Why Firefighter Suicides Should Not Be Considered as LODDs

Put aside the emotion when considering adding to a number we try to lower each year

The topic of firefighter suicides is one that gets raised once or twice a year and is full of intense but quiet emotion. Quiet because the subject of suicide is one that people do not like to discuss; intense because when it is discussed some people make the mistake of passionately identifying these deaths as part of the sacrificial duty of a firefighter and consider them worthy of recognition equal to having been killed inside a burning structure. Unfortunately, when we talk about the actual number of line of duty deaths, the fire service has a hard time keeping the facts, or data, separate from the emotion. Considering a firefighter taking his or her life as a line of duty death has many consequences that range from skewing yearly fatality data to causing deep divides among firefighters from the local level on up to our national fire service figures and organizations. The intent may be noble but the end result would be torment.

LODD and On-Duty Death

Before we discuss adding firefighter suicides we need to first understand or remind ourselves the official terminology and definition processes. Two national organizations, the United States Fire Administration (USFA) and the National Fallen Firefighters Foundation (NFFF) each have specifics that govern the identification and inclusion processes for a fallen firefighter to be considered as a line of duty death. The terms themselves are also unique and need to be understood. Many states have their own definitions and guidelines regarding the determination of firefighter fatalities, but for this article and the relation to yearly national reports, we will focus only the USFA and NFFF material.

For the USFA, “on duty” refers to being involved in operations at the scene of an emergency, fire or non-fire; responding to or returning from an incident; performing other assigned duties; and being on-call or standby, except at home or work. Firefighters who become ill performing duties and have a heart attack shortly after returning home, or at another location, may be considered as “on duty.”

For memorial purposes, the NFFF considers a line-of-duty death (LODD) as that which occurs during an activity or action where a firefighter is obligated or authorized by various rule, agreement or other law to perform as part of the fire service he or she serves, and the action is legally recognized. Documentation must be shown to provide a direct link from the incident to injury and death. In the case of deaths resulting from heart attack or stroke, proof must be presented to show the victim’s participation in emergency response or training activities within the 24-hour timeframe before the cardiovascular event.

The NFFF also identifies specific causes of deaths that exclude firefighters from memorial consideration: deaths attributed to suicide, alcohol or controlled substance abuse, and deaths resulting from the victim acting in a grossly negligent manner. There are other specifics and criteria used by both the USFA and the NFFF in determining eligibility into their respective accounts in cases such as deaths from previous years, delayed reporting or other causes of death that are individually weighed by the respective programs.

Reasons Not to Add to Our Yearly Numbers

The Fog of Suicide

The very nature of this mode of death (suicide is not a cause but one of four modes used for legal definition) gives it a stigma that makes even the best reporting of it foggy. Data the fire service relies on when reviewing firefighter fatalities in efforts to prevent more is and should remain as specific and detailed as possible. The problem with the proximal intent of suicide is that the external factors are many and develop over a period that can be seen as elongated when compared to firefighter fatalities of the line of duty or on-duty nature, even when compared to deaths involving stress/overexertion as autopsies show cause. For example, the autopsy of a firefighter who suffers a fatal cardiac event can reveal that the victim died from atherosclerotic and hypertensive cardiovascular disease. The victim’s medical history can be researched back for many years to reveal a diagnosis of hypertension and type 2 diabetes mellitus. We can further learn of this history through department medical reports and family history/details, which may include being a life-long smoker, obese and someone who did not participate in regular exercise or a healthy diet.

One could say that similar information can be taken from the autopsy of a firefighter who died as a result of suicide, and be used to support information geared toward prevention. The rub is that not every firefighter fatality has an autopsy performed. If one did for a victim of suicide, the findings of cause and mechanism of death, as well as toxicology, may not be released and if so do little to provide a strong enough resource for preventative information. It might be reported that a victim was prescribed the antidepressant Lexapro, but unlike being described a drug for lowering cholesterol, antidepressants and the treatment of depression have a far wider range of delivery, coupled with other treatments, too far to be isolated AND that is if the act of suicide can be undeniably linked to depression.

