While life-threatening and highly stressful events such as firefighting, a child’s death or horrific fatality incidents have adverse reactions on emergency response professionals, they receive little if any training or support to manage emotional trauma and grief. Our Grieving Behind the Badge program offers advice and skills to help them cope. We welcome the opportunity to facilitate a workshop for your department or conference. Please contact us at peggy@sweeneyalliance.org for our brochure. Read more!

Life-Alerting Events: Retirement

by Peggy Sweeney
Despite the fact that the fire service is one of the most physically demanding, highly stressful, and emotionally challenging professions firefighters receive many benefits for their dedication. Unlike other jobs, firefighters share a special bond with the members of their department that is seldom seen outside the fire service community. They laugh together. They care for the needs of one another. On the fireground or responding to an emergency call a firefighter is never alone. They perform their duties as a team and safeguard each other’s lives. They thrive on the adrenaline rush and the overwhelming feelings of a job well done following a good call. Firefighters need to feel needed. Although firefighters often find themselves in life-threatening situations in order to protect and care for the needs of others, these unselfish acts give meaning and purpose to their life. Many of the benefits you enjoy as an active firefighter are often sacrificed when retirement becomes your way of life. As with many other life-changing experiences you may find yourself grieving what you have lost.
Retirement. What does that mean for you personally? If you are young, those glorious days may feel as if they are an eternity away. You hardly give it any thought. If you are a seasoned veteran and your dreams of rest and relaxation are just a few years or even months within your grasp how do you feel right now? Are you anxious to receive your reward for the many hours of dedication as a firefighter? Have you planned all your life for that moment in time when you can enjoy the fruits of your labors? No more stress. No more sudden alarms, screaming sirens in your ears, or back breaking work. Retirement will also mean the end to a lifetime of coping with the emotional trauma of witnessing countless human tragedies and the beginning of peace and happiness. Are you ready or are you apprehensive? Maybe this article will help you eliminate some of your uneasiness.
I am sure that for many retired firefighters retirement is everything and more then they had hoped. They are basking in all its merit and their former duties and responsibilities are happy memories. But I believe that for some firefighters retirement has proven to be less then they had envisioned. Retirement is change. After years of living life by schedules, pagers, and job-related responsibilities it can be very difficult for some people to adapt to retirement. Not only can this new way of life be difficult for the person who is no longer working but this new lifestyle can be challenging for their spouses as well.
During your active career relationships and commitments to family and friends were greatly influenced by the role you played within the fire service. No matter how rewarding life as a firefighter was your personal rewards following a job well done may have come with a high price. As often as you may have planned to devout quality time with your family, we all know that the demands of the emergency service world do not always permit us to accomplish this goal. How many times did you disappoint your family because you had to respond to a call? How many family celebrations were shared without your presence? Although your loved ones accept your commitment to duty and are proud of your dedication this does not lessen the feelings of guilt you may have had for disappointing them.
Let us focus for a moment on some of the positive advantages that freedom from work will offer you. Retirement will give you time. Time to spend with those you love. Time for hobbies, travel, and much needed relaxation. Time to decide what you want to do with the rest of your life. I’ll admit that retirement may mean that you will have to sacrifice some of the benefits you had as a firefighter. You may never quite experience the excitement of the adrenaline rush again; however, you can still find reward and realize a sense of accomplishment that will satisfy your need to feel needed. Join a community service organization. Use the talents you gained as a firefighter to teach people about fire safety. Become a mentor to young adults eager to become a firefighter or EMS provider. Your choices are endless. As you search for meaning and purpose to your life as a civilian I have no doubt that there will be numerous opportunities before you.
Do not be apprehensive about retirement. Instead of focusing on what you will lose celebrate life without constraints and the many positive goals you can achieve. In spite of what you may be feeling now never forget for one moment that you are needed. Congratulations on a job well done! Retirement… Enjoy!

Copyright Peggy Sweeney. All rights reserved.
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Life-Altering Eevnts: Addictions

by Peggy Sweeney
No one intentionally chooses an unhealthy behavior or habit. These destructive tendencies usually develop over a period of time and are often the result of physical and/or emotional trauma or multiple traumas. In this article, we will explore some of the reasons we make the choices that we do as well as some of the struggles people must cope with during their recovery from addiction.
Several years ago, I served as a consultant for a local hospital. During that time, I provided help and support for adult and adolescent patients recovering from chemical dependency and emotional trauma by way of one-on-one conversations and group support meetings. The patients shared their personal stories of grief, abuse, and other misfortunes that had influenced their need to find a way to cope with these events. Flashbacks from childhood of sexual, physical, or emotional abuse were common themes as well as feelings of abandonment by a parent or caregiver due to death, divorce, incarceration, or the unwillingness to care for their offspring. Some adults remembered the shame they felt as children or teenagers when classmates and neighborhood bullies belittled them because of their appearance, physical abnormalities, or social status.
Traumatic events that happened during childhood are not the only reasons for addictive or unhealthy behaviors. Sometimes the paths we choose in our adult life lead us into the world of emotional chaos and nightmares. The day-to-day occurrences of human tragedy and suffering witnessed by firefighters and emergency service personnel as well as life-threatening situations they encounter are prime examples of this. Although we thrive on the adrenaline rush and the good feelings of a job well done helping others, tragedy and trauma can and often do take their toll on us. Some of these men and women are able to cope with these experiences. Many, unfortunately, cannot. As each new stressful or traumatic event occurs, the need to heal mentally and emotionally builds until they must find an outlet for their inner pain.
Addiction or unhealthy behaviors manifest themselves in many ways. Alcoholism, substance abuse, and gambling are some examples of a person’s need to find solace for coping with life. Many children not only suffer from chemical dependency but also express their cries for help through self-mutilation, sexual promiscuity, and eating disorders. Adults and children alike may communicate their feelings of fear and anger through violence.
Addiction does not happen overnight but rather over time. For instance, what may begin as a few beers to numb our feelings and temporarily block out the horrific scenes that play over and over again in our mind eventually become many beers in the same time period. We have a strong need to suppress what is painful to remember. We want to erase from our memory all the unpleasantness in our life. Unhealthy habits or addictions become the outlet for overcoming the emotional and physical suffering we have endured. Unaware of what is happening, we add another element of struggle to our life. Now we must not only resolve the issues that brought us to this place in life, we must also cope with one more demon: the addiction or harmful behavior. This demon has the power to destroy our life and the lives of those we love. Our unhealthy remedy (the addictive/harmful behavior) to heal our emotional wounds may become a financial burden in addition to a detriment to our health. In some cases, addiction can result in job loss, long-term disability, incarceration, or even death.
