You drive by white crosses at the side of the road all the time and know what they signify: Someone died here. First responders have a different, more intense experience.
“You can drive all over the county, see those crosses on the roadsides and say, ‘Yeah, I was at that one,’” said Gale Blomenkamp, an assistant chief with the Boone County Fire Protection District.
A day in the life of a first responder can involve medical emergencies, motor vehicle or structure fires, car crashes, domestic violence, suicide attempts, death investigations, child abuse, assaults, shots fired and homicides. Missouri State Highway Patrol troopers regularly see the grisly aftermath of fatal traffic crashes and natural disasters.
Officers from small and midsize police departments respond to an average of about 189 critical incidents during the course of their career, according to a 2015 survey published in the Journal of Traumatic Stress.
Exposure to critical incidents is significantly correlated with alcohol use and symptoms of post-traumatic stress disorder among police officers, according to a 2014 Pennsylvania State University study.
It’s the mixed bag that comes with “having a front-row seat in life,” said Todd Burke, who was a Boone County firefighter, Columbia police officer, emergency medical technician and director of Tactical Training Specialties.
“As a first responder, you will see absolutely gruesome things,” Burke said. “If you don’t have a mechanism to help you cope with them, they could destroy you.”
In the moment
Open communication among firefighters, police officers and emergency medical service workers is important because of their regular exposure to traumatic incidents.
“It’s not just looking out for one another,” Blomenkamp said. “It’s about what went wrong, what we can do better and what we can improve on. It also lets people know that, if they experience issues, we have resources.”
The Fire District responds to about 4,000 calls a year, Blomenkamp said. Because the agency operates with the help of about 200 volunteers, the number of calls each firefighter responds to varies based on the person’s availability. Some firefighters might run about 50 calls a month, while others run only two or three.
In 2018, the Columbia Fire Department exceeded 12,000 calls — which equates to a little more than one call every hour of every day in the year — Assistant Fire Chief Brad Fraizer said. Naturally, the number of calls has been rising with the growing population of the city.
Excessive work hours or response to critical incidents can take a toll on emergency personnel by triggering feelings of extreme exhaustion and being overwhelmed, defined by the Centers for Disease Control and Prevention (CDC) as “burnout.” Signs of burnout can include depression, frustration, isolation and reliance on drugs and alcohol.
The nature of an incident can also play a role in the effect on the mental health of first responders.
“What affects a person most depends on the person’s life experiences,” Blomenkamp said. “There are certain calls that will affect me differently than what will affect the person sitting next to me.”
There’s near-consensus among first responders that calls involving children are the most difficult, especially for those who have children of their own. Incidents with fatalities can also be hard for many first responders.
“You think about your own family and also what the surviving family is going to go through,” Blomenkamp said. “You think about how you can help the family involved, how you can provide them with closure and how you can answer their questions. Every parent, spouse or child has a question.”
While on the scene of a critical incident, first responders fall back on their training to get them through the most emotionally intense moments.
“It’s very different than a bystander, who is probably just soaking it all in,” Fraizer said. “Actually having a job to do takes your mind off of it. That being said, the toughest part is after the fact, when everything calms down and you start to reflect on what happened.”
The trauma of witnessing devastating incidents in person is much different from watching them take place in a video game, television show or movie, Columbia police Assistant Chief Jeremiah Hunter said.
“It’s real life,” Hunter said. “You can’t desensitize yourself like you can while staring at a screen. When you’re physically in a room with someone that has been murdered or abused, there are so many emotions that you feel.”
Some, you never forget
Many first responders are able to recount critical incidents throughout their career that have had an impact on their mental health.
Blomenkamp, who has worked as a firefighter for the past 27 years, said his most traumatic incident happened early in his career at the small, rural Brush Volunteer Fire Department in Colorado.
“My best friend died in my arms,” Blomenkamp said. “Among my peers, when we did our debriefing, a counselor told us that 10 percent of us would experience a divorce because of the tragedy.”
That statistic turned out to be true for him and for others, he said.
Fraizer, who has worked as a firefighter for the last 18 years, recalled an incident that took place less than two years into his career. A high school softball tournament took several carloads of students to Columbia from St. Louis. While driving along Interstate 70, the drivers of two of the cars tried to get close enough for the passengers to high-five each other from their car windows, he said.
“One car lost control and ran into another,” Fraizer said. “They collided, and one of the cars went across the median and hit a semi-truck head-on.”
Of about eight adolescents involved, many were ejected from their vehicles, he said. There were several fatalities at the scene.
“That was one that stuck with me for a while,” Fraizer said.
Hunter’s 21 years of experience as a police officer came with traumatic incidents like responding to a “gruesome” plane crash where seven people lost their lives, a little boy who was shot and passed away in front of him and being shot at himself.
The stress often experienced by first responders as a result of being exposed to other people’s traumatic experiences is called “secondary traumatic stress,” according to the CDC. Symptoms of secondary traumatic stress can include excessive fear that something bad will happen, nightmares and reoccurring thoughts about the traumatic incident.
More firefighters and police officers died by suicide as a result of work-related trauma in 2017 than in the line of duty, according to the Ruderman White Paper on Mental Health and Suicide of First Responders.
Time of year, time of day, location, smells and other similarities in incidents can trigger negative thoughts in first responders about calls from earlier in their career, Blomenkamp said.
Although years of experience don’t make first responders immune to the effects of trauma, experience can make it easier to recognize when an incident is bothering you and when to seek help, Hunter said.
“When you’re more and more exposed to critical incidents, you realize that you’re not Superman,” Hunter said. “You’re a human being, and you need to take care of yourself just as much as you are trying to help the public.”
The CDC recommends that first responders adopt self-care techniques like communicating openly with friends, family, peers and supervisors; maintaining a healthy lifestyle with a nutritious diet, exercise and adequate sleep; working in teams when possible and staying limited to no longer than 12-hour shifts.
The Ruderman White Paper cites easy access to firearms and societal ignorance about mental health as the main causes of first responder suicide. Nearly one in five adults in the U.S. experience mental illness, but only about 43 percent of those received mental health treatment in 2017, according to the National Institute of Mental Health.
Until relatively recently, emergency service workers didn’t freely talk about mental health issues unless it was mandatory in the aftermath of an extreme event.
“We will push stress down into our inner depths with a sledgehammer until, at some point, it explodes,” Burke said.
To break the habit of bottling up emotions, society has to shed some myths, like “boys don’t cry,” Burke said.
“I heard someone say that once,” Burke said. “I remember saying, ‘That is absolutely wrong. It’s totally okay to cry — not during the emergency but afterwards. You have to be able to deal with it.’”
Although working in emergency services comes with long hours, dangerous conditions and traumatic incidents, responding to incidents with positive outcomes makes the work rewarding.
“People don’t call us on their best days,” Hunter said. “But the most satisfying thing is being able to solve the problems that the public need you for.”
Burke has experienced the full range of emotions as a first responder.
“I’ve held the hand of people taking their last breath and welcomed people as they took their first breath,” Burke said. “I’ve had people bring me cookies and say things like, ‘Thank you for saving my son,’ ‘Thanks for saving the house. We thought the house fire was going to claim it’ and ‘Thank you for clearing the bone out of my dog’s throat.’ That is priceless.”
Supervising editor is Katherine Reed.