Red Flags I Missed
As a Spouse Looking Back, There Were Red Flags…
Hindsight is 20/20 but these are the behaviors I should have caught. It’s worrisome because I’m sure there are firefighters and families there right now and they might be reading this entry. Last week included Stress Awareness Day, ironically on a day Ryan had to go through one of his tougher calls detail by detail and relive it in exposure therapy.
In collecting my thoughts of red flags that went up while Ryan was floundering, not reaching out for help with his PTSD and trying to recover from each shift at Woodstock Fire Rescue District only to be thrown back into the arena every third day, a few uncharacteristic and unhealthy coping mechanisms came to light. Everyone is different, but in Ryan’s case, he followed fairly closely to the acronym RAILS that Jeff Dill, founder of Firefighter Behavioral Health Alliance uses to describe the warning signs of unhealthy mental and behavioral states.
Recklessness/Impulsiveness – this can show up for some people as subtle signs of doing things differently then they’ve always done them. Being impulsive while on the job on at home. For Ryan, this showed up in increased hyperawareness and worry about Jude and Lucy. Some of it was normal parental paranoia about safety but some of his thoughts and behaviors were irrational. When I attempted to talk to him about his fears, he would immediately become defensive and shut down or lash out in my general direction making me feel as if I didn’t care enough for their safety. At work, he was still dealing with and processing the aftermath of a hit and run that left a child around Jude’s age dead. Or when Jude would fall asleep in the car Ryan would flashback to a traumatic car accident call and try and deal with his anxiety until we got home.
Anger – Explosive anger would come out of nowhere from minor issues. I thought it was me, the way I was handling something or not handling something at home. I would ask Ryan to do something at home and he would forget and when I would ask him about it, he’d immediately get angry and defensive. Truth is, he most likely didn’t even remember the conversation. His short term memory has been affected so much so that day-to-day conversations are wiped from his conscious mind because he is spending all of his mental bandwidth battling inside his mind. He would feel shame about not helping and that turned to anger and frustration. When we married, ten years ago, Ryan was one of the most laid back people I knew. Passionate in the causes he cared about but wouldn’t let the day to day stresses get to him. This changed into displacement of anger (directing one’s anger at someone else instead of the intended person or situation) when there was a call he felt helpless about at work. Or, in not even talking the call through being debriefing sessions on shift, he would bottle it up, bring it home and it would escape at random times during mundane situations.
Isolation – This showed up first and was the most confusing action for me to process. Ryan first started escaping work and the bad calls by mindless scrolling on his phone or playing games incessantly on his phone. I remember the guys on shift giving him the business about being on his phone a lot or incessantly checking it like a nervous tick. He also started to shrink back from work involvement and other fun family activities like meals we had always gone to at the station. As one of the founding members of Woodstock Career Firefighters IAFF Local 4813, he was the first vice president, third president and was really proud of organizing. Over the years, he started distancing himself from being a leader and sunk back as he was struggling. Which was a major change in personality for him turning more introverted, not happening quickly but gradually through the years. When he started to spiral down before sending him to the IAFF Center of Excellence, he wouldn’t get out of bed, isolating himself further from work and activities as a family. Or cope by escaping with mindless games on his phone while I was trying to have tough conversations with him. This made me feel confused and afraid at the distance he was driving between him and everything he ever cared about.
Loss of Confidence in Skills and Abilities – this mainly shows up at work when FFs and EMTs lose confidence in their ability at work because of the amount of focus they are using while they battle in themselves. This appeared at home through his memory loss. He wasn’t to the point where he would forget Lucy was home with him but he would forget whole conversations about appointments or things to do during the day and become quickly frustrated with himself. Embarrassed and incessantly apologetic, sometimes would appear as anger if I inadvertently struck a chord with him when I would ask about his day. At work, which is something I didn’t know until early October of this year, he would forget skills he’s used thousands of times in his 14 year career with Woodstock Fire Rescue District. He would feel embarrassed, shrinking back during the training session instead of leading by example. My fear quickly turned to being afraid the same would happen during a life-or-death call or structure fire and that he would die or cause another death because of the inability to quickly process the skills that were once routine. I wonder how many of his crew or shift noticed and didn’t know what to say, or maybe shrugged it off as a fluke. But when a fellow veteran firefighter forgets a mundane skill during a training session, I hope it acts as a red flag rather than something to joke about. (This wasn’t the case with Ryan but I also know the culture of the firehouse)
Sleep Deprivation – loss of sleep can indicate stress, anxiety, PTS or several other emotional issues a member might be struggling with and not realize. Maybe you, like I did admittedly, have no idea the amount of sleep or not sleeping your firefighter actually does on the job. But, if they are so tired that they seem so irrational to the point of acting belligerent, there are medical reasons why. Studies have shown that staying awake for just 17 to 19 hours straight impact performance more than a blood-alcohol level of .05 percent. This level of impairment slows an individual’s reaction time by 50% compared to well rested people. Twenty-four hours of continuous wakefulness (a typical firefighter shift) induces impairments equivalent to a BAC level of .10 percent, beyond the legal limit for alcohol intoxication. Since the prefrontal cortex is impacted the most by sleep deprivation and also happens to be the part of the brain responsible for judgement and logical reasoning. Experts think this may explain why people stuck in sleep deprivation cycles have such a hard time recognizing their own fatigue and level of impairment. Meaning they need other shift members, friends, family or those higher in command to help recognize their impairments. This is especially important through bouts of overtime and difficult calls involving death or young children. When Ryan returned from the IAFF Center of Excellence up until October, he wasn’t speaking more than minutes at a time while he was on shift. If he wasn’t physically going on the calls overnight, he was up catastrophizing the calls other stations would on as soon as he would hear the tones. Even at home, he would wake up from hearing phantom tones or nightmares. Melatonin, Rx medications and weighted blankets only give him restless sleep now. It would take him longer than 48 hours to recover from the 24 hours of non sleep, leaving Ryan further and further in the hole of sleep deprivation, so there was never enough. It was receiving a K.O. punch every 24 hours – and that was a normal shift, one without a particularly traumatic call not being able to stand up before being dealt another punch.
