Webinar: PTSD in the Fire Service: Signs and Solutions
Transcript
Joe Booth / Ventura Fire Foundation: Okay, thank you everyone for joining us tonight especially if you're joining from outside of the Pacific time zone. We know it's a little bit late, but we appreciate it. Whether you're joining us live or watching later, we appreciate you taking an interest in this very important subject. So I just have a couple words to say, then I'll turn it over to James who we are very fortunate to, to be our presenter tonight.
The Ventura Fire Foundation was started by firefighters. With the mission to support and enhance the lives of firefighters and their families, particularly with regard to mental health. We are working to normalize conversations on mental health so firefighters and their families can thrive. One of our main programs is the Firehouse Roundtable podcast.[00:01:00]
Let's see if I can figure this out. It's over one of my shoulders. This one. Firehouse Roundtable invites firefighters, their families, and the community to the heart of the firehouse. the kitchen table to discuss issues critical to the fire service with a focus on mental health and families. I encourage you to subscribe to the podcast.
Many of the issues covered today are explored in depth on the show, and, and they have some fun too. One of our co hosts, Jason Kay, is listening in today so hopefully hopefully he'll be able to take some of this and bring it into the show. This webinar is part of a series the Ventura Fire Foundation is hosting this year.
The next three topics Include how to manage when your firefighter is on duty for extended periods of time, such as deployed to a wildfire, maintaining relationships as a firefighter couple, and parenting in the fire service. [00:02:00] You can register for all the webinars on our website, VenturaFireFoundation. org.
This series is made possible with the generous support from Vanguard Charitable. A couple of housekeeping issues before we get started. Please keep your microphones muted. We don't want to hear, you know, the busyness in your lives in the background. And James is going to leave time at the end for questions.
So, if you have a question or a comment, Just type it into the chat. There's a, the bottom of the screen, there's a little chat box. Type your question in there, and then I will feed them to Jane, James, at the end, as time permits. And just a reminder, the webinar is being recorded. We'll post it to our YouTube page soon.
I think that's it. So let me introduce James. And I'm going to get some of this wrong, I'm sure, because James has a lot of abbreviations after his name, and I don't know what any of them stand for, so I'm just going to skip over that. James Boomhauer has been involved in [00:03:00] EMS for over 20 years in a variety of health systems throughout New England.
He currently functions in the role of Critical Care Transport Specialist Paramedic and is the Lead Peer Support Director at Boston MedFlight in Bedford, Mass. So basically, he has the cool job of flying around in helicopters all day. Sure, it's not so cool at times. His desire to bring mental health awareness to the EMS arena has spurred him to create the Stay Fit for Duty platform.
You should go check out his website. It's it's got a lot of good stuff on there. And not only is he a first responder, but he's a graduate intern of clinical psychology. And with that, he promotes the recognition, management, and acceptance of acute stress in EMS. Throughout the world. James was a recent guest on our podcast, Firehouse Roundtable.
I encourage you to go listen to it. A lot of what he talks about here, he goes to there in depth as well.
James Boomhower / Stay Fit 4 Duty: And with that, James, I
Joe Booth / Ventura Fire Foundation: [00:04:00] think I'm finished. So, I'm just going to turn it over to you and thanks for, thanks
James Boomhower / Stay Fit 4 Duty: for presenting today. Thank you very much for having me and thank everyone here for, for joining.
Regardless of the time zone, it can be tricky to be here on a Tuesday night, so I really appreciate that. And Joe, your intro was flawless. Thank you. Thank you very much for that. The only other housekeeping note I'm going to add is once I share my screen, I'm going to turn off my camera. I'm not trying to hide from you guys, but for anybody on like a shakier bandwidth, it'll make the presentation a little smoother and then you won't have like my floating head kicking around.
My dream is to do this all in about 50, five, zero minutes. To leave some time for some Q and a and as Joe said, please don't hesitate to just throw something in the chat when I'm sharing my screen for the presentation. It's just hard for me to see. So please don't think I'm ignoring you. If you don't see anything on that end here Joe, sir, if I can just grab the host permission from you, I'll be able to share my screen and we can go ahead and get started.[00:05:00]
Perfect.
All right, folks in a perfect world. You should see one full size screen. This is PTSD in the fire service. Yep. Looks good. Awesome. Thank you very much, sir. So I like to start these presentations in the beginning especially because Joe did such a great job introducing the presentation as a whole and telling you a bit more about who I am.
So I'd love to go ahead and just get right into the meat and potatoes and then talk a little bit more about what I do after. Some unfortunate statistics that we're all too well aware of at this stage of the game. According to the CDC, one first responder dies by suicide every four days. Joe talked briefly about the work that I do both in clinical medicine and clinical psychology, along with some work I do as a peer supporter, and [00:06:00] as you all know all too well, we can set our watch to that number.
When we looked at this pre pandemic, we recognized that suicide rates among first responders were reaching an all time high. We surveyed 4, 000 first responders, 2 in 5 have contemplated suicide, with 1 in 10 attempting to die by suicide. Here's the issue with this 1 in 10 number. This isn't just some jaded grad student that's poking holes in someone else's research.
The research that was referenced in that news article was a mail in survey. So I just want you all to think for a second. You are at absolute wit's end. You are burned out. You are tired. You are hopeless. You get an envelope in the mail. You're not filling it out. You're likely not even opening it. So I want to point out that the work that they did, I thought was fantastic.
But I hope that we all [00:07:00] recognize that. As alarming as 1 in 10 is within our industry, I truly feel that that number is artificially quite deflated. I think the actual number is much higher because we all know that this is a problem within our industry, regardless of your profession, fire, EMS, law enforcement, military, it does not matter.
