicides have been veterans of their respective professions, with decades on the job.  

The second element is what is going on outside of work.  As the burden grows, life events can have a magnified effect on an already heavy burden.  Relationship problems, financial strains, family health issues and deaths can be the final straw.  Family can be your greatest support structure or your greatest source of stress, depending on its dynamic.  I saw this first hand during my divorce as a single father, juggling two jobs and paramedic school whilst running 56 hour weeks on one of the busiest rescues in the County.  This is where removing the stigma from PTS comes in.  Having that support from family and peers is imperative to lessening this burden.  We must create an environment where we are comfortable talking to each other about calls and how we are coping.  Talking about the incidents and their effects on us is one way of offloading some of the accumulated stress.

This leaves the third and most important element in this perfect storm.  The coping mechanisms that we choose are really the only part of this trifecta that we can control.  A healthy outlet for this Post Traumatic Stress can help unload some of this burden.  The most common positive outlets are exercise, family, faith and altruism.  Healthy body, healthy mind is not just some catchy phrase.  It is true both physiologically and psychologically.  Exercise releases endorphins and flushes out cortisol, resulting in reduced stress and an increased sense of happiness.  Having a functioning body eliminates additional stressors such as pain and ill health.  Sleep is another area were wellness and hormonal balance can be achieved.  This takes a concerted effort from the first responder who works shifts.  

PTS becomes a “Disorder” when you stop controlling your shadow and it starts to control you.  Choosing poor coping mechanisms further breaks down the pillars that were holding you up.  Drugs and alcohol, infidelity, gambling and other self-destructive practices weaken our defenses in an already compromised structure.  So let’s remove the “Disorder” from this acronym and all start acknowledging that we suffer from PTS.  Make a video and join your brothers and sisters on The Dark Side Project Facebook page.  Listen to the amazing men and women on the Behind The Shield Podcast and use their lessons.  Create a positive environment that enables healthy conversation around the table, a chance for all of us to say how we feel.  Help lift those who are hurting and learn from those who have pulled themselves out of the darkness.

We ALL suffer from PTS.  It’s a simple as that.  I have listed the most common symptoms below.  I hope we can remove the stigma once and for all and stop any more of our brothers and sisters from feeling they have nowhere to turn. Remember, if you bury the seeds, they will only grow until they cannot be contained anymore.

Stay safe out there and Happy Holidays to you all!

James

SIgns of PTS in the First Responder:

Flashbacks of traumatic calls
Unexplained anxiety
Difficulty sleeping or inability to sleep
Dreams or nightmares
Unexplained anger or frustration
Lack of energy
Susceptible to “Triggers”.  These can be sights, smells or sounds.
Unexplained sadness or depression
A feeling of hopelessness
Feeling emotionally numb
Feelings of guilt or shame
Loss of sex drive
Memory Problems
Self destructive behavior
Thoughts of self harm or suicide

Art by DanSun - http://www.dansunphotos.com

 

"He's just a bum!" - Regaining compassion in First Responders.

It was one of the very first calls of my career.  The deafening tone that caused an instant adrenaline rush was followed by a monotonous voice.  “Person down” was the incident description from the dispatcher.  There was an immediate response from the men on my crew that day; a chorus of groans and eye rolling.  I wondered how two short words could create such disdain among these men.  “This is going to be bullshit” one guy exclaimed as we walked out into the bay.  I wondered if he’d had this Nostradamus ability since birth or after a science experiment gone horribly wrong.  We jumped into the engine and drove to the location of the gravitationally challenged individual.

Upon arrival, there was a small framed man lying prone on the pavement.  Two police officers were already on scene and my crew stepped up to join them.  “Oh surprise, surprise!  Another bum!” I heard one of them mumble.  One of the police officers proceeded to continuously push the man with her foot shouting “buddy, get up, get up!”.  The man was clearly unable to get up, obviously unconscious and unaware or our presence.  I had had enough of the way the call was going so decided to initiate an assessment seeing as noone else had even checked to see if he was breathing.  After establishing that his vitals were within normal limits, I began to search his pockets to look for clues as to his identity.  

