With the hands I use to eat my breakfast I held the body of a lifeless newborn, I sweep the kitchen floor in the same motion used to clean and dispose of bullets and brain matter. I teach my children to drive as I envision the limbs of young adults scattered across the highway. These are examples of the ghosts that could haunt first responders throughout their everyday life. A gunshot can bring back the horror of a shooting. The slosh of a rain puddle can surface the memory of pools of blood. Fire fighter Captain Brian Warta, yes, my father, recalls a call that haunts him to this day, “Arriving on a cold, foggy night to a call that was just supposed to be a car in a ditch, I crawled into an upside down car that had three dead young people and later finding another one that had been ejected from the car. The smells and saturation of blood are unforgettable. There is a spiritual sense that feels like they are still around you." Post-Traumatic Stress Disorder, most commonly referred to as PTSD, is a psychological disorder caused by exposure to a traumatic event (Frantz). PTSD is commonly recognized within war veterans after their time in the combat zone; however, there is a lack of knowledge and prevention concerning PTSD within first responders. In a study as recent as 2015, 85 firefighters died in the line of duty, 101 firefighters, 15.8% additional firefighters lost their lives due to suicide. First responders are on the battle field for an average of thirty years (PTSD Afflicting). They are repeatedly exposed to horrific events repeatedly. It is because of the nature of the repetition of horrific events and a blend of the stresses of being a husband/wife and/ or a mother/father that first responders suffer a cruel form of PTSD. Caren Zavala a firefighter, wife, and mother of two children recalls an incident branded into her memory, "Performing CPR on a little child whom we all knew would likely not survive, desperately hoping we could revive her, and then learning the circumstances surrounding her drowning made for the worst day of my career in the fire service. There are not many details about that call that will escape my memory; although the sight itself was not gruesome like many other calls, the sight of a lifeless little girl stabs at the heart forever." It is calls such as these that create an imbalance of chemicals in the brains of first responders. Officers and first responders are unaware of the mental danger that comes with their career. Post-Traumatic Stress Disorder affects first responders on three levels; physiological, emotional, spiritual, as well as, impact on the family, an awareness and education must be reinforced in order for this worldwide crisis to be prevented.
http://www.pandys.org/articles/invisibleepidemic.html
For one to truly understand the effects of PTSD, there must be an understanding of the science behind the brain. When the body is under exposure to life threatening events (CI stressors) the stress response system in the brain is triggered. The three major parts of your body that control your stress response are your hypothalamus, pituitary and adrenal glands. When stress is triggered nerve signals are sent to your adrenal glands to produce adrenaline therefore causing the blood sugar and heart rate to increase. Once the hypothalamus is triggered it puts out signals to the pituitary gland which stimulates the adrenal cortex to produce cortisol. The Hormone Health Network states, “Cortisol can help control blood sugar levels, regulate metabolism, help reduce inflammation and assist with memory formulation." The levels of cortisol found in the body is one of the main factors that can predict, prescribe and regulate PTSD. While cortisol is vital to the functioning of the nervous system, high levels of cortisol may weaken the immune system and kill cells in the hippocampus resulting in impaired memory (Stress). According to Joe Herbert's lab in Cambridge cortisol slows down the production of brain cells created by the hippocampus. Studies have proven that an overproduction of cortisol can also result in depression. While the average person may only experience high cortisol levels a handful of times throughout their lives, first responders daily encounter high stress levels and an over production of cortisol, therefore resulting in PTSD (What Does Cortisol Do).
The fight-or-flight response within our nervous system was made by God for survival purposes. In contrast, this aspect of the nervous system often becomes "dysregulated" under extreme exposure to survival situations. "Chronic dysregulation of these systems can lead to functional impairment in certain individuals who become "psychologically traumatized" and suffer from post-traumatic stress disorder. It has been found that pathological features found in PTSD are also found in patients suffering from traumatic brain injury. PTSD results from particular characteristics of the trauma and the factors to an individual. These effects on the nervous system include; reminders of the occurrence (nightmares, flashbacks), activation (hyperarousal, insomnia, impulsiveness, and anger) and deactivation (withdrawal, numbing, avoidance)(Sherin). Johnathon E. Sherin states, "The signs and symptoms of PTSD, therefore, appear to reflect a persistent, abnormal adaption of neurobiological systems to the stress of witnessed trauma. The neurobiological systems that regulate stress responses include certain endocrine and neurotransmitter pathways as well as a network of brain regions known to relate fear behavior at both conscious and unconscious levels." Those suffering PTSD suffer from an imbalance of the Cortisol and thyroid hormones. The imbalance of cortisol found in PTSD victims of today replicate victims of the Holocaust, refugees and abused individuals. When these hormones are out of balance, causing endocrine dysregulation patients begin to suffer the three types of symptoms as described above. This dysregulation and imbalance found in PTSD patients can also be found in patients suffering with TBI as a result of damage to the pituitary stalk (Sherin).
