In the early morning of January 12, 2017, on the outer reaches of Baltimore’s East side, a two-story house burned to the ground.
The Baltimore City Fire Department rushed to the scene. They contained the blaze and set to work rescuing the family of eleven, the Malones, that lived there.
Firefighters ran straight into the fire and started pulling people out. But the fire was hot and moved fast, and the house collapsed, killing the six children who were inside.
The Baltimore firefighters did remarkable work. They rescued four sleeping people and got them to a hospital. They contained the blaze, leaving neighboring houses mostly undamaged.
Yet, months later, the firefighters and medics who responded to the blaze felt horrible. They wondered if they could have done more.
“It hit them like a ton of bricks,” Rich Hoffman, head of Baltimore’s International Association of Fire Fighters Local 734, told the Baltimore Sun. “We’re trained to go through hell to get people away from death. When we can’t do it, it’s a heavy burden. It’s a truly heavy burden.”
Firefighters join the service to protect and help people in their community. Firefighters can be heroic, as they were in the Malone fire, but still feel that they’ve failed.
“They take on so much responsibility for themselves, and they have a hard time forgiving themselves for things that they haven’t done wrong,” says Dr. Abby Morris, a psychiatrist who works with firefighters at Maryland’s IAFF Center of Excellence for Behavioral Health Treatment and Recovery. The IAFF Center is a mental health and substance abuse treatment facility for firefighters and paramedics in Prince George County.
Many first responders replay violent or traumatic events over and over in their head and may begin to display behavioral changes and withdraw socially and emotionally.
There’s a name for such psychological trauma: post-traumatic stress disorder, or PTSD. It’s epidemic among firefighters. According to the IAFF, one in five firefighters and paramedics will suffer from the disease at some point in their career.
Other severe behavioral symptoms of PTSD include substance use and suicide. People with PTSD are six times more likely than the general population to commit suicide. Substance use is even more common. According to one study cited by the Department of Veterans Affairs, 46.4 percent of people with PTSD also had a co-occurring substance use disorder.
Chuck Talbott, a former firefighter treated at the IAFF Center for Excellence, had a hard time processing some of the awful things he saw on the job.
Talbot struggled with his mental health, and began to drink extreme amounts of alcohol: “If I wasn’t drinking, I was at work having withdrawals. Anxiety, shaking hands — I had it all.”
By his estimation, Talbot drank 30 beers and six to seven shots per day during the worst stage of his struggle with alcohol addiction. He didn’t drink on the job, but the withdrawals and hangovers he experienced while at work made him struggle to perform his duties.
Like firefighters anywhere, Maryland firefighters deal with house fires, car accidents, and medical calls. However, Maryland is in the midst of an opioid epidemic that will put many first responders in physical and psychological danger before it’s over.
Maryland has experienced a wave of deaths caused by substance misuse. According to the Maryland Department of Health and Mental Hygiene, 2,089 Marylanders died from drug- and alcohol-related intoxication in 2016. Firefighters and paramedics were often the people who tried to resuscitate them or found them dead. The crisis is unlike anything firefighters have responded to before.
In fact, the opioid epidemic has put some first responders in danger. In May 2017, two Harford County EMTs and a sheriff’s deputy nearly died when they responded to an overdose. The first responders came into contact with fentanyl, a potent opioid that can be fatal in amounts as small as a quarter of a milligram. Each of the first responders overdosed themselves and had to be treated in a hospital.
Fire officials don’t mince words when they talk about the scope of the epidemic.
“This is not a problem that is going away soon — this is not Ebola, or Zika, not something that comes and goes,” explained Matthew Levy, the medical director of Howard County’s fire department, to the NFPA Journal. “This is a problem of epidemic proportions and it is going to be with us for a long, long time.”
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Addiction brought on by PTSD must be treated by addressing the underlying problem. Firefighters who self-medicate are not treating the trauma that caused them to develop PTSD in the first place.
Firefighters encounter extreme trauma repeatedly over the course of their careers. Firefighters rescue and treat survivors of shootings, fires, and pileups. They see death and injury at a scale that is hard for most people to comprehend.
Some firefighters who have entered mental health treatment report that their stories of such events have been hard for even mental health professionals to hear. The firefighter winds up counseling the tearful counselor.
In light of these unique challenges, the International Association of Fire Fighters, has established a mental health and substance use treatment center in Prince George County. It’s open to firefighters and emergency medical workers only, with a staff well-versed in the challenges of the fire service. The IAFF Center of Excellence for Behavioral Health Treatment and Recovery is a supportive environment created by and for firefighters. There, firefighters struggling with the same problems, who truly understand each other, help one another get sober and healthy.
At the IAFF Center, firefighters can take a break from their protector role, and care for themselves. Firefighters face danger and death for the citizens of Maryland. The Center is one way that Marylanders pay them back for their heroism.