Preventing Provider Suicide

People don’t talk about death for a lot of reasons. In public safety fields, we often don’t talk about death because we feel like the moment you start thinking about your own death is the moment you lose your ability to effectively put yourself in harm’s way to protect others.

But more than death, we really don’t like to talk about suicide among our peers. It’s created a perception that suicide in EMS and the fire service isn’t a big problem. But it’s bigger than you think.

In a recent webinar sponsored by the National Volunteer Fire Council (NVFC), Jeff Dill, founder of the Firefighter Behavioral Health Alliance (FFBHA) and Counseling Services for Firefighters (CSFF) spoke about “Behavioral Health and Preventing Suicide in the Fire/EMS Service.” Dill says he started FFBHA because he didn’t think suicide was a big problem in the fire service and EMS, but when he started looking for data on firefighter/EMS suicides he couldn’t find any.

Since FFBHA began in 2011, Dill says the organization has documented and validated 444 firefighter/EMS suicides in the U.S. The first documented firefighter suicide happened in 1880 in New York. Between 1880 and 1999, Dill says, 89 firefighter/EMS suicides were documented. Since then, the numbers have increased exponentially. From 2000–2005 there were 51 documented firefighter/EMS suicides; in 2006 there were 21; 2007, 19; 2008, 33; 2009, 26; 2010, 39; 2011, 41; 2012, 57; 2013 54; and in 2014 there have already been no less than nine documented firefighter/EMS suicides.

Dill also notes the suicide methodology runs the gamut across those 444 documented suicides. Seven were female, the rest were male. Firearms accounted for 251 of the suicides. Hanging was second with 74. But suicide methods have taken all forms, from stabbing, overdose and suicide by cop, to asphyxiation, jumping in front of train, etc. The one that scares Dill the most: immolation. “How much pain were these two people in that they had to end their lives by setting themselves on fire?” Dill asks.

One of the newest suicide methods, Dill says, is called “easy exit.” That’s when the individual puts a plastic bag over their head, inserts a tube into the bag that’s hooked up to an asphyxiant—like helium or nitrous—and then turns it on, displacing the oxygen in the bag so they fall asleep, suffocate and die.

Dill says those numbers, while alarming, don’t even begin to capture the whole picture. “Maybe 10% of the fire departments across the U.S. might know about us. It begs the question what our numbers of suicides might be if 90% or 100% of departments knew about us and reported their suicides. People ask for a comparison to society in general, where the average is about 11 per 100,000 people. I can’t even guess because the numbers just aren’t there. That’s why FFBHA is trying to push for a national reporting system. We don’t want to forget our brothers or sisters. They’re good human beings who didn’t know where to turn when something went wrong in their lives.”

Dill notes when public safety workers like firefighter and EMS providers put on the uniform, they kind of brainwash themselves—this is how we’re supposed to act, this is how the public sees us: strong and brave. “We do have to be that,” he explains, “but what happens is we engrain this in ourselves and carry this into our personal lives. I don’t want to change our culture; I just want to make sure we’re aware of what’s going on out there so we can be proactive rather than reactive. I’m a big believer in Firefighter Life Safety Initiative 13—firefighters and their families must have access to counseling and psychological services.”

Dill says a lot of emergency personnel in rural areas, or who are part of a volunteer service, don’t have access to employee assistance programs (EAPs). Providers in bigger cities who do have access don’t always take advantage of the service. And an even bigger problem is EAP counselors may not have any idea how to talk to firefighters or EMS providers because they don’t really understand the jobs we do.

According to Dill, there are things agencies can do to be proactive about combating provider suicides. Those include:

• Developing a peer program, so firefighters and EMS providers have people within their agency they can talk to whenever they have a problem, whether it’s going through a divorce, to PTSD following a particularly traumatic event, to having seriously contemplated suicide already.
• Educational training on firefighter/EMS suicide awareness and prevention that includes:
  • Knowing the signs and symptoms. Signs and symptoms include isolation or becoming distant; loss of confidence in skills; sleep deprivation (particularly if providers are foregoing sleep because their dreams are troubling); anger, especially when it’s displaced and manifests in the provider’s personal life; and impulsiveness. For that last one, Dill says if a provider who doesn’t like guns suddenly tells you he bought several, the right questions to ask are why did you buy them and what’s going on in your life that you felt the need to suddenly do so?
  • Learn how to talk to each other. Providers should all take a behavioral health course, so they can recognize behavior that could lead to suicide.
  • Know your organization’s outside resources. If an EAP isn’t available—and even if it is—knowing where to point providers who need to speak to someone about a problem in their life is imperative.
• Educate your EAP counselors about the fire service/EMS culture. Bring them to the station and take them on a ride-along. If they’re going to counsel providers on the issues they encounter in the field, counselors need to first understand what those issues are firsthand.
• Promote a better retirement approach to reduce firefighter suicides post-career. Dill notes FFBHA tracks retired firefighter/EMS suicides because more than a quarter of the 444 documented suicides in the U.S. were providers who weren’t active, and the bulk of those were retired. For many providers EMS or the fire service is a 24/7 profession, he says, and when that’s gone it’s like losing a big part of your life. Agencies should start talking to providers before they retire so they can plan for what life will be like when there’s no longer a pager going off all the time.

Resources are available for firefighters and EMS providers who need to talk. NVFC has resources available at www.nvfc.org/help. And the Fire/EMS Helpline is free, confidential and available 24/7 at 888/731-FIRE (3473). Firefighters and EMS providers can call for issues including addiction, anxiety, depression, stress, PTSD, relationship problems, work-related concerns, critical incidents and more.