much longer. You can be completely cured with good
treatment. Currently, 40 percent are completely cured
and then 40 percent have virtually no symptoms. A
final 20 percent may never get better, even with treatment such as prolonged exposure therapy.
Tustin: Recently, there has been a flurry of programs (Road to Mental Readiness, First Responders
First, TEMA, Heroes Are Human) aimed at first
responders to assist them with identifying and dealing
with PTSD or with building resilience. Can you help
me differentiate between some of them? Or, if not,
what are the components of good programs?
Foa: There is evidence from other areas of study that
these types of programs are working. But I am not specifically familiar with these. Generally, though, programs that
assist with mental preparation work very well. Critical
incident debriefings do not seem to be helpful, as they
can cause secondary victims. But the part of critical incident stress management that uses pretraining to focus on
talking/seeking peer support, advocating the value of professional assistance, getting adequate rest, avoiding alcohol
and stimulants, ensuring proper nutrition, and exercise is
quite helpful. But after a month or so, if symptoms don’t
go away, then it’s time to see a professional.
Tustin: So stress is normal for people to experience
after traumatic events; it’s just not normal for it to persist. Then I’ll steal a quote from Dr. Jeffrey Mitchell,
clinical professor of emergency health services at the
University of Maryland in Baltimore County, “This is
a normal response, by normal people, to an abnormal
Foa: Yes. When it persists, that’s when treatments like
prolonged exposure therapy work really well; for many,
as little as five sessions are all that’s necessary. It’s impor-
tant to know that 90 percent of people do not develop
PTSD after a traumatic event. The majority of people
recover naturally after an event. They don’t necessarily
forget, and they may be more cautious, but they don’t
have a disorder.
Tustin: If I have a firefighter returning to work after
a prolonged absence because of PTSD, how can I help
that person be successful in reintegrating back into the
Foa: What’s important to remember is that, when
they do come back, they’ve had treatment and no
longer have PTSD. Gradual integration is helpful; so
are compassion and a stigma-free workplace. PTSD
doesn’t discriminate. People should be aware that it
could have happened to them just as easily.
Tustin: What can you tell me about the term post-traumatic growth?
Foa: Individuals will tell you that they’ve learned
a lot from PTSD, and this is what they mean. This is
a brand-new area and still being studied. Generally,
though, my patients don’t talk about growth; they’re
here to talk about suffering and loss. Post PTSD, each
person is mentally a different person, but that is from
an experiential perspective. They have overcome something that was seriously affecting their life.
Tustin: If you could tell first responders one thing
that would help them to avoid PTSD, what would it be?
Foa: Understand the facts and the preparedness. Be
tolerant of yourself if you have symptoms, especially
immediately after. Don’t isolate yourself; stay connected. Talk to the one person you really trust. Your
mind is processing a terrible event; this is normal.
They should also know that for it to be a compensable
injury, you must have it for at least a month or more,
and it must meet the criteria of DSM- 5. Benzodiaz-epines are not good for PTSD, and antidepressants
aren’t necessarily helpful either.
Prolonged exposure therapy and cognitive processing
therapy are generally the most effective treatments. But
these treatments should be done by trained professionals
who are certified in these treatments. The fire service
needs to make sure that the mental health professionals
your department is dealing with are trained in the
evidenced-based diagnosis and treatment of PTSD.
Cynthia Ross Tustin is a 31-year fire service veteran and is the chief
of the Essa Fire Department in Ontario, Canada. She is a member
of the Fire Department Instructors Conference (FDIC) International
Advisory Board, a vice president with the Ontario Association of Fire
Chiefs, chair of the Ontario Home Fire Sprinkler Initiative, and the
co-chair of the Home Fire Sprinkler Coalition–Canada. Tustin has
worked as a critical care nurse, a volunteer firefighter, and a deputy
chief. She has been published in fire service magazines and journals
throughout Canada and the United States.
There are generally three basic categories of post trauma symptoms:
1. Reexperiencing symptoms: These include unwanted memories and
nightmares of the traumatic event, flashbacks, and the experience of
feeling distressed when recalling the event.
2. Avoidance and numbing symptoms: These include any efforts to avoid
remembering the trauma or anything that might be associated with
the trauma, amnesia, and a dampening of positive emotions (loving
and affectionate feelings), lack of interest in previously rewarding
activities, feelings of isolation or even detachment from loved ones,
and a sense of foreboding about the future.
3. Arousal symptoms: These include irritability, anxiety, problems concentrating and sleeping, and startle.