My hand found a piece of paper, which I pulled out and unfolded.  It was from a lab and showed the results of a recent blood test.  The man had just learned that he was HIV positive.  I’m pretty sure that every judgemental person on that scene would most likely have got drunk after hearing that kind of news.  This man was lying on the side of the road, having been given a death sentence and the men and women he paid to protect him were treating him like some sort of subhuman scum.  Now let me point out that this is one of the absolute lows of my career and is far from the norm in most firefighters, police and EMS crews.  It was the perfect storm of disgruntled people having a bad day.

I have worked some of the most desperate neighbourhoods on the East and West coast.  The men and women who walk the streets vary anywhere from angels to demons and everywhere in between, but they are all still people.  Any first responder who has walked into a filthy crack den with expensive cars outside and children running around in filthy clothes and empty stomachs knows that those kids don’t stand a chance.  We are blessed to be raised by one or more parents that gave us the tools and confidence to follow our dreams and serve our communities.  The children we see didn’t dream of becoming drug addicts, homeless or turning to prostitution.  These men and women are our most desperate brothers and sisters, victims of a twist of fate or just poor life decisions.

Our society is suffering from a malignant cancer in the form of selfishness and a lack of compassion.  This is a sweeping generalization and there are many men and women who do not fit this mold.  That being said, there has been something missing the last decade that has hurt us not just in our community, but in our profession.  The compassion for our fellow man has been dampened by news stories of welfare abuse and greedy corporation fraud.  We are raised in a competitive society where you must “destroy the opposition” and be victorious.  This has bled into the First Responder arena where burnt out firefighters, paramedics and police officers become numb to the suffering.

Now understand, this is not me standing in a glass house throwing stones.  I have to constantly check my own heightened sense of self importance.  I wear the badge of a profession that is pretty well respected by complete strangers.  There is an allure of the power that comes with this responsibility.  To me, what I love about the fire service is that when it hits the fan, there is no prejudice, whether cultural, racial or socioeconomic.  A person in need is a person in need and we are there to make their worse day ever a little better.  Historically, tragedy has brought people together, created the much needed tribe that we as a culture are missing these days.  9/11, the London bombings and the Pulse shooting are just a few of the terrible events that brought communities together, circumnavigating cultural bias.

I think we can learn a lot from the communities that banded together during these tragic times.  To me, that is the true essence of humanity.  This year has been one of the worse for this concept.  The coveted position of commander in chief was fought over in a way two five year olds would be spanked for and sent to their room without supper.  We signed up for fire academy, medic school or police academy so we can help people.  As Joel Salatin mentioned in the interview, First Responders are at the fringe of society.  He is right, we see the tears in the fabric of our community.  This also goes both ways though and we can either inspire or infuriate the people that we serve.  I truly believe that we have the power to help our neighbours rediscover their humanity, compassion and sense of community.

We are dying for a tribe in 2016.  I believe this is the underlying reason that Crossfit and mud runs are so popular.  Deep down, people are good and want to do good for others.  As first responders, this is one of the key ingredients to good mental health.  Nothing feels better than helping another human being and expecting nothing in return.  I am proud to wear my badge and stand side by side with like minded first responders around the globe.  We are role models whether we like it or not and our actions are magnified by the eyes of those who look up to us.  Compassion is taught by all religious doctrines and was practiced by their prophets.  We have a responsibility to be the person that our community thinks we are.  We can truly affect our countries for the better if we just hold ourselves to the same high standard.  

“Our human compassion binds us on to the other, not in pity or patronizingly, but as human beings who have learnt how to turn our common suffering into hope for the future.” - Nelson Mandela.

Picture of Larry DePrimo of NYPD.

Homless Fisherman by Diado

Listen to Sebastian Junger talk about our tribal yearning on the Podcast next month.  

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We're all addicted to the thing that takes away the pain - How modern medicine has failed the First Responder.

I never wanted to get hurt on the job but had always envisioned it happening in some heroic way.  I saw myself showing off scars to a wide eyed audience whilst I recalled how I had just extricated the last preschooler when the car shifted or building flashed.  The reality was that my career was almost ended by a 165 pound panic attack patient that was sure he was dying.  As consummate professionals, we had offered to take him to the hospital for further evaluation, which he accepted.  The rescues we have in our department do not dump so the deck is ridiculously high.  As I went to load the patient into the back, the stretcher caught on the deck.  I arched my back to gain the extra couple of inches needed to push the stretcher into its cradle.

