At the scene of a house fire, ACEs cast long shadows

 
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I am on the scene of a house fire in a town near where I live in Brant, NY. As part of my duties as EMT with my fire company ambulance (I'm first assistant chief firefighter), I make sure firefighters who are working a fire stay healthy while they’re fighting it. The firefighters that wear SCBA gear — self-contained breathing apparatus — when they go into a structure can only stay about 30 minutes. They need “rehab” before they can go back in. “Rehab" is an assessment of firefighter vitals after their allotted time in a fire. 

I have five young firefighters before me — four men, one woman. They all had been resting for at least five minutes or more. The first firefighter is ex-military, so I expected that they would have a great set of vitals, meaning that they’d be recovering quickly. But their heart is racing, a diastolic blood pressure over a hundred — it’s supposed to be 80. 

I had just taken a class on doing a better job helping rape victims and had learned about the data on the high rates of rapes in the military for men and women. Not only are there high rates of rape, but, to add insult to injury, the military puts a label of "Personality Disorder Discharge” on the records of many rape victims. 

I ask them what type of discharge they received. "Honorable discharge, sir,” they reply. I decide to share my new knowledge anyway. They are visibly startled by the information. 

The second firefighter has a resting pulse of 130 and diastolic blood pressure over 100 also. A resting pulse of 130 is alarming. I asked other questions about their health. They had asthma as a child. BINGO! That’s an indication that they may have a history of adverse childhood experiences. 

After taking the vitals of the other three firefighters, I start over again with the first one. They drink way too much Red Bull; it’s clearly an addiction. They receive my sleep hygiene lecture and how caffeine chases away restorative sleep.

My asthma patient still has a racing heart and high blood pressure. I remove them from the area and put them in the back of the ambulance where it's warm and away from the fire scene. Sounds, action and flashing lights can keep firefighters in a hyper-vigilant state, which delays their recovery. 

I finish up with the rest of the crew and release them back into service. I return to the ambulance and continue taking vitals, which were still off. Asthma is a huge indicator of childhood trauma. I express my concern about the vitals, and ask a couple of questions. They tell me a bit more about their life; there's depression and anxiety. I decide to do my usual ritual of educating about ACEs. I have a laminated sheet with five of the 10 questions of the original ACE survey on one side, and five on the other. I ask them to read it and tell me how many ACEs they have. Sure enough, they have all of the ACEs on the front page, and I don’t need to continue. 

This is where the reward for my efforts happens. "I'm 19 years old and no one has told me about this,” they tell me. Not even their physician has talked to them about this. I explain that if they are treated for their childhood trauma, their symptoms will be greatly reduced, and they'll have a better shot at a healthier life. 

(To avoid inadvertent identification of the firefighters, pronouns are changed from 'he' or 'she' to 'they'.)

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At my first CISD [Critical Incident Stress Debriefing] training, I think about my 'Aviation Public Safety Officer' duties, work conditions, assorted training, and changes in equipment at the time: Going from heavyweight Asbestos firecoats to light weight 'aluminized full coverage Proximity suits good to 1.900 degrees fahrenheit; the almost simultaneous change from the old 6% 'fish-guts' Aviation Fire-Fighting Foam (AFFF) to the new 3% 'synthetic' AFFF; helping draft our Airport's first 'Mass Casualty Plan'; my first time driving the chase vehicle with an air pack on, inside my aluminized proximity suit-with a bulge in the back of the coat to protect the 'breathing apparatus--chasing one of the Federal Aviation Administration's own Cessna Citation jets-unable to engage it's 'nose gear' down, reportedly due to low hydraulic pressure... Assorted wildlife accessing the airfield: geese, woodchucks, mother Foxes with Fox Kits in tow, Moose... ... .... Getting our [NH] State Police Firearm certification .... dealing with college fraternities bringing 'Pledges' blindfolded' to the airport at night... and kids racing go-karts on the runway at night-after the tower closes; and the volatility of 100 octane aviation gasoline....the FAA timing our [90 second] response time requirement for airfield 'incidents'- with two intersecting runways each over one mile long...

Thanks to our EMTs and fire/police servants!  you save all of us... yet you carry your own weight too.  I'd once again suggest that your department consider providing availability of the Grief Recovery Method to your staff - it's an easily accessible, evidence-based program to help address grief of all kinds, from childhood through the present.  We teach methods and skills to help recovery from those old hurts.  Go to www.griefrecoverymethod.com to learn more, and to find a certified specialist in your area.  The program is a closed group class of 8 sessions - and is available throughout the US and around the world.  Persons can also work 1-1 with most specialists.  And insurance may cover these services.  

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