Iowa Ideas
Iowa Ideas

To provide a nonpartisan, statewide learning experience

designed to explore the key questions and big ideas that will shape the future of Iowa.

First responders often the last to get help for mental health, trauma

Firefighters face barriers to care for on-the-job trauma

Aug 5, 2019 at 6:30 am
    Members of the Mount Vernon Volunteer Fire Department work July 2 to extinguish a vehicle fire during a training exercise at the Kirkwood Community College Environmental Training Center in Cedar Rapids. (Kat Russell/The Gazette)

    Muscatine Assistant Fire Chief Mike Hartman remembers the shock on his crew’s faces the day more than 16 years ago they lost a longtime member of their team.

    “It was a bad situation all around,” he said. “We did everything we could to get to him, but there unfortunately there was nothing we could do.”

    After the crew extinguished the fatal blaze, Hartman said, the loss really settled in.

    “Initially, I think we were all just shocked at what had happened,” he said. “There was also a lot of questioning — could we have done more? Could we have done something differently? Even though we knew that we couldn’t. And I think that’s normal.”

    Michael Kruse had been a Muscatine firefighter for 27 years when he died Sept. 14, 2002.

    Hartman said Kruse was one of two firefighters working on the roof of a three-story wooden house that was consumed by fire when he fell through the roof.

    “When you have a guy go down like that, the focus shifts from fire suppression to rescue,” Hartman said. “And we got in there pretty quickly considering how extensive the fire was, but unfortunately the upper level of the house (where he had fallen) was totally engulfed,” Hartman said.

    Kruse’s death had a profound impact on the small, tight-knit department.

    “We’re talking about a veteran member of the fire department who had more than 25 years of experience,” Hartman said. “He was well-known, well-liked and well-respected, and to lose someone like that, it’s of course going to leave a scar.”

    The tragic loss is one of many scars Hartman carries as the result of trauma experienced on the job — trauma that for many first responders can result in long-term emotional and mental health issues.

    At higher risk of developing mental health issues

    For first responders, repeated exposure to death and trauma can put them at an increased risk of developing mental health issues, such as depression, post-traumatic stress disorder, substance abuse and suicide.

    A study commissioned in 2017 by the Ruderman Family Foundation, a Boston philanthropic foundation, found that firefighters were roughly twice as likely to suffer from PTSD and depression than the public.

    Additionally, researchers have found that first responders, especially firefighters, are more likely today to die by suicide than they are in the line of duty. That was the case in 2017 when there were at least 103 firefighter suicides nationally compared with 93 on-duty deaths.

    To complicate matters, first responders face a multitude of barriers when it comes to accessing resources for mental health care — the most prevalent being stigma.

    “Most first responders have a tendency to shove things down and not really deal with what they’re feeling or experiencing,” said Dr. Jim Coyle, a Cedar Rapids Fire Department chaplain and mental health professional who specializes in trauma intervention and sudden loss.

    “It’s that mentality of ‘put your game face on, put your boots on, get out there and go after it,’ because that’s the way we’re trained,” he said.

    A firefighter for more than 30 years, Coyle has worked with numerous fire departments in the area to provide mental health support after crews have responded to traumatic calls.

    “There is a perception that first responders are heroes — we’re out there protecting our communities and our nation — and so there can be a perception among first responders that having a mental health issue is a sign of weakness,” Coyle said. “It’s a huge burden and at the same time, it’s a badge of honor, and unfortunately we tend to hide behind that badge because we don’t want our community or our peers to see us as weak. And that’s been the stigma — that there is something wrong with me if I’m struggling.”

    Volunteer vs. career firefighters

    But stigma isn’t the only barrier.

    Funding also can be an issue, especially for volunteer departments, which make up roughly 70 percent of the fire departments in the United States. They typically are underfunded, understaffed and under-resourced.

    “I have a real passion for volunteer fire departments because those volunteers are just juggling so much and they’re doing it voluntarily because they care and want to serve their community,” Coyle said.