When people say they “heard a pop”, they are not exaggerating.  It felt like I had been stabbed in the back by an invisible assassin, leaving no visible mark.  In 39 years, I had never had a twinge in my back, no less an injury.  It took all my strength to assist my partner in removing the stretcher at the hospital and completing the transport.  The appropriate steps were taken to begin the Workman’s Comp process and I was told to report to the local urgent care clinic.  

After an x-ray and physical exam, I was offered a smorgasbord of pharmaceuticals, from opiate pain killers to steroidal anti-inflammatories.  Knowing that this was a traumatic injury, I tried to get the ball rolling on physical therapy but was told to report back to the clinic in three days.  Upon my return, I was greeted by a different PA who informed me that he would not authorize physical therapy and ordered me to take the meds.  Yes you heard me right, I was ordered to take drugs by a physician’s assistant at the clinic all local First Responder agencies use.  Needless to say, I don’t do well being told what to do by a medical professional that can’t even take care of his own health so I sought out the original doctor and finally got my referral for PT.

Trauma to the body is like trauma to a car.  The damage has to be addressed and the structure has to be rebuilt and strengthened.  I don’t know too many drivers that would be happy with a fresh coat of paint over a smashed up fender.  The human body is the same.  Prescribing medication as a long term fix to trauma is, in most cases, both ineffective and in my opinion, a violation of the Hippocratic oath.  “First do no harm” resonates deeply with me and my employer.  I have a set of protocols that dictate my medical choices for my patients.  If I deviate from these, I put the patient at risk for potential harm or even death.  So why doesn’t a fireman or police officer get this same courtesy extended to them?

I began the journey to heal myself without the chemicals that had been offered as my only solution.  I attended my first physical therapy session and was told the initial diagnosis was a type II tear to three of the ligaments connecting my L4 and L5 lumbar vertebrae.  This caused herniation of the discs and severe pain.  When I raised my leg in a prone position, my vertebra would actually rotate.  At this point, my son was 5 and mad about football (soccer for my American friends).  In an instant, I had gone from the cool dad who would kick a ball around the park with his son to a hobbling shadow of my former self.

You can’t describe what it is like to not be able to pick up your child.  I am a very hands on father and at five, my son loved to be picked up and flung around the room.  I couldn’t kick a ball, run, swim, do my martial arts, do a Crossfit workout or even make love to my wife.  Every type of movement was agony and it took its toll physically, mentally and emotionally.  The temptation to take the pills they had offered me was overwhelming.  Beer became an easy way of numbing the pain and helping me get to sleep but just felt even worse in the morning.  To add to this, I had been taken from my tribe, the job that I loved.  The ability to make a difference in someone else’s life was gone so this just added to a feeling of inadequacy.  I could feel myself slipping into some sort of depression, feeling emasculated by this inability to move as my body was designed.

I got pissed off.  Really bloody pissed off.  Firstly at myself for letting what ever weakness had caused this occur.  Secondly, at the awful lack of understanding and treatment options for a man who uses his body to put food on his family’s table.  This injury was legitimately threatening the two loves of my life; my family and being a firefighter.  I decided to devote every day to not only getting better but getting fitter and stronger that I was before.  I went to physical therapy four times a week, spending an hour and a half per session.  My fellow patients were elderly as Ocala has a large retirement community.  The physical therapist was not used to training occupational athletes so I had to help steer them in exercise choice.  The most basic of movements had become agony and it took going to a dark place to find the strength to push myself through the therapy.  

The treatment would end with a 20 minute ice therapy, where I would sit and contemplated how the next time I would push even harder.  I would also try and figure out what went wrong.  How had I got hurt when on paper, I did everything right.  I found a chiropractor and paid out of pocket for treatment four times a week.  His initial assessment confirmed the damage in my back but also showed how I had developed an excessive curve in my spine.  The treatments began with an adjustment but were followed by 30 minutes of traction and exercises to begin to reverse the damage.  As I sat with my neck in traction, a video would play of a bloke doing what looked like a strange form of yoga.  One day, my chiropractor told me to find the routine on YouTube and do it every day before seeing him.

