赫希·威尔逊（Hirsch Wilson）
写作National Volunteer Fire Council (NVFC)
Rehabilitation: the action of restoring someone to health or normal life…
I was sitting on the curb by the ambulance entrance to St. Vincent’s Hospital in Santa Fe, New Mexico. I must have been holding my head in my hands. An ED nurse just coming on duty asked me: “Are you okay?” Knowing the firefighter “code,” I said, “I’m fine.”
But I wasn’t. It was my third year as a firefighter-EMT. A mom of two kids had just died in our ambulance of a massive abdominal bleed, a bleed we had missed, a bleed we couldn’t have done anything about. A seat belt dissected her descending aorta in a motor vehicle collision (MVC). The kicker was I had told her kids that their mom was fine, and she would see them in the hospital. Then, she bled out and died right in front of us.
I felt unmoored for weeks; I couldn’t stop thinking about it. I dreamt about it and thought of quitting. (“I’m not tough enough to do this work.”) I was irritated and irritating.
相关的消防员培训
Can Peer Support Prevent Firefighter Suicide?
Looking back on it from three decades as a firefighter, now I can name what I was experiencing. It was a traumatic stress event (I’ll define that in a moment). I went into a month or so of what we now call “Acute Stress Disorder”然后，尽管这个呼唤的记忆坚持了我，但情感行李却消失了。
我有一个本能地知道该怎么做的部门有帮助。我们有一个酋长带我出去午餐谈论这个电话（并告诉我不要戒烟，不要有外遇，不要开始喝酒）和其他检查我的消防员。
作为官员，我们的主要责任是第一响应者的健康和安全。如果他们在身体和情感上健康并且知道他们是一支高性能团队的一部分，那么他们可以在真正的不利条件下做惊人的事情。
But the fact remains that this vocation is sometimes dangerous, often stressful, asks us to do things with little sleep (and we succumb to lousy nutrition). We are exposed to traumatic events that have the potential to affect our mental health.
Our Mental Health
We have made great strides in recognizing the threat of cancer for firefighters. So, too, with focusing on cardiac health. It is now standard procedure to have rehab stations dealing with decontamination to remove carcinogens and paying strict attention to cardiac and heat-stress health.
但是，下一个“边境”是在急救人员接触创伤事件时将同样的护理和专业知识应用于他们的心理健康。
支持这一结论的数据令人震惊。
根据一项引用的研究188金宝搏是正规吗, more than 45 percent of firefighters have consideredsuicide, and 15 percent have attempted it.Deaths自杀于2018年超过了停职死亡。
在一个2018调查conducted by the International Association of Fire Fighters of 7,000 firefighters nationwide, respondents overwhelmingly reported “that stressful or traumatic experiences on the job have impacted their mental health. Among the struggles they say are directly connected to the job: 19 percent have had thoughts of suicide, 27 percent have struggled with substance abuse, 59 percent have experienced family and relationship problems, and 65 percent are haunted by memories of bad calls.”
We have a mental health crisis. There are broad policy and budgetary implications, but I want to focus on what we can do at the department level.
Before we dive into solutions, here are two ideas that have helped me understand what we are dealing with.
First, a working definition of traumatic stress is “extreme stress that overwhelms a person’s ability to cope.”
Second, traumatic stress is in the eye of the beholder. For example, a one-year volunteer EMT, seeing his or her first MVC fatality, might experience traumatic stress. To a veteran firefighter, it’s just another day at the office.
Preparing for Traumatic Stress Events
- 消防官不是专业顾问。但是我们需要关于创伤性压力和PTSD的体征和症状的工作知识。
- We need to recognize what are traumatic events (even though it is always in the eye of the beholder). For example, traumatic events could be trauma or death involving pediatric patients. They could be multiple casualty scenes, burn patients, line-of-duty deaths, suicides, or the death of someone known to department members.