Current efforts to reduce line of duty deaths have as their support firm data derived from the fatal incidents and investigations. The fire service relies on this data to support the most reliable actions to take as a preventive of further fatalities. When a firefighter is killed in a building collapse, we are given information on the building’s construction and the actions the victim and others took prior to, during and after the collapse. Supportive information is given to reinforce lessons learned and support recommendations and best practices. The same is true when a firefighter is killed after having been ejected during an apparatus accident. Once the investigation is complete, we learn about the lack of seat belt use, vehicle speed and characteristics, the victim’s training and more. Similar definitive information, in most cases, cannot be derived from the investigation of a firefighter’s suicide.  The wide range of methods of suicide and the even wider range of contributing circumstances – if proven and publicly released – make it impossible for the CDC or other related fatality prevention organizations to make any sound recommendations. Just look at the dialogue about NIOSH reports and recommendations from any fireground fatality; the debate is active and large about their usefulness.

Adding More Statistically Irrelevant Data

Each year the USFA and other national organizations issue a yearly report on firefighter fatalities. The data, which I am critical of (it needs to be broken down in greater detail), is quite broad but does a fair job in disseminating the causes of firefighter fatalities and related details. The data is broken down by agency type; duty type; causes of fatal injury; nature of fatal injury; and other categories such as time of injury and more. It should be noted at the start that the USFA already does not include in their reports fatalities that occurred when the victim became ill after going off-duty and had participated in activities that did not involve physical or mental stress. There is also no reporting of deaths due to illnesses developed over a long period of time in the same reports.

“Other” is the field in these yearly reports and current year to date information where deaths that don’t fit the specific fields under Cause of Fatal Injury, such as Stress/Overexertion; Vehicle Collision; Struck By; Collapse; Fall; Caught/Trapped; and Contact With. In 2012 Other contained four deaths: pulmonary embolism; drowning; natural causes and a cause still to be determined. In 2013 seven fatalities were listed in Other. 2014 currently has no fatalities listed in Other but does have two under Unknown. The point of understanding Other is that unless there is specific, reported follow-up on these fatalities, Other simply becomes just part of the lump sum and is useless in having any educational relevance. Now, add in suicide data as recorded and reported by the Firefighter Behavioral Alliance for this year and the past two years:

2014

Current On-Duty Deaths per USFA: 37

Suicides per FBHA: 21

Total: 58

 

2013

On-Duty Deaths per USFA: 107

Suicides per FBHA: 59

Total: 166

 

2012

On-Duty Deaths per USFA: 81

Suicides per FBHA: 58

Total: 139

The big question the fire service will have to answer, if you count suicides as on-duty deaths, is what do we do with “Other”? We know that the exact data on firefighter suicides is grossly inaccurate and under reported, so when we add suicide we take what is already questionable data and skew it even further. If we are going to be having these honest, hard discussions, then when it comes to fatality data the first discussion we need to have is what do we do with suicides? Current information for the fire service on suicides already makes it known that, as Richard Gist, PhD. said during a 2013 conference on the subject, we just don’t know a lot about firefighter suicides.[i]  A similar message is also presented in material for clinicians and chief officers from the NFFF.[ii]

Does this imply that the data will eventually be better as it is recorded? For the study of firefighter suicides, yes, but for the statistical value of yearly fatality reporting, no. Take a look at the “Other” data we have as well as the data where the victim died “several hours after shift”. What relevant training value comes from that data? How will you as a fire officer compile and present training information on health and fitness using, for example, the death of an over 60-year old volunteer who died at home within 24 hours of having responded to his station for a call? For all we know, that victim may have died without the call having happened at all. Add in suicides, if you will, and you will include the following:

Overdose

Firearms

Cutting

Carbon Monoxide

Suffocation

Hanging

Drowning

Vehicular Crash

Electrocution

Jumping from Height

Officials would have to sort through the complexities of these methods and the victims’ histories, if the details are made available, and then transfer it to related training information. Ask any fire chief, line officer, training officer or firefighter doing training what the low hanging fruit of preventing firefighter fatalities is and you can be certain that preventing suicides is not one of them.

Just like trying to include a victim who died of natural causes in his bunk at the firehouse, using a NIOSH report that says “The following recommendations would not have prevented the [victim’s] death. Nonetheless, NIOSH investigators offer these recommendations to address general safety and health issues,” for training, details on suicide will be viewed as irrelevant when compared to the more popular (widely embraced/recognized/shared) fireground fatalities and apparatus accidents.

I leave you with a word of caution about relying on statistical data and victim information as a support for on-duty death inclusion. Information about suicides presented to chief officers shares that while the death should be openly discussed, the method or means of the death should not be described[iii]. Now, by using a ‘best practice’ to eliminate stigma, you’ve also just made the details irrelevant.

