Signs and Symptoms of PTSD

Posted on December 23, 2021
Tags: EMS, Fire

The concept of Post-Traumatic Stress Syndrome, or PTSD, is not a new concept today; most of us associate it with combat veterans or someone who has experienced an extreme negative event in his or her life. PTSD can manifest itself as hypervigilance, flashbacks, and triggers to certain cues.

Many psychologists today also suggest that people exposed to ongoing, repeated traumatic events may experience something known as complex PTSD (C-PTSD), which can add more subtle symptoms.

First Responders: Experiencing Second-Hand Trauma on a Daily Basis

So how does this tie into first responders?

Unfortunately, first responders witness traumatic events involving injury and death, loss of homes and businesses, missing loved ones, ongoing sickness, and natural disasters on a regular basis. And while one could argue that these events may not directly impact first responders, it’s impossible to not have the memory of these experiences remain long after the shift is over. After years of the repeated exposure to trauma, the effects can start to weigh on minds and hearts of first responders, exemplified by the high rates of binge drinking, risky behaviors, and even suicide as compared to the general population.

Signs and Symptoms of PTSD

PTSD and C-PTSD can slowly begin to creep into a first responder’s daily life in subtle yet harmful ways. If you or someone you care about is experiencing the following symptoms, it may be time to talk to someone and reach out for help.

  1. Hypervigilance: After a traumatic event, a person can enter a state of hyper-awareness as the body tries to prepare you for the event happening again or for another trauma. This state of constant high alert can be exhausting for a first responder and affect sleep patterns and interactions with others.
  2. Intrusive Thoughts and Memories: While what we think of as “flashbacks” may not be as common with first responders, intrusive thoughts and images may plague them. First responders see extremely graphic and vivid images of suffering on the scenes of incidents; these can come to mind unexpectedly or from related triggers, instantly changing mood or even causing panic attacks.
  3. Anger or Irritability: Related to the state of hyper-vigilance, a person suffering from PTSD may be quick to anger, as his or her brain is closer to its “fight or flight” mode than usual. This may lead them to lashing out at seemingly insignificant issues, even without fully understanding why. This can occur at home with family members, or on the job.
  4. Loss of Interest or Motivation: Someone suffering from PTSD or C-PTSD may experience a notable loss in interest in hobbies and activities they used to enjoy. Instead, they may “escape” into their phone, tv, or video games, or simply have difficulty making decisions about what to do and when to do it.
  5. Sleeplessness and Nightmares: With the hypervigilance and vivid images from incidents stored in the mind, sleep can be directly impacted for first responders. Ongoing sleep disruption can cause irritability and even physical health problems if it continues for an extended period of time.
  6. Avoidance and Isolation: Someone who has “seen too much” in their role as first responder may have difficult interacting with others without the same experience, which can include loved ones. The feeling of not being able to relate, or the fear of a triggering conversation, may drive a first responder to self-isolation and distance.
  7. Increased Risky Behaviors: Some first responders may try to cope with PTSD or C-PTSD with “chronic comfort seeking” from risky behaviors such as alcohol, drugs, gambling, and unsafe physical encounters. The goal of numbing your brain and emotions can turn into dangerous habits that were previously out of character. This can also occur when responding to emergency calls, as a person suffering from PTSD may suddenly start taking unnecessary risks during response efforts.
  8. Negative Thoughts About the World and Self: While seeing the worst in mankind from crime scenes sometimes forms the well-known dark humor of first responders, it really can negatively alter the way a person views the state of the world. Over time, this can develop into depression and difficulty in maintaining regular routines and activities. A person suffering from PTSD might feel like he or she is a burden to co-workers or family members, or experience thoughts of hopelessness when responding to calls.
  9. Anxiety and Difficulty Concentrating: Hypervigilance can keep the mind running at a high rate, causing a first responder to appear dazed and “out of it.” It can lead to anxiety and picturing a wide range of “what-if” scenarios that create anxiety and difficulty functioning as normal, both at the fire station and at home.

Increasing Understanding of PTSD

As the rate of suicide among first responders grew over the last decade to alarming levels, chiefs and administrators recognized that there was a serious, unaddressed issue. While today the concept of PTSD is rightly viewed as a mental injury, not so different from a physical injury needing care and treatment, the stigma is still hard to battle.

Some first responders may fear asking for help will affect their job security or their perceived mission-readiness. Others feel the pressure of the stoic, strong-and-silent culture passed down from generations past. But as research continues to show that first responders experience higher rates of suicide or suicidal ideations than the average person, the issue has to be addressed. Studies show that firefighters are more likely to die from suicide than in the line of duty, and that EMS clinicians are 10 times more likely to experience suicidal ideations or attempt suicide than the CDC national average.

What Agencies Can Do to Prioritize Mental Health

First responders and their repeated exposure to traumatic events can make them especially susceptible to PTSD, so it is important that EMS agencies and fire departments understand the warning signs, triggers, and ramifications, as well as the helpful support tools to battle it.

Some experts recommend regular visits to the station or office by a licensed counselor, with a mandated 5-10 minute check-in for everyone, leadership included. Agencies can also work to make space and time for positive mental-health activities like meditation and stretching/Yoga, and even host informal trainings on therapies like positive self-talk, which can greatly impact mental health. Encouraging healthy meals and exercise at the station – with the proper equipment and facilities – can also show a commitment to physical and mental health, which are tied together closely for those in high-stress positions.

Additionally, pairing a newer team member with a veteran can be a helpful way to ensure a person is able to debrief with someone who can understand and relate to his or her experiences. This can be especially helpful after a traumatic event or during a busy season. Informal conversations around the breakfast table can be extremely helpful in helping both veterans and newbies handle difficult times.

How Incident Tracking Can Help

Stations can also use technology to battle PTSD. For example, some fire departments have begun using their incident reporting software to track exposure to traumatic events just as they would track exposure to harmful chemicals. When a firefighter or medic passes a threshold of a certain number of traumatic incidents in a certain amount of time, station admins would reach out in an inconspicuous way to offer support. This could include time with a chaplain, a casual debrief, or even sessions with a therapist specializing in first responders.

Slowly but surely, fire departments and EMS agencies are working to turn the tide of first responder suicide rates by increasing communication, making tools more available, and tearing down the stigma around mental health. First responders must be healthy in body and mind do not only do their jobs well, but continue long and happy lives away from their jobs.

Get Help Now: Resources for PTSD and Suicide Prevention

Medical Disclaimer: The information provided in this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.