- 作为一名官员，您可能有一系列资源列表，从逆向挖掘到动物控制。从牧师到辅导员和创伤专家，也必须有一系列心理健康资源清单。（注意：至关重要的是，他们熟悉与急救人员合作。）这是国家志愿消防委员会（NVFC）的清单地方行为健康专家。
- Officers need to leave their assumptions about mental health, mental “illness,” and firefighter “invulnerability” at the door. Thirty-five years has taught me that very few are immune to the trauma we see. Invulnerability is a myth. The more important question is how we can help firefighters become moreresilient。
- Publicly acknowledge the issue. Talk about mental health issues and include those issues in trainings. Put up suicide awareness and post-traumatic stress disorder (PTSD) awareness posters. Post the phone numbers of suicide helplines and the Employee Assistance Program number. Access the NVFC’s分享负载程序。提高自杀意识，了解压力，韧性，并认识到该部门年度培训课程的PTSD部分。
- 有“谈话”。一个有力的工具是让首席或高级消防员与新的消防员坐下，并公开谈论创伤和职业的压力。锤击每个人的压力都不同 - 没有“一种方法”的感觉至关重要。接下来，强调该部门“有您的支持”，目标是使您在身体和精神上健康。
- 建立朋辈心理辅导计划。最有效的early intervention tool is us. A career firefighter-paramedic, who regularly sees a counselor as part of her mental health regime, told me that once she sat down with her counselor and described a call she had had that week. The counselor — a professional — began to weep. The point is twofold. First, it is often hard for civilians to cope with what we see, and it is hard for us to talk to people outside the vocation about what we see. Often our best counselors are firefighters who have been there. It takes skill and training to be an effective peer counselor. There are all sorts of resources available to help departments (or a collection of departments) develop peer counseling programs. But informally, just the ability to sit down with another first responder and honestly talk about a call, or series of calls, can help re-orient perspective and, if needed, point a fellow firefighter towards clinical help.
Psychological Rehab
作为一名军官，当您滚动结构射击时，清单上正在设置康复站。以同样的方式，当我们对可能是一个痛苦和压力的呼吁进行滚动时，我们需要考虑心理康复 - 我们可能不需要它，但是我们的工作要做好准备。
- Debrief the call. Do a quick “tailboard” conversation. It doesn’t have to be long or emotionally draining. Just get a sense of how everyone is doing. Make sure you have eyes on everyone.
- 跟进。无论是个人，还是通过电话，文字或缩放，请确保您与参与电话的每个人接触。
- 您是否需要专业运行的关键事件压力汇报（CISD）？关于有效性的数据CISD is mixed，因此重要的是自愿。即使没有干预，大多数人也可以在三个月内解决症状。但是CISD可以帮助您确定可能需要更多帮助的个人。
- Keep an eye out for different behavior. We had a young firefighter who had erratic attendance. We didn’t think much of it until we had a car fire in our district, and we found him in the car, using drugs. We got him out, and it turned out that he attempted suicide in our district so we would find him. (He survived.) Minor changes in behavior can be an indicator of more serious problems.
- A chaplain is your friend. The chaplain has played a traditional role in the fire service. By tradition (and law in the United States), they cannot proselytize. When there are fatalities, a family losing their home in a fire, a line-of-duty death, or a first responder suicide, the chaplains are the ones who step in. They help manage the logistics of tragedy, the handling of chaos. This is crucial when shock and grief are overwhelming everyone, whether among civilians or in the department.
Over the past decades, the workload of officers, both volunteer and career, has increased exponentially. (My one piece of advice is to delegate, delegate, delegate.) But the North Star for any officer is the health and safety of the people. We want them to be able to bounce back from tough calls and, most importantly, finish their careers mentally and physically healthy.
And finally, it is always okay to ask one of your firefighters: “Are you okay?”
勇敢起来。善待。战斗。
作者注：I’d like to thank Chief Sean Daniels of the Mt. Lebanon Fire Department in Pittsburg, Pennsylvania; Mike Bucy, Fire Chief at Stevens County (WA) Fire Protection District #1; and Captain Faith Applewhite, Santa Fe City (NM) Fire Department, for help with this article.
赫奇·威尔逊is the retired assistant chief of the Hondo Volunteer Fire Department in Santa Fe County, New Mexico. His latest book，消防员禅：艰难时期繁荣的现场指南，可以在您当地的书店或在线购买。
