By Anne Gagliano
The divorce rate for firefighters is three times that of the general population, which is the highest rate in the nation, second only to that of the military. A functioning, long-term marriage in this profession is uncommon; a happy, thriving, intimate one is rare. My husband Mike and I are fortunate to have the latter. Over the years I’ve tried to fill the gaps that surface as he works to fulfill his calling as a firefighter. Some things I’ve learned by accident and some I’ve learned the hard way. Some aspects of the job are hard to understand, but for 24 years I have tried. Below is what I have learned and what every firefighter’s spouse should know.
EXPOSURE TO DANGER AND TRAUMA
The exposure to danger and the exposure to trauma are two major factors that make this job different from most others. Firefighters can face danger at every call. Exposure to danger (psychosocial stressors) triggers the body’s stress response—the body undergoes physical changes to ensure survival. This is commonly known as the “fight-or-flight” response, in which the body is fueled by the secretion of the hormones adrenaline (also called epinephrine) and noradrenalin (also called norepinephrine). A third hormone, the adrenocorticotropic hormone (ACTH), is simultaneously released into the brain. Adrenaline and noradrenalin fuel the heart, lungs, and muscles for extra strength; ACTH fuels the brain, allowing it to monitor the release of the fight-or-flight hormones. ACTH does this by shifting the brain’s activity away from the cerebral cortex (which processes information from the five senses) to the brain’s limbic region where the emergency response occurs. This shift causes the cerebral cortex to lose almost two-thirds of its functioning power to the limbic region. Afterward, firefighters often describe this experience as tunnel vision. They describe a sense of slow-motion, muffled sounds, and gaps in memory and detail errors.1 Because of the transfer of brain function, deeper cognitive thought is temporarily impaired, causing the firefighter to go into “autopilot.” Training is life-saving for this very reason; actions must be automatic, for creative, original, on-the-spot decision-making abilities are not functioning at full capacity.
ACTH raises blood pressure to increase blood flow to the systems needed for action. At the same time, it suppresses the digestive and immune systems. Research shows that firefighters take a strikingly high proportion rate of antacid medications. This is because ACTH slows or suppresses the digestive process, resulting in acids not being sufficiently removed from the gastrointestinal system, which can result in sour stomach, diarrhea, spastic colon, and gastroesophageal (or acid) reflux. (1) Immunosuppression, if prolonged or continuous, can result in an increased vulnerability to illness. This is particularly problematic since most firefighters respond to numerous EMS calls where they are routinely exposed to a wide variety of contagious illnesses.
Firefighters can also experience skeletal and muscle pain after a fire, even though no injury exists. This is another side effect of ACTH and the release of adrenaline and noradrenalin; they increase skeletal muscle tension, a critical necessity for the fight-or-flight response. In addition, the increased muscular activity exerted in action produces the waste products lactic acid and ammonia, which adds to the experience of soreness and fatigue the day after. (1) It is important to be aware of the fight-or-flight response and the effects of the hormones it releases. Eliminating these hormones as soon as possible can avoid chronic conditions.
It is especially important for spouses to be aware of the effect that occurs after the adrenaline wears off; this leaves firefighters completely exhausted. At work, they are alive, alert, energetic, and involved. When they come home, the aftereffects may set in, and they may be tired, detached, isolated, and apathetic. The greater the demand at work, the greater the possible backlash at home, debilitating them for family involvement, which, if misunderstood, may be destructive to intimate relationships.2 Although this is certainly not the case in all instances, spouses need to know the factors that may be causing changes in behavior.
Unique to the firefighter is his work environment. The dangers at a fire scene are obvious: fire, smoke, building collapse, explosions, and so forth. Firefighters can see and study these dangers and, thus, prepare for them. However, there is a big unseen danger—cancer.