Like sleep deprivation, being in the middle of any of the RAILS situations, especially all of them at the same time makes it difficult for the firefighter to notice, making it very important for the support system and those closest to the person be able to notice the red flags.
If you notice these signs, you must act, even if in your mind you are worried that it may be an over reaction – your “over reaction” just might save their life. Here are some of the things you should do as suggested by the Firefighter Behavioral Health Alliance:
Be Proactive – Be very direct. Your firefighter does this when they respond to emergencies. Take the same approach with them. Upon noticing a red flag be direct with them and let them know you are worried about them. Reach out to their loved ones if they are not directly witnessing the red flags and voice your concern. Don’t assume you will embarrass or upset your coworker/family member, chances are they have no idea.
“There comes a point where we need to stop just pulling people out of the river.
We need to go upstream and find out why they’re falling in.”– Desmond Tutu
Ask Direct Questions – while we were going through this, Ryan’s dad told me to ask Ryan directly whether he was thinking about killing himself. That was a difficult question to ask and it was even more difficult to find out days later that Ryan lied to me when I asked him. So go one question further and try to notice if the person is avoiding eye contact or hesitating in their answer. First ask, “Do you feel like killing yourself now?” Follow up that question with another one, “Do you have a plan?” Like it or not the truth is if your firefighter as many years on the job, they have responded to suicides and attempted suicides which can be even more traumatic. They most likely have a plan influenced in part by ones they have responded to. A “yes” to either one of these questions means you need to engage your department procedures or protocols if in the firehouse. If outside of the station or off shift like Ryan’s then they need help immediately. Do not leave them alone.
Be Compassionate – The Firefighter Behavioral Health Alliance was workshops dealing with firefighter compassion and in some firehouses, avoidance of these feelings is practiced more, afraid of being seen as weak or soft. Be direct and be compassionate, staying in the moment when talking and listening to them. Always speak from the heart and realize it’s a difficult conversation to have. Make talking about it the norm in your station, reducing the stigma and calming the shame of bringing it up in the first place.
Walk the Walk – The support with taking care of Ryan and donated time while we try to deal with getting Ryan the help he needs has been overwhelming and incredibly helpful. If you notice someone floundering, physically take them to get help. I had to push Ryan to get him on the phone with intake to be accepted to the IAFF Center of Excellence, make all the arrangements and physically deliver him to the airport making sure he made it through security and checking that they received him on the other side. Drive them to counseling, to AA, to a hospital, whatever it takes. Drive them to their appointments to show them they aren’t alone, wait for them and drive them home. Taking care of our firefighters goes beyond the station or fire ground.
Hopefully the details and descriptions of how RAILS played out with Ryan will help others become more vigilant and less dismissive of these very real events that if left unchecked could become deadly for the firefighter either by their own hands or through accidents of judgement at home or on shift.
–Ryan Mains is a 14 year career Firefighter/Paramedic with Woodstock Fire Rescue District in Woodstock, Il. He was diagnosed with PTSD in 2016 and has struggled with the disorder. After attending the IAFF Center of Excellence in April 2019 for 32 days he returned to gold shift. On October 8, 2019, he was deemed unfit for duty after back-sliding from his work at the center. He’s currently attending a partial hospitalization program at the Alexian Brothers Behavioral Health Hospital in Hoffman Estates, Il. as he works through exposure therapy, 40 hours a week.
In May 2020, Ryan will be running 1k for every firefighter who commits suicide in 2019 to shine a light on the firefighter suicide epidemic and raise money for Illinois Firefighter Peer Support.