Forcing It on Others and Tarnishing Honor

Suicide, for anyone, is a hard subject to discuss. Personal views range from what a person reads in the media to what a family member or coworker experiences. Just as those views are many, so are the acts of suicide, or what behavior the victim believed in that led to the decision to act. Not every firefighter suicide is a product of post-traumatic stress disorder (PTSD). Some may involve criminal or socially inappropriate behavior. Others may involve a murder-suicide. The trouble with these and the victim who acts out of despair is that the value placed, right and wrong, on on-duty deaths is one of honor. Many have written on this subject, a ‘duty to die’, in an effort to change attitudes and lower the number of firefighter fatalities. The view of suicide, in and out of the fire service is one of cowardice. To officially add firefighter suicides to on-duty death information distorts the efforts made by others to change cultural attitudes and the value placed on existing on-duty deaths in their recognition by the fire service and the public.

I have had the privilege to speak with many in the fire service, from firefighters to chiefs and commissioners, on this subject and while all agree that we need to work together to bring the subject out in the open and work on preventative measures, those who have experienced a suicide have had different reactions. One firefighter spoke to me about how when a member of his shift had killed himself, the others were practically ostracized by the other shifts and department. Another firefighter told me how his department wanted nothing to do with the funeral of a firefighter who took his own life and pushed the firehouse to “get over it” as members tried to cope. A chief told me the unique time when a member took his own life and the department wanted to provide a nice funeral for the family. Unfortunately, due to some details about the death and firefighter the department wasn’t privy to, the family wanted to have nothing to do with a funeral or any other type of service. This left the members in limbo for how to grieve and speculate about what they didn’t know of their colleague.

It is a sticky mess, dealing with the family and adding suicide it becomes stickier. One item that was stressed by many of the participants and presenters of the NFFF workshop was that the wishes of the family should come first. This is hard for the fire service because many see on-duty death identification and a LODD funeral as a salute to the service the victim provided. We see this with the non-LODD funerals given to members who have died. However a department wishes to provide a memorial service for its deceased members is one thing, but to have emotion be the leverage for why a suicide should be placed on par with a collapse or heart attack victim is another. PTSD is not the only factor in the contribution of suicides and as already shared and can be documented, the data on firefighter suicides is incomplete. How can we add to the reports and list of names a victim whose death we may never know the full details of, among those who in most cases we know all the steps that lead up to their end? Many will question how does this honor the sacrifices of others? What do we say about valor and courage (and I openly admit that not every firefighter fatality is about those) when we place alongside it what others – and ourselves – may consider cowardly and selfish? It is a sticky mess indeed.

The Implication of Saying Something and Doing Nothing

If as proponents suggest, we add firefighter suicides to official on-duty deaths, then onus of preventing them, like the other fatalities, is on the fire department. We have all read of news stories about line of duty deaths where the municipality was fined by OSHA, the widow sued the department and the union called out the chief. In most of these stories, the underlying issue was a failure to act or prevent the tragedy. While the current efforts to prevent firefighter suicide should be widely adopted, by adding suicide as an on-duty death we have now put departments in a hard position of having to prevent them just like they would prevent members from not wearing their seat belts, not using all of their PPE or not establishing a collapse zone. This becomes a huge gray area between legal cause to act/intervene, information confidentiality, public image and funding for resources. Take this to an already overtaxed, underfunded department, or better, a volunteer department that can barely deliver health and fitness improvements to its members and having to deal with suicides as a preventable act equal to fireground and apparatus safety will frustrate the lot of them and cause a fear of liability.

It’s Not about Service or Emotion

It is important to understand, as I always do when I write about on-duty deaths, that the discussion doesn’t focus squarely on the victim, but on related information (data, status, and training) and must be done outside the context of the victim’s service to the department and without the passion or emotion. When others say that firefighter suicides should be listed as on-duty deaths they are saying that the victim needs to be remembered in some officious manner. They say this because of emotion and without knowledge (or maybe a blind eye) of the existing national criteria and definitions. When emotion is allowed to run contrary to the science (even if it is imperfect) of the data, all the data is in jeopardy of being misinterpreted. Likewise, citing PTSD as the main reason for including firefighter suicides is also bent on emotion and shows a misunderstanding of suicide in general.

Before we can ever get to a discussion on a national level about this subject, we should first encourage our shifts and departments to talk openly about how we would handle the suicide of one of our own and his or her family. Everything beyond that is data and we need to be careful to not let emotion influence the facts.

