Communications

Don’t take offense by my previous statement. It is a natural reaction to talk and offer help to others who are hurting. In fact, as first responders it is what we were trained to do. What is the first thing we are supposed to do when arriving on a call, either fire or EMS? It would be scene size-up, right? As an example, the crew arrives on the scene of a single story, residential with the report of a woman not feeling well. She is conscious but sobbing and incoherent at times. Upon entering the home, a family member says they found a bottle of medication empty near the bed. They know something is wrong since this family member filled the prescription two days ago. Now what is your next step? Typically, we do an assessment. We ask her questions on her condition, find out everything you can to help because this could be a true emergency. Most of us ask her why she took the pills but do we ever truly talk to her when she begins to pour her heart out or are we in the mode of taking care of her physical issues. She is beginning to have an increase in B/P, heart rate, and feeling sleepy. So our first thought is to get her to the hospital ASAP, as it should be. Yet, reflect back on this call. Who probably did all the talking? We did as first responders. It is what we are trained for.

What FBHA has learned over the years has been incredible due to the thousands of firefighters and EMS people we have met, talked to, listened to, hugged and unfortunately have lost. One thing we have learned is in the “regular world” where an estimated 42,000 lives are lost by those who completed suicide, that there is a belief of this statement by the American Foundation for Suicide Prevention.

Suicide Warning Signs

Most people who take their lives exhibit one or more warning signs, either through what they say or what they do. (https://afsp.org/about-suicide/risk-factors-and-warning-signs/)

Now I do not disagree with this, but I have my own belief from my experiences that most firefighters and EMS personnel might not exhibit warnings signs. Why? Because we are darn good actors. We can bury things we have seen and done better than most people in other careers.

So where do we start the educational process on behavioral health and suicide awareness? We do this through our fire and EMS academies, to our officers and leaders of our organizations. FBHA has three concepts within our workshops.

1. Challenge with Compassion

2. Be Direct

These two are about watching out for warning signs. If you see or hear something from your brothers or sisters, then ask.

3. Perform an Internal Size-Up

This means looking within yourself and to see how you are acting or feeling. One of the easiest ways to do this is to listen to others. They see us better than we see ourselves. If your loved one or friend says you’ve changed, then do not automatically respond with “No, I haven’t.” I can make this guarantee. If you have been in this business, then guess what YOU HAVE CHANGED. How can we not? All the stress, anxiety, images of death, horrific scenes and watching people die in your arms changes you but you still must be strong. Yes, we chose this life, but it doesn’t mean we have to suffer the rest of our lives through PTSD, depression, addictions, having no family support or whatever has afflicted us. By performing an Internal Size-Up allows us to seek help for ourselves!

Now back to the communications issue. If there is anything you take away from this article it is to become better listeners. This is a role-reversal for us. Because we want to help out, offer our talents as first responders but at times people struggling just want to talk about issues in their lives. We see this playing out in our workshops when we role-play. One person will play the officer while another plays the first responder struggling with an issue. During the role-play we see the officer doing most of the talking because they want to help. It is a natural reaction as first responders. Yet listening is the key. You need to be in the moment. Listening to every word. If there is silence, which is completely uncomfortable, then that is OK. Let the first responder gather their thoughts, process what they want to say. Here are some tips:

1. Allow them to talk.
2. Silence can be good.
3. Avoid “jumping in” with responses.
4. Avoid perfect solutions — offer options — EAP, chaplains, and local counselors. Have your department create outside resources list.
5. Let them choose the help they want.
6. Focus on skills of communications – body language, tone of voice.
7. Be Direct. Challenge with compassion. If something doesn’t sound right then ask!

The best way to practice on how to listen to every word is to watch your favorite television show with closed-caption on. You will see how difficult it is because the tendency is to read the words and disregard what people are saying. Try this to focus on what people are saying because when your brothers or sisters come to you to talk about an issue in their lives you need to listen to every word without distraction. You deserve this same courtesy when you ask for help.

As stated in this article, education is a key component. By becoming aware of our own emotions we can begin to see others that are possibly suffering. It allows us to become leaders by stepping up and saying, “I am hurting and I am going to do something positive to get help, who is with me?” You will start to see the wall of resistance break down. It doesn’t make us weaker fire or EMS providers. It opens the door to a great career and a better life.

Recognizing Suicide Warning Signs in Firefighters and EMTs

Behavioral health is a key component of an overall firefighter health and wellness program. Unfortunately, it is a difficult subject to discuss — many factors affect a firefighter’s ability to understand when a fellow brother or sister is suffering, but that does not make it any less critical an issue.

By far, the number one comment by fire and EMS chiefs associated with departments that have suffered a loss is that they didn’t realize or recognize the warning signs that their member was displaying until after the loss had occurred.

The Firefighter Behavioral Health Alliance (FBHA) tracks and validates firefighter and EMT suicides in the United States. A key component is validation: Whether we receive a confidential report, text message, or phone call of a tragic event of a suicide, confidentiality is always maintained.

FBHA has traveled across North America presenting behavioral health workshops with an emphasis on suicide awareness. Our workshops focus on warning signs and actions to take when a brother or sister is in need of help.

