If the flames licking the landscape don’t consume the firefighters, the post-incident stress just might.

Fire programs in Nevada and California are addressing the emotional side of serving as a first responder. What’s been viewed colloquially as “battle shock” or “heart sickness” in the past is now formally known as post-traumatic stress disorder, or PTSD, and it’s proving to be a very real and invasive enemy for those in the field, lashing out in a multitude of ways.

Three-and-a-half years ago, Sue Farren, a paramedic for 33 years, was in the hospital. She was recovering from a surgery to combat her initially terminal kidney cancer diagnosis when one of the surgeons who’d removed a tumor from her right kidney walked in.

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“We see a lot of this in first responders,” he told Farren. “Organ cancer.” Farren had just finalized a divorce from her husband two weeks earlier — another common fall-out among first responders. The surgeon’s comment opened the flood gates in Farren’s mind around the question, why first responders?

“When I got out of the hospital, I started researching organ cancer and first responders,” Farren said. “That would lead to heart attacks and strokes, substance abuse, and suicide … I knew this was happening to us, but I kept thinking someone would do something about this.”

She shed the bystander effect pretty quickly post-hospital, eventually creating First Responders Resiliency Inc., a nonprofit that aims to proactively address first responder PTSD.

“If stress is the number one contributing factor to diseases like cancer and heart attacks and all that, then by reducing the stress, we can reduce the disease,” Farren said. “What we do is train people proactively in stress reduction so they can not only be more resilient, but they can recover faster. We’re putting tools in their toolbox instead of giving them a Band-Aid after they’re injured.”

First Responders Resiliency, which recently contracted with Cal Fire to deliver resiliency training for the next two years, provides information through presentations and seminars. Farren and her fellow presenters share their personal stories, followed by a dive into the neuroanatomy of post-traumatic stress.

“When we get partway through that presentation,” Farren explained, “every first responder in the room goes, ‘Oh my gosh,’ because they realize this is not about a choice, it’s not about whether they’re strong enough, fast enough … this is not about any of that. These things that are happening to you are happening because of the exposure.”

That range of exposure is vast, said Mike Ming, Cal Fire deputy chief and program manager of the statewide Cal Fire support program, Employee Support Services: “That could be anything from I just witnessed my partner get burned, it could be a serious chainsaw accident, it could be a slip and a fall … It could even be watching a member or members of the public burn up and you can’t do anything about it or you tried.”

One of the biggest pushes within the statewide fire program is a push for normalization of post-incident stress, particularly on a leadership level. As a deputy chief, Ming stands in front of many classes and shows his humanity through past experiences he’s had in the service, and while a few in the audience might think him weak for revealing his emotions, he said more will show respect for the authority he holds.

“That would probably be the most beneficial thing,” he said, “to actually lead by example.”

Ming’s recognition for the need to share emotions and reactions happened back in 1991, when he was a volunteer firefighter “surrounded by all these brave men … They were my mentors.”

At one point, a call came in “which involved a 4-year-old girl … [dying] on a scene,” Ming said. He wasn’t involved with the response team during the incident. “We had a crisis intervention and I asked if I could be a part of it … I watched these men weep because they associated it with their own children and their own nieces. At that point, I was like, if I’m going to get in the service, I’d really better pay attention to the emotional/psychological part.”

In addition to the normalization and the First Responders Resiliency methods comes outreach and education to the families, helping them understand their relationships with a first responder.

Nevada is also addressing the need for first responder support. Derek Reid is a captain with the Truckee Meadows Fire Protection District (TMFPD), and the head of peer support efforts in his region.

“First responders in general are there to come to somebody’s aid on their worst day, and we’re supposed to have our lives together to mitigate,” Reid told Moonshine Ink. “We have this stigma with each other and the public’s perception that we’re the superheroes. And superheroes aren’t supposed to have weaknesses.”

TMFPD’s peer support program has a team of 27 trained peer supporters who focus on listening skills and normalization, and are able to refer first responders to an  appropriate counselor or therapist if needed. The program began a little over a year-and-a-half ago and was quickly put to the test.

“Once we established our program, I sent out our peer support contact list to every station, and a week later we had a department suicide,” Reid said. “Without that [program] in place, our department wouldn’t have known what to do. But because we had peer supporters, we were able to activate the team.”

The team performed a crisis management briefing with each station in the district, sharing accurate information about the death to avoid rumors or confusion. Reid said it made all the difference and proved the program’s worth.

Moving forward, Reid is now leading the charge for the Northern Nevada Peer Support Network, a gathering point for law enforcement, military, emergency medical services, and fire departments to share peer support contacts.

“Once we get the website stood up and all the facilities on board,” Reid explained, “we’ll create a not-for-profit and we’ll be able to do fundraisers [and] have a donation link on the website. With the monies we collect, we’ll be able to help somebody. If a neighboring facility has a suicide, we’ll be able to help with funeral expenses [and] … fly in family.”

The culture of normalizing discussion about post-traumatic stress among first responders is a progression both Ming and Farren noted.

“Thirty-five years ago, we didn’t wear gloves on trauma calls,” Farren said. “Today if you showed up on a trauma call without gloves on, you’d be suspended. We evolve as a species, as a society, as a culture. We are realizing now that  suppressing your emotions, suppressing these experiences … is contributing to making you sick.”

Ming, who spoke to Moonshine Ink from the Sonoma County fairgrounds during the recent Kincade Fire, described the progress as a “battle rhythm” moving forward, with Cal Fire out front, on the bleeding edge.

“I’ve been in this service for 28 years … I’m surrounded by my team of good quality human beings,” Ming said. “There are people, chiefs, unit chiefs … We all know people who are really high up that are willing to come forward and say,  Yeah, I’m broken.’”

Main Image Caption: HAUNTING MEMORIES: Firefighters may have to battle more than just the flames. Cal Fire Battalion Chief Bryan Farrell said he can describe specific details (including physical traits, call details, sights, and sounds) from traumatic calls over the past 29 years in his field. “These exposures are like barnacles forming on the bottom of a boat,” he said. “At first they go unnoticed, and have no effect on performance, however, if ignored can diminish performance and eventually cause a breakdown of that boat.” Photo by Wade Snider/Moonshine Ink