My progress had been painfully slow up to this point.  My back would start to feel a little better and I would begin to get encouraged.  The next morning, I would wake up, praying that the pain was gone, only to be greeted by the same burning pain.  Getting out of bed was an effort in itself and putting on my shoes was damn near comical.  I started to incorporate the video into my morning routine and was amazed that my back actually felt better after it.  The video was 12 minutes of Foundation Training, a back health routine developed by chiropractor Dr Eric Goodman to fix his own back.  He too had become so frustrated by the lack of options that he developed his own.  After a week, the progress was so good that I started doing it as part of my physical therapy and showed my therapist this incredible system.  My back got stronger and stronger and the pain got less every morning.

After 3 and a half months, I had strengthened my back to the point where the pain was gone and I could complete the tasks required of a fully functional firefighter.  Three months later, I competed in a 9/11 tribute charity event to honor the fallen, deadlifting 225 pounds for reps.  This wasn’t a superficial removal of pain, this was a legitimate fix to an injury that could have forced me to retire from the profession that I know I was born to do.  I managed to convince my department to send me to California and I became certified in Foundation Training.  Upon my return, I gave the class to every single firefighter in my department, giving them the tools to avoid the terrible journey I had been on. 

I had learned that this injury came from muscle imbalance placing the joints in biomechanically horrendous positions.  From sitting my entire life, my pelvis was tilted, my hamstrings and glutes were short and weak, my shoulders were rolled forward and my neck craned over my chest.  After six months, my posture had shifted completely and I was pain free.  I could squat properly, deadlift with good form and most of all, do anything a 5 year old asked me to do.  The journey has not stopped.  The anatomical damage will always be there, like a scar, so I have to work on my body like the athlete a first responder should be.  I sought out Julien Pineau of Strongfit to further challenge me, especially carrying the heavy loads a firefighter is required to do.  He found more imbalances and helped me further strengthen what was weak.

I can honestly say that I move better as a 42 year old man who got beat up in both firefighting and martial arts that my 21 year old former self.  The road the medical professionals I initially was sent to created a path to failure.  Without the exercises I used, my back would never have healed and the pain would always be with me.  The drugs they prescribed would be the “first one is free” slippery slope to opiate addiction.  In the 12 years of my career, only about 20% of the overdose deaths I ran on were from illegal street drugs.  The remaining 80% that tore the hearts out of the families were from pills prescribed by a physician, legally under our current “healthcare” system.  Now I’m not blaming all doctors but I am underlining the fact that the current system is not working and something needs to change.  I have brother firefighters that are addicts and some who died from this affliction.

As first responders, we need to understand that many injuries are treatable without medication or surgery.  This is a bitter pill to swallow as it requires patience.  The body is amazing but it needs time to heal.  You need to remove whatever imbalance caused the injury so it doesn’t happen again.  There’s no point going to a chiropractor if you’re not addressing the imbalance that caused the injury in the first place as it will merely repeat itself the moment it can.  We have to look at ourselves as athletes because we are.  Athletes have a team around them.  Nutritionists, trainers, chiropractors, coaches, and more.  If you cannot physically find these people then begin to educate yourself and become your own advocate.  Question everything you have been taught up to this point and start to see how it affect you personally.  If your doctor is morbidly obese, maybe he or she is not the best person for wellness advice.

William Osler said “one of the first duties of the physician is to educate the masses not to take medicine”.  Medicine certainly has its place and the drugs I carry on my engine can be extremely effective.  Medicine for chronic illness and injury, however, results in a lifetime dependency on chemicals.  In the realm of pain killers, this can lead to the destruction of families.  It’s time we started challenging this system as first responders.  When you get hurt, research how you can heal the injury without surgery or medication.  You’ll be surprise how many injuries can be healed without chemicals or traumatic surgery, getting bones glued together ensuring a lifetime of immobility and arthritis.  You are your own advocate and the more you understand about your own body and the treatments available, the more power you have over your own health.

Next week’s Podcast will feature Julien Pineau and Dr Eric Goodman will be on the show in January.  Please listen to these great teachers and begin the road to healing your injuries and preventing any future ones.

Take care out there brothers and sisters.

James


 

Sleep Deprivation - The other silent killer of First Responders

The tones scared the shit out of me.  I had managed to enter a deep sleep that night after a busy day of calls and training.  The dorm had been eerily quiet up to that point, in a firehouse that was normally getting hammered at night.  The jarring voice of the dispatcher caused an adrenaline dump that catapulted my heart, feeling like it would burst through my chest.  “Structure fire”, the two words that sent you from unconsciousness to fight mode in a fraction of a second.  The station had a two story pole slide that was challenging, even with all of your faculties.  At 2 am, thirty seconds after being ripped from sleep, it was basically a free fall to the bay floor below.