We also know that it's not going away and this doesn't even pay any attention to the wireline firefighting season and what our colleagues in the west coast like yourself are going to have to deal with very very soon. This is just looking at good old fashioned first responder life kind of in the greater U.
S. And the complexities of all of the puzzle pieces that come into play to make this all the more complicated for us to try to manage. So what I want to do today is talk about [00:08:00] what we can do about it, what we can change and what we can take control. Really briefly here, just a slightly more in depth introduction.
I've been in EMS now for about 20 years. A vast majority of my pre hospital emergency care has been throughout New England, New York, Maine, Massachusetts, Rhode Island, and New Hampshire. My firefighting experience was as a fire paramedic lieutenant with the Kennebunk Fire Rescue Department. All of my other first responder experience has been in either the EMS or critical care transport side of the coin.
I am so, so close to wrapping up my MS in clinical psychology, which I'm obtaining through Colorado State University. Within my practice there, I specialize in post traumatic stress disorder and trauma, and my client population are individuals with ADD or ADHD and are first responders in military active and veteran population.
I hold a bachelor's in medical [00:09:00] biology from the University of New England. I hold a board certification in the topic of critical incidence stress management. For the HEMS and critical care professionals here some of you may be familiar with the group Every Coast Helicopter Operators. I am part of their peer support team.
I'm a member of the Rhode Island State Critical Incident Stress Management Team and the founder of Stay Fit for Duty. We started Stay Fit for Duty in 2018. We want all of our medical and first response professionals to treat their mental health with the same dedication and tenacity as they treat the physical health of those that took an oath to serve.
We run into burning buildings, no question. Double check our SCBA and call it a day. I've crawled into cars that are on fire, realizing that I had to take my turnout coat partially off and able to get into the car. We routinely are health and well being at risk to help the individuals that we took an oath to serve, [00:10:00] yet it's a struggle for me to remind my colleagues the importance of self care and the importance of mental health and wellness and that dichotomy, that shift, that I'm so willing to do everything for everyone for everyone.
Except for myself is really what we're working to change. We do that by supporting and advocating for the need for better mental health and resilience education and practice within the profession. We help create peer support platforms and institutions, and we not only help align individuals with mental health professionals, we help align individuals with culturally informed mental health professionals.
These are individuals that you EMT and a paramedic too, and that's fine. They may not know that firefighter one and firefighter two is a thing. Now I'm showing my New England bias, right? Who's interior qualified, who's not, but they understand the trauma, the stress, and most importantly, the [00:11:00] management of that work.
If you want to know any more about what stay fit for duty offers. I know Joe's going to put some stuff up here in the notes. I have a QR code that we can scan and I'll have this back up here towards the end of the presentation.
So I talked about what we can do and one of the first things we can do when we start to have this bigger discussion on post traumatic stress disorder is differentiate between post traumatic stress and post traumatic stress disorder. A very clinical, very deliberate terminology that gets tossed around in our profession with nothing but good intention, but can often skew the resources and support that we need to recover from this while simultaneously taking what is a normal reaction to an abnormal [00:12:00] event and making it seem like something much bigger than it is.
So first and foremost, I want to encourage all of you and anyone who's watching this to reduce the stigma of mental health and Give ourselves some grace. Give ourselves permission to make mistakes. Give ourselves permission to not feel awesome, to not feel great, to need some help, some love, and some support.
Can we give ourselves that space?
One of the ways that we can reduce the stigma is to recognize what actually makes an event traumatic. And one of the things I didn't do when we started this presentation, because I know we're going to have a number of people watching it once the live offering is done, is asked who's done what? Who's in fire?
Who's in primarily EMS? Who's in HEMS? Who's [00:13:00] in critical care? Who's in fire rescue? Who's in fire aviation? Who are all these different components? Because when we have a better sense of who the audience is, I then say what's a bad call to you, what is universally recognized as a bad call, and what I get are really terrible fires, terrible car accidents, often with fires, calls that involve children or animals or these very unifying and very emotional.
And the simple fact that we can talk about those. are fantastic, but it misses a humongous chunk of what actually makes an event traumatic to our, and you'll notice the grad student in me is being very good and adding citations to a vast majority of the slides you're going to see here. This isn't like James's musing of what I think a traumatic event might be.
This is the American [00:14:00] Psychiatrics Associations. definition of that event. So the people that come help take care of us when we're in need have already illustrated and defined these terms. A real or perceived threat to your physical or emotional well being. An event that is overwhelming. An event that results in intense feelings of fear and lack of control.
An event that leaves you feeling helpless. And the final one here I think is most important, which is why I bolded it in white. It changes the way a person understands the world, themselves, or those around them. And when I talk to my responder colleagues, I point out topics like child abuse, bad, bad traumas, right?
When's the first time that you've seen someone missing a limb or with a terribly broken [00:15:00] extremity and ways that early in your life or in your career? You didn't know the human body was capable of doing or experiencing.
Now that you have this list, this admittedly very broad list, real or perceived threat, a call that is overwhelming, a call that makes you feel helpless, a call that results in intense feelings of fear and lack of control, or a call that changes your worldview. Now, I want you to think about the number of times you've experienced a call that meets that criteria.
Now it gets way bigger because what so often happens when our senior members of an organization are mentoring our younger members of the organization is we fall into this trap. A brand new firefighter, a brand new [00:16:00] EMT comes back. We're just going to put them on the rescue because it's easier. They come back from an ambulance call.
They're pale, trembling. And you come over and you're like, Oh my goodness, what do you need? Is everything okay? Tell me about that call. And you're mentally ready for gore and destruction in all of what you inherently would consider a bad call to be. And this person tells you that they've never seen a leg that badly broken before, never seen a compound fracture, never seen bone sticking out of the skin, and your face changes a little bit and you say, Oh, child, Oh, just wait until, or my personal favorite.
If you think that's bad, let me tell you about the time, blah, blah, blah, blah, blah. So if we zoom out and we recognize that traumatic calls fall under a very, [00:17:00] very large umbrella, we can then take a step back and say, that must have been tremendously traumatic for you to experience in that moment with your lived experience.
and with your tenure within the organization. And it widens that net and it allows us to be a little bit more empathetic and a little bit more graceful to our colleagues that are in need of support. Now, I get ready to share this next slide knowing full well that I'm giving a presentation in the West Coast, in California, and this is a very hot topic in California, and I don't want everyone to leave the call.
But as a mental health professional, I am reminding you that post traumatic stress injury isn't a thing. It doesn't actually hold space within the DSM 5, or DSM 5 text revision, and it's not a recognized term from [00:18:00] the American Psychiatric Association. Now, I love the metaphor. A disorder sounds nasty, and lifelong, and awful, and an injury sounds recoverable.
When I suffer an injury, I get help, I get support, I maybe go to some semblance of physical therapy, and I heal. I love everything about the imagery. What I don't like is when we too frequently say, you don't have PTSD, you have PTSI. We're arming our individuals with tools that therapists don't use. And when I come to a therapist and say, I've been really struggling for quite some time and, you know, my captain thinks I have post traumatic stress injury, and I have been documenting my paperwork as such, and the mental health professional says, I'm going to diagnose you with post traumatic stress disorder.
[00:19:00] We've unintentionally made it a bigger thing. I very much want to see post traumatic stress injury become a thing. I want you all to know that, especially within the military, there are actual committees sitting down talking about whether or not we can start to change this language. And I, too, am in favor of The future language change, but I want you all to know, especially as you continue this series with more mental health professionals that are in the mix when you hear some of them poopoo the term PTSI, it's not because we don't love what it stands for.
It's because we want to ensure that we're aligning individuals with the right terminology. in the event that they undergo a diagnosis. I also want to create some space for your body's natural response to stress and trauma. The best way to think about trauma and your body's response to it is [00:20:00] a trauma response is a normal response to an abnormal event.
Zoom out and think about this for a second. For the individuals here that either are in emergency services or first response or love someone in emergency services and first response. You come home, and you're stressed out, and you're not sleeping well, and your partner, your loved one asks what's wrong, and you're like, I just can't, I just can't get this call of this kid dying out of my head.
Something must be wrong with me. And I'm going to tell you that that is a very normal response to the very abnormal event. Of being part of someone's death and one of the problems of being in the first responder community and being so inherently resilient is we occasionally lose sight of just how abnormal some of the things that we see are [00:21:00] because they were our day to day.
I see a car accident every day. I see a sick person every day. I see a human die weekly. That's abnormal. There are plenty of humans in the world that don't share that same lived experience. And I bring this up so you understand that some of the early responses that you have to that are completely normal reaction to a really abnormal event.
Now, because this talk is uniquely about post traumatic stress disorder, I want to get a little diagnostic for just a minute and point out what some of the clinicians will look for when we try to differentiate what is a normal stress response to something that has become disordered. We need a handful of criteria to make that happen.
So first we need an event or a stressor. Something has to happen. We then have what's called an intrusion [00:22:00] symptom. So this is that thing that I can't shake. I can't sleep, or I can't stop hearing that person call for help, or I can't stop smelling the fuel that was in the car. I have something that continues to interrupt my day to day.
What do I do? Naturally, as I'll get out, I work really hard to avoid it, and avoidance becomes complicated when it lasts for a really long time or interrupts my job. If I'm calling out sick from work because I can't possibly think about that car accident again when I'm at work, it's the only thing I can think about.
Now I'm starting to undergo what we call avoidance, right? I'm actively working to avoid that stimuli. We then have a negative alteration in cognition, and this is what our brain does to tell us all of the terrible, nasty things that are untrue. Oh, I'm a terrible provider. I should have been able to save that [00:23:00] person, or I failed my battalion because they looked for me.
I'm the paramedic, I'm the most senior, and I couldn't save that person. And all of the things that we tell ourselves that are on.
We then look at alterations and arousal and reactivity for any of you that have performed any level of first response care in your life. Think about the first rip and fire you went to, right? It was exactly what you covered in school. Your heart rates up, your respiratory rates up. You're trying to get all your equipment on, but you're shaken.
You tried to turn on your tank 3 times and you just can't do it because you're losing fine motor skills. And you end up doing the work. You come back to the station, and somebody hits the air horn, and you jump out of your skin. You find the person that hit the air horn, you're screaming, yelling, how dare you, blah, blah, blah, blah, blah.
Two weeks ago, you would have said, hey, keep [00:24:00] it down, and chuckled. So our arousal and reactivity either skyrockets or plummets.
These are the core five set of symptoms that we're looking for when we start to Think about a diagnosis of post traumatic stress disorder. Technically four, because the stressor itself isn't a symptom, it is just the event that's the precursor. What is imperative to remember at this stage of the game, we have all of these things, and I'm sure as I'm sharing all of these examples, everyone in here is going, Oh my gosh, I've had, and or currently have, every single one of these things on this list.
Before we can start to talk about post traumatic stress disorder as a diagnosis, We need to have those disturbances, we're going to go back for a second, the [00:25:00] intrusion symptoms, the avoidance, alteration and cognition, or alterations and arousal and reactivity, for more than one.
This is where peer support, critical incident stress management, and good familial communication come into play. Because what I'm not saying here is you're screwed for the first 29 days. I hope that you suffer your traumatic event in February so you can get help a couple days sooner. We want you to reach out to the support.
We want you to interact with trauma focused and trauma aware individuals as soon as possible to help mitigate. The normal responses to trauma before they become disordered. I know I'm sounding like a linguistics coach right now and appreciate the irony that I couldn't get linguistics out on the first time.
When we talk about [00:26:00] disorders in a psychological community, we are talking about persistent symptomology that gets in the way of daily living. So we're saying, here are very normal Responses to traumatic events in the short term that we have not seen any improvement on or we've seen worsening of now we're looking at an individual that may.
The suffering from post traumatic stress disorder. That very clear delineation is why I'm currently anti post traumatic stress injury. Because it muddies the water. It's either a normal stress response, or it's a disordered stress response. And we need to keep it in those two categories so we know how to manage it.
It's also imperative for me to remind you that not everything that is diagnosable in a trauma and stress [00:27:00] related disorder will result in post traumatic stress disorder diagnoses. This slide is much more pointed towards the fellow mental health professionals that are in the room, but I want you all to be informed that you can have a lot of trauma in your life and a lot of maladaption to that trauma and not come out with a diagnosis of post traumatic stress disorder.
You could be suffering from acute stress disorder. And adjustment disorder or the universal catch all for anyone who's ever seen like an EAP counselor or someone who's on a very, very short timeline to try to generate a diagnosis the unspecified trauma and stress disorder, the unknown medical and the psychological community.
I actually have no idea, but it sounds like a traumatic event brought him here. So we're going to slap this on them and figure it out later. The biggest delineator between any of these. [00:28:00] Is
I cannot overemphasize early. In your experience of a traumatic event, we're talking the first 24 to 72 hours. A lot of what we just talked about are completely normal stress responses.
Makes those responses disordered is continued perseveration and continued persistence of those symptoms.
The last big thing I want to talk specifically to the diagnoses of post traumatic stress disorder, these diagnoses have to be made by a licensed mental health professional, LPC or LMHC, masters of social work, psychologist, psychiatrist. [00:29:00] You need an individual that accepts your insurance. That's not fair.
Let me, let me walk that back. You need an individual that has an MPI number and is licensed in the topic. And in a perfect world is board certified in the topic. Now for the baby therapists, like myself in the room, you cannot sit for your board exams for a couple thousand hours. You have to do a lot of supervised care before you can sit for your board exams.
But I want to clarify that really good, hardworking, well meaning individuals, chaplains, peer supporters, life coaches, all phenomenal members of the mental health care spectrum. None are able to formally diagnose you. Only our mental health professionals are. So please, especially for my fellow peer supporters in the room, be very cognizant of the terminology that you throw around and be very aware of the [00:30:00] boundaries and the limits of what you can do.
You don't ever want someone walking away from a conversation with a peer supporter saying, well Joe is a peer supporter and he told me that I have PTSD. Joe can't diagnose you with PTSD. What Joe might have meant was, it sounds like you're really struggling with this event, and let's get you some support so we can get you to the right people, but I just want to hammer that home, because there are a lot of incredible humans in the mental health community, especially in the first responder space.
And unfortunately, when we get to the level of diagnoses, We need to escalate that to our mental health.
What we're all here for. We knew all of the statistics. I'm willing to bet you knew a vast majority of some of the diagnostic stuff that I threw at you. Now let's talk about what we can actually do. And the first question I [00:31:00] have for you is what do other people in your crew or battalion think you're doing tonight?
Did you leave work saying, yeah the Venturecraft Foundation's putting this putting this really cool thing together. I don't know, some dude from Boston, he's a flight medic. I, he's got a logo. I, I got no idea. But it sounds like it's on like post traumatic stress disorder. And I was gonna take a listen to it on the ride home or while I'm eating dinner.
Or whenever, or are you telling people that you're listening to the Joe Rogan podcast, your headphones in, hood up, hiding your computer from your colleagues, because God forbid you're in a webinar on mental health when you're sharing this with individuals and you're sharing the recording, being open about what you're sharing?
Hey, I saw this thing. I think it's really neat. I thought he did a really good job explaining what post traumatic stress disorder was and answered some questions that I thought you'd like to see it. How are we explaining to our friends, family and [00:32:00] colleagues? what we're doing. We all know the beauty of the firehouse is in the fraternity and in the connections that we make and the power of the 20 year guy or girl in the department looking at the newest recruit saying, Hey 1900 hours.
I'm going to listen to this podcast, excuse me, webinar on PTSD. Why don't why don't you wrap up when you're done with your nightly's and come over and we'll listen to it together. The power of saying. I know this is important. It's worth my time. It's worth your time, too, is invaluable. Seems like such a small thing, but oftentimes it's overlooked.
East Coast guy to West Coast team. You guys have a ton of amazing and really valuable resources. I'll tell you that the East Coast is [00:33:00] really trying to catch up to what our West Coast colleagues are doing as far as recognition. Awareness and openness of mental health in not only the fire service, but in the first responder community as a whole.
So bravo, all of you, because that is work that you have all done, and I'm going to lean on Joe and the team here to share those very specific resources, but I'm happy to share anything that is national. or anything that is a bit outside of the West Coast. If you're looking for something that's not in your immediate area.
Next, we're going to talk about resilience. And as we talk about resilience, you're going to see a bouncing ball sit back here because there's a ton of confusion about what resilience is and what resilience is.
People will come to me and say, God, I'm really, I'm really going through stuff. I got stuff going on at home. [00:34:00] I got stuff going on at work at a terrible call the other day. I am not resilient. And I remind you that just like that ball can't bounce until we drop it to the ground. We don't become resilient until we face Again, look at the citation.
This is from the American Psychological Association. Resilience is the process of adapting well in the face of adversity. It means bouncing back from difficult experiences.
All too often, people confuse the idea of resilience, which is bouncing back from adversity, and resistance, which is not being affected by it altogether. And I don't care too, too much about the specific definitions, except that when someone suffers. [00:35:00] any type of adversity and they experience some emotion or some difficulties in their day to day because of it, they come to me and they say, I'm not resilient.
And I say, no, now is when we start resilience. Resilience hasn't even entered the chat yet. Now we're talking about resilience.
I talked about this at length at a presentation I gave up north. If you ever go to a talk about resilience. and they tell you that they are going to teach you how to become resilient,
pack up your stuff, go home. You cannot look another first responder in the eye and tell them that they did not have resilience before they sat in your chair. [00:36:00] Hands down, first responders and healthcare providers are the single most resilient group in America.
When I talk about what I consider a responder, I get a really, really broad brush out and I say, If you've ever been in somebody else's home at 3 o'clock in the morning because they needed help, you're a responder. And that fact alone shows that you have resilience. Have you ever woken up and or not been allowed to sleep?
Until 0300 where you walked into somebody's home who needed your help primarily for something probably not super life threatening or critical or the total other side of the story and I'm getting ready to set up the medical aid tent while you guys are entering the B side because the house is all the way on fire.
You are already resilient. What I'm going to spend the next 10, 15 or so minutes talking about is how [00:37:00] we can strengthen. That existing resilience. It's a muscle just like everything else in the world. How can we strengthen our existing resilience? Because increasing resilience and having a plan for what to do when you are inevitably affected by the traumatic things that you see help create distance between being affected at all and a lot of distance between having some Normal responses to abnormal events and PTSD.
Because I have all of these other tools, tips, tricks, and awareness in place where I can either not need professional support, can get by with [00:38:00] just good critical incident stress management, psychologic first aid, peer support, chaplaincy, all of those wonderful things, or can get myself to a mental health professional before.
An entire month has gone by, two months, three months, four months of just constant suffering. I can get to those individuals sooner so I can get the care and support I need. I
do not care what your family looks like. I do not care who you consider your family. I do care that you remember that your family and help you. If I had another two hours to talk to you all, I would spin into this entire diatribe on relationship wellness. And I don't want to take any of Maggie's thunder because I know she's going to give an amazing talk on this topic, but it is imperative that you as responders.
Look at your significant others [00:39:00] and your family as members of your team. All too often, especially the fellow men in the room, get a little too focused on, I have to be the protector, I have to shield them, I have to be the provider, I have to be all of these things, and that doesn't leave space for these people in your life that love you.
to have their eyes out and be able to provide you some insight that is challenging to obtain when you're in the middle of it and can provide you some support.
Again, without stepping on the toes of any of our upcoming presenters here, one of the things that I'm going to share with Joe is what I call a relationship action plan. You all know that when you are stressed to the max, your cognition falls. If you've ever Gone to a car accident [00:40:00] and had a bunch of people wandering around.
They're really stressed out, but they're not super injured. Right. Somebody's got a headlack and you're like, okay, ma'am, I need you to go sit on the sidewalk over there. And they look at you and they say, okay. And they stand there and you say, okay, the sidewalk over there. I need you to go sit down and they don't.
And you're back and forth and back and forth and back and forth. We know that the higher our stress level, the lower our cognition. We can almost plot it. We know this in our training. We know this in the academy. We know this in the day to day. There's a reason why we blind your mask and make you do confined space egress.
There's a reason why we train all of these tremendously high stress scenarios so that your cognition is built up in preparedness of that. The Relationship Action Plan gives you the space to have a conversation with your loved ones. [00:41:00] So, when you come home from a 36, that will change your life forever. It might not have even been traumatic, it may have just been long and awful.
And your partner hits you with the, what do you want for dinner? Tommy's gotta get some homework done, can you help him with that? Can you do this? Can you do that? Can you do the other thing? Because your partner has been without their significant other for 36 hours. You have something you can point to and you can say I don't have it in the tank right now.
I am capped out.
How can we make it work? Having that conversation beforehand is so, so much better than having it in real time.
When we talk about resilience, sometimes it's as easy. It's getting back up.[00:42:00]
We don't get a ton of time to watch TV where I am, but when we do, we often watch that show. And that is our routine fifth, sixth, seventh transport call. You just got back from a flight and you're exhausted and you're staring at your lunch that's been on the counter for forever. And you think maybe you can grab a bite before you have to restock and go on another call and comms goes, med two pilot, med two, and you all look at each other exhausted and you say, I didn't hear no bell.
And you make your way out because sometimes it's all we can do. I'm sorry that this skips ahead of me here. When we look at physical and actionable tools that we can use in real time, I would like to introduce you to the Swiss army [00:43:00] knife of breathing techniques in the psychological community. As you can see, this is called box breathing and I'm going to try to reset it here so it plays well, just one second to see if we can make this work.
Ah, beautiful. So what I want you all to do is two things. I want you all to not laugh as the screen went away. I want you first to do this. We're going to do it twice. We're going to watch the gift once I'm going to narrate it the second time. And then we're going to talk about some aspects of this breathing exercise.
So along with me, you're going to inhale to count of four.
Hold your breath.
Exhale to the count of four. Hold your breath. I'll narrate this one here. We're going to breathe in. Two, three, four. Hold our breath. Two, three, four. [00:44:00] Exhale. Two, three, four. Hold our breath. Two, three. And then just one breath. In your nose. And out your mouth.
Now I can all but guarantee that nobody fell asleep and all but guarantee that none of you have met the state of absolute Zen that you've been aiming to achieve since you first did a yoga exercise.
Did that turn a 9 on 10 Did that at a minimum give you a 2nd to recalibrate? On the paramedic side of the coin, especially on the helicopter EMS side of the coin, I don't intubate a patient or do any surgical procedure. without box breathing in real time. It keeps my fine motor skills in check. It keeps me situated.
It gives a [00:45:00] deliberate little bit of delay to the intervention I'm about to provide and do a lot of good. You can practice it in the car ride home. You can practice it in a standby that you've been at for hours. You can practice it when you're communicating with your significant other. Awesome tool to use when you're trying to intently listen to someone.
If you're like me and your brain starts to wander and you think about what we could maybe have for dinner, And gosh, really hungry. And I wonder if my show's on while your partner's trying to talk to you. If you work through this technique, it helps keep you focused in the moment. It is not the end all be all, but it is an incredibly useful tool in real time.
I strongly recommend that you all keep this in your repertoire. And I want you to all notice for those of you that actually did the exercise. There's no bell. There's no home. There's no having to sit in a particular [00:46:00] place and do this and do that. I literally did it with you while I was narrating. Many of you did it next to somebody who didn't even know you were doing it.
And I think that's an important point. It's a very useful tool that is simultaneously very subtle. And it can be utilized mid conversation, can be utilized when you're driving the engine, can be utilized while you're talking to a patient or talking to a bystander. There's a lot of different ways.
Next up here, I want to point out exactly what I mean by trying to keep the slide kind of graphically sound and some red and some white and not a whole ton of verbiage here, there is no replacement for this. For sleep, as far as the [00:47:00] physiology of our body is concerned, each and every one of you know this, you've worked an overnight, you've worked a string of them, we are as an industry starting to talk about walking away from these really long shifts, because while they're great for our paychecks, and really good for our schedules, gosh, they can be really complicated and just about every other facet, we know that as mammals, as firefighters, paramedics, forget it, As mammals, we need sleep.
You have to have sleep. However, in the scope of psychological improvement or critical incident stress utilization, if you can't sleep, mindful rest is just as beneficial. So you come home, you're wired, right? We just spent the first 15 minutes talking about stress responses, right? You're wired. Your pupils are [00:48:00] dilated.
Your heart rate's up. Your partner is like, Oh my gosh, you look so stressed. Are you okay? And you're like, I don't, I just, I'm going to take a shower and try to lay down and you take a shower and you try to lay down and now your heart rate's 105 down from 130 and you're staring at the wall wide awake, but I tell you now, remember Joe, I need you to get seven hours of sleep to make the bad thoughts go away.
You're gonna laugh at me, gonna toss and turn, you're not gonna get any sleep, you're gonna shame yourself for not getting sleep throughout the interim, and potentially worse, you're gonna grab some booze to try to help you sleep. If I say, do what you can, I want you to lie in a cool dark room, and I want you to perform a breathing exercise or two.
And really try as best as you can to tell your brain that we are going to rest. [00:49:00] We don't need to fall asleep, we do need to rest. Off of our cell phone, off of our portable, quiet, calm, dark space, to allow us to try to start to decompress is as psychologically beneficial as actual sleep. Unfortunately, as humans, and as mammals, we need to actual sleep or physiology, but our brain, we can help get by with some mindful rest.
I understand that an image of raindrops right now, especially in your area is not the most soothing videograph I could have picked. And I apologize for that. When we talk about mental health and trauma, we talk about it in a scope that says doing the work we do and being unaffected by it is just as unrealistic.
It's walking through [00:50:00] water without getting wet. So we use the umbrella metaphor as a form of self care and we say, so if that's true, if you're walking through a rainstorm, what can I give you to help prevent or deflect some of this trauma and self care is it. When we talk about what self care is, it's what we do for ourselves to not only establish and maintain, but prevent.
and deal with illness. There is an emotional self care aspect of this as well. Perhaps I go after my favorite hobby. Perhaps I spend some time with my loved ones, but perhaps I just spend some time with myself. I have a media blogger that I'll share with Joe that just talks about how to decompress on the ride home.
What can we do to ensure that we are not only establishing and maintaining health and preventing and dealing with illness, But [00:51:00] give our brain some time to do something other than fight fires and take care of sick people. Because we need that separation in order to keep our brain as ready and prepared to undergo inevitable trauma as best as humanly possible.
Now one aspect here on the self care front that I don't have the right slide for, and I apologize for that, is to the point on mindful rest and alcohol use. I am a German Irish paramedic. I'm a paramedic. For just shy of 20 years, I've been an EMS for over 20 years. I'm not going to look any of you in the face and say that I have never drank myself silly.
I did it to be cool. I did it because I thought it helped. I did it because it gave me some good rest. I'm simply not going to tell any of you on some soapbox that, you know, you got to be really mindful of your alcohol intake. What I will tell you is being mindful of your [00:52:00] alcohol intake. improves quality and the quantity of your sleep.
And what we know as we study brains and trauma, the better the sleep, the better the time our brain has to catalog and process the trauma.
Easiest way I like to go about this, unless you have a disordered or addictive existing history with alcohol, Is for every alcoholic beverage I consume, I consume a glass of water. One for one. It lowers my bar tab. It keeps me hydrated. It still allows me, the fraternity, to consume some alcohol, but doesn't get me in such a space that my sleep is going to be affected.
A one for one. [00:53:00] As I wrap up here, I want to talk about what is arguably the most important part of this whole deal. The idea of post traumatic and vicarious growth. As I went on my little diatribe about post traumatic stress injury, I said, what I love about post traumatic stress injury is the metaphor behind an injury, right?
You heal, you suffer an injury. It wasn't your fault. And then you heal. And that's fantastic. Post traumatic and vicarious growth are the same thing. The importance of acknowledging what you have already done and how far you have already come is imperative. I work with clients all the time that have made leaps and bounds of improvement in a period of weeks.
Tremendously short periods of time that come to me and say, feel no progress. And we zoom [00:54:00] out, and we talk about all of the ways that they've progressed over a period of time. And they say, oh, cool, I didn't feel that progress before, and now I do. So the recognition of how far we've come and what we can do is imperative.
I
also want you to be very cognizant of your metrics for success. Now, admittedly, this is pointed more towards my hems and critical care colleagues, but I think it's really important, right? If I live every day in pre hospital emergency medicine saying I haven't succeeded as a flight medic unless I met a human in cardiac arrest, resuscitated a human out of cardiac arrest and got them home completely neuro intact, I will be devastated throughout my entire career.
Can I reframe that and celebrate the wins? Can I celebrate [00:55:00] calls that are relatively straightforward? I celebrate the days where I have great partners for me personally. Am I in my favorite aircraft with a good pilot and a great nurse? I'll take it. Wins all around. Come at me day. Let's do this. My neck of the woods.
We have Cumberland farms, tiny little gas station sells pretty okay. Coffee. Every now and again, either the cashier or someone there will toss me a free cup. If I'm in my flight suit, which I do routinely try to avoid, but every now and again, it's unavoidable. That's huge. That's a win. And I recalibrate what I consider my wins to be so that I can capitalize on the tremendous amount of good that happens during my shifts.
Rather than waiting for this one very particular type of call, one very particular type of fire, this one very particular type of incident.[00:56:00]
I know we got started a few minutes late, and as promised, I really wanted to leave some time for some Q& A, so I'm going to leave my contact info up here. I can bring that QR code back up here in just a second, but easiest way to get a hold of me is through email, james at stayfitforduty. org. My social media of choice is Instagram for any of you that also have Instagram.
You can find me at stay underscore the number for duty, and I'll throw this QR code back up here for just a minute, and I would love to take some Q and a it's
Joe Booth / Ventura Fire Foundation: fantastic. James. Thank you so much. It's really learned a lot in the past, whatever, 55 minutes. If you have a question for James, throw it in the chat.
And I will, I will ask it of James, although we're getting close to 11 o'clock his time. So we want to be cognizant of that, but I'm going to start off with a question that James, you hit on a little [00:57:00] bit earlier. But talked a lot more about when you were on the podcast, and that's the idea of cultural competency, and you have a little bit of a nuanced view of cultural competency when seeking a therapist or when seeking. Mental health supports. And you really use the term cultural awareness. I'm wondering if you could kind of explain the difference between the 2 and why, why you think it's important.
James Boomhower / Stay Fit 4 Duty: Absolutely, that's a fantastic question and I'll alliterate a little bit here.
So everyone's heard of the term culturally competent. Oh, you've got to find a culturally competent therapist. They got to know what you do. They got to be able to understand all of these things. And at the risk of, of over inflating my career, you could argue, I'm a culturally competent therapist.
Worked in the fire service, worked in good old fashioned, 9 1 1, done every facet of VMS you can do. And now I'm in the medical helicopter, right? And my law enforcement experience kind of begins and ends at like the [00:58:00] tactical paramedic side of the coin. Right, but I can sit with names that I can see on the screen.
I'm not calling anybody out, but I can sit with Clarissa and I can sit with Kevin and they can say, yeah, man, I missed my promotional exam and how that really sucks and this and that. And I don't need to ask them for a lot of filler, right? I've done the job. I understand the work they're doing. Like, they can use paramedic aside beside this.
I had to cut the a post and this happened. I've done the work. I'm very well informed in that space. I'm a competent clinician when it comes to not only understanding the work that you do, but having such an intimate awareness that I've done it with you as well. And there are a very small group of those therapists around.
And they're phenomenal. They're the unicorns. And I'm happy to kind of join the herd as it were, right? I'm very, very honored to be in this space. But there are also a tremendous number of individuals. that specialize in caring for individuals that have suffered trauma, that understand kind of the cognitive behavioral [00:59:00] aspects of that, that utilize the right therapeutic framework in their eyes to help you manage and mitigate your trauma, and might just barely understand the difference between an EMT and a paramedic.
Or understand that a law enforcement officer has a different job than a firefighter. Like more than just like transient, right? And understand that a nurse and a paramedic aren't the same thing. And what you have to ask yourself then is if that person checks all of the psychologic boxes that I need, but isn't like I have to do a little bit of explaining.
It's a little super understand what a battalion is, and they're not totally on board with, like, how my schedule works. The question you have to ask yourself is. Does that person check enough of the boxes? Because the one thing we occasionally forget to mention is you could find me as a therapist on paper and be like, I am all in.
Are you free on Tuesday? And we can have a handful of sessions and we might not be aligned as people, right? I might just [01:00:00] not answer questions the way you need them to be answered, or we simply might not share that same space. So, I want to make sure that when we have this big discussion over culturally competent clinicians and culturally informed clinicians, and then culturally aware clinicians, we're understanding that it's never about the quality of the mental health care they provide, but it has to do with the What they do specialize in and the work they do do and how much they're willing to learn about our profession in our space in order to best take care.
Awesome. Thank you.
Joe Booth / Ventura Fire Foundation: That, that explained it really well. I don't see any, any questions in the chat, which means that you are completely thorough and comprehensive. And the folks are like me, they'll think about it 3 hours from now. The question they wanted to ask. So with that, I think
James Boomhower / Stay Fit 4 Duty: we will close it
Joe Booth / Ventura Fire Foundation: out.
James, thank you again very, very much. We appreciate [01:01:00] your time and your effort to help educate us on on these important issues, and I encourage everyone to reach out to James. If you have any other. Issues or questions, follow him on Instagram. He has a lot of good content there that I find helpful to watch and for everyone listening, thank you for joining us.
I'll send out. The recording in a couple of days and
James Boomhower / Stay Fit 4 Duty: have a good evening. Yep. Thank you. I can't echo that enough. Thank you all very much. Thank you, Joe. And thank you for the foundation for having me. And Joe is a man after my own heart, right? If you're like, oh man, I'm going to have so many questions at the 2200 hours.
By all means, shoot me an email, send me a message on Instagram. The only caveat I do want to make just quickly is in the space that I'm in here on social media and through email, I'm not acting as a crisis counselor. So please, if it's a mental health emergency, please reach out to your 24 seven crisis lines, 9 1 1 9 8 8.
Your local kind of Samaritan line but for all the other stuff [01:02:00] or for questions about therapy or, or asking a therapist, like what the whole therapy process is like, you have questions about what I talked about. You want to challenge anything I talked about, please. I'm very well aware of the room I'm in.
I have no hesitation whatsoever to have a dialogue about what you liked, what you didn't like. I really work to make sure this is polished and prepared as possible. So please don't hesitate to reach out via any of those mediums. And I'd love to continue this conversation later on. Thanks
Joe Booth / Ventura Fire Foundation: so much, James.
And thanks everyone for joining us. Have a good evening. Take care, everyone.
Why Supporting Firefighters and Their Families is Important
Firefighters are some of the bravest people in our Ventura. They put their lives on the line every day to protect us from fires, medical emergencies, and other disasters. But being a firefighter can also be a very demanding job, both physically and emotionally.
Firefighters are often exposed to traumatic events, such as seeing people injured or killed. This can take a toll on their mental health. Firefighters are also at risk of developing physical injuries due to the nature of their work.
Firefighter families also face unique challenges. They often have to worry about their loved one's safety, and they may have to deal with the emotional fallout of traumatic events (aka secondary trauma).
Supporting firefighters and their families is important because it shows our appreciation for their service and it helps them to cope with the challenges they face. Ultimately, ensuring our firefighters and their families are healthy helps them to protect us more effectively.
On Giving Tuesday, please consider supporting the Ventura Fire Foundation. Your donation will help to ensure that firefighters and their families have the resources they need to thrive.
Click Here to Support Ventura Firefighters on Giving Tuesday
The Ventura Fire Foundation: Making a Difference in the Lives of Firefighters and Their Families
The Ventura Fire Foundation is a non-profit organization that provides support to Ventura firefighters and their families.
The Ventura Fire Foundation provides a variety of programs and services to support firefighters and their families, including:
Mental health and wellness programs: Firefighters are exposed to traumatic events on a regular basis, which can take a toll on their mental health. The Ventura Fire Foundation provides mental health and wellness programs to help firefighters cope with stress and trauma.
Financial assistance: Firefighters and their families often face financial hardship due to medical expenses, job loss, or other unforeseen circumstances. The Ventura Fire Foundation provides financial assistance to help firefighters and their families get through tough times.
Family support programs: The Ventura Fire Foundation provides family support programs to help firefighter families cope with the challenges of having a loved one in the fire service. These programs include support groups, educational workshops, and social events.
The Ventura Fire Foundation is a vital resource for Ventura firefighters and their families. On Giving Tuesday, please consider making a donation to the foundation to support the brave men and women who protect our community.
Click Here to Support Ventura Firefighters on Giving Tuesday
Giving Tuesday: Supporting Firefighter Families
Every year on Giving Tuesday, people around the world come together to support the causes they care about most. This year, we encourage you to consider supporting the Ventura Fire Foundation, a non-profit organization that provides support to Ventura firefighters and their families.
Firefighters put their lives on the line every day to protect our communities. They are often the first on the scene of emergencies, and they work tirelessly to keep us safe. But being a firefighter can also be a very demanding job, both physically and emotionally.
The Ventura Fire Foundation provides a variety of programs and services to support Ventura County firefighters and their families. These include:
Mental health and wellness programs: Firefighters are exposed to traumatic events on a regular basis, which can take a toll on their mental health. The Ventura Fire Foundation provides mental health and wellness programs to help firefighters cope with stress and trauma.
Financial assistance: Firefighters and their families often face financial hardship due to medical expenses, job loss, or other unforeseen circumstances. The Ventura Fire Foundation provides financial assistance to help firefighters and their families get through tough times.
Family support programs: The Ventura Fire Foundation provides family support programs to help firefighter families cope with the challenges of having a loved one in the fire service. These programs include support groups, educational workshops, and social events.
On Giving Tuesday, please consider making a donation to the Ventura Fire Foundation to support the brave men and women who protect our community. Your donation will help to ensure that firefighters and their families have the resources they need to thrive.
Click Here to Support Ventura Firefighters on Giving Tuesday
How to Support Ventura Firefighters on Giving Tuesday
There are several ways to support Ventura firefighters on Giving Tuesday:
Mail a check to Ventura Fire Foundation, P.O. Box 5175 Ventura, CA 93005.
Include the Ventura Fire Foundation in your will, living trust, retirement plan, or life insurance policy. Contact us to learn more.
No matter how you choose to donate, your gift will make a difference in the lives of local firefighters and their families. Thank you for supporting the Ventura Fire Foundation on Giving Tuesday!
How the Ventura Fire Foundation Supports Ventura Firefighters
This Giving Tuesday, we encourage everyone to support Ventura Firefighters by donating to the Ventura Fire Foundation.
The Ventura Fire Foundation supports our firefighters in a variety of ways, including:
Providing financial assistance to firefighters and their families who have been impacted by injury, illness, or death.
Offering programs that promote firefighter mental health and wellness.
Hosting educational events to help firefighter families navigate the difficulty of having an active firefighter at home.
Here are a few specific examples of how the Ventura Fire Foundation has helped our firefighters:
The Foundation recently helped pay the mortgage of a firefighter who was out of work due to an on-the-job injury.
The Foundation produces the Firehouse Roundtable podcast. Through expert guests and personal stories, Firehouse Roundtable provides fire families with important information and advice on how to thrive.
In addition, the Foundation offers programs that promote firefighter mental health and wellness. These programs can help firefighters to cope with the stress of their job and to maintain a healthy work-life balance.
Click Here to Support Ventura Firefighters on Giving Tuesday