Once someone has acknowledged his or her addiction problem, recovery must follow. Recovery is not easy. It is not a sugar-coated cure for emotional trauma, but rather a lifelong commitment to coping with life without the aid of alcohol, chemicals, or other addictive activities. Nonetheless, the benefits from recovery far outweigh the consequences of addiction.
As I stated previously, recovery from an addiction or unhealthy habit is never easy. Case in point: Someone has acknowledged that they have an addiction to alcohol. They have begun their rehabilitation within the safe confines of a treatment facility. During this time, they have undergone physical withdrawal from alcohol, daily one-on-one and group meetings with counselors and other alcoholics as well as rebuilding relationships with family and friends. The source of the addiction has been removed from their life for now. The patient is given advice and resources to help them address and resolve the events in their life that played a major role in the addiction process. As difficult and painful as it may be to talk about our memories and feelings, I believe this is a key factor to recovery. At the end of their time in the treatment facility they must return to everyday life and deal with situations that challenge their abstinence.
Remember that this unhealthy pattern of coping with emotional trauma has developed over years. Staying sober is not easy. It will be their responsibility to make choices that will help them avoid a relapse. For instance, they may realize that certain places of entertainment that they once enjoyed must now be avoided at all costs for their sake. A major challenge facing people in recovery within the emergency response community is the recurring stressors and traumatic events that may have lead to their addiction. It will be very important for them to receive encouragement and support from family members, co-workers, and friends as they re-invest in their new life. I support the fact that their choice for an addiction-free life is their responsibility but no one can do it alone. If someone you love or care about is in need of your help, do not judge him or her by their addiction but rather by the gifts and talents they possess. With your help, their addiction can become a life-altering event of recovery and inner peace.

Copyright 2004 Peggy Sweeney. All rights reserved.
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Life-Altering Events: Disabling Injuries

by Peggy Sweeney
   There is an epidemic sweeping this country that is finally getting the attention it deserves. Injuries and deaths among emergency response workers are at an all time high. Recent studies have shown that firefighters in the United States have an estimated fatality rate of 12.7 percent per 100,000 workers, more than twice the national average1. According to the US Department of Labor Bureau of Labor Statistics, in 2006 the fatality rate for firefighters was 16.6 percent of all occupational fatalities2. Emergency response workers “are more likely than other workers to die violently—from gunshots, vehicle accidents, and fire-related incidents. Their risk of suffering a fatal incident is three times greater than for all workers.3”    Patients under the influence of narcotics or alcohol, family members of the victim or bystanders may threaten them with knives, guns, physical assault, or verbal abuse. They are constantly exposed to the dangers of communicable diseases such as Hepatitis and AIDS. Occupational injuries such as back strain from lifting patients and hearing loss due to loud sirens are routine in their line of work. Recently more and more injuries and deaths are occurring because firefighters and EMS workers are not wearing their seatbelts. Government agencies including the United States Public Health Service and Department of Labor as well as the National Transportation and Safety Board are finally addressing these incidents of job-related injuries and deaths and making recommendations to protect their safety and health.
   Although personal protective equipment is protocol for firefighters and pre-hospital caregivers, studies reveal that additional safeguards for the health and safety of these workers need to be standardized. Mandatory classes in the safe operation of emergency vehicles as well as self-defense and strength building programs will further reduce death and injuries. These same studies have encouraged all fire and emergency service directors to take an active role in protecting the health and wellness of their staff.
   What effect can a disabling injury or illness have on the mental and emotional well being of someone in the emergency response community? How can someone cope with the trauma of a permanent disability that prevents him or her from performing their duties as a firefighter or EMS professional? What can you do to prepare yourself should a tragedy such as this happen to you? These are some of the issues addressed in this article.
   As providers of care, we have talents most civilians do not. We thrive on the good feelings of a job well done when we are able to make a difference in someone’s life. Each of us made a conscious decision to become a firefighter or emergency service provider because we wanted to help others in distress. We do not take our calling lightly but rather seek to be the best we can be. When one of us suffers a physical injury or life-threatening illness that takes away the very thing that gives meaning to our life we grieve. This type of loss is similar to having someone we love die. We may experience many of the same feelings and emotions that we do when we are bereaved. We believe that our role in society as caregiver or firefighter helps to define who we are and our value as a person. In other words our self-worth. When this defining element is eliminated due to a permanent disability, we may think that we are less of a person or no longer of value to our family or the community we served.
   No one should take life for granted. In the blink of an eye your future can be forever changed. What if something unforeseen happened that would prevent you from fulfilling your planned role in life? What would you do? How would you reinvest in life following a catastrophic injury or illness? God willing you will never be faced with a crisis of this magnitude. However, it is important that you take the time now, while you are healthy, to explore your options if a tragedy happened. Center your choices on your talents. Choose a career that will give you the same feelings of accomplishment that you have now in emergency service. Never forget that there will always be someone who needs you. There are many people in your community who would benefit from your help and expertise. If you make decisions with an open mind and a loving heart, I have no doubt that if you are ever faced will a disabling injury that the choices you have thought about now will enable you to heal physically and emotionally.
   If you are one of the many professionals that have suffered a disabling injury, I hope my words will offer comfort and help in coping with your loss. As you begin to heal physically, you will need to heal emotionally as well. You may feel at times that you are riding a roller coaster. Up one day and down into despair the next. This is normal. You may experience anger because fate has stepped in and robbed you of so much. Surround yourself with family members and friends who will provide a positive outlook for your future. Draw upon your inner strengths. You have always had goals and dreams. As a result of your disability your goals and dreams for life will need to be redefined or altered. This does not mean that you are less of a person in any way. You will need to accept your limitations and accommodate your life to fit your disability. You can and will remain a valuable asset to your family and community.
   In conclusion, I strongly believe that emergency response administrators should make every effort to allow disabled firefighters and EMS personnel to participate in the day-to-day activities of the department should they so desire. Although these men and women may be unable to fulfill their former responsibilities they still have much to offer. Their knowledge base is invaluable to new members of the departments. They can lend assistance to the staff in many areas including moral support following a stressful emergency call. Do not overlook these opportunities. You will be helping them not only recover emotionally from their injuries but more importantly you will be offering them an outlet to regain their feelings of self-worth.