I threw my bunker gear on as the second repeat came over the loudspeaker.  “Apartment complex, flames showing, multiple calls.”  These magic words told us that this was not a false alarm.  This time of night, most residents would be in their homes and fast asleep.  The chances of people being trapped by the flames was very high.  I threw on my bunker gear and climbed into the doghouse of the tiller truck and signalled to the drive in front that I was ready. The plymovent rails screeched as the truck pulled out of the bay and separated itself from the yellow umbilicus.  As we turned the corner, the familiar yellow glow filled the sky as a column of dark smoke rose through the night air.  I navigated the back of the truck around parked cars and around sharp turns whilst trying to shake off the massive fatigue.


The structure in question was literally a block away from the station so it took less than two minutes to arrive on scene.  Packs were thrown on backs, outriggers deployed and saws were fired up in the cool winter night.  The aerial was surgically placed to the edge of the roof so we could climb to the top of the three story building.  The fire was licking out of the windows below but had not compromised the roof yet.  We cut our inspection hole and then sounded our way to the seat of the fire, cutting indicator holes as the lead firefighter pounded the roof with their hook.  The saws began to scream as if in agony as they tore through the shingles and sunk into the plywood below.  As the louver was pulled back with the rubbish hook, the fire blew out, angry and impatient.  The holes were extended to match the intensity of the fire below and finally sapped the strength from the raging inferno.


This isn’t a story of heroism or inhuman feats of strength or courage.  It’s what firefighters do every day, around the world.  Only five minutes prior, I had been in a dead sleep and now I was standing on a roof, fifty feet in the air, cutting with a chainsaw as fire licked all around me.  A fire like this requires hours of hard manual labor, initially fighting the fire, then overhauling and trying to save the resident’s possessions in the process.  Luckily on this particular fire there were no victims to find, no dead dogs to bring out to a heartbroken child.  But still, people’s lives had been shattered. 


As dawn broke, we wearily drove back to the station to begin the arduous process of cleaning tools, changing saw blades and fuelling the power tools.  Our gear reeked of the toxic chemicals they absorbed during the fire, off gassing into our airways and skin.  Gear needed to be cleaned and switched out to minimise the contact with the potentially life threatening carcinogens.  Bodies are scrubbed in piping hot showers to remove the chemicals from the pores.  Noses are blown to reveal a tissue full of black, noxious snot.  Then, the message is given to dispatch that we are back in service to do this all over again.


The drive home from a night like this is the next challenge.  Many fill themselves to the brim with tar like firehouse coffee to make it through the commute.  Eyelids feel like a thousand pounds as you strain to maintain mental clarity.  Windows are down, music is up and the occasional slap to the face are tools to maintain consciousness.  You finally make it home safely and say a little thank you to your God or the Universe.  You are met by the neighbour from hell who starts bitching at you about your rubbish bins not being put away at the correct time.  The thoughts of knocking him out there in the middle of the street are overwhelming.  You are spread so thin between mental and physical exhaustion, lack of sleep and the memories you carry from your worst calls.  But you find the strength, unfold your fist and just walk away.  “It must be nice having so much time off” you hear him mutter as you close the door behind you.


Sleep deprivation is an issue that is rarely if ever addressed in First Responders.  In the fire department, we have become very good at protecting ourselves from the hazardous chemicals from fires and other incidents, yet we are still twice as likely to get certain cancers than civilians.  When a brother or sister contracts a horrific disease, we look back to a certain incident and assume it was connected to that.  The missing link, the part that is overlooked is the lack of sleep.  A First Responder will lose sleep every night they work for their entire career.  Whether it is a 12 hour night shift or a 24 at at Firehouse, the effects are the same.  The sleep that is allowed on quieter nights is of poor quality as the anticipation of a call blocks the ability to fully switch off.


Dr Kirk Parsley is a Navy SEAL who went to medical school to become the SEAL’s doctor.  He was finding the same chronic medical conditions in his young uber athlete soldiers, who were exercising like maniacs and eating all of the right foods.  It dawned on him that the one common denominator was lack of sleep.  Whether going through Hell Week or just extended deployments, the men were coming back with blood work that was less than optimal.  Dr Parsley began to focus on the men’s sleep and saw an immediate change in their overall health.  He began to delve deeper in this field and is now considered one of the authorities on Sleep Medicine in tactical athletes.  


