Firefighter Behavioral Health Alliance Releases White Paper on Moral Injury

From 2014-2020, more firefighters died by suicide than in the line of duty.

That was just one of the findings in a white paper: "Moral Injury in Firefighters: Wounds of the Spirit" released by the Firefighter Behavioral Health Alliance (FBHA), along with Elizabeth Anderson-Fletcher, Ph.D. and Chaplain Mark Schimmelpfennig.

“The fire service culture has begun to recognize the effects of Post-Traumatic Stress Disorder, but an emerging issue firefighters face is Moral Injury, which occurs just as often in the men and women serving their communities. Moral Injury is a relatively new term in First Responder circles, with signs and symptoms that can mirror those of the more widely recognized PTSD – even though they are distinctly different ailments,” authors wrote.

They say Moral Injury generally results from a major conflict in one’s moral code which causes a negative response, such as having to prioritize who can be saved and who cannot.

“The purpose of this pilot study was to explore how firefighters perceive Moral Injury relative to their experiences with traumatic stress, job satisfaction, burnout, and relationships…”

The authors added MI examples:

1. A firefighter witnesses bullying of a rookie on the job and says nothing. He is upset with himself the rest of the shift about why he didn’t step up and say something. He continues to be ashamed even after his shift is over.

2. A paramedic is directed by a supervisor to provide treatment to a patient that goes against what she believes to medically appropriate. She feels betrayed by management.

3. A fire crew on a hose line is instructed to evacuate and go defensive, but the primary search team has not yet confirmed whether there are victims/patients in the structure. The Lieutenant, who is with a rookie firefighter on the hose line, disagrees with the call and feels conflicted.

4. An EMT is forced to work overtime and forego vacation days due to staffing shortages. She is already having marital problems, and now has to tell her husband they have to cancel their vacation plans yet again. She is burned out and resents management.

5. A firefighter feels guilty for having an affair, but he can’t seem to end the relationship. His wife leaves him and takes the two young children. He feels betrayed by both his family and his own selfish actions.

6. A firefighter/paramedic suffers her sixth pediatric death this year. She begins to feel helpless and questions whether her training has been a waste of time.

Data for the study was obtained from career or some combination departments in the western states. Volunteer firefighters were not included.

“Whether the label is PTSD, Moral Injury, or Cumulative Stress Overload, our brothers and sisters in fire/EMS are suffering. Although the fire service culture is changing, there needs to be less stigma around behavioral health, wide-spread implementation of mental wellness programs in departments, and better access to mental health treatment…”