Copyright 2004 Peggy Sweeney. All rights reserved.

1 Maguire BJ, Hunting KL, Smith GS, Levick NR. Occupational fatalities in emergency medical
services: a hidden crisis. Ann Emerg Med 2002;40:625—32.

2 U.S. Department of Labor, Bureau of Labor Statistics, Census of Fatal Occupational
Injuries, 2006.

3 Clarke, C. & Zak, M. (1999). Fatalities to law enforcement officers and firefighters, 1992-97.
Washington, D.C.: United State Department of Labor, Bureau of Labor Statistics.


About the Author: Peggy is a bereavement educator and formerly a firefighter, EMT-B, and a mortician. She has conducted numerous workshops and support groups that offer help to families and professionals coping with life-altering events. Her seminars address difficult topics such as grief, divorce, abuse, long-term illness, and the quality of life. A special program entitled Grieving Behind the Badge deals with the emotional wellness of firefighters and other emergency response professionals and their families. You may contact Peggy through e-mail at peggy@sweeney-alliance or by calling 830.895.5759 to request a brochure.
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Emotional Support for Line of Duty Death Survivors

"Firemen are going to be killed right along. They know it, every man of them... firefighting is a hazardous occupation; it is dangerous on the face of it, tackling a burning building. The risks are plain.... Consequently, when a man becomes a fireman, his act of bravery has already been accomplished."
   ~~~Edward F. Crocker, Chief of Department, FDNY 1899-1911

by Peggy Sweeney
   Local newspaper headlines report the sad news of another fallen hero; the tragic death of a brave firefighter who has died in the line of duty. A dedicated professional who sacrificed his or her life that others may live or that homes and property would be saved from the ravages of fire. Most people half-heartedly acknowledge the event while searching for more significant information relating to their personal lives; a baseball score, stock market figures, want ads, or horoscopes. This newsworthy article is often overlook by the casual reader. Civilians can not relate to this type of tragedy nor can they comprehend the depth of grief and pain that every member in the fire service feels. Their lives will not be changed by this tragedy. Unfortunately this is not true for the family and co-workers of this fallen hero. Life as they knew it will never be the same again. Emotions run rampant and their seemingly normal lives spiral into a frightening and dark abyss where pain, loneliness and grief are constant companions. Surviving this personal tragedy is at times almost unbearable. How does one survive? What lessons can be learned from these experiences?
   Before we can learn to cope with pain and grief, we must first understand why we feel and respond to traumatic events as we do. In any loss (divorce, loss of a friendship or job, or geographical relocation) there is grief and mourning. Grief is the emotional, physical, mental, and even spiritual responses human beings experience when their dreams and plans for life take an unexpected turn. Mourning is our outward expression (such as crying) to these feelings. A small loss experience such as a rained out ballgame or a broken promise can cause grief. We are disappointed, saddened, or angry at the outcome. We unwillingly must surrender control of a situation to unforeseen circumstances or to another person. Grief and mourning are normal, healthy responses. Each one of us journeys through grief in our own way and on our own time schedule.
   When someone dies, our response to this loss is equal to our relationship with this person. The stronger the emotional bond the more intense the grief reactions. To illustrate, the death of an acquaintance pales in comparison to the death of a much loved family member, friend, or co-worker. In addition, the manner of death (sudden or anticipated) and our personal life stressors will also influence our grieving.
   When our loved one dies suddenly (auto accident, heart attack, line of duty death) we experience immediate grief. There is no time for goodbyes. We cannot tell them we love them, let them know how much we value their friendship, or ask forgiveness. In contrast, when a loved one dies from a long-term illness or injury (anticipated death) we may have had the opportunity to prepare for the loss. This is not to say that we will not grieve following an anticipated death but rather that our length of grieving and the extent of our pain may be lessened somewhat because we have expressed our thoughts and vocalized our love and have helped the one who is dying accept their death and put closure to their life. Furthermore, our grieving process may be complicated by various everyday problems like job-related stress, family struggles (such as divorce), financial worries or personal health issues. These distractions can greatly influence our ability to focus on our grieving which can delay or even suppress the grieving process.
   Healing grief is not an easy task. Your grief journey is like a roller coaster ride. Just when you think you are doing better, a memory or a special event in your life will hurl you into the depths of despair. Rejoice in the good moments and days you have; they will help you survive the more painful and lonely ones. Surviving a loss takes a very long time; many months or even years. Get plenty of rest, eat healthy, and exercise. A journal of your thoughts and experiences will mark your progress in healing and your reinvestments in life and living. It's ok to cry. This is not a sign of weakness. You are not going crazy. You are very normal.
   Do children grieve? Many people believe that children are resilient. When someone they love dies, they may continue their normal behaviors (playing, interacting with their peers, or even misbehaving) in spite of this person’s death. It may appear that this death has not made an impact on their lives. Do not be deceived. Children, even toddlers, are affected and do grieve. It is important to continue their normal routine as much as possible. They will need tender, loving care. While it may seem that they are adjusting to life after the funeral, it is imperative to keep the lines of communication open. Do not be afraid to share your feelings and frustrations with them. Don't shy away from talking about the deceased person or asking the child how they are feeling. Be aware that some adolescents and teens may experiment with drugs or alcohol as a means of coping with their grief and emotional pain. A family that has suffered the devastation of loss must reach out and help one another.
   A line of duty death impacts the life of every member of the department as well as their families. It is imperative that they are given information about grief and how to cope with the pain and suffering it creates. The tragic event may trigger nightmares, anxiety, anger or guilt. It is very important to their physical health and emotional well being that these men and women are provided with an outlet to express their feelings. As a result of this life-altering event, they may question their self-worth. They may wonder if anyone appreciates the risks they take.
   There are many lessons to be learned on the journey through grief. This special hero has touched many lives and in their living and dying they have shared their gifts and talents and have taught us the value of life. Reach out to adults and children who may be hurting emotionally and share with them all you learned from your grief experience. By reinvesting in life and sharing love with others you will honor this hero who made the ultimate sacrifice. In so doing, they will never be forgotten.

Copyright 2008 Peggy Sweeney. All rights reserved.