Finally, for the matter of transparency and for the eventual “you don’t know how it feels” rebuttal, I offer this:

Yes, my department has experienced the death by suicide of one of its members.

Yes, I even considered and planned my own suicide. I was stopped and thankfully received help.

That’s all you need to know. Anything else is just emotion.

p.s. Might as well add that this view does not reflect the view of my employers and those related to them or anyone else associated with me and fear some form of social ostracizing or being unfriended on Facebook. I’d hope that if this makes you mad, you would at least turn that energy into making your department have this discussion.  – Bill

“In order to know a community, one must observe the style of its funerals and know what manner of men they bury with most ceremony.”

Mark Twain


[i] “While we don’t know the exact data, based on general population rates, we are three times more likely to experience a firefighter suicide over a line of duty death.” R. Gist, NFFF Suicide Workshop, Emittsburg, MD 26-27 October 2013

[ii] “Contrary to common belief, we do not really know the scope of firefighter/EMS suicide, because suicide data as related to occupation has previously not been systematically recorded or reported. Since many firefighters (upwards of 75%) are volunteers, the relationship between occupational stress and suicide becomes even cloudier.” Suicide: What you need to know – A Guide for Clinicians, NFFF 2013

[iii] “Suicide: what you need to know – A Guide for Fire Chiefs”, NFFF 2013

 

BioPic

Bill Carey is the online public safety news and blog manager with PennWell Public Safety, or more specifically FireRescue Magazine/FirefighterNation.com, JEMS.com, LawOfficer.com and FireEMSBlogs.com. Bill started in the fire service, as a third generation firefighter in 1986, on the eastern shore of Maryland and then continued after moving to Prince George’s County. He served as a volunteer sergeant and lieutenant at Hyattsville. Bill’s writing has been on Firehouse.com, Fire Engineering, FireRescue Magazine, FirefighterNation.com, the Jones and Bartlett 2010 edition of “Fire Officer: Principles and Practice”, The Secret List and Tinhelmet.com. His recent writing on firefighter behavioral health has been nominated for 2014 Neal Award for Best Subject-Related Series.

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42 Comments

  • Ken Kolbe says:

    I am in EMS since 1982 and also worked as mental health intake for a VA medical center. I am in a family that had a non Emergency provider suicide.
    It has been a devastation to this family. I also know that what we see in out world can never be explained to those who are not. I absolutely believe just that we are the homeland uniformed public servants that see and do the same as military and that suicide of an emergency servant should be a LODD!

    • Bill Carey says:

      Thank you Ken.

    • Tom says:

      Ken,
      First, I commend your many years of service, but to say that fire and EMS see a do everything that the military does is grossly inaccurate. As a member of the military for 24 years, and as a member of the fire service for 24 years, I have to disagree. While some members have to deal with tragic events in fire and EMS, they are not comparable. A firefighter’s suicide should never be listed or considered a LODD. Nor should the fire service honor a firefighter who was killed when he/she made a conscious decision not to wear a seatbelt. For those of us who have made it their life’s work to change the irresponsible culture of many in our business, listing suicides as an LODD is also irresponsible.

  • B. Kane says:

    Anyone who believes suicide in our line of work needs to get back on the front lines.

    I live in a rural area; I vol. as a Fire fighter & an EMT, I work as a Paramedic. I spent a year in Iraq. What I have seen here is perhaps worse than what I saw in the sandbox.

    My very first cardiac arrest was a one year old Amish Crack baby. Mommy had been a crack whore; and this family adopted this child; knowing it would die & gave it a home. They all knew CPR, knowing the day would come when they would have to preform it. Truly they did the work of The Lord.

    I have seen men burn to death; I’ve seen mothers burned over 70% of their bodies well carrying their child to safety. I’ve taken highschool class mates to the hospital after ejections; I’ve had students I coached recognize me over & over because of their head injuries.

    I’ve watched husbands of 60 years lose their wives. I’ve told more people than I can remember their father was dead.

    I’ve had the parents of good friends die on my watch; people who could not be saved – but were still my responsibility.

    I’ve watched paramedics who I grew up under lose their own children to horrific situations.

    I’ve. Watched. Patients drown on their own fluids. Restrained good Christian men who in 40 years of marriage had never uttered a curse word; actively calling their wife a whore as she cried, not understanding he has having a stroke.