    A study by the Substance Abuse and Mental Health Services Administration found that “volunteer firefighters have greater structural barriers when it comes to the use of mental health services.” Those barriers, the report said, can include cost, inadequate transportation, getting time off from their paying job and the proximity to and availability of resources.

    At the same time, the study found, volunteer firefighters “reported markedly elevated levels of depression as compared to career firefighters.”

    “I’d venture to say there are a lot more stressors involved for volunteer firefighters because they’re all working full-time jobs and they are volunteering their time to serve their small community,” Coyle said. “And a majority of the time, when they are responding to a traumatic event, they are likely responding to a scene where they know the casualties in that event.”

    That combination of added stressors and hindered access to resources could be a factor in why volunteer firefighters kill themselves at a higher rate than those working in career departments, Coyle said.

    Changing the culture

    “We’re trying to change that ‘we don’t ask for help, we’re the ones who provide the help’ culture because that’s killing us,” said Cedar Rapids Fire Capt. Eric Vandewater, coordinator of the fire department’s peer support team.

    “You can’t deal with these things alone. If you’ve got issues from a call you’ve seen — or multiple calls — you’re probably going to need some help working through that stuff.”

    That’s why Cedar Rapids — like many other departments across the country — formed a peer support team, about five years ago.

    Spearheaded by Vandewater and Coyle, the peer support team consists of about 20 firefighters who have undergone training to recognize signs of trauma and depression — such as agitation, restlessness, quickness to anger, isolation, anxiety and sudden changes in behavior — and intervene before the struggling firefighter goes too far down.

    “Just checking in with the guys is a big part of that intervention,” said Mount Vernon Volunteer Fire Department Capt. Mehrdad Zarifkar.

    “If we respond to something that could potentially be stressful or traumatic, we try to make sure to talk to the crew about how they are dealing with it and make sure they know that it’s normal to feel emotions. Then again, we also want to let others know it’s OK if they are not struggling with the call. Everyone experiences things differently.”

    Within most fire departments that have developed intervention programs, Coyle said there typically are three levels of intervention.

    First is the peer-to-peer approach. If there was a particularly difficult call, the next level might be bringing in a critical incident team to debrief those who responded to the scene. And that third level of care might be meeting with someone one-on-one — a trusted figure like a chaplain or a priest or a mental health professional.

    In many departments, Coyle said, creating these peer support teams has led to firefighters paying closer attention to their peers, “keeping an eye on each other,” and a greater acceptance that sometimes help is needed.

    Seeing the signs

    For Capt. Vandewater, the realization he might need help coping came about four years ago when he responded to a fatal car wreck involving a toddler.

    “A few days later I was at home, and I’m in charge of the peer support team, and I’m at home yelling at my kids,” he said. “And it dawned on me that I don’t know why I’m yelling at them. It wasn’t until after I sat down and processed what I was feeling that I realized I was yelling at them because I couldn’t save that little girl.”

    “She was so young and that, I think, was one of the hardest things for me to deal with,” he added. “One minute she was playing and the next she was passing away.”

    Calls involving children are some of the toughest ones first responders face, Coyle said. For others, a fatal fire or car wreck or assisting sick or injured elderly people who don’t have anyone to care for them can be challenging.

    For Mount Vernon firefighter Casey O’Connor, his toughest call was responding to wreck on Highway 30 where a pedestrian had been struck by a semi.

    Afterward, the department debriefed with Coyle, who often travels to departments throughout the state conducting debriefings and offering mental health support.

    O’Connor was a new firefighter at the time and seeing his peers, especially the veteran firefighters, allowing themselves to be vulnerable “made me feel better about the way I was feeling,” he said.

    That’s exactly what these peer-to-peer support teams and debriefings are meant to do, Coyle said.

    “It lets those that are struggling know they are not alone and that help is available,” he said. “And it supports the idea that there are tools out there, there’s support out there and part of their responsibility, not only to themselves, but also to their co-workers and friends and family both is that they step up and talk to someone when needed.”

    l Comments: (319) 398-8238;

    Direct Iowa Ideas updates sent to you for free.