For the Love of the Job

Firefighters 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 fire ground 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. Justas progressive fire prevention strategy is essential for community risk reduction, so too is a prevention strategy 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 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 s 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.

by Brittany Hollerbach, Ph.D.


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
  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
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  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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