Firefighter PTSD lessons from POWs
U.S. prisoners held in the infamous Hanoi Hilton had remarkably low incidents of PTSD; here's how they did it and how that can be adapted to the fire service
Anyone who has been a firefighter for any length of time will have seen some bad things. It’s inevitable: most people call the fire department on the worst day of their lives.
Fires, medical calls, vehicle and industrial accidents – all of these types of responses have the potential to affect individual responders in ways that run deep and may have lasting effect.
According the National Fallen Firefighters Foundation, firefighters have a 6 to 20 percent rate of developing post-traumatic stress disorder; versus around 8 percent for the general population. Virtually all firefighters will exhibit some temporary symptoms of post-traumatic stress related to an on-duty event at some point during their time of service.
Are there things that a crew can do to minimize the effect of these traumatic situations?
In his book, “The Evil Hours: A Biography of Post-Traumatic Stress Disorder,” author David J. Morris tells the story of the notorious Hanoi Hilton, where prisoners of the Vietnam War were held for years. Sen. John McCain is perhaps the most famous of those held at the prison.
The men held there were tortured and kept in terrible conditions for many years. Yet the survivors of the Hanoi Hilton have one of the lowest lifetime rates of PTSD recorded, just 4 percent.
Compare that to one study of Americans held as prisoners by the Japanese during World War II who suffered from PTSD at rates up to 85 percent.
Mental survival guide
The factors that contributed to the low rates of PTSD for the Hanoi Hilton veterans are instructive for fire departments as well. These factors relate to who the prisoners were, the culture of their imprisonment and how they were treated once released.
First, those imprisoned at the Hanoi Hilton were on average 15 years older than the average draftee during the Vietnam War. Virtually all of them had attended college and as pilots and members of flight crews, they were among the best trained of all service members.
They were at the peak of physical fitness and a large number had attended training specifically designed to help those who might be held as prisoners of war.
So the prisoners were more mature and better prepared than the average draftee. Not only did they benefit from this training and preparation, but they also knew that their country had already invested a large amount of time and money in each and every one of them.
Second, the Hanoi Hilton developed a unique culture among the prisoners held there. It was geographically stable and despite (or perhaps in reaction to) its harsh conditions, prisoners were able to create a strong and emotionally supportive culture that was based in mutual care, unity and optimism in the face of adversity.
Newly captured prisoners later talked of being mentored by more experienced prisoners.
Finally, once the men were released from prison, they were welcomed home with public appreciation and recognition. Their sacrifice was honored and they were able to tell their stories in many different contexts. As Morris states, these men’s reintegration following trauma was eased by having “opportunities to be understood.”
Applied to fire crews
These three factors, which can mitigate PTSD, are ones that fire crews have some control over. In particular, company officers can create a crew culture where preparation, inclusion and recognition are high priorities.
First, training and preparation for dealing with work-related trauma are critical. One long-standing fire department mental health professional has pointed out that to prevent PTSD related to emergency calls, put attention into running better calls.
It is true that PTSD is often related to feelings of guilt or powerlessness – if firefighters feel that they have always done their best given the circumstances, these factors will be mitigated.
Second, fire crews that are cohesive and inclusive can do much to minimize the lasting effect of those really bad calls. All firefighters know the value of dark humor and rude jokes, and those 02:00 talks around the kitchen table after a bad call.
Company officers can be the catalyst in creating the kind of culture among their crews where people feel comfortable talking openly and where all members are equally valued and included. Senior firefighters of all ranks can act as mentors to newer members.
Finally, appreciation and recognition are important. Firefighters don’t expect (or even want) to be singled out for their accomplishments. But as a team, the work that firefighters do, even when there are bad outcomes, must be recognized and appreciated.
Ideally, this recognition happens at several different levels, including among the community and from the top down in the department. But company officers can and should take the lead in actively appreciating the contributions of their crew members and making sure that every crew member feels valued.
Part of this recognition comes from creating “opportunities to be understood.” These opportunities can come from formal debriefs where everyone offers their perspective on what happened to informal conversations that occur one-on-one.
Regardless of the context, the feeling of being prepared, supported, included, appreciated and understood will go a long way toward minimizing the negative effects that come with the inevitable bad calls that every firefighter faces.