Contributed by MnFIRE Medical Director Dr. Zeke McKinney, MD, MHI, MPH, FACOEM

The job of a firefighter means helping people, including during times that are traumatic and devastating for everyone on the scene. Firefighters can experience – through all of their senses – dangerous, deadly, scary and extreme cases of human suffering that can stay with them long after the call is complete. Over time, it can become impossible to ignore these feelings and the repercussions. There are countless stories of firefighters mentally or emotionally struggling in their day to day or while on duty – and it isn’t their fault.

It’s a proven fact that ongoing exposure to trauma can lead to developing post-traumatic stress disorder (PTSD), also known as post-traumatic stress injury (PTSI). There is a movement to use the term PTSI instead of PTSD, to better emphasize the condition as a recoverable “injury” as opposed to a chronic disorder.

The International Association of Firefighters (IAFF) indicates that around 20% of firefighters will experience a post-traumatic stress injury during their careers, compared to the general population’s 6.8% risk. It’s less well-known that people can experience short-term stress after trauma, and mental health can return to its baseline or even to a higher level of resilience. This is called “post-traumatic growth.”

When your mind and body don’t process trauma effectively and you don’t return to the same level of mental health after one month, that is PTSI. This is not a sign of weakness or wrongdoing. It’s a reaction by your body, just like if someone broke their arm from falling or had a heart attack.

PTSI can sometimes be difficult to identify. Even though a person may not have experienced any physical trauma, it can cause physical symptoms such as abnormal heartbeats, chest pain and dizziness, as well as psychological symptoms such as flashbacks, nightmares, sleep problems, anxiety, being on guard or easily startled, among many other symptoms. Health professionals are still learning about PTSI, including the differences between how to understand, diagnose and treat PTSI after a single traumatic event versus when someone consistently experiences traumatic events.

Fortunately, there are ways to treat PTSI. The most effective treatments for PTSI include a combination of talk-based therapy, medication and other specialized approaches such as eye-movement desensitization and reprocessing (EMDR) or accelerated resolution therapy (ART). For firefighters, one of the most effective tools is consistently checking in and debriefing about traumatic events after they happen.

For career firefighters with an official PTSD or PTSI diagnosis, it is possible to receive workers’ compensation from the state of Minnesota. Even though the workers’ compensation system is not perfect, Minnesota is working to improve how PTSI is addressed, and the Department of Labor and Industry recently produced a report for the state about how to best ensure workers can get the help they need.

It can be challenging to start a workers’ compensation claim, but MnFIRE provides many no-cost resources for firefighters that are easy to access, including therapy sessions and a Critical Illness insurance policy, which covers a PTSD/PTSI diagnosis. Those who receive a qualifying diagnosis are eligible to receive a cash payment to help manage expenses your health insurance might not cover. You can call our helpline anytime at 888-784-6634 to get connected with these resources or visit the Hometown Heroes Assistance Program page for more information.

Responding to high-stress emergencies on a regular basis can take a toll on firefighters, especially over the course of a career. Research from the International Association of Firefighters (IAFF) shows approximately 20% of firefighters struggle with a post-traumatic stress injury (PTSI) or post-traumatic stress disorder (PTSD) at some point during their careers. This is notably higher than the 6.8% risk for the general population during their lifetime.

What is PTSI?

PTSI is a mental injury that can occur after someone is involved in a traumatic event. There is a movement to use the term PTSI as opposed to PTSD, to better emphasize the condition as a recoverable “injury” as opposed to a chronic disorder. Those experiencing PTSI may experience symptoms such as:

• Intrusive memories/flashbacks: Many people experiencing PTSI relive the traumatic event(s) through memories, flashbacks, nightmares and upsetting thoughts.
• Avoidance behaviors: Those struggling may avoid certain places, activities and even people, potentially disrupting their normal daily functioning.
• Increased irritability: They may also have frequent mood swings, anger, aggression, heightened sensitivity and other out-of-character behaviors.
• Negative self-image or outlook: They might have distorted beliefs about oneself, others and the world, feelings of detachment and guilt, or lack of interest in previously enjoyable activities.
• Poor sleep habits: They may struggle with a regular sleep routine and find themselves waking often or sleeping too much.
• Substance abuse: There’s often a strong link between PTSI and substance abuse since turning to alcohol or other substances can help mask negative feelings and pain. The IAFF found 27% of firefighters admitted to substance abuse related to their job.

Asking for help

A longtime Minneapolis firefighter who was part of the crew who responded to the George Floyd emergency call and other countless tragic situations, started to struggle with her mental health and found herself at a breaking point in 2022. She started to miss shifts, drink heavily and panic while on the scene at fires and crisis situations.

Desperate, she told her captain she wasn’t doing well at work or by herself at home. Not sure what to do, she fortunately received a referral to MnFIRE from another firefighter. Connecting with a peer supporter was a step in the right direction for her. Today, she credits MnFIRE with saving her career and well-being, as she’s continued professional therapy sessions and used other resources to strengthen her resilience.

Trusted source in MnFIRE

It’s important for all first responders to have a healthy outlet to release their mental and emotional struggles. Counseling can offer professional support by giving you tools to manage and relieve mental and emotional symptoms. Peer support is another great option for having a trusted person you can talk to and relate to with your story.

As a Minnesota firefighter or family member, you have a support team behind you. The MnFIRE helpline is staffed by experienced clinicians. From one-on-one calls to department debriefs, during the middle of a crisis or after a tough call, we are here for you. Don’t hesitate to use this no-cost, confidential resource available 24/7 to all firefighters and their families in Minnesota. Just call 888-784-6634 and select option 1 for immediate help and more information.

Through the Hometown Heroes Assistance Program, all active firefighters are also enrolled in a Critical Illness insurance policy, which covers diagnoses of critical illnesses, including post-traumatic stress injury and disorder (PTSI/PTSD). Those who receive a qualifying diagnosis are eligible to receive a cash payment to help manage expenses your health insurance might not cover. To file a claim, call 888-784-6634 and select option 3.

We’re ready to help when help is needed.

Contributed by MnFIRE Mental Health Director Melinda Coscarelli, PhD, LPCC, LADC

According to the Minnesota Department of Health, recent data shows more than 800 Minnesotans die by suicide every year. In Minnesota’s fire service, research by the National Alliance on Mental Illness tells us that nearly 50% of firefighters are currently experiencing or have experienced suicidal thoughts. Sadly, approximately four to six Minnesota firefighters will choose to die by suicide each year.

The causes of suicide are complex, but we do know the repeat exposure to traumatic events that firefighters face can pose significant risk to their mental health, and leave them at a higher risk for suicide. Suicide is preventable, but there is a stigma around the topic that stops people from admitting they are struggling and getting the help they need. By raising awareness and learning how to support each other, we can make a positive change and save lives.

Know the risk factors

Being aware of risk factors is one of the first ways you can help prevent suicide. Two of the most common risk factors for suicide are depression and post-traumatic stress injury (PTSI). Studies show that firefighters are five times more likely to experience depression. It usually presents as continuous sadness, hopelessness and a lack of interest for the activities previously enjoyed. Additionally, PTSI can also be a warning sign. In fact, because of the daily high-stress and sometimes tragic calls that firefighters respond to, one in five firefighters meet the criteria for PTSI.

Know the warning signs

Something to look out for when concerned that a person may be suicidal is behavior changes. Warning signs could include isolation or withdrawing from family and friends, a substance abuse disorder, poor sleep habits, mood swings, or lack of hygiene and weight loss. Listen for language that refers to not being included anymore, or the world being better after not being around any longer. It’s important that if you fear someone is in immediate danger of harming themselves, do not leave them alone – call a crisis line or health care provider.

There is help

It’s important for all first responders to have a healthy outlet for releasing their mental and emotional struggles. Counseling can offer professional support by giving you tools to manage and relieve mental and emotional symptoms. Peer support is another great option for having a trusted person you can talk to and relate to with your story. Exploring faith and spirituality can also sometimes help you find more direction, connection and clarity in life.

Life is full of ups and downs and twists and turns. We all experience hard times. But it’s always temporary. Suicide is never the answer. Know that it’s OK to ask for help, and it’s a gift to allow someone to help you.

MnFIRE is here

As a Minnesota firefighter or family member, you have a whole support team behind you thanks to the MnFIRE Assistance Program! The MnFIRE helpline is staffed by masters-level clinicians all day, every day. From one-on-one calls to department debriefs, during the middle of a crisis or after a tough call, we are here for you. Don’t hesitate to use this free, confidential resource available 24/7 to all full-time, part-time, on-call and volunteer firefighters and their families in Minnesota. Just call 888-784-6634.