Today’s fires involve plastics, which are in everything—carpeting, furniture, TVs, appliances, combs, bottles, and even pipes and other building materials. When plastics burn, they typically produce much more smoke and heat than comparable wood products. Plastic smoke is also more deadly and may include carbon monoxide, formaldehyde, nitrogen oxides, ammonia, phenol, benzene, hydrogen chloride, hydrochloric acid, methane, and even hydrogen cyanide. If breathed in large enough doses, these gases can lead to immediate death and even in the smallest of doses can lead to cancer.3
Firefighter Mark Noble, who died of brain cancer, compiled the statistics below. They compare the likelihood of firefighters developing the following cancers to that of the general population:
- Brain cancer: 3.5 times more likely in firefighters with 10 to 19 years of experience.
- Leukemia/lymphoma: three times more likely.
- Non-Hodgkin’s lymphoma: two times more likely.
- Multiple myeloma: 2.25 times more likely; after 30 years, 10 times.
- Bladder cancer: three times more likely.
- Kidney cancer: four times more likely.
- Prostate cancer: two times more likely.
- Testicular cancer: 2.5 times more likely.
- Colorectal cancer (large intestine): two times more likely.
- Liver cancer: two times more likely.
- Skin cancer: two times more likely. (3)
Breathing smoke is the primary culprit for these cancer rates, but skin absorption can also play a role.
Dr. Grace LeMasters, et al reported a direct correlation between the chemical exposures firefighters experience on the job and their increased risk of cancer. The study further indicated the need for enhanced protective equipment, in addition to the gear already provided, that would help prevent inhalation and skin exposure to known carcinogens. This study is the largest comprehensive effort related to firefighter cancer done to date.4 In other words, what firefighters either breathe in or are exposed to through their turnout gear very likely increases their chance of contracting cancer compared with other work environments. The hazards of the toxic, smoke-filled environment, combined with the immunosuppressant effects of ACTH, make firefighters a prime target for cancer.
Firefighters are routinely exposed to trauma and death. A study found that they generally reported medical emergencies and vehicle accidents as the most upsetting types of calls to which they respond. When they witness trauma, it is perfectly normal for them to experience a stress or emotional reaction. Some typical reactions to trauma are listed below.
Physiological and emotional
- Heightened anxiety or fear about the death of others, anxiety about the future.
- Irritability, restlessness, overexcitability.
- Feelings of sadness, moodiness, more crying than usual.
- Feelings of numbness or detachment.
- “Survivor guilt” or feelings of self-blame.
- Mood swings; small reminders or emotional events that seem insignificant can trigger sudden changes in mood or intense reactions.
- Difficulty concentrating.
- Feeling confused, disoriented, distracted, unable to think as quickly or as easily as usual.
- Difficulty making decisions that normally would be easy.
- Worrying about death or thinking about people who have died.
- Nausea or upset stomach.
- Exaggerated startle response (easily startled).
- Fatigue; a lot of energy goes into grief work, and it can be overwhelming and physically draining.
- Hyperactivity or less activity than usual.
- Withdrawal, social isolation.
- Avoidance of activities or places that bring memories of the event.
- Loss of appetite.
- Inability to fall asleep or remain asleep, disrupted sleep, deep sadness on awakening.5
On occasion, these symptoms can descend into a slightly more severe state called acute stress disorder (ASD). In ASD, a person may experience dissociation or a perception of a detachment of the mind from emotions or even from the body. ASD sufferers may perceive the world as dreamlike or unreal and may also have a poor memory of the specific events, which in severe form is known as dissociative amnesia. ASD symptoms include generalized anxiety; hyperarousal; avoidance of situations and stimuli that are reminders of the trauma; and persistent, intrusive memories through flashbacks and dreams or visual images.6
If the symptoms of ASD persist for more than a month and begin to impair the sufferer’s basic functions, the diagnosis can then be changed to post traumatic stress disorder (PTSD), a more serious, debilitating, and chronic disorder. Firefighters do develop PTSD at a rate of between seven and 37 percent.7 PTSD can occur when a person has experienced a traumatic event where both of the following have occurred:
1 The person experienced, witnessed, or was confronted with an event in which there was the threat of actual death or serious injury. The event may also have involved a threat to the person’s physical well-being or the physical well-being of another person.
2 The person responded to the event with strong feelings of fear, helplessness, or horror.8
One of the reasons most firefighters never deteriorate into PTSD is that their training helps ward off feelings of helplessness and experience decreases the raw horror of death, since it has been seen before. Firefighters tend to develop close relationships at work that allows for some blowing off of steam after a tough job. Debriefing at work helps them to get it off their chest and share the events with seasoned, more experienced members. Repressing trauma is a bad idea, since it can fester and erupt over time. Lieutenant Dave Grossman writes, “Unchecked, extreme stress is an emotional and physical carnivore. It chews hungrily on so many of our (officers) with its razor-sharp fangs and does so quietly, silently in every corner of their lives. It affects their job performance, their relationships, and ultimately their health.” (2) Therefore, stress must not be allowed to go unchecked. No matter how tough firefighters may be, they need help battling this foe.
Sleep disruption is another form of trauma for the firefighter. On a 24-hour shift, a firefighter may get to “sleep” at some point during the night. But at any time during the night, that person may be awakened suddenly and abruptly by a bunkroom light coming on and some form of a bell indicating there is an alarm. This can be shocking to say the least. Bobby Halton, editor in chief of Fire Engineering, writes that a study of firefighters noted that their heart rates typically rise to 80 percent of maximum when the alarm is received.9 The firefighters must then quickly don bunker gear, race to the apparatus, and receive instructions, all in a matter of moments and all while being aroused from sleep. As a result, many firefighters develop hypervigilance or sensitivity to lights being turned on.10
Sleep disruption at work can lead to sleep disorders at home. The inability to sleep easily and deeply may result in sleep deprivation, which may physically predispose oneself to becoming a stress casualty. One of the most debilitating problems facing firefighters is a steady dose of sleep deprivation that impacts all areas of their life.
HOW TO HELP
Exercise.It is vital that firefighters exercise regularly. Exercising on shift is simply not enough—buy a gym membership or equipment for the house. Exercise has been scientifically proven to be the only effective way to help the body eliminate excess adrenaline that is nearly always present in the hyperaroused firefighter. It literally helps them calm down. It has been proven to be extremely beneficial after traumatic events if combined with sufficient rest. If adrenaline is simply left in the system, all of its negative impacts will result (e.g., immunosuppression, gastrointestinal suppression, irritability, soreness, and so forth). Regular exercise also keeps firefighters fit and better protected from injury. (1) Mild cardiovascular exercise and stretching help burn off lactic acid and ammonia accumulated from exertion, which can help prevent muscle soreness.
Water. Water is another vital component in dealing with a high-stress job. It aids in digestion, helping to prevent gastrointestinal problems that are so common to firefighters. Dehydration is a constant hazard at the fire scene, so it is paramount that firefighters are well hydrated at all times.
Foot massage.Relaxation is key for off-duty firefighters. The ACTH response is easily triggered in seasoned veterans, causing them to have difficulty resting. It leaves muscles tight and sore. As a result, many firefighters fall victim to the abuse of alcohol, pain pills, and muscle relaxers in their desperate efforts to find relief. A simple five-minute foot massage can be beneficial. Foot massage is a scientifically proven way to significantly reduce stress and relieve muscle tension. A study of heart patients after surgery found that those who received regular foot massages showed significant decreases in blood pressure and faster healing rates than those not receiving foot massages. They also slept more deeply. A similar study on critical care patients noted significant decreases in heart rate, blood pressure, and respiration rates.11 Experts aren’t exactly sure why these results occurred, but it is believed to be linked to the number of nerve endings in the foot, which is roughly between 3,000 and 7,000. Rubbing them stimulates different nerves and nerve zones that run throughout the entire body, including the brain. Foot massages have even been shown to relieve headaches and promote sleep.
Toxin awareness.It has been clearly demonstrated that firefighters are exposed to cancer-causing toxins and are falling victim to cancer at higher rates than the general population. Toxins kill normal, healthy cells before their time, which requires your body to replace these cells. The more toxins, the more cells are killed, and the faster your body has to increase production. We all know that sloppy work can result when it’s done too quickly, and this is exactly how cancer cells originate—from an error occurring in an overworked system. Once the error is in place, the body replicates the error, and cancer eventually results.12 This is the reason toxins are so deadly and why you must either avoid them or quickly remove them through proper nutrition.
Since it is best not to breathe toxins in the first place, firefighters must better manage their air consumption rates at a fire scene. Using air management techniques, firefighters can better monitor their air supplies to avoid breathing deadly smoke. The topic is now getting serious attention across the country.
Cancer testing.A few cancers can be tested for, and early detection can save lives. For the general population, these tests are not recommended until age 50; but for firefighters, testing should begin at age 40. Firefighters will resist these invasive and unpleasant procedures, but it is the spouse’s job to force them to go! Make the appointments yourself!
Check for melanoma (skin cancer) once a year; monitor moles, and look for any changes. Prostate cancer testing requires a rectal exam and a prostate specific antigen (PSA) blood test. For an excellent, in-depth look at how to fight or prevent this disease, see “Prostate Cancer: Fighting the ‘Fire’ Within,” by Jon Gillis.13 A colonoscopy can detect and often prevent colon cancer. Remember, the average cancer risk for a firefighter is three times that of the general population, so make your spouse get regular physicals and testing.
Communication. The number one cause of divorce in the country today, for any marriage, is poor communication. For the firefighter’s marriage, it is especially pertinent. A loving, supportive and communicative marriage is the best source of stress relief for the firefighter; the better the support system, the lower the rates of ASD and PTSD. Unmarried men are more likely to develop ASD and PTSD than married men. Those without a support structure take longer to recover from trauma and suffer more severe repercussions. (7) Your role is vital to your spouse’s mental and emotional well-being, since trauma exposure is recurring. Be willing to talk, listen, be patient, and know what you’re dealing with.
During time off.Even if no run occurs in the night, firefighters don’t really sleep on shift. They are in a constant state of waiting, preparedness, or tangible anticipation, waiting for the bell to go off in the night. When it does, the jarring shock of bright lights and loud noises disrupts their natural circadian rhythm (the body’s internal clock that regulates sleep and wakefulness in a 24-hour period). It has been proven that continual circadian rhythm disruption can lead to an absolute mental and physical breakdown, just as can perpetual lack of sleep in a combat soldier. The two- to four-day break has been established to be the minimal time needed to break the circadian rhythm disruption and return it to normal; four days is optimal. The break also returns the firefighters’ cognitive abilities to 100 percent (after only two nights, circadian rhythm disruption can reduce cognitive abilities to 65 percent). Without the break, firefighters would have difficulty performing their job tasks for more than one or two years. Additionally, ongoing research is finding that continual circadian rhythm disruption has also been linked to cancer. What this means is that your loved one physically needs the multiple-day breaks. You can build up sleep deprivation, but just as our bodies can catch up on dehydration and malnutrition, so, too, can our bodies catch up on sleep. Getting caught up on sleep is one of the best ways to heal and recover from psychological stress. (2) Do not load days off with extra chores. Instead, let this break include plenty of time to catch up on sleep and to exercise; this is vital to the firefighter’s well-being and improves job performance.
Encouragement.A common result of exposure to trauma is depression or a sense of hopelessness. Witnessing pain, death, and violence can make life seem a little bleak. Take the time to remind them of all that is good in their lives. And tell them how proud you are of their work. They need to hear it once in awhile.
DEATH IS A REALITY
Many people ask me if it’s hard to live with the constant threat of death. Is it depressing? Do I resent it? The reality of the profession is that it can kill you at any time. Firefighters have the highest on-the-job mortality rate in the country. I’ve had my share of panic attacks; if I’m talking to my husband on the phone and the alarm bell goes off in the background, my heart races, even after all these years. It’s not easy, and it’s not pleasant. But I’ve chosen to make it a positive; life is short, therefore it is to be cherished.
Some see the stress of this job as a negative, as a wedge that can drive couples apart, but we choose to see it as a very powerful reason to stay close. Each day, each moment is precious to us, for these moments may be numbered. I appreciate my husband for the hero that he is; he saves lives for a living. In my opinion, there is no more noble calling.
Anne Gagliano has been married to Captain Mike Gagliano of the Seattle (WA) Fire Department for 24 years. She and her husband lecture together on building and maintaining a strong marriage.