3-Step Process for Mitigating Firefighter Suicides

I answered the battalion chief’s extension in my office and listened as the shift captain from a neighboring fire department informed me that one of his members had just taken his own life while off duty. The jurisdictional engine company and paramedic crews were still at his home, trying to come to grips with what they had found, while at the same time assisting a grieving family. Thus began a tough road for the deceased firefighter’s family, his coworkers, and the local fire service in general. Yet another seemingly happy and well-adjusted firefighter had succumbed to … what?

Growing problem

Suicide is a growing problem within the fire and EMS community, where risk factors often go undetected or ignored until the actual event occurs. A proactive education program for first responder agencies and employees can be effective in preventing or reducing this silent killer.

Research indicates that death by suicide among firefighters and EMS providers is three times that of line-of-duty deaths (LODDs).¹ The U.S. Fire Administration has been tracking LODDs for the past 36 years. With the exception of the World Trade Center terrorist attack and the 343 firefighters killed on September 11, 2001, LODDs have averaged around 100 fatalities per year. By contrast, there are, at a minimum, 300 suicides per year within the fire and EMS profession. This is profound and demands a national response. 

Three-step process

Training all first responders, from the academy recruit through the command staff, is the first in a three-step process of prevention, intervention and postvention. 

1. Prevention

Prevention is an ongoing effort to recognize post-traumatic stress disorder (PTSD) and other risk factors, promote healthy living, teach stress management, offer safe environments to seek help, and encourage reality checks by coworkers and leadership. 

The National Fallen Firefighters Foundation (NFFF) white paper Suicide Surveillance, Prevention, and Intervention Measures for the U.S. Fire Service was researched as part of the NFFF behavioral and personal wellbeing of firefighters and their families, and is a critical element of its 16 Firefighter Life Safety Initiatives, with FLSI #13 focused on Psychological Support. In the paper, Thomas Joiner, PhD, is quoted as saying; “… that people die by suicide because they want to and because they can” (p. 12). One of the nation’s most respected experts on the etiology of suicide, Joiner describes three essential conditions for a person to move from ideation to action:

• Thwarted belongingness leading to addiction, depression and withdrawal
• Perceived burdensomeness, which is almost always a misperception
• Capability for suicide due to lower thresholds of pain and suffering

The inability of peers and supervisors to recognize these precursors often leads to missed preventative opportunities. Indeed, it is the coworkers who are the most stunned when a crewmember or paramedic partner takes their own life. There are few workplaces in America that are as intimate as the fire station. Survivors, post-suicide, are at risk themselves when they feel guilty for not seeing the signs to another’s suicide.

2. Intervention

Intervention is an affirmative action when suicidal tendencies are recognized. Intervention is what first responders do best. Our training and experience propels us toward situations that civilians would normally flee. We usually arrive on scene to suppress the fire, stop the hazardous materials leak, provide medical treatment, remove the hazard, pick up the pieces, and restore order to a chaos. Suicide intervention is similar in that, with proper awareness and training, first responders should be able to rescue the rescuers. 

The challenge is for everyone within the organization to be alert for these indicators as they interact with their coworkers and subordinates. Then, a specific procedure must be followed to address the concerns. Suicide is preventable, and fire chiefs can play a key role in prevention and intervention.

The NFFF Guide for Fire Chiefs suggests a QPR (like CPR) approach—Question, Persuade and Refer. Never be afraid to question a firefighter about their intentions or meaning. Mental health professionals say that this line of questioning will not cause a person to think about or act upon suicide. We should always attempt to persuade at-risk individuals to accept or seek help. Ambivalence is not tolerable and may have very disastrous consequences. Finally, be ready to refer the person to approved and vetted resources for care and follow-up.

3. Postvention

Postvention means we get another chance to save our coworker. Studies show that, unfortunately, most suicide actions taken by firefighters are successful and not a cry for help. By the time one decides to end their life, the pleas for assistance went unspoken or unheard. On the rare occasion, when the act of suicide was in effect the “help me” behavior, an aggressive intervention is needed. 

A hidden tragedy

The NFFF white paper Suicide Surveillance, Prevention, and Intervention Measures for the U.S. Fire Service reported on apparent “suicide clusters” occurring in large metro fire departments across the nation. One statement in the white paper was, “Despite the level of concern in the fire service and the perceptions of an escalating problem, very little is actually known about suicide rates among fire service personnel” (p. 11). The real data is cloaked by incomplete death certificates, lack of occupational statistics related to the volunteer fire service, and inadequate tracking of retirees. 

Literature is consistent in reporting the fact that suicide is a subject that is taboo in many fire service organizations. When it occurs, the lack of established policy and the human reaction to ignore the causes contribute to the under-reporting. Without proper data, it is hard to gain funding and interest in this tragic topic. 

The young firefighter/paramedic mentioned at the beginning of this article was remembered in eulogy as a great firefighter, a kind person, a loving son and a wonderful brother. He was indeed all of those. Perhaps out of respect for the deceased and his family, the news reports only mentioned he had died at home while off duty. Suicide was never mentioned except in whispers and among colleagues … another tragic loss and an unreported statistic.

Reference

1. Savia, J. “Suicide among North Carolina professional firefighters: 1984–1999.” Dissertation, Regent University. 2008.