THE WEIGHT OF RESPONDING
This multi-part series examines how post-traumatic stress disorder, or PTSD, affects local first responders, to tell their stories and see how they cope with a problem that’s just now being truly uncovered.
This week, the FCN looks at how PTSD has been handled in the past and today, following the story of one first responder through his experiences on the job and how PTSD slowly unraveled his life.
Next week, the FCN will examine how PTSD is treated clinically, socially and professionally.
The first time that Matthew Jones saw a dead body was in 2005.
Jones had just been hired that year by the Forsyth County Fire Department. He had always wanted to be a professional firefighter, but until then Jones had only worked with volunteer departments, first in Colorado and then in Cherokee County after he moved back to Georgia with his family in 2003
As a veteran firefighter of both professional and volunteer fire departments, Jones had seen a lot of bad things, but the first time always stood out to him because of its senselessness.
While covering another firefighter’s shift, Jones and other first responders responded to the scene of a nasty wreck and found that two teens had been killed.
“It blew my mind,” he said. “It was like something out of a movie.”
After the bodies of the victims were taken away and the crew began to load up the gear, Jones remembered that a battalion chief got everyone in a circle to see if anyone needed to talk about the experience.
In the end, Jones remembers that the group went silent and no one stepped forward to say anything.
“I don’t know if I felt like I needed it. Again, I was that tough guy,” Jones said. “I didn't want to be like the one that said something. It was bad, but I put it in the back of my head and hoped it would go away.”
Because firefighters in a busy county like Forsyth County are basically working around the clock every third day, Jones and his team constantly saw people put into the worst situations of their lives, working with the stress of life or death situations and never knowing when they might be called out to do it again.
Jones said that when bad things happened, they learned to juggle their emotions by filing them away and ignoring the memory, or by making light of it with black humor.
He said that they quickly realized how much worse it was to deal with very young or very old people in bad situations, remembering their pain and helplessness.
The Forsyth County Fire Department Rules and Regulations lists that there are certain incidents, like mass casualty events, death of children, death or serious injury to a firefighter, that warrant more scrutiny from command staff, chief officers and battalion chiefs.
Division Chief Jason Shivers, spokesman of the Forsyth County Fire Department, said that these incidents are generally evaluated more intensely because of their inevitable impact on the first responders.
“For one particular reason or another, the incident has indicators that we pick up on,” Shivers said. “But the death of a child is almost always when we start being concerned.”
Shivers said that when these incidents do occur or it is otherwise deemed necessary by command staff, the department mobilizes a number of its officers who are trained in critical incident stress management to meet with crews that experienced a traumatic event and give them a chance to talk about it.
Like the county fire department, the Forsyth County Sheriff’s Office developed and adopted a number of critical incident stress management techniques for when its deputies are put into traumatic, high stress or abnormal emotional incidents while on the job.
According to Sgt. Terry Hawkins, agency coordinator for the Forsyth County Sheriff’s Office Crisis Intervention Team, over the last decade the department has attempted to improve retention of deputies after traumatic events and reduce the stigma of seeking mental health professionals.
Hawkins said that after an incident, they will meet with affected individuals to tell them what they should expect, help normalize their experiences or give them coping strategies and a chance to talk.
“The body has natural responses to those kinds of incidents. It’s predictable,” Hawkins said. “And we have evidence-based practices that can mitigate those impacts to our personnel.”
‘How we’re made up’
Critical Incident Stress Debriefing is a method of dealing with critical incident stress that is experienced during traumatic events. The process involves talking about stress-related symptoms and discussing involvement, thoughts and feelings relating to a traumatic incident and providing techniques to deal with them, according to the fire department’s standard operating procedure handbook.
“Sometimes it’s the next day or the next shift, but that’s one of the first places where you start to recognize if someone needs further help,” Shivers said. “It’s an initial effort with some recognition and ability to let people gather and start talking their way through an incident.”
But according to Shivers, rarely, if ever, do firefighters actively participate in debriefings, choosing instead to try and move past it and get back to work.
“I won’t even use the word hesitation as much as I would use the word almost refusal,” he said.
“Frankly, it is rare for a firefighter to truly take that opportunity and open up. It’s just how we’re wired.”
Shivers said stress is an integral and inseparable part of being a first responder, and learning to cope and care for yourself mentally is just as important as learning how to lay attack and supply lines when fighting a fire or how to drive an engine or ambulance properly.
“We don’t have the luxury of being able to build a battle plan for every incident,” Shivers said. “It’s literally a matter of training, training, training and experience ... expecting the unexpected is the rule that we have to live by.”
But beyond training and preparation, Shivers said the team aspect of firefighting means the vast majority of personnel experiencing critical incident stress will go undiagnosed and unreported to command staff.
“Hardly any of those ever actually make it to fire headquarters,” Shivers said. “That’s not how firefighters are wired. That’s why our world is relatively fragile in how it’s built, and this is a distinction between us and law enforcement.”