    I’ve cares for people who have try for days to kill themselves; multiple consecutive attempts only to be found by concerned co-workers .

    I’ve watched respected coworkers self admit to the psychiatric ward. I can name a hell of a lot fewer EMS people (paid or volly) who has not lost a marriage, or is not on psych meds, or having an affair, that I can list who has, it is.

    Sh!t happens.
    People die.
    You move on.
    But to say those who stepped into the sh!t, restocked the truck & went home broken before they died are any are less line of duty deaths – is amazingly, willfully, benighted.

  • Brent says:

    I work in EMS where suicide is far greater at 20 times the national average.

    This whole LODD I watch from afar where individuals are put on pedestal simply by association is interesting to say the least.

    While PTSD is not the only cause of suicide. It is also far from the only category of mental illness suffered by emergency professionals, that leads to taking one’s life.

    Taking mental health by the horns and not waiting for some number cruncher at the CDC to do it for you is the only way to begin. Realsing that the career you have chosen can affect you in so many negative ways and agencies realsing that so many facts of the job from conditions and wages to case and team dynamics can all have signficant negitive impacts ensures that many of these deaths are not hidden as collateral damage.

    They ARE in the course of you employment. Maybe not on duty but they are. They ARE worthy of our emotions- because I colleagues shouldn’t have to suffer at the point of no return.

  • Mike says:

    I don’t agree with this at all. I think not all suicides are due to stress from our job but there are some that are. Why should we not count these as LODD’s? We count as a LODD when someone died in a vehicle accident due to willingly not wearing a seat belt. Why should those people get honored as LODD when someone that has suffered a mentally traumatic injury and commits suicide because we couldn’t get them help doesn’t. I think the whole LODD needs to be revisited and adjusted. Why is occupational cancer not counted as a LODD? Same story. This shouldn’t be a numbers or statistics game. This should be about doing the right thing. Yes the numbers are going to increase but they are probably going to increase to what they really are.

  • Clark Hurlburt says:

    While enrolled in the Executive Fire Officer Program at the NFA, I suggested a study of Firefighter suicide as a research paper topic. The proposal was not well received to say the least. It was obviously not something that the powers that be wanted to broach, especially in a paper that would have to be accepted at the national level. The subject would not have been “conventional” suicides if there is such a thing but the proliferation of LODDs that occur at or near retirement age. We read way too often of the Firefighter very close to the end of his/her career who suddenly begins to take unnecessary risks on the fireground, accepting assignments above their abilities etc. Much of this has been attributed to “trying to keep up with the kids” but as our careers tend to end before much of our financial obligations are complete , I believe many look at the difference between a basic pension versus the financial benefits that a LODD death would give to our families leads many to take a self destructive mindset. While this sounds farfetched a statistical analysis of this very tabu subject may prove otherwise.

  • Rhett Fleitz says:

    My thoughts…

    The days of “Suck it up” are over. We are no longer able to simply suppress what we see, experience, and are involved in. The truth is, we may never have been able to…The whole macho “Get over it” might have been a long-standing misunderstanding that worked years ago and ultimately was the fire service (us) turning a blind eye to behavior health.

    Bill, great job with an informative article. I thought you were going to go at this from a different angle. What I got from it was that IF we added suicides THEN we would be adding names/statistics which cannot be easily deciphered to learn from in order to decrease the total LODD’s. While I agree with your thoughts, I do not think this is the primary reason we should not be including suicides as LODD’s.

    I DO NOT think suicides should be considered LODD’s. I DO welcome others opinions on the matter in order to learn differing viewpoints.

    I think that we should be focusing more on professional wellness and behavior health in order to prevent suicides. We are way behind in understanding, treating, prevention, etc.

    I think that the organizations which can make a difference are on the right path with attempts at understanding firefighter related suicides and other behavioral health issues enough to begin making a difference.

    I think that if suicides were included and families were given the Federal benefits of a LODD there is potential of seeing an increase in suicides.

    These are just some of my thoughts on the topic. The truth is that I am learning a lot about it right now and hope that others are too.

    • Bill Carey says:

      Thank you Rhett. Your second paragraph emphasizes what I have written. It, the data once created if you add them, is a numbers game that some may not want it to be.