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Firefighters at Risk

     In 2000, I wrote a research paper on the effects of stress and grief on firefighters. My efforts were the result of my personal experiences as a firefighter, EMT-B and mortician witnessing first-hand the emotional trauma these men and women experience in the field. I strongly believe that programs such as Grieving Behind the Badge must be provided to help reduce heart attacks, suicides, substance abuse and divorce in the fire service as well as the emergency medical service and law enforcement communities.

EXECUTIVE SUMMARY
     The rapid growth of business and industry in the United States over the last few decades has precipitated a growing concern by government agencies to enact laws and establish guidelines on workplace practices to protect the health and safety of workers. A key issue that has become paramount is the effect of job-related stress on the physical, mental, and emotional health of adults in the workplace.
     As the result of the overwhelming concern for firefighters' health and safety, organizations including the International Association of Fire Chiefs and the National Fire Protection Association have recommended safety guidelines and training programs that will reduce injury, death, and long-term emotional stress in the fire service. Although most fire departments have implemented the safety guidelines, many have not provided resources for coping with stress and grief. This may be the result of insufficient budgets, scheduling problems, or lack of interest. However, the rise in the divorce rate and health problems related to stress and grief in the fire service community have made educational programs to cope with these issues necessary and crucial for the emotional health and physical wellness of firefighters.
     This paper discusses the current situation of job-related stress in the fire service, the effects of stress and grief on its members, and the additional burdens faced by volunteer firefighters. Furthermore, information will be provided with respect to the Grieving Behind the Badge program offered by the Sweeney Alliance. This educational workshop is the solution to these problems and promotes emotional wellness for all firefighters as well as their families and fire department chaplains.

INTRODUCTION
     Today, in the United States, what were once considered safe environments are now battlegrounds. No longer are schools, homes, places of business, or even churches safe from violent acts of aggression. Moreover, our society is witnessing an alarming increase in homicides, rapes, domestic violence, child abuse, and highway injuries and deaths. The aftermath of these traumatic events is having a devastating and adverse reaction on everyone. Nowhere is this more apparent than in the emergency service professions: the men and women who serve their communities as firefighters and pre-hospital caregivers. Their daily experiences with life-threatening and highly stressful events are affecting them physically, mentally, and emotionally. Furthermore, divorce, substance abuse, and heart attack rates in these professions are among the highest in the nation. "In the fire service, heart attacks claim more lives than any other line-of-duty injury" (International Association of Fire Chiefs' Foundation [IAFCF], 1991). Efforts have been made to address some of the critical needs of these community servants. However, there is a lack of opportunities to deal with job-related stress as well as personal trauma and grief for firefighters, their families, and fire department chaplains.

History and Background of the Problem
     Many jobs are considered dangerous and stressful by their very nature. Firefighting is one of the most life-threatening and emotionally traumatic occupations. The high levels of stress that firefighters routinely encounter can lead to chemical dependency, physical illness, emotional problems, post-traumatic stress disorder (PTSD), and poor interfamily relationships such as divorce. The lack of public support and compassion by citizens, government agencies, and business officials for the risks these firefighters endure and the occasional negative editorial coverage by the news media adds to their anxiety level.
     On average, one hundred firefighters die every year in the line of duty. Of these one hundred deaths more than one third is due to heart attacks either while on duty at the fire scene or shortly thereafter (United States Fire Administration, 1999). Evidence suggests that stress plays a major role in chronic health problems such as cardiovascular disease and psychological disorders (Substance Abuse and Mental Health Services Administration [SAMHSA], 1995). Furthermore, "it is not known for certain, but it is believed that stress may lead to mental illness (including depression), substance abuse, divorce, criminal behavior or suicide” (IAFCF, 1991). Unfortunately, it has not been until recent years that emphasis has been placed on the emotional and mental needs of firefighters. Organizations and agencies such as the International Association of Fire Chiefs and the National Fire Protection Agency have recently made recommendations and implemented standards to address the growing problem of job-related stress along with physical and emotional illness in the fire service.
     Firefighters receive little if any training or support to help them cope emotionally with stress. Following a traumatic incident (the death of a child, a mass fatality, or the death of a fellow colleague) some fire departments may implement a critical incident stress debriefing (CISD) or offer the assistance of a department chaplain. However, only a small number of departments offer educational programs on coping with stress. The International Association of Fire Chiefs' Foundation (IAFCF) states that, "with the plethora of recommendations for controlling stress in the fire service, few have been implemented" (1991). This may be due to the lack of initiative or funding. Some department administrators do not believe that help is needed. They believe that traumatic incidents are part of the job and firefighters must learn to cope as best they can with their stress and depression. Retired firefighter, Dr. Harry Carter, writes, "The pressures of life are far greater than they were in the past.… If you mix the problems we all face with our families, our health, and commitments to the community, you can wind up with seemingly insurmountable problems (2000, March 8).      Fire departments that want to offer training programs for coping with traumatic events may not have the financial resources to do so. Furthermore, firefighters are frustrated by the federal government’s willingness to fund similar programs for law enforcement officers but seemingly disregard their needs. For example, the National Institute of Justice (NIJ) funds the Corrections and Law Enforcement Family Support program (CLEFS). From 1996-1998, the NIJ awarded twenty-five grants totaling two million dollars. The "grantees are providing stress services to law enforcement and correctional officers and their families…" (NIJ, 1999).

Scope of the Study
     The Sweeney Alliance has developed and implemented many educational workshops and community service projects for families and professionals. Because firefighters want help and support in coping with their emotional problems, the Grieving Behind the Badge training program was developed to help them understand and cope with post-traumatic stress issues. This program addresses incidents of job-related stress as well as grief issues encountered in their personal lives; such as, divorce, death of a loved one, or a long-term illness of an aging parent to name a few. Likewise, the Grieving Behind the Badge program is beneficial for the families of firefighters, fire department chaplains and fire academy students.

LITERATURE REVIEW
Definitions
     The terms emergency service professional and emergency service worker in this paper mean firefighters (paid and volunteer) along with trained professionals skilled in pre-hospital care to patients (first responders, emergency medical technicians, and paramedics). The terms firefighter, emergency service professional, and emergency service worker are interchangeable. The use of the male gender is in no way meant to overlook or make light of the many contributions women make to these professions. This terminology is being used for simplicity and ease in writing. In addition, the term grief in this paper means the feelings and emotions following any loss that contributes to a person's stress levels.