Unlike most professions, First Responders don’t know what a call is going to entail until it happens.  For firefighters it could be a fire, traffic collision, rope rescue, marine rescue or some other emergency that no one else is trained for.  A police officer may be involved in a car chase, foot pursuit, fight or gun battle.  The paramedic may roll up on an active shooting or explosion.  The zero to a hundred nature of our professions takes a huge toll on the human body.  This adrenal fatigue, the constant stress of expecting the worst case scenario to occur prevents the body from repairing and growing.  The fight or flight response is a primitive mechanism that still keeps us safe today.  


The problem is that the same mechanism can kill us if it never turns off.  Stress keeps this sympathetic nervous system ticking over and doesn’t allow the parasympathetic (feed and breed) to kick in and start repairing all of the damage from the previous day.  This is further exacerbated by lack of sleep.  Nighttime is when the body heals injury and grows muscle.  In order to do this, the sympathetic nervous system has to be turned off to allow the parasympathetic system to begin the repair process.  Dr Parsley states that by missing one night of sleep, your body’s hormones become completely unbalanced.  Testosterone is halved, blood sugar rises and you have the same neurological function as having a blood alcohol level of 0.08.


The other element that was often thought as fallacy is sleep debt. In his book “The Promise of Sleep”, Dr William Dement details how sleep debt is in fact a very true phenomenon and it is unknown how long this debt spans.  The other fact that he verified is that the average person needs either side of eight hours sleep, every night, to perform optimally.  So this being said, just one night with no sleep immediately puts you 8 hrs in debt.  Multiply this by a career of 20 to 30 years and you have a big problem.  Naps can certainly help get some of this sleep back but is not a substitute for good REM sleep.


The immune system cannot function well in this deprived state, putting the First Responder at much greater risk to heart disease and cancer, the top two physiological killers in our profession.  The brain is not spared from this destructive sleep behaviour.  In fact it has been shown that sleep deprivation mimics traumatic brain injury.  The same injury attributed to depression and suicide among soldiers, football players and combat athletes.  I am convinced that this is one of the missing pieces in the treatment of PTSD.  


So what is the answer?  Certainly, playing with shift schedules is not the solution.  The bottom line is that someone has to work at night to protect the citizens were serve.  Someone has to climb that ladder to reach the trapped victim or arrest the violent husband before he hurts his estranged wife.  The answer is twofold.  Firstly, the First Responder’s work week needs to be reduced and yes, that includes more personnel but that’s the price of protecting a community.  A 56 hour work week with no sleep is a recipe for disaster.  Time needs to be given to recover from these shifts and catch up on the sleep debt.  Naps need to be encouraged not banned.  Would you want the person driving your child to hospital in an ambulance to be functioning like a drunk driver?


Secondly, as an individual, you need to practice good sleep hygiene at home.  That means being strict with yourself about going to bed early.  Black out your bedroom, as light is a cue for alertness and can stop deep sleep.  Turn down the air.  The optimal temperature is 67 degrees which may sound cold but again, this has been proven.  The last point is to try and avoid alcohol in the evening as it will prevent the REM cycle, which is where the body repairs itself.  We have an opportunity to make a huge difference in our own mental and physical health.  Sleep deprivation is another area that must be brought to the forefront as its physical and mental effects are devastating.  


Dr Kirk Parsley will be on the Behind The Shield Podcast later this month so make sure you listen.  


Stay safe out there!


James

 

Artwork by DanSun Photo Art

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I wish my head could forget the things my eyes have seen - PTSD in First Responders.

The Gods were not happy with me.  I had handed in my notice with my previous Fire Department after going through a nasty divorce and becoming a single father of my five year old son.  The new department offered much better pay and the all important Kelly day needed to take care of my little man.  The day in question was my very last day with the County.  I had just got to the station and had barely got my gear on the rig before the first call came in.  It was a cardiac arrest, a GI bleed, the messiest and most frustrating of medical emergencies.  The all important airway is overcome by the stomach contents rendering intubation attempts impossible.  After twenty minutes of cardiac algorithms and futile attempts at ventilation, the termination of the code is met with the heart shattering wails of the patient’s wife.