  • James G says:

    This was a very interesting read. A fire department close to my home town had a member commit a few felonies right before he shot himself. He was “honored” with a firefighter’s funeral. It wasn’t considered a LODD but he still got the whole nine yards. It made my skin crawl. I believe that some times you need to put your head down and walk away. I don’t care how many years of service you have, lives you have saved or any other accomplishment you have made in your life, if you choose suicide (a long term solution to a short term problem) then you should not be honored with a firefighter’s funeral.

    • Bill Carey says:

      Thank you James. The matter of the funeral is a huge challenge for the fire service when it comes to suicide.

  • Chief D says:

    For the MOST part I agree that suicides are not to be considered LODD. An honorable LODD funeral ceremony should be on a case to case individual incident. I lost my Asst Chief in the LODD and I was blamed by many for his death. We lost a young fireman in the line of duty and his father was the Chief in charge on the call where the son was lost. Each of these are examples of cases where a suicide should qualify for a LODD funeral ceremony. I can agree there should be no benefits but I think these and similar situations, should there be a suicide by a fire personnel, should qualify for a LODD ceremony. STAY SAFE and HAVE A GREAT LIFE!!!!!!
    Chief D

    • Bill Carey says:

      Thank you Chief D. It is interesting that while you agree suicides should not be considered as LODDs but should receive a LODD ceremony. Honoring or paying tribute to the person and the life they lived is far different than including them in a statistical report and a sum that our organizations work each year to lower. Are we sending a conflicting message when we give them ceremony? Does this hurt our efforts to prevent suicides in the fire service?

  • Doug says:

    My initial reaction to this article was visceral and angry. I walked away, cooled off, and came back to it again. I have been diagnosed with job related PTSD, aggravated by a severe concussion (TBI), which was also received on the job. I’ve done therapy, medication, withdrawn, and forced myself back into the world. I’ve accepted and rejected religion, I’ve sought the solace of family and friends as well as hoped the answers might be in the bottom of the next bottle. Through it all, I went to work. I had to keep going in, none of this is recognized as a serious enough problem by insurance or worker’s comp to devote me to truly intensive therapy and I can’t miss the time to seek it on my own.

    My point to all of this is that without counting suicides as LODDs, we, as a profession, are not working to help our brothers and sisters that are dealing with depression and/or PTSD. It’s unfortunate that it clouds the waters of statistics, but the truth is that many of us would not have had these problems if not for the job. Recognizing it as a LODD, as was pointed out, means that we have to do studies to work to prevent it. Prevention would likely include more robust insurance policies which cost more. But isn’t that money well spent? It was pointed out that we would need to record the method used. Why? The end result is the same, so the method is irrelevant. The investigation of suicide as a LODD is different from the more traditional statistics in that the “why” is far more important than the “how.” Did the member seek help? What was their diagnosis? Did they follow the recommendations laid out for them? Did they make progress? Did they stop treatment prematurely? These questions are all far more important than if they used a rope or a gun.

    Obviously, I have an emotional stake in this. I do, however, believe that I can remove myself from it and look at the bigger picture. Speaking with coworkers and having seen other agencies in our area dealing with the mental health issues of members has lead me to believe that the problems of depression and/or PTSD related to the job are far more pervasive than any study would have us believe. We have a culture of denial and of “sucking it up and moving on” that must end. Failing to acknowledge suicides, at least some of them, as LODDs only perpetuates that mind set.

    • Bill Carey says:

      Doug, thank you for reading it again and sharing your personal view. I respect that greatly. The specifics of your own circumstance highlight how a suicide can be considered as a line of duty death due to a on the job injury. This is not the norm, for as the experts, panel and coworkers with the NFFF state, ‘we don’t have specific data’ – but – we do recognize as was said in our workshop in October, we are three times more likely to experience a suicide than a LODD (compared to the general population). The parameters are already set, as explained in the beginning of the article, but if they were to be changed then the decision to include would rely on in part what you have written (proof of seeking help; credible diagnosis; treatment followed; department actions towards rehabilitation). The issue is, if we want to include them, or some of them, then we should double the effort to prevent them. We are already on a solid foundation, with help from the NFFF and others in these articles below, but it now rests on the fire service to decide what they will do.

      A New Approach to After-Action Reports
      New Trauma Screening Questionnaire for Firefighters
      Understanding Stress First Aid in the Fire Service

      Thank you for coming back to read it, for sharing your personal experience and for staying with us.