Stress in the Workplace
     The concern for the health and safety of Americans has prompted the federal government to implement programs and set standards to reduce injury and death in the workplace. For example, the Occupational Safety and Health Act (OSHA) has addressed the issue of hazardous materials by regulating the proper clothing and protective eyewear that must be worn by persons who come in contact with or who must handle these dangerous agents. Safety devices on machinery, proper ventilation of highly toxic gases and fumes, and strict rules for handling blood-borne pathogens further enhances the safety and health of today’s workers.
     Job-related stress is another priority in today's workplace environment. Job-related stress is not only a serious concern of workers, but it can affect health organizations as well. The short- and long-term aftermath of stress on the job can eventually increase workers' compensation costs, medical and mental health premiums, and death benefit payments. According to the American Psychology Association (APA, 1997), "… stress costs American industry more than $300 billion annually" as the result of absenteeism and reduced productivity. On average, forty-three percent of adults in the United States suffer adverse health effects from stress following corporate downsizing, company layoffs and mergers, and bankruptcies. Additional stress can be brought on by "computer surveillance of production, fewer health and retirement benefits, and the feeling they [workers] have to work longer and harder just to maintain their current economic status" (Miller, L. & Smith, A., 1997). However, these examples pale in comparison to the stress incurred following a traumatic event that threatens the safety and emotional well being of employees. "Traumatic stress encompasses exposures to events or the witnessing of events that are extreme and/or life threatening" (Volpe, 1996). These extreme or life threatening events include deliberately caused man-made disasters (homicides, arson, etc.) and accidental disasters, such as motor vehicle accidents, fires, and explosions. It is important to note that "homicide is now the second most common cause of death in the U.S. workplace" (VandenBos, G. & Bulatao, E., 1996). Examples of other traumatic disasters include September 11, 2001, the Oklahoma City bombing, train derailments, airline crashes, and school shootings.
     Following any type of stressful situation most adults will experience some degree of emotional instability. They may feel nervous and apprehensive. They may experience guilt, anxiety, depression, and sleep disturbances or they may be unable to concentrate for long periods of time on simple tasks. However, for adults who suffer from traumatic or chronic (long-term) stress, the long-range effects may include high-blood pressure and an increased susceptibility to heart disease, diabetes, and cancer. Furthermore, the Substance Abuse and Mental Health Services Administration (SAMHSA, 1995) states that chronic stress may cause "psychological problems including depression, withdrawal, apathy, and relationship problems in general." In addition, this type of stress can lead to an “increase use of alcohol, tobacco, and other drugs.” If left untreated, chronic or long-term stress can lead to post-traumatic stress disorder (PTSD). PTSD is a condition that manifests itself through flashbacks (mental or visual re-experiencing of a trauma), nightmares, a sudden and painful onslaught of emotions, or avoidance phenomena, which affects the person’s ability to relate well with others (American Psychiatric Association, 1997). Moreover, the Occupational Safety and Health Administration has declared, “stress a hazard of the workplace" (APA, 1997).
     Companies and government agencies continue to address the safety and health of employees as well as their emotional needs. Moreover, business owners and human resource managers are taking a holistic approach to employee wellness. These business leaders realize they must provide not only a safe working environment, but also a workplace that offers positive mental and emotional re-enforcement; much more than the proverbial "pat on the back." In the past, stress, grief, and violence in the workplace were topics that few company executives viewed as potential problems. However, these issues have initiated the implementation of support programs and training seminars. Classes on time and anger management, conflict resolution, and self-defense tactics as well as coping with stress and grief have been effective in promoting a healthier and safer work environment. These programs have helped associates and their families cope with an array of emotional issues thus promoting a healthier outlook on their job and their personal life.

Stress in the Fire Service
     With the advancement of fire prevention technology, such as flame-retardant building materials, smoke detectors, and sprinkler systems, fire departments are responding to fewer and fewer fire calls than ever before. However, for the more than one million firefighters in the United States, firefighting is still considered a very hazardous and highly stressful occupation. Firefighters are at greater risk of injury and death than most other professions as the result of flames and intense heat, “poisonous, flammable, or explosive gases and chemicals, or radioactive or other hazardous materials” (Bureau of Labor Statistics, 1999). Clark & Zak (1999) state that firefighters “are more likely than other workers to die violently—from gunshots, vehicle accidents, and fire-related incidents. Their risk of suffering a fatal incident is three times greater than for all workers.” Likewise, firefighters risk the chance of injury and death with every emergency call that they respond to. Patients under the influence of narcotics or alcohol, family members of the victim, or bystanders may threaten them with knives, guns, or physical assault. "Firefighters often become the object of a victim's anger" or they may be "blamed for not doing enough" (IAFCF, 1991). Because of this, many fire departments have issued bulletproof vests to protect the lives of their members.
     Fire departments respond to more and more non-fire emergency calls. For example, "In 1997, there were over 10 million emergency medical calls made to fire departments in the United States" (Clarke & Zak, 1999). Because of this, firefighters are usually the first on the scene of accidents, suicides, and acts of violence (assault and battery, rapes, bombings, school shootings, etc.). Emergency service workers respond to floods, earthquakes, and airline crashes where the death toll and property destruction is overwhelming. They care for victims of domestic violence and child abuse. Firefighters extricate mangled bodies from motorized vehicles following an accident and provide medical assistance to homeless patients on the streets of inner cities. At times, they must physically restrain patients who are combative due to mind-altering drugs or head injuries. Likewise, they comfort parents and family members when a child or loved one has died. All too often they must cope with grief following the death of a fellow firefighter in the line of duty. As a result of these examples and many more, "firefighters frequently experience trauma, death, and sorrow" (NFPA, 1997).
     Firefighters routinely struggle with the trauma of witnessing tragedy and death. The frequent contact with patients who die has a profound effect on the emotional well being of emergency service professionals (Floren, 1984, p.43). "Disaster and emergency workers are affected by traumatic events irrespective of rank or years of experience" (SAMHSA, 1995). For example, many emergency service professionals are still coping with emotional trauma as the result of their rescue and recovery efforts following the events of September 11, 2001 and the Oklahoma City bombing in 1995 because "a disaster with [only a few or] no survivors can be especially frustrating to deal with" (Laughlin, 1980, p.25). "Research indicates that the critical time for a delayed trauma to surface is between three to five years after the initial tragedy" (Owen, 1999). A large number of rescue and recovery workers were experiencing stress and emotional trauma years after the Oklahoma City bombing and the events of September 11. Owen writes that "divorces were three times higher than normal in the Oklahoma Fire Department" and numerous suicides occurred on the Oklahoma Police Department. Owen further states that, "family violence and addiction--including substance abuse and gambling--has increased among workers connected with the bombing rescue."