He said that in his 20-plus years on the job, he has seen his companions and teammates turn to each other to deal with problems, whether it be as simple as a malfunctioning lawnmower, to deep delicate issues like nightmares from a traumatic call.
“You solve your problems around the supper table in the fire station,” Shivers said. “(Former) Chief (Danny) Bowman’s always said it and there’s no truer statement I’ve ever heard ... a quiet fire station is very dangerous, because if you walk into a fire station after a bad call and it’s quiet, something’s wrong.”
For the sheriff’s office, Hawkins said that possibly the most important part of righting that “something wrong” is just explaining to deputies what they might feel or experience after something like a fatal shooting or a serious vehicle wreck.
By explaining that, he said they let deputies know that everyone experiences what they are feeling and nothing is wrong with them.
But it wasn’t always like this. In his 18 years at the department, Hawkins said that he has seen the way local law enforcement thinks about mental health change drastically, as the old guard filtered out and the world began to really learn about Post-Traumatic Stress Disorder, or PTSD, during the war on terror.
“It's not shameful or it shouldn't be considered shameful because it's normal, and because it's normal it’s predictable,” Hawkins said.
‘I don’t think I slept again after that’
When Jones began struggling, what he was feeling didn't seem normal or predictable at all.
For several years, he coped with the worst experiences imaginable by compartmentalizing his life and filing the memories away.
But in 2012, that stopped working when he and his team responded to a drowning call involving a 6-year-old boy. Jones performed CPR on the boy in the ambulance on the way to the hospital and was crushed when the child died at the hospital.
Jones said that for whatever reason, there was no debriefing called after the drowning and no way to get past it by ignoring it or by making light of it like in the past.
He said that even if they had held a debriefing after the incident at the pool, he wouldn’t have wanted to talk about it and “appear weak” in front of his crewmates.
So instead he closed himself off from everyone while the memory festered like an open wound.
“I don’t think I slept again after that,” he said. “I don’t really even remember going back to the station that night ... I know I didn’t sleep a wink and I went home that next morning and drank until I was drunk.”
Jones began drinking more and more on his days off. He knew it was wrong, Jones said, but getting drunk was the only way he knew how to cope with what he was feeling.
“It was daily,” he said. “My wife and kids would be asleep and I’d be sitting on the front porch with a beer in my hand talking to myself the whole time ... but that didn’t stop the fact that when I’d get overwhelmed or flooded with thoughts, it was the fastest way to get rid of them.
“I don’t think I could drink fast enough. It got to the point where I built up such a tolerance; I almost couldn't even get drunk anymore.”
Eventually, Jones considered himself a functioning alcoholic. But he took painstaking efforts to make sure the drinking wasn’t affecting him on the job.
“I was still responsible enough to quit drinking the day before I went (to work),” Jones said. “I never showed up to work high, drunk, nothing, not once and that's one thing I’m proud of. When I took that oath, that was important to me.”
Every day, every shift, the effects of sights, smells and events on Jones began to grow worse.
“In the end, I see every one of them, there’s not a road I can’t go on in Forsyth County that I didn’t respond to something on,” he said. “I see their faces, I know what it smelt like ... I don’t know how else to say it ... Whatever was going on, I didn’t need any more faces.”
At the same time, Jones felt stuck. He knew that the department needed to know what he was going through, but he felt unable and unwilling to expose what he thought was his weakness to his co-workers.
Every time he thought about going to fire headquarters to let someone know what was going on, Jones said he couldn’t make himself do it. He often imagined getting in a wreck that would save him from facing his coworkers.
“I just couldn’t get there .... I was hoping that I would run off the road or that someone would hit me, just as an excuse not to go,” he said. “I surely didn’t want them to see me having a panic attack and not being able to function. I didn’t want anyone to see it.”
According to multiple mental health experts, what Jones was experiencing was a classic presentation of post-traumatic stress symptomatology: avoidance and re-experiencing of memories, hyperarousal to situations, sights and smells, and an exaggerated fight or flight response.
Dr. Nancy Wesselink, founder of One Source Counseling and Employee Assistance Services, a group that specializes in assisting public safety organizations with mental health services, said that the type of alcohol abuse that Jones exhibited is not uncommon of untreated cases of PTSD.
Wesselink said that while alcohol or drug abuse is not necessarily indicative of a PTSD diagnosis, it is part of the high risk behavior that they often see associated with it.
“Behavior may be riding the motorcycle a little too fast, going running into a fire without thinking really clearly about their own safety and the safety of others,” she said. “This, behaviorally is where we can pretty much see the outward visibility factor of PTSD.”
After almost two months of struggling with the drowning incident, Jones’ mom, Sharon, found him drunk and crying in his bathroom. She convinced Jones to call in sick to his lieutenant for the first time.
“I was home, of course drunk, sitting on the toilet drinking,” he said. “She knew something was wrong because she came over and I was just sitting there crying ... that was the first person I ever said anything to.”