    • Tom says:

      Thank you Doug! As a professional Firefighter for 28 years, and a retired military firefighter for 28 years also, I agree that PTSD is a real issue in the fire service, and that Deaths by suicide by any Firefighter under treatment for PTSD should be considered a LODD. I think Mr. Carey completely missed the mark by not considering PTSD in his article.

      • Bill Carey says:

        I did consider PTSD in the article and wrote that it is not the only factor in suicide. The problem is that we will have a hard time determining and defining PTSD in the fire service, especially since the military is struggling with this. Let’s also add instances of fraudulent disability claims as well, to reiterate that simply saying all firefighter suicides should be listed as LODDs is not so simple.

  • Wes says:

    This. This is why mental health continues to have a stigma in public safety. For all of the talk in the fire service about pride, brotherhood, integrity, and honor, you just stuck a giant knife in the back of every brother and sister who struggles with their own illnesses. This is like saying that heart attacks shouldn’t be LODD because we don’t know what the firefighter ate when off duty.

    “Everybody goes home” applies to mental health too, not just wearing your seatbelt and using your SCBA.

    With all due respect, while I’m currently in a single role EMS system (although I started out with a fire department), I consider myself more of a firefighter than you. Your disregard for other firefighters proves you unworthy of the title. And sadly, I can’t consider you a brother if you turn your back on your station mates.

    I would encourage you to reconsider your position. You’re not much different than those who question the motives of victims of sexual or domestic violence.

    • Bill Carey says:

      Thank you for reading Wes. I’m confused how you come to the conclusion that my opinion is an attack on those who struggle with mental illness. You’ve made a great stretch to say my motives are like questioning sexual assault and domestic violence victims. I’ve written on this subject before and am a supporter on the national level as well as personally with many friends in the fire service struggling with this issue. As stated at the beginning, this is not about letting your emotions guide you but about looking at the issue in black and white and the problems and liabilities of inclusion. They are already not counted, so what is lost? This, as well as the whole subject of suicide, should be discussed based on the facts and not on the sentiment of brotherhood – something I would expect a lawyer to understand. We’ll simply have to agree to disagree.

      A New Approach to After-Action Reports
      New Trauma Screening Questionnaire for Firefighters
      Understanding Stress First Aid in the Fire Service

      • B. Kane says:

        The onus, as with cancer, should my be on the diseased to prove t was caused by the exposure, but by the liable party to prove it was not.

        In other words: when a paramedic suck starts a pistol – you’d better be able to prove it was not line of duty related. It counts for a service member. But we must not forget that the fire service is 200 years of tradition unhindered by progress.

        Considering every paramedic works two jobs, plus overtime – was once a normal human being, perhaps had a spouse, kids – which tend to not understand why we are detached. Considering we see every day illness & injury, often encountering the life changing events of whole families – or damningly for ones soul, the expungement of an entire family in matters that would make HP Love Craft uncomfortable to reproduce in text – I can firmly say with the moral conviction of Moses smiting the stone tablets upon the golden calf of the Jews that denying that suicides are line of duty deaths would require you to say that the interactions & events noted above are so inconsequential as they should not affect our personal well being, mental health or interpersonal relationships.

  • Rob says:

    How can you possibly look your brothers and sisters in the eyes after writing this? How is suicide caused by the things someone saw on the job any less of a LODD than someone dying in a house fire? They devoted their life to helping others and paid the ultimate price for it. seeing the horrific things we see, hearing families after they’ve lost a child, telling people their loved one is dead. You’re going to really say it shouldn’t be counted because it would take too much work to break down the statistics? Wow, and firefighters complain about the stereotype of being lazy…I wonder where that comes from.

    Everyone has a right to their own opinion but wow…that’s all I can say.

    • Bill Carey says:

      Thank you Rob. How can we positively state that a suicide was directly related to work? This is what I have explained, that we have certain parameters for inclusion, and exclusion, and since suicide is so largely under-reported we have little concrete data to support it. I can look them in the eye because some of them have written to me, called me and spoken to me about this problem. They’ve shared problems that range from being outraged and embarrasses that a fire service funeral was given to being shamed by department leadership for wanting to do something for the family. We need to understand that not every single firefighter suicide is a direct result of effects from duty. I’d encourage you to read this again but without the sentiment of service guiding your heart.

  • John C says:

    I find this article to be a good assessment of things and I agree that a suicide should not be considered a LODD. I don’t say this to be callous, nor feign off the emotional aspects and so forth, but simply, I disagree that a suicide should be considered a LODD.