     Research has shown that “forty-three percent of all adults suffer adverse health effects from stress” (Miller, L., 1997); however, it is the men and women in the emergency service professions that are at a greater risk of suffering long-term stress that can lead to PTSD. The “rate for diagnosable PTSD among firefighters was 16.5 percent compared to a one percent to three percent rate for the general population—about one percent higher than PTSD rates of Vietnam veterans” (DeAngelis, 1995, p.36). The International Association of Fire Chiefs’ Foundation (1991) has stated that

Stress is one of the most serious occupational hazards in the fire service, affecting health, job performance, career decision-making, morale, and family life. Emotional problems, as well as problems with alcohol and drugs, are becoming increasingly evident. High rates of attrition, divorce, occupational disease, and injury continue… [and] suicide is a real and tragic alternative for some.”

     In addition to the life-threatening and job-related stress they encounter in their professional lives, firefighters must also cope with an array of personal and family issues as well. "The dangers of the job create anxiety in the firefighter's family" (Martin, 1991, p.2). These factors may include, but are not limited to, a troubling child in the home, the death of a loved one, “aging or invalid family members, terminal illness, divorce, and the daily demands of raising a family” (SAMHSA, 1995). "Some firefighters take their problems home to their [spouses] and families or seek outside employment (moonlighting) to compensate for the stress and frustration of the firefighting job" (IAFCF, 1991). Many of these emergency service workers feel that their families and friends do not understand the magnitude of their duties nor the emotional strain they must endure on a daily basis. The International Association of Fire Chiefs’ Foundation (1991) states that firefighters "want to protect loved ones from what happened [on the job]." Also, a firefighter's spouse must cope with the constant stress, sacrifice, and frustration of "living with the worry of having their husbands [or wives] constantly walking into the jaws of danger" (Burns, 1998). Most firefighters are very reluctant to discuss the death, carnage, and human suffering they witness on the job with their family and friends. Moreover, emergency service professionals struggle with thoughts of inadequacy as a spouse, parent, or social friend. They may suffer from restless sleep or nightmares, alcohol and drug addiction problems, and thoughts of suicide as the result of their constant exposure to life-threatening situations and the multitude of mentally and emotionally challenging emergency calls. "Despite the nightmares, the guilt for not doing enough, the questions of their own sanity, the trauma stays inside" (Owen, 1999). All of these examples, and many more, contribute to the growing concern by government agencies and members of the fire service community as a whole for the health, safety, and emotional wellness of firefighters today.

Stress Among Volunteers in the Fire Service
     Volunteer firefighters comprise approximately eighty-four percent of all firefighters in the United States and "save localities across the country an estimated $36.8 billion per year" (National Association of State Foresters, 1993). Most do not receive monetary compensation for their efforts. Most volunteer firefighters have full-time jobs in addition to their duties and responsibilities at the fire department. However, these firefighters are exposed to the same dangers, experience the same job-related stress, and must cope with grief just as their comrades in career (paid) departments. They fight fires, save lives, and protect property. Many are trained as first responders, emergency medical technicians, or paramedics. Some receive additional training in specialized areas, such as vehicle extrication, high-angle rescue, hazardous materials, and water rescue. Volunteer firefighters respond to major disasters, motor vehicle accidents, domestic violence and child abuse calls, and school shootings. They are placed in life-threatening situations and many of them are victims of violence. Sadly, one hundred firefighters die in the line of duty each year. The majority of these firefighters are volunteers (National Fire Protection Association, 1999).
     Although some volunteer departments are in large cities most are in small, rural communities. Therefore, these "emergency workers frequently know the victims and/or their families thus compounding their levels of stress and emotional trauma" (SAMHSA, 1995). Furthermore, many rural departments may only respond to ten or fifteen calls per year. These firefighters "may not be as regularly exposed to certain types of incidents and may not be as emotionally desensitized (SAMHSA, 1995). Because of this, many volunteer firefighters in rural areas with few calls may find it just as difficult to cope with stress and grief as firefighters who respond to many calls in larger cities.
     Most volunteer departments must rely on fundraising or donations to replace unsafe clothing (turnout [bunker] gear), repair older vehicles, and purchase or replace mandated safety equipment such as self-contained breathing apparatus and personal protective alarm systems. This is due in part to the expensive costs and very low budgets for operating a volunteer fire department. In some cases, volunteer firefighters must purchase their own safety equipment. In addition, the diversity of their emergency calls has required specialized training classes. For the most part, these classes are paid by the volunteer firefighter themselves rather than by their department. Therefore, "Volunteering in the fire and EMS service… is one of the most demanding volunteer activities today" (Bush, Schaenman, & Thiel, 1999).
     Since 1983, the number of volunteer firefighters has declined steadily. Because of this, volunteer fire departments "are having to do more with less" (Bush, Schaenman, & Thiel, 1999). This decline is due to an increase in time demands at the fire department (greater number of emergency calls), an increase in training hours to comply with national standards, fund raising activities, and responsibilities of family and home. In some states, volunteer firefighters and emergency medical personnel must meet the training requirements established by the National Fire Protection Association. Although important, these training requirements add to the number of hours that firefighters must be away from their families and non-fire service responsibilities. Many businesses may allow volunteer firefighters to respond to emergency calls during work hours; however, they may not pay them for the hours they are away from the job. This may contribute to additional financial burdens. As a result of these issues, "Stress is a major problem in volunteer fire departments and it's a big reason for attrition" (Streng, 1985, p.24).

Current Methods to Reduce Stress in the Fire Service
     Due to the overwhelming concern for the firefighters' safety and health, government agencies and fire service organizations have established standard operating procedures and strict guidelines that can reduce injury, death, and long-term emotional trauma. Flame and heat retardant protective clothing (turnout gear), self-contained breathing apparatus, and personal alarm safety systems have helped to deter the life-threatening aspects of firefighting. Fire service administrators have been encouraged to install “gentler wake-up systems for firefighters that replace clanging bells with dim lights, speakers, and a tone” (DeAngelis, 1995, p.36). Furthermore, DeAngelis writes that “equipping firefighters with radios so they can hear what’s going on in an emergency” can also save lives. The National Fire Protection Association (NFPA), an international codes and standards organization, has made recommendations and has established guidelines to further reduce the risk to firefighters’ health and wellness. Three of these recommendations include the Members Assistance Program (MAP), the Critical Incident Stress program, and the Chaplaincy program (1997).