Once the damage has occurred to the individuals mentally, the emotional symptoms begin to penetrate throughout their every day lives. According to the DSM-IV a patient may be diagnosed with PTSD if he suffers from symptoms from one of the three categories: reminders of the occurrence, activation and deactivation. The physiological and emotional symptoms must occur within a month of the incident and last for at least two days (Responders). These symptoms can be physical such as hyper-arousal, increase in blood pressure, respiration and heart rate, insomnia and difficulty with regularity of metabolism. However, the emotional symptoms are often far less recognizable and can accumulate into severe damage to the brain. Some of these symptoms may include depression, anxiety, nightmares, flashbacks, withdrawment and numbing (Pulido). Victims of PTSD often develop a fear of their own emotions and adverse social interactions (Research). The accumulation of stresses on the brain without relief creates a fear within the responder towards their own brain. Natalie Harris, a young female paramedic states, “I’d be crying and crying … I couldn’t control it and I didn’t know why I wished I had a broken leg. If I could’ve just had something that was fixable and explainable, then my recovery would have been a lot easier eventually, suicide was my only option to get away from the terror in my mind”(Kane).
To assume Post Traumatic Stress Disorder simply affects the individuals at hand would be a sheer action of ignorance. A firefighter, paramedic or police officer goes into the battle field every single day only to return to their families wounded, scarred and traumatized. Often the emotional wounds are handed into the hands of the family. The average additional rate for divorce across all occupations is 17%. Police officers have an average divorce rate of 14.5% and firefighters with a leading 32.1%. The following are divorce rates aside from the average national divorce rate. Divorce is simply one of the many factors that can affect the family of a PTSD victim. Violence, isolation, substance abuse, and memory loss often fill the households creating an environment of emotional trauma for the family. Being the daughter of a firefighter I have witnessed this first hand. I cannot begin to describe the frustration and pain I have felt as a young teen when my dad didn’t remember when I told him I set a new record for my mile time or asked to go to a friend's house. I would find myself talking with my dad and it didn’t feel like he was present in the moment. My senior year of high school my parents separated because of the effects of PTSD. Growing up the child of a first responder can be a difficult experience in many ways. It wasn’t until I was seventeen years old that I was able to better understand the effects PTSD had on my father, it wasn’t that he didn’t hear me or didn’t care, he simply could not retain all the information his brain was gathering on a daily basis. PTSD can create strains within the marriages and interpersonal relationships that a responder has with their loved ones. According to the Society of Occupational Medicine, "Mental health problems prior to the traumatic event and weak social support increase the risk of PTSD." If the family of the responder is educated about PTSD the family can be there as a support system for the first responder (Pietrantoni).
Much to my dismay many of the myths concerning PTSD lie within the church. The myth that living a prayer filled, Christ centered life mental illness is never an issue. Mental illness is not simply an emotional disability but rather a physical condition within our brains. I am the daughter of a first responder whom has suffered PTSD. As the issue of mental illness began to consume my home life I was shocked to see the response from Christian friends, family and the church. To state that because one is a Christian they are excluded from any form of physical injury such as a heart attack, broken bone or disease would be outrageous and naïve. However, within the church we continue to deny the scientific proven physicality’s of mental illness. To live in disbelief and denial of mental illness is to deny the anatomy of God’s creation. God created PTSD. Our bodies nervous system was designed to produce high levels of hormones in life threatening circumstances in order to protect us. During the duties of the job public safety officers often encounter an above average amount of mental stress.
As we look deeper into the beliefs of the denominations, we find that many churches' doctrine supports the welfare of workers and unity of family. The Orthodox agrees with Biblical passages about the treatment of workers such as Jeremiah 22:13, "Woe to him who treats his workers unjustly". Concerning the safety of workers the Catholic denomination claims, "Work is more than a way to make a living; it is a form of continuing participation in God's creation. Workers have rights to decent work, just wages, safe working conditions, unionized disability protection, retirement security and economic initiative". The Methodist denomination states, "We support social measures that ensure the physical and mental safety of workers that provide for the equitable division of products and services"(Communications). The Evangelical Nazarene denomination supports the practice of medicine in the healing of disease, "We believe in the Bible doctrine of divine healing and urge our people to (seek) offer the prayer of faith for the healing of the sick. We also believe God heals through the means of medical science"(Church).
How can we, the people who are served by these heroes whom sacrifice their mental and physical health daily take preventative measures to save the lives of those who risk their own to save us? There are three steps to the dissolvement of a world-wide crisis: education, diagnosis and treatment. Yes, the awareness of the disorder is in the hands of the first responder. However, many first responders lack the training and knowledge to recognize the signs of PTSD and how to take the next step. "If you look at the man hours or the hours you’ve been trained both through individual training records, and the daily the supervision, and then the CEU's for our licenses, the training that we've had for behavioral health is really nothing. Zero (Fire/EMS). Mental health education and awareness should be required for first responders as a building block, laying a foundation of knowledge surrounding a disorder that the first responders will face at some point in their career. In various law enforcement agencies, officers are required to sign a form stating that they acknowledge the heightened potential for divorce (Gagliano). What would be at risk for departments to begin implementing contracts making the employee aware of the potential dangers? Could a course be incorporated within the police and fire academies' curriculum teaching the science behind a brain facing regular trauma? It is crucial that the ill stigma concerning mental health is diminished beginning the first day of a first responders training.
Neurologists often refer to PTSD as a "soft disorder"-a disorder lacking an objective biological path to diagnosis. First Responders have been traditionally monitored and evaluated by mental health experts however, accurately diagnosing PTSD has a stigma of being a "shot in the dark"(Drummond). Recent advancements and investment into technology have paved a pathway for our generation to monitor PTSD with relative accuracy. Magnetoencephalography (MEG) is a brain imaging method which can be compared to a CT scan and an MRI. Unlike the CT scan and MRI the MEG machine measures the electric activity in the brain by milliseconds giving the machine a 90 percent accuracy rate by picking up signals other tests miss (Drummond). The MEG is not the only piece of technology that can be used to monitor PTSD, the Pentagon is currently in the process of developing a brain chip to treat and/or monitor PTSD. The Defense Advanced Research Projects Agency (DARPA) wants to pioneer a form of technology in which a chip lies deep within the soft tissue of the brain and monitors, records and possible treats abnormalities of brain activity that lead to PTSD. The chip will use a technique called deep brain stimulation. Just as a defibrillator sends electricity to start a heart after cardiac arrest, the chip will put out low doses of electricity. Justin Sanchez, the DARPA program manager stated, "DARPA is looking for ways to characterize which regions come into play for different conditions – measured from brain networks down to the single neuron level – and develop therapeutic devices that can record activity, deliver targeted stimulation, and most importantly, automatically adjust therapy as the brain itself changes (Tucker)." Ethics continues to play into this issue as too how much can we monitor and treat the brain before we strip away the essence of humanity? Is the life of first responders so heavy of risk that a chip should be inserted to monitor brain activity? Would one life be worth it, much less hundreds? These are the questions our generation must face as we weigh the benefits of technology and frailty of humanity within first responders.
In the late 1980's Francine Shapiro created a form of therapy for physiological trauma patients called EDMR (Eye Movement Desensitization and Reprocessing). According to the EMDR Humanitarian Assistance programs, "EMDR therapy is a cost-effective, non-invasive, evidence-based method of psychotherapy that facilitates adaptive information processing. EMDR therapy is an eight-phase treatment which comprehensively identifies and addresses experiences that have overwhelmed the brain’s natural resilience or coping capacity, and have thereby generated traumatic symptoms and/or harmful coping strategies. Through EMDR therapy, patients learn to reprocess traumatic information until it is no longer psychologically disruptive." Certified therapists lead EMDR through a series of lateral eye movements. Bilateral eye movements can be stimulated through sound and touch. When the eyes are stimulated bilaterally the right and left brain begin to connect and communicate promoting natural healing to take place. Steven Silver states, "Precise and careful use of these procedures can lead to a safe processing of memories, such that the negative thoughts and emotions disappear. "
A local anonymous source quotes, “We joke around and pretend it doesn’t bother us. You don’t want to be the one going to counseling. Everyone would call you a wimp.” Leadership throughout the departments of first responders must understand the effects of PTSD and support the recovery process. Norman Traversy, a former firefighter states that he was bullied after his diagnoses of PTSD. Above his desk was hung a sign that said "Caged Animal", Traversy states, "I was totally humiliated and embarrassed"(Kane). The stigma surrounding the mental health field must be destroyed if any progress is to be made (What is EDMR).