Top 5 Warning Signs –
Think “RAILS”

1. Recklessness/Impulsiveness: These might be subtle signs such as purchasing guns when a person has always been against them. Riding a motorcycle recklessly or charging into burning buildings against policy or procedure.
2. Anger: Suppressed anger or explosive anger from seemingly minor issues can be a dangerous sign. Displacement (directing one’s anger at someone else instead of the intended person) is often observed. Displacement is most often directed at a firefighter or EMT’s family.
3. Isolation: Becoming distant from their career company around the station or volunteer firefighters who don’t participate in drills or calls as much. Members might even display isolation around their family. They lose interest in family activities.
4. Loss of Confidence in skills and abilities: Several firefighters and EMTs have advised FBHA they lost confidence in their ability to get the job done due to concentrating on emotional or personal issues they were battling. A seasoned firefighter who can’t remember how put an engine in gear to pump is an example.
5. Sleep Deprivation: Loss of sleep can indicate stress, anxiety, PTS or several other emotional issues a member might be struggling with and not realize.

Recommendations:

When you see someone struggling or just off his or her game, follow these recommendations as a starting point:

1. Be Proactive; Be Direct: We do this when responding to emergencies. We need to take the same approach when our brothers or sisters appear to be struggling.
2. Direct Questions: Remember these two questions if a member comes to you with suicidal ideations.a. Do you feel like killing yourself now?

   b. Do you have a plan? 

   A “yes” to either one of these questions means you need to engage your department procedures or protocols if in the firehouse. If outside of the department then they need help immediately. NEVER leave them alone!

3. Compassion: The theme in our workshop is: Be Direct and be compassionate. Stay in the moment when talking to them. It is the most difficult type of conversation but always speak from the heart.
4. Discretionary Time: If a member comes to you to talk about a difficult issue they are struggling with and you have never dealt with this type of issue, then let them know but also use discretionary time. Do not make statements just to fill a void. For example: I never realized you were struggling with this issue and I don’t have a lot of knowledge on this problem, but let me find out a little more about it and we will talk later. (If this is a crisis moment then do not leave member alone.)
5. Walk the Walk: The number of firefighters, officers and EMTs/paramedics who help their brothers or sisters out by taking them to AA classes or counselors cannot be overstated. They sit outside and wait until the appointment is over. Taking care of our own goes well beyond the station or fire ground.

Posters and tip cards are available for your departments and personnel. Please contact Jeff Dill at jdill@ffbha.org for more information or visit our web page at www.ffbha.org.

Top 5 Warning Signs – Think ‘RAILS’

1. Recklessness/Impulsiveness: These might be subtle signs such as purchasing guns when a person has always been against them. Riding a motorcycle recklessly or charging into burning buildings against policy or procedure.
2. Anger: Suppressed anger or explosive anger from seemingly minor issues can be a dangerous sign. Displacement (directing one’s anger at someone else instead of the intended person) is often observed. Displacement is most often directed at a firefighter or EMT’s family.
3. Isolation: Becoming distant from their career company around the station or volunteer firefighters who don’t participate in drills or calls as much. Members might even display isolation around their family. They lose interest in family activities.
4. Loss of Confidence in skills and abilities: Several firefighters and EMTs have advised FBHA they lost confidence in their ability to get the job done due to concentrating on emotional or personal issues they were battling. A seasoned firefighter who can’t remember how put an engine in gear to pump is an example.
5. Sleep Deprivation: Loss of sleep can indicate stress, anxiety, PTS or several other emotional issues a member might be struggling with and not realize.

Recommendations:

When you see someone struggling or just off his or her game, follow these recommendations as a starting point:

1. Be Proactive; Be Direct: We do this when responding to emergencies. We need to take the same approach when our brothers or sisters appear to be struggling.
2. Direct Questions: Remember these two questions if a member comes to you with suicidal ideations.a. Do you feel like killing yourself now?

   b. Do you have a plan? 

   A “yes” to either one of these questions means you need to engage your department procedures or protocols if in the firehouse. If outside of the department then they need help immediately. NEVER leave them alone!

3. Compassion: The theme in our workshop is: Be Direct and be compassionate. Stay in the moment when talking to them. It is the most difficult type of conversation but always speak from the heart.
4. Discretionary Time: If a member comes to you to talk about a difficult issue they are struggling with and you have never dealt with this type of issue, then let them know but also use discretionary time. Do not make statements just to fill a void. For example: I never realized you were struggling with this issue and I don’t have a lot of knowledge on this problem, but let me find out a little more about it and we will talk later. (If this is a crisis moment then do not leave member alone.)
5. Walk the Walk: The number of firefighters, officers and EMTs/paramedics who help their brothers or sisters out by taking them to AA classes or counselors cannot be overstated. They sit outside and wait until the appointment is over. Taking care of our own goes well beyond the station or fire ground.

Posters and tip cards are available for your departments and personnel. Please contact Jeff Dill at jdill@ffbha.org for more information or visit our web page at www.ffbha.org.