Member Assistance Program
MAP is a "generic term used to describe the various methods found in the workplace for the control of alcohol and drug abuse, stress and personal problems that adversely affect job performance" (IAFCF, 1991). Fire departments that provide Member Assistance Programs refer firefighters to various agencies that provide counseling and treatment centers. Health promotion programs also provide a variety of activities for the firefighter and his family. Programs, such as "career advisement, family orientation and education programs on… weight control, healthy heart, … smoking cessation and pre-retirement planning" are also available through the MAP program (IAFCF, 1991).

Critical Incident Stress Program
     A vital and intrinsic aspect of emotional help for firefighters is Critical Incident Stress Debriefing (CISD). "Critical incident stress is a normal reaction experienced by normal people following an event that is abnormal" (NFPA, 1997). CISD is a "reactive form of treatment either on the scene of a disaster or within a short period of time after the disaster by means of a debriefing" (IAFCF, 1991). The "main goal [of CISD] is to lessen the long-term psychological impact of the event and to accelerate the recovery process" in the emergency service worker (Clark, 1991). Clark also states that CISD is "used solely to regenerate the normal support process." A CISD is implemented following "mass casualties… fatalities involving children, fatalities or injuries involving fire department members, and any other situation that affect the psychological… well-being" of an individual (NFPA, 1997). However, CISD does not afford the emergency service professionals preventative training or long-range, follow-up support and education. Therefore, the firefighter may experience recurring, adverse side effects as the result of continuous emotional trauma. These side effects can include, but are not limited to, anxiety, insomnia, gastro-intestinal problems, and an increased risk of heart attacks and severe depression.

Chaplaincy Program
Many fire departments request the assistance of chaplains following a line of duty death of one of their firefighters. "Chaplaincy programs are beneficial in helping fire department members deal with the stress of their work" (IAFCF, 1991). In addition, chaplains provide emotional and spiritual help for firefighters and their families as well as CISD members. Firefighters who do not initially "relate well to outsiders will often turn to and accept the help of a chaplain who practices strict confidentiality when dealing with personal problems" (IAFCF, 1997).

CONCLUSION
     Traumatic events, including mass casualties, injury or death of children, life-threatening situations, or a line of duty death have a profound impact on the mental and physical health of firefighters. Without coping skills, emergency service professionals can experience unhealthy side effects, such as stress, high blood pressure, and depression, as well as disabling illness including heart attacks, substance abuse, and post-traumatic stress disorder (PTSD). Personal life issues such as divorce, long-term illness, or death of a family member, etc. can have a negative effect on them as well. Although research has shown that there are some resources available for firefighters and their families to cope with stress, there is a need to have a training program that will provide information on grief, suicide and addiction prevention, and promoting emotional wellness for everyone as well.
     The International Association of Fire Chiefs' Foundation (1991) states, "continuing education and training within fire departments are favored by many as tools for alleviating stress." Furthermore, "Specific training in dealing with death, crisis and suicide are needed, and orientation programs may help recruits better prepare for the physical and psychological rigors of their new profession." SAMHSA (1995) has made the following recommendations:

1. "information about normal reactions [to stress and grief], education about ways to handle them, and early attention to symptoms can speed recovery and prevent long-term problems.
2. "The use of prevention and treatment strategies can potentially decrease or eliminate negative effects of stress such as decline in job performance, burnout, high turnover rate, health problems, and family problems for workers.
3. "Such training should be an integral and ongoing part of regular training programs. Protecting emotional safety is just as important as protecting physical safety."

Floren (1984, p.43) suggests that there is a "strong need to provide a more humanistic approach in the training of emergency [service] personnel." Also, "we need to learn more about death and dying, the stages of grief, what to expect from a suddenly bereaved family and how we may most helpfully interact with family members." Furthermore, emergency service workers must be able to talk about the pressures involved in traumatic situations, to understand what others have experienced in similar situations, and know that they are not alone in their feelings. Floren continues,

Our training should emphasize the need for supportiveness and free expression of feelings… in stressful situations to help prevent serious problems. We need to be prepared for the internal conflicts that may surround a patient's death and know how our self-image may seem threatened by that event.

     Finally, the National Institute of Mental Health states that "The use of both prevention and treatment strategies can potentially decrease or eliminate negative effects of stress" (1990).
     The Grieving Behind the Badge training program addresses stress and grief and promotes emotional wellness for everyone. Unlike critical incident stress debriefing the Grieving Behind the Badge program does not focus on a single incident but rather the frequent professional traumas as well as personal life stressors these men and women experience. Throughout the training everyone is encouraged to openly share their anxieties in a safe environment. Interactive dialogue provides opportunities to discuss issues that cause nightmares, family discontent, substance abuse, and thoughts of suicide. The students learn coping skills for job-related stress issues as well as personal life traumas. These men and women realize they are not alone in their thoughts and feelings. Family members can discuss their needs as well as their fears and frustrations. Fire department chaplains receive information to help them provide emotional support to firefighters and their families. Additional programs on coping with grief can be offered to families and departments who have experienced a line of duty or non-duty related death of a firefighter. Recruits receive valuable information and coping skills that can prevent long-term stress and grief. As a result of the Grieving Behind the Badge program, emergency service professionals, their families, and chaplains have a better understanding of stress and grief and the effects they have on their lives. Moreover, everyone can gain the knowledge necessary to resolve many of their professional and personal problems because of the information and resources that are provided.
     If fire departments and organizations want to reduce the number of lives that are lost from physical illness, substance abuse, and suicide in the fire service then they must provide firefighters with help and coping skills. Training them to deal with trauma, stress, and grief is no less important then training them to be safe on the fire ground. No longer can job-related stress in the fire service be ignored. It is the duty and responsibility of every fire service officer to provide for and enhance the emotional wellness of his or her department. Without the support and dedication of everyone stress and grief will continue to take a toll on firefighters and their families.