On a national level, the state of Florida is currently trying to pass a law that would provide compensation benefits to first responders suffering from PTSD. Senate Bill 516 would amend the existing law that has prevented first responders from claiming mental injuries under worker's compensation. After spending hours carrying out and tagging 49 dead bodies during the 2016 Orlando shooting a police officer reported to the press that he was suffering PTSD. The officer was denied worker's compensation and the issue made headlines because Florida law finds the nature of a first responder's work to be "a part of the job". If passed the new law states that the mental injury must be, “demonstrated by clear and convincing medical evidence by a licensed psychiatrist to meet the criteria for post-traumatic stress disorder as described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association and if the mental or nervous injury arose out of an activity performed within the course of employment.” If passed this law will go into effect July 1, 2017. I question how the workers are expected to practically diagnose themselves and seek help from a licensed psychiatrist if they are not properly educated (Esola).
Globally it is no coincidence that PTSD can be found in various forms of ancient literature dating back to the days of William Shakespeare in the renown classic, Henry IV (Bennet). Samuel Pepy, an English navy administrator in the late 1600's, wrote about his continued "stress" in his diary accounts after he endured after the Great Fire of London in 1666 (A Jonsson1)). These given accounts allow one to recognize the historical recognition of the topic. As history has evolved The United States of America has failed to recognize the grasp that cold hand of PTSD has on the nation, economy and health system. In comparison to other nations such as Canada, England and Sweden the United States' health care system is falling behind in the race against PTSD prevention. England has continued to fund studies on the London Ambulance Service and discovered that CI stressors were the most prominent factor of sickness, 15% of workers possessed symptoms that were characterized as PTSD (A Jonsson1). Next month a group of first responders and families in Canada plan to call for a national strategy to help Canadian first responders suffering from PTSD. Todd Doherty, the British Columbia MP, will be introducing a private member's bill that will create a structure for the nation to track PTSD, establish diagnosis guidelines, form treatment and produce education curriculums to be used by public health providers. Scott Bardsley, Public Safety Minister spokesman said, "The government is working on a plan to address post-traumatic stress injuries. It has consulted with provinces, territories, public-safety officers and health-care practitioners. Consultations have emphasized the need for prevention and early intervention, more research and awareness, the reduction of stigma, and an enhanced support for diagnosis, care and treatment. We promised Canadians renewed federal leadership on post-traumatic stress injuries". In 2016 Ontario revamped its legislation to recognize PTSD as a workplace injury. The United States has yet to presume such legislation. Our nation was founded on the pursuit of life liberty and the pursuit of happiness, therefore I believe we should be the first country to cross the finish line in solving the health care epidemic of PTSD (Kane).
"Ten years from now we will still wonder what happened. What did we miss", Lew Lewis the mother of local firefighter Billy Lewis states. Billy Lewis was a firefighter and paramedic in the Live Oak, Sutter County, Yuba City and Sacramento areas. Lewis began serving as a teenager until his passion took his life at the age of 43. Billy took the steps to recover, he sought help from a counselor, and even attended a retreat for people diagnosed with PTSD. Billy was adored throughout our community as an astonishing 450 people attended his memorial. I would like to dedicate my senior project in the memory of Billy Lewis. In his honor I hope that the awareness of PTSD throughout first responders will surface. "Firefighters are their brother keeper" as Karen Lewis states (PTSD Affirmation). I will continue to spread awareness concerning PTSD within first responders. Without the help of doctors, the research of my mother and God's sheer grace my father may not have been here to watch me receive my diploma on June 2nd. My senior project resulted in many late nights, tears burning my eyes as I stared into a computer screen and read the symptoms my father had/was dealing with. No hero deserves to pay the price of living in fear of their own brain. God has given us the tools to conquer this through science, technology and awareness. Stand with me, spread awareness and let's give back to those who so willingly give to us. Next time you see a first responder, veteran or abuse victim shake their hand with the recognition that some of the most vile wounds lie within the human body. 2 Corinthians 1:3-5 states, "Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, who comforts us in all our affliction, so that we may be able to comfort those who are in any affliction, with the comfort with which we ourselves are comforted by God. For as we share abundantly in Christ's sufferings, so through Christ we share abundantly in comfort too.