That was victim number one of that scorching August day.  Mid afternoon, a call came in for a missing homeless lady, who lived in the woods.  Each step towards her urban camping spot brought greater confirmation that she was deceased.  The smell of rotting human flesh was confirmed by the gruesome scene in her makeshift home.  Later that same afternoon, a car had swerved off the road and into a bus stop, where a woman was waiting to go to work.  The lady’s body was no match for the hurtling mass of steel when it finally came to rest over her body.  She was still fighting for her life when my neighboring crew got to the trauma center.

The last call of the shift was at 3am.  A man had run out of a burning house, still on fire himself.  When we got on scene, the only part of his body not horrifically burned were the soles of his feet.  After climbing a fence and muscling him back over, he was rushed to the local trauma center where he fought for an hour before succumbing to his injuries.  In just 24 hours, three people had died and one more was fighting for her life.  This was just one day in a career that usually lasts 25 to 30 years.

The point of this macabre anecdote is that First Responders see trauma that can never be forgotten.  These events can be in two forms.  The catastrophic event, like 9/11 or the Pulse shooting here in Orlando can create massive trauma.  The lesser known and accepted version is the cumulative form.  These smaller yet equally tragic events chip at the person incrementally.  As time goes on, the weight of these events start to pile up.  What once may not have bothered someone may now start to cut a little deeper.  As you advance into your career, you realize that the Hollywood code saves rarely occur in the real world.  The sense of helplessness watching a person die in front of your eyes magnifies with each event.

The military has done a good job of recognizing the effects of this trauma.  Sadly, the Fire Service, EMS and Law Enforcement are lagging behind, with acceptance of this being held as a sign of weakness.  The reality is that there are many First Responders who will witness much more trauma in their career than many soldiers.  This needs to be acknowledged in our profession.  Pretending that this trauma and tragedy doesn’t have an effect on the men and women that serve their communities is unacceptable.  This old school mentality is leading to huge amounts of depression, alcohol and drug abuse and even suicide.  It is time that PTSD and the associated mental health issues are brought to the forefront.

In his book, Tribe, Sebastian Junger talks about how a group offers strength and support.  This is particularly true in the Fire Service and Military.  These men and women spend a large percentage of their life with the same group.  The laugh together, cry together and see the same horrific scenes together.  When a person leaves the tribe, that support structure is lost and that’s when symptoms can manifest out of nowhere.  This could be leaving the military, retiring from the Fire Service or even injury.  Finding a tribe both at work and outside of work is imperative in dealing with the demons that haunt you.  Humans are innately tribal and find solace in groups of their peers.

One of the worst philosophies toward treating this affliction is by using medication.  As with many chronic diseases, this just serves to mask the symptoms instead of treating the cause.  The only tried and tested treatment that has proven to be successful is exercise.  This may be in the form of sport or fitness training.  People who immerse themselves in taking care of their bodies have been shown to deal with PTSD much better than any other treatment modality.  Green Beret and UFC fighter Tim Kennedy attributes his investment in his body as the reason he can deal with the horrors he has seen in combat.  I myself can testify to this.  After 12 years seeing the results of horrific accidents and human cruelty, martial arts, strength training and recreational sport have helped keep me balanced.

These images will never go away.  Detroit FD Engineer Dave Parnell’s quote “ I wish my head could forget what my eyes have seen” sums it up perfectly.  They are burned into our memories to carry to the grave.  A drive around the streets we serve is a constant reminder of the tragedy we have seen.  That being said, there is hope.  The human body and mind a resilient when nurtured.  Finding your tribe, that group of people you love to be around, is the first step toward finding balance again.  Giving your life purpose is the second.  Having a reason to get up in the morning, making a vow to eat clean food and exercise will prime the body and help flush out the hormones contributing to depression.

We must look out for our brothers and sisters that may be hurting and make this issue as acceptable as it is in the Military.  You took an oath to carry the burden of your service but no one said you had to do it alone.  It is time that this mental trauma was highlighted among First Responders and that treatment and support become readily available.  It is unacceptable to hear of our brothers and sisters taking their own lives or succumbing to addiction.  We are a tribe and its time to start taking care of our own.

Image Artist - Agnes Cecile