     The emotional wellness of firefighters is at risk. Stress and grief are problems that are not easily detected or easily resolved. Severe depression, heart attacks, and the high rates of divorce, addiction, and suicide in the fire service prove this. There has been a call to action and The Sweeney Alliance has answered that call. The Sweeney Alliance is the solution to these problems. The Grieving Behind the Badge training program is proven to address these problems and to help resolve them for the men and women in the fire service. Grieving Behind the Badge should be made available to all emergency service professionals, their families, recruits, and fire department chaplains.

Copyright 2003 Peggy Sweeney. All rights reserved.

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American Psychological Association. (1997). Stress: How and when to get help.
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Bureau of Labor Statistics. (1999). 1998-99 Occupational outlook handbook. Washington, D.C.: U.S. Department of Labor.

Burns, C. (1998, June 22). Firemen's wives live through sacrifices, frustration, fear [16 paragraphs]. Post Registrer. [On-line serial]. Available FTP: Hostname: Idahonews.com.

Bush, R., Schaenman, P., & Thiel, K. (1998). Recruitment and retention in the volunteer fire service: Problems and solutions. Wasgington, D.C.: National Volunteer Fire Council and United States Fire Administration.

Carter, H. (2000, March 8). Workplace violence: The landmine we all fear [15 paragraphs]. Harry R. Carter Ph.D. MIFireE. [On-line Commentary]. Available FTP: Hostname: harrycarter.com Directory: Comms_Mar_2000/march_8,_2000.htm.

Clark, William E. (1991). Firefighting principles and practices. Saddle Brook, NJ: Fire Engineering Books and Videos.

Clarke, C. & Zak, M. (1999). Fatalities to law enforcement officers and firefighters, 1992-97. Washington, D.C.: United State Department of Labor, Bureau of Labor Statistics.

DeAngelis, T. (1995, February). Firefighters' PTSD at dangerous levels. APA Monitor, pp. 36-37.

Floren, T. (1984, March/April). Impact of death and dying on emergency care personnel. Emergency Medical Services, 13 (2), pp.43-47.

International Association of Fire Chiefs Foundation. (1991). Stress management: Model program for maintaining firefighter well-being. Washington, D.C.: Federal Emergency Management Agency and The U.S. Fire Administration.

Laughlin, J. (Jan, 1980). Psychological stress in firefighters - Part one. Fire Command, Vol. 47(1), pp.25-26.

Martin, S. (June, 1981). Stress and the fire service. The Minnesota Fire Chief, Vol. 47(6), p2.
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Miller, L. & Smith, A. (1997). Stress in the workplace. Washington, D.C.: American Psychological Association.

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National Fire Protection Association. (1997). Fire department occupational safety and health program. Quincy, MA: Author.

National Fire Protection Association. (1999). Fire departments. Quincy, MA: Author.

National Institute of Justice. (1999). Corrections and law enforcement family support program. Washington, D.C.: Author.

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Streng, P. (1985, December). Stress and the volunteer fire department. The International Fire Chief, p24.

Substance Abuse and Mental Health Services Administration. (1995). Disaster work and mental health: Prevention and control of stress among workers. Washington, D.C.: Author.

United States Fire Administration. (1999). Firefighter casualties. Emmitsburg, MD: National Fire Data Center.

VandenBos, G. & Bulatao, E. (Eds.). (1996). Violence on the job: Identifying risks and developing solutions. Washington, D.C.: American Psychological Association.

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From the heart~~~ Grief 101

by Peggy Sweeney
Although most adults associate grief with the death of someone loved, this is not the only reason we grieve. It is important to note that grief follows closely behind any traumatic event; a divorce, a life-threatening or debilitating illness or injury, an unpleasant emergency call. The list of grief-generating experiences is endless.
Elizabeth Kubler-Ross, a world-renowned expert in the field of death and dying, is credited with the development of the Five Stages of Grief: denial and isolation, anger, bargaining, depression, and acceptance. Many people believe that these stages, if followed in succession, will resolve grief. Unfortunately, for those of us who have experienced a loss or emotional trauma, this is not necessarily true. Grief is not just the emotions and feelings we have during or immediately following a loss. Grief has no set time pattern nor does it ever go away completely. It can however be an instrument of learning about love, life, and living. Grief can have a positive or negative impact on our lives. Grief is choices. We can choose to journey through our grief and at the end of our journey emerge a better person for having experienced grief (positive) or we can stuff it within are very being, try to ignore it, and fail to receive its rewards (negative).
We must also keep in mind that everyone responds to grief differently. No two people will react to a shared grief experience in the same way. Although we may share similar feelings and emotions with other family members, friends, and co-workers, many factors will determine the end result of our personal reactions to trauma and grief; namely, how the loss occurred, our emotional involvement with the person or event, our previous loss experiences, and the lessons we learned as children for coping with emotions and feelings. Please bear in mind that your individual responses to grief are both normal and natural and not a sign of weakness or the inability to carry out your daily responsibilities.
Grieving is very necessary to heal the mind and spirit. Grief involves the whole person; the physical, mental, emotional as well as the spiritual self. It is not governed by a set of rules that if followed consecutively will erase the grief. In other words, you do not deal with one emotion or feeling and move on to the next. You do not deal with anger or sorrow for a few days and erase it from your list. Rather, you flow back and forth between some of the same—or previously unacknowledged—emotions and feelings until you come to the end of your grief journey. It is important to remember that this individual journey can last many months or even years. The intensity and duration of your individual grieving process is comparative to the loss. In other words, the more emotionally involved you are with the person or event the deeper the emotional trauma and grief.
In upcoming postings of From the heart, you will learn that grief is very diversified. We will explore the many facets of grief, the reasons that we grieve, our reactions to loss and trauma as well as healing our grief. In the future, we will discuss a wide range of topics and issues that can debilitate the human spirit and prevent us from enjoying life to the fullest. Eventually you should come to the realization that unpleasant events both on the job and in your personal life can and often do have a very negative effect on your emotional health and physical well-being. However, I will offer positive coping skills and resources to help you resolve many of these issues in addition to enriching your lives and enhancing your commitment to your department, your family, and the communities in which you serve. I hope that you will use these articles as a reference to help you cope with your personal grief and loss issues. Please feel free to contact me with comments or suggestions for future articles.

Copyright 2002 Peggy Sweeney. All rights reserved.
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