The mental and emotional toll of firefighting

In the end, it was a song that saved Brendan McDonough’s life. 

McDonough had been a member of the Granite Mountain Hotshots of the Prescott, Arizona Fire Department for a little over three years when assigned as lookout for the Hotshots at the searing Yarnell Hills Fire on June 30, 2013. By day’s end, he was the unit’s lone survivor, as his 19 brothers-in-arms were overrun and killed – the worst loss of firefighter lives since 9/11. 

Torn by survivor’s guilt and tormented by panic attacks and the pain of constantly reliving the horror, McDonough spiraled downward in the months that followed, isolating himself and drinking to numb the pain. Eventually, McDonough found himself in his car by the side of a lonely Arizona highway, desperate to “take away the pain.” He pulled a pistol from his glove box, pointed it at his head, and asked himself “do I truly want to live like this forever?”

And then a song came on the radio.

“Earlier that day, me and my daughter were dancing in the living room,” he later recalled. “That was my 15 minutes of energy to be able to watch her laugh and giggle … that’s the image God showed me.” 

Dropping the gun to his lap, McDonough thought of the brother and sister firefighters who would respond to his suicide, still feeling the pain of the Yarnell tragedy themselves. He thought of his mother. He thought of his daughter. Eventually, “I unloaded the gun, threw it in the back seat, and I drove home, but I still … knew I needed help.” 

A month later, at yet another memorial service, Brendan confided in a trusted friend who guided him to the help he needed. It was only then that he learned that his misery was shared to varying degrees by many of his fellow firefighters – victims of post-traumatic stress. 

The Health and Safety Issue of the 21st Century

Post-traumatic stress disorder – PTSD – affects roughly one out of every five firefighters – more than double the general population. The effects are sobering. Suicide in the fire service is approaching epidemic proportions: In 2015, more firefighters died by their own hand in the U.S. than died in the line of duty from traumatic injury and job-related illness. Research shows that rates of alcoholism and substance abuse related to stress run well above average. Broken marriages, panic attacks, abuse and depression are typical.

“I would venture to say that nobody really comes out of this career unscathed as far as behavioral health,” says Jeff Wells, a recently retired paramedic/firefighter for Sacramento Metro Fire Department. “I think that there is a degree of effect that it has on every firefighter or paramedic in the fire service.”

Jeff knows what he’s talking about. More than two decades into his fire service career, he narrowly escaped death himself after falling through the roof of a single-story home while cutting a ventilation hole. While his physical injuries – burns and a dislocated knee – healed, the accident unlocked a lifetime of painful experiences on the job. Two years of panic attacks, family problems, blind rage and his own brush with suicide followed before Jeff finally found help and a way forward.

“It’s like you start your career with a bucket and it’s empty, and as you start going on these horrendous calls, you’re putting stuff in the bucket each time,” Wells said. “In my case, the bucket was full from a long career and a big old rock was dropped in it and it all came out at once.”

“Post-traumatic stress is triggered by a specific event (and) firefighters have these events all the time,” said clinical psychologist Dr. Suzy Gulliver of the Warrior Research Project at a recent IAFF symposium. “Civilians have them maybe once or twice in a lifetime. Firefighters can have them every week.”


Understanding the Struggle

For the fire service, the challenges of dealing with behavioral health issues are compounded by a culture that is suspicious, if not downright dismissive, of injuries that rest in the heart and head. “Generally, it’s just hard to talk about your emotions in the firehouse,” says Alex Galang, a Sacramento City firefighter and member of IAFF Local 522. “The culture is ‘tough it out … boys don’t cry.” You don’t want to be seen as weak or that you can’t handle the stress.”

Tammy Shobert knows that mentality all too well. Her husband Matt lived and breathed the job for nearly three decades, eventually landing as the chief of Murietta Fire Department. A freak accident on the job turned Tammy from partner to caregiver and made her the target of angry emotional outbursts from a husband who thought post-traumatic stress was “only for soldiers.”

“They think they have to be tough … that it’s a vulnerability to show that they might be struggling mentally or emotionally,” she said. “They are afraid their peers would look bad on it. That has to change … it has to change.”

For his part, Matt Shobert’s awakening to the reality of post-traumatic stress prompted a new appreciation for the importance of awareness. “When I reflect back on decisions (as fire chief) regarding firefighters who make poor life decisions, I second-guess myself,” he reflected. “Were they making silly decisions or were they having some kind of reaction to the calls they were responding to?”

The Path to Healing

The jarring suicide numbers among first responders, as well as a surge of critical incidents have combined to open a dialog on the behavioral health challenges facing the profession and how to address it. Last month, nearly 300 fire service leaders in California – labor and management – gathered in Sacramento for a CPF co-sponsored symposium on behavioral health. In addition to hearing the stories of those most affected by post-traumatic stress, leaders learned about how behavioral health issues are manifest and how unions and departments in California are leading the way, creating their own avenues for treatment and early intervention.

“As we’ve learned when addressing safety issues like cancer, the best solutions require labor-management collaboration,” said CPF President Lou Paulson.

Collaboration is already resulting in programs that are working every day to ensure members get the help they need. The Granite Mountain tragedy helped prompt Phoenix Firefighters Local 493 to develop, a clearinghouse website that helps firefighters find local resources and peer counselors. This Spring, IAFF is scheduled to open its Center of Excellence for Behavioral Health Treatment and Recovery. Closer to home, Jeff Wells’ experience prompted Local 522 to ask him to work on a regional peer counseling program, developing departmental training and establishing a crisis hotline. 

“There are many different things that can cause (post-traumatic stress) but the bottom line is that (it is) an injury like any other injury,” said Wells. “We need to treat the injury and do what we can to help prevent people from getting injured.”