"9/11 changed the foundation forever," said its executive director, Ron Siarnicki, a former Prince George's County, Md., fire chief. The foundation, which believes in the essential resilience of most firefighters, began developing a program to prevent PTSD through interventions that rely heavily on peer support. Those include informal gatherings, soon after they return from a call, in which firefighters review what went right and wrong at the emergency scene. Trained firefighters administer "psychological first aid" to colleagues after potentially traumatic events.
Siarnicki has high hopes for a web-based trauma screening questionnaire that lets firefighters learn, in the privacy of their own homes, if they're at risk of PTSD. The foundation also is collaborating with the Medical University of South Carolina to educate civilian therapists in firefighter culture, because when a roomful of firefighters sense that a clinician doesn't understand their world, they're "just going to turn off," said Siarnicki.
An excellent depiction of that disdain for outside therapists can be seen in the first episode of the hit "F/X" series "Rescue Me," said Ellen Kirschman, a clinical psychologist in Redwood City, Calif. who treats firefighters, paramedics and police. In a key scene, set shortly after 9/11, a psychotherapist drops into a New York City firehouse and tells the guys sitting around the table that she's available if they'd care to talk about their feelings. "They just freeze her out," Kirschman said. "I've been in her position a lot in my life."
Given the stigma that can surround a PTSD diagnosis, some therapists have proposed the less pathological-sounding term, emergency responder exhaustion syndrome. "If we can call it something else and get them to come in (for treatment), that's great," said Roberts, the New Jersey psychologist.
A troubling spate of firefighter suicides in major cities has further highlighted the need to help firefighters with stress, grief and other emotions. Ayers said Philadelphia has lost eight firefighters to suicide in the past decade. The Chicago Fire Department reported a half-dozen firefighter suicides in the year ending in March 2009. Last year, four Phoenix firefighters killed themselves in seven months. In response, Phoenix last month launched a six-week mental health training program.
Battalion Chief Jeff Dill, of the Palatine Rural Fire Protection District outside Chicago, has mounted a one-man campaign to help his firefighting brothers and sisters everywhere. Firefighters who routinely put their lives on the line for others are reluctant to "call 911 on ourselves," he said.