California firefighters: Burnout and PTSD are top concerns

For four years, California firefighters specializing in wildfires have been facing exceptional challenges that extend beyond battling blazes.

Wildland firefighters deliver bad news to families, coordinate extensively with the police and local governments, and live with constant concern about funding. They also spend a considerable amount of time away from home, face significant danger and experience sleep deprivation that often progresses to sleep exhaustion.

Let’s take a look at some of the psychological and physical stresses, from the perspective of providing whole-person care to these first responders.

Endless anxiety

Wildland firefighters’ work hours are unpredictable, placing significant pressure on their families. There is also the additional stress from the unexpected duty of being in the national media spotlight. A good first question to ask a firefighter is: How have you been these days?

Garrett Huff, Santa Barbara County fire captain behavioral health specialist, explains that one of the psychosocial concerns firefighters face is: will the California wildfires keep getting worse? The cumulative psychological effects of fighting wildland fires can lead to burnout, extreme exhaustion and feeling overwhelmed, particularly in periods of continuous and tremendous exertion with little time to rest.

As in the military, a lot of the psychosocial stress that wildland firefighters experience is due to their deployments, Huff notes. Wildland firefighters are typically deployed for two weeks, working 12- or 24-hour shifts, and can be assigned to deploy again two weeks later.  Throughout the deployment, the firefighters come away beaten up by the rigorous schedule and the intensity of their work.

Few respites

The traditional fire season, typically from April to October, is a thing of the past due to climate change and drought, says Woody Enos, Santa Barbara County Fire Department division chief. Wildland firefighters worry that the new California fire season may be year-round.

It is important for the medical community to come together and build upon the dialogue already taking place to support wildland firefighters, who are managing the mental, emotional and physical stresses of combatting an unrelenting natural disaster.

By and large, firefighters are resilient professionals, and most who are exposed to traumatic events do not go on to develop post-traumatic stress disorder (PTSD). That said, physicians should recognize that PTSD is a risk for these professionals.

The role of the physician is to help ensure firefighter patients are educated on acute stress symptoms and have access to appropriate care. We can help them understand that acute stress symptoms such as anxiety or agitation may result from traumatic, life-threatening situations and from witnessing traumatic events.

Another consideration for the medical community is how to best serve firefighters’ families. Imagine how scary it must be for children to know that their mother or father is going into harm’s way with each new wildfire.

It is important for physicians, fire department leadership, fire unions, and the International Association of Fire Fighters (IAFF) to promote behavioral health services targeted to firefighters with PTSD and other psychosocial issues, including substance use.

Physical considerations

In addition to the psychological aspects, physicians should be on the lookout for respiratory ailments most likely to afflict wildland firefighters. The associated respiratory ailments can be career-ending due to significant limitations on daily activities.

Wildland firefighters are undoubtedly being exposed to recurrent smoke inhalation. Wildfires are different from house fires, where one can find a smoke-free area to adjust gear or remove protective equipment when overheated. The California wildfires offer little escape because of their size and the variance of prevailing wind directions.

Due to chronic smoke exposure, wildland firefighters are at increased risk of acute or chronic inhalational injury. Cumulative smoke exposure is known to cause reactive airways dysfunction syndrome (RADS), asthma, COPD, hypersensitivity pneumonitis, and other interstitial lung diseases.

COPD is often insidious and patients may attribute their fatigue and breathlessness to being out of shape. Physicians should take detailed occupational histories including job descriptions, types of exposures, protective gear worn, family history, smoking history, and allergies. Keep in mind that X-rays can remain “normal” until the disease is advanced. Limiting exposure to smoke can at least halt the accelerated loss of lung function.

Pulmonary function tests performed every year or two can identify and track early accelerated loss in lung function over time. Specific interventions can change the trajectory of these troubling trends and keep these heroes on target to hit their public life service retirement achievement.

Another physical condition for physicians to look out for is rhabdomyolysis due to extreme physical exertion and dehydration. Rhabdomyolysis is a serious medical condition caused by abnormal muscle protein breakdown that can result in severe kidney dysfunction. Symptoms of rhabdomyolysis include, muscle weakness, generalized muscular pain, dark-colored urine and possibly decreased urine output.

Ever vigilant

Wildland firefighters are also fighting against complacency.

One wrong move with the fire engine could result in a serious collision. Driving conditions during a firefight involve poor visibility, unexpected obstacles in the road, and the usual sense of urgency to get to the next location. In many cases, firefighters are themselves fleeing a blaze advancing on their location.

Treating firefighters with a holistic approach is best for ensuring successful outcomes. Getting to know firefighter patients and their families, along with mental health screening, is an important part of their care. For the physical health of firefighters, a detailed history and physical exam that encompasses occupation-related health concerns helps to guide the need for additional evaluation.