News roundup, November 15, 2017

Suicide rate among wildland firefighters is “astronomical”

From 2015 to 2016, 52 wildland firefighters took their own lives.

The number of wildland firefighters who have resorted to suicide is shocking — 52 in a two year period, 2015 to 2016. According to Nelda St. Clair of the Bureau of Land Management so far this year there have been another 16.

Wildland firefighting is a niche within the firefighting world. High rates of structural firefighters taking their own lives have been known for years, but these kinds of “astronomical” numbers, as described by Ms. St. Clair, in a much smaller population is stunning. There are only about 13,000 wildland firefighters in the five major federal land management agencies, along with several thousand others working for state and local agencies. It is likely that most of them personally know a firefighting brother or sister who succumbed to what might be called an epidemic.

Assuming for a moment that there are 17,000 wildland firefighters in the United States, approximately 0.3 percent of them took their own lives in 2015 and 2016 — a shocking percentage.

Most firefighters in general, and in particular, wildland firefighters, have a macho, can-do attitude, regardless of their gender. Just give them an objective, and they will figure out how to get it done, with little or no outside help. This can carry over into their personal lives and mental state. When the fire season is over their environment may shift from being part of a close brotherhood working with their buddies for long hours toward a common goal, to something completely different. The reduction in adrenalin and accomplishment of important tasks is more difficult for some to adjust to than others. Suicide rates can rise during the wildland fire off-season.

The fact that a national publication, The Atlantic, has published an in-depth article on the issue is an indicator of the seriousness of this problem. I suggest you read the entire article, but here is an excerpt:

…It’s hard to quantify both completed and attempted suicide rates in populations that aren’t prone to talk about mental health, but both factors are known to be high among “structure” firefighters—those who fight fires in buildings—and members of the military who face similar traumatic, high-stress situations as wildland firefighters. Jeff Dill, a captain at a fire station in Inverness, Illinois, and the founder of the Firefighter Behavioral-Health Alliance, which tracks firefighter suicides, says firefighters are more likely to die by suicide than in the line of duty. In a 2015 study on suicide risk in firefighters, half of those who responded reported that they’d contemplated suicide.

Those concepts align with the wildland reports: St. Clair says they’ve lost five smoke jumpers to suicide in the last seven years, and had two in-the-line-of-duty deaths in the same period. But while structure and wildland firefighters are similar, the groups aren’t perfect analogs, which is why it’s particularly hard to address some of the most insidious risks for wildland firefighters. Urban firefighters, and people who fight structure fires, will usually have year-round work, health insurance, and mandatory trauma training. Their support system is fundamentally different…

The Wildland Fire Lessons Learned Center’s Spring 2017 edition of Two More Chains was dedicated to this issue. An excerpt:

…In researching suicide in the wildland fire service for this issue of Two More Chains, it has been brought to our attention that, in some cases, a stigma regarding employee suicide has been observed not so much among young firefighters—who, it is said, are more open to addressing their emotions—but among some more senior wildland fire and agency managers who are apparently uncomfortable addressing the topic of mental health.

Unfortunately, we have learned that, in at least one instance, a fire manager believed that a firefighter who had died by suicide should not be entitled to an honor guard or a memorial stone in the Wildland Firefighter Foundation monument at NIFC, “because it would dishonor those who died innocently.” Similarly, we have heard about fire managers who have declined offers of free critical stress debriefings for their staff after a coworker suicide—without even asking their staff.

It’s also been brought to our attention that employees have been directed not to send emails that contain information about someone dying by suicide or to mention it in staff meetings—even though the victim’s family has been open about their family member’s cause of death.

We hope and believe that these are isolated incidents. That they are exceptions to the positive efforts that our fire agencies are currently pursuing—reflected throughout the input from our agency SMEs that is shared in this issue’s “SME Insights and Info” document.

By openly addressing the topic of mental health among our employees we can embrace the notion that this issue is no different than any other injury or disease.

We need to help ensure that all of our managers and senior leaders are on board with this enlightened perspective. We should not blame the victim, or treat the person in pain as “weak,” or otherwise refuse to acknowledge their mental health problems.

To be sure, if safety is truly our top priority, then it is our duty to take care of all of our people…

Two More Chains highlights work that is being done on this issue by several people, some of whom are intimately familiar with wildland firefighting. Patty O’Brien worked for 10 years on the Lolo Interagency Hotshot Crew and has a total of 15 years’ experience as a wildland firefighter. She is a fifth year PhD candidate in Clinical Psychology at the University of Montana.

Kim Lightley writes about how she experienced Post-Traumatic Stress Disorder after nine of her fellow crewmembers of the Prineville Hotshots were killed on the 1994 South Canyon Fire along with five other firefighters. After dealing with depression and survivor’s guilt for two years she sought counseling, which helped.

She wrote in Two More Chains:

When I was in the depths of PTSD—because I had all the symptoms—it would have been really awesome if somebody would have come up to me and said: ‘Hey, what you’re experiencing right now is normal, because what you experienced is very abnormal’. If I had heard that, I think I would have felt less crazy.

Today she is the Critical Incident Response Program Management Specialist for the U.S. Forest Service’s Fire and Aviation Management program.

Amanda Marsh’s husband Eric Marsh was one of the 19 firefighters that perished on the Yarnell Hill Fire in 2013. She established the Eric Marsh Foundation which is committed to serving those directly affected by wildland line-of-duty deaths, as well as living wildland firefighters and their families. We asked for her insight:

It saddens me greatly knowing that our wildland firefighters are suffering. In 2015 I came very close to ending my life. I have PTSD and we are not talking about this enough in the fire service, wildland or structure.

PTSD is cumulative. Every traumatic event builds upon the last one, creating a situation where sometimes we feel so hopeless and so helpless that taking our lives seems like the only way out.

At the end of the season the fire family often disburses and the support that was so available during the fire season is no longer present in the way it was. We must begin talking about PTSD in every department, every agency. Our wildland firefighters deserve better, they deserve the ability to discuss openly and without fear of judgement when the stresses of the job begin to compound. I am talking about PTSD, I am talking about suicide openly because it is the right thing to do.

There is help out there. Call the Suicide Prevention Hotline (1-800-273-8255). We also offer help through the Eric Marsh Foundation for Wildland Firefighters by helping wildland firefighters get treatment for PTSD. You are not alone. There are many of us who know how you feel. You are loved and you are seen and you are valid.

Further reading

The Wildland Fire Lessons Learned Center solicited and received insight from six wildland fire agency subject matter experts about the wildland firefighter suicide issue.

Help

Thanks and a tip of the hat go out to Brian.
Typos or errors, report them HERE.

NBC News: cancer among firefighters

Above: Firefighter working on a smoky wildfire at Buffalo Gap, South Dakota, March 3, 2016.

(Originally published at 10 p.m. MDT October 23, 2017)

This report by NBC News about the rising rates of cancer among firefighters exclusively shows the structural side of the job. Obviously they are exposed to different toxins than their wildland brothers, so it is unknown how much the data crosses over. One of the big differences between the two disciplines is that for structure and vehicle fires a breathing apparatus (BA) is always available. Firefighters on wildland fires NEVER have access to BAs, which only last for minutes, while they can be exposed to smoke for most of their shifts which on large fires are typically up to 16 hours. And wildland firefighters rarely have the opportunity to, as the video recommends, change clothes and shower within an hour after exposure.

In 2010 we began calling for the wildland fire agencies to conduct a study led by medical doctors and epidemiologists to evaluate the short and long term effects of smoke on firefighters. The federal agencies that should take the lead on this are the National Park Service, Bureau of Land Management, Bureau of Indian Affairs, Fish and Wildlife Service, and the Forest Service. State agencies with significant numbers of wildland firefighters need to also be involved.

It is possible that the agencies that employ firefighters do not want to expose the facts about the dangers of smoke. It could cost them money to change their practices, provide a safer workplace, and cover the costs of presumptive illnesses.

Various bills have been introduced in Congress that would establish a cancer registry for firefighters, but to our knowledge none have passed.

Here is an excerpt from an article we wrote March 17, 2017:


“On Wednesday [March 15, 2017] a Montana legislative committee voted down a bill that would have provided benefits for firefighters who developed a lung disease on the job. Republican Mark Noland of Bigfork said firefighters “know what they’re doing”, and:

That is their profession, that is what they chose, and we do not want to, you know, slight them in any way, shape or form, but it is something they’re going into with their eyes wide open.

That is asinine, ridiculous, reprehensible, and irresponsible.

Rep. Mark Noland
Rep. Mark Noland of Bigfork, MT.

He is assuming that when firefighters began their careers they knew there was a good chance they would damage their lungs. If that is common knowledge now, or was 20 years ago when the firefighter signed up, why haven’t the employers already established coverage for presumptive diseases? There is a great deal we do not know about the effects of breathing contaminated air on structure, vehicle, and wildland fires.

Many agencies and government bodies have already established a list of presumptive diseases that will enable health coverage for firefighters. For example the British Columbia government recognizes at least nine “presumptive cancers” among firefighters, including leukemia, testicular cancer, lung cancer, brain cancer, bladder cancer, ureter cancer, colorectal cancer, and non-Hodgkins’s lymphoma.

The Montana legislation would have only covered one of these nine illnesses.

When a person enlists in the military and they come home injured or permanently disabled, should we ignore them, saying they knew what they were getting into? Their “eyes were wide open”? How is treating firefighters injured on the job different? One could argue that they are both defending and protecting our homeland; one of them actually IN our homeland while the other may have been on the other side of the world.” [Update October 23, 2017: for example in an African country, Niger, many Americans have never heard of].


Early diagnosis of firefighter mental and physical health issues

It can extend or improve the quality of life.

The leading cause of fatalities on wildland fires is medical issues, according to data for 1990 through 2014 supplied by the National Interagency Fire Center. The numbers would probably be significantly higher if deaths that occurred away from the fireline but caused by the job were figured in, such as leukemia, testicular cancer, lung cancer, brain cancer, bladder cancer, ureter cancer, colorectal cancer, and non-Hodgkins’s lymphoma. Many jurisdictions list these as “presumptive cancers” and will automatically cover the medical bills of firefighters diagnosed with the conditions.

Another medical issue affecting firefighters, the elephant in the room, is mental health, something that is rarely talked about in a job where physical prowess and endurance is often used as a measuring stick. We are reminded of a firefighter who earlier in his career was highly regarded and respected, but has changed to the point where he is causing serious problems on and off the job. Some of his colleagues think he might benefit from professional psychiatric help.

Early diagnosis and treatment of physical and mental conditions can extend or improve the quality of life. We often hear, “If you see something, say something”. Usually that is used in the context of possibly dangerous conditions or crew resource management, but it can also apply to our co-workers who might need treatment for a dangerous physical or mental issue.

All firefighters and their families need to see the excellent nine-minute video covering the physical and mental health of firefighters  produced by Edmonton Fire Rescue. It was made possible by the family of deceased firefighter Edward James Paul (1954-2015).

Watch the video.

And, be careful out there.

Prevention of heat related injuries among wildland firefighters

When we were writing the July 13 article about Frank Anaya, the latest California inmate firefighter that died on a fire, we discovered details about a previous inmate fatality that were shocking. It involved the death of Jimmy Randolph in August of 2012 whose passing was associated with heat stroke. The shocking part was that Mr. Randolph was found unresponsive one morning in the sleeping area on a fire and died in a hospital seven hours later. He had complained of a headache the previous evening and was checked out by the medical unit, but apparently no one was aware of the seriousness of his condition.

Here is an excerpt from a summary of the fatality from wlfalswaysremember.org:

Firefighter Jimmy Randolph was assigned to the Buck Fire as a part of a strike team. At approximately 1800 hours on August 18, 2012, Firefighter Randolph advised a correctional officer that he had a headache. He was escorted to a medical team, evaluated, and given a three-day no-work note. At approximately 0530 hours the next morning, Fire fighter Randolph could not be awakened. He was treated and transported to the Desert Regional Hospital in Palm Springs. With his family by his side., he was pronounced dead at 1230 hours on August 19, 2012. The cause of death was listed as anoxic encephalopathy combined with complications of heat stroke.

Anoxic encephalopathy is a condition where brain tissue is deprived of oxygen and there is global loss of brain function. The longer brain cells lack oxygen, the more damage occurs.

I checked the weather for August 18, 2012 for San Jacinto, California which is in the general vicinity of the Buck Fire, and the high temperature that day was 92 degrees — a temperature commonly found on a large wildfire in the summer.

Today the National Multi-Agency Coordination Group: issued a memo titled, “Wildland Firefighter Heat Related Injury Prevention, Awareness, and Rhabdomyolysis”.

Here’s how it begins:

The wildland firefighter community has experienced an alarming increase in heat related and other physiological injuries in the last few days. Heat related injuries and Rhabdomyolysis are not the same, but can occur at the same time. Extreme weather conditions are predicted to continue across western states for the next week. The National Weather Service is issuing Heat Warnings for the SWCC, GBCC, RMCC, OSCC, and ONCC.

It is a very well-written document about how to prevent, mitigate, and recognize heat related injuries.

Read it, dammit.

You don’t want to wake up dead.

Full Stop.