    I happen to work on a dept where we experienced a LODD and a year or so later a suicide of a member, where the LODD affected him. So I can speak from some experience in this area. I’m not saying this makes me an expert, but simply that real world experiences are part of my focus as I reply.

    Personally, I think that the definition of a LODD should be redefined and looked into a bit more. While there are definately job factors that can impact a LODD, not everything should be linked to a LODD blindly. I believe that there should be a greater focus on the person, the dept, and so forth before just declaring a LODD. I find it hypocritical to preach about reducing LODDs and creating buzz phrases like “Everyone goes home”, but neglect to look into what should define a LODD.

    For example, take the 24 hour time frame after a shift or incident. We see many LODDs that fall into this catagory because a FF is found dead the next day where they responded to an incident. While I agree there can be many contributing factors from an incident, I believe that more should be looked at. Instead of just linking the death to a LODD because of an incident, what did the person do at the incident? Did they just sit in a rig? What was their role? etc. I think there should be more focus on the dept. After all if change to reduce LODD is to be taken seriously, then so should a focus on the depts themselves. This means depts should be following standards, having dept physicals, etc. These factors should be looked into.

    Another aspect as touched on is the refusal to wear a seatbelt. I can agree with that as something that should be looked at because if we are to truly reduce LODDs, then utilizing safety equipment should be assessed. Yet the focus should not stop there, there are plenty of LODD contributed to vehicle accidents in personal vehicles. Did the FF have EVOC training before allowed to get a light and siren for their POV? etc. I recall a double LODD from a MVA a few years ago. The 2 FF’s killed were returning from a dept training, yet they were racing other members on the highway. Sorry, but this should not be considered a LODD in my opinion, this was carelessness taken too far and “honored” as a LODD.

    So yeah, I think there should be more looked into to truly reduce LODDs and not just add to the current list of LODDs without accounting for the bigger picture. So in regards to suicides, I disagree they should be classified as LODD just because of the job. Sure there is much one sees on the job, but does that mean the job itself is the contributing factor to define a suicide as a LODD? I don’t believe so and as the article mentions, there is too much that can’t be statistically defined to make the conclusion a suicide is a LODD. In regards to heart and cancer issues, I know many of these are linked to the job because of those statistics and data. There isn’t enough there to link a suicide as a LODD and yes, we need to seperate emotions from statistics if we truly want to reduce the number of LODDs.

    • Bill Carey says:

      Thank you John. First, the drag racing incident you mentioned, the USFA quietly removed that from on-duty death status a year after the incident. You raise a point that goes along with the implication of adding suicides to our LODD data – the 24-hour window of cardiac death. With these, we have to question the relevance to training, as far as prevention, and the difference between honor and prevention. Your personal experience does make you an expert because that experience is what we need to hear from, to learn from and keep the discussion going.

  • Around 552 BCE the Babylonians attributed epilepsy to the supernatural (Wilson & Reynolds, 1990). In 1881 President Garfield died after being shot because his physicians did not understand that putting a finger in the wound in an attempt to dig out the bullet would cause infection (Millard, 2011). Cigarettes were not believed to cause cancer until the late 1950s in spite of five studies published at the beginning of that decade (Doll, 1998). It is my sincere hope that my peers in the public safety fields are not mired in the misperceptions of the past, but rather understand the reality afforded us by modern science.
    It is interesting that the United States Fire Administration and the National Fallen Firefighters Foundation will accept a death secondary to a cardiovascular event within 24-hours of responding to an emergency or being engaged in training activities as a line of duty death (LODD). Is a stroke or heart attack only caused by physical activity? No, it is caused by a combination of many factors, which may include heredity, use of tobacco, dietary habits, and stress (both on and off the job). Why do we not just exclude these cardiovascular events because they they are the “fog of cardiovascular disease” that makes it hard to determine if the proximate cause was scene or training related activity? What about the firefighter who responds to a scene or participates in training and was not involved in any physical activity, yet dies within 24-hours of the event? This is alluded to with the statement, “For all we know, that [cardiovascular] victim may have died without the call having happened at all.” I would submit to you that the 24-hour rule is rather arbitrary and not based on science. The arbitrary nature of the determination of LODD after a cardiovascular event also lends itself to “irrelevant” data as defined in reference to suicide stated in the article.
    Please indulge me for a moment while I draw a corollary between acute coronary syndrome and suicide. If you believe we should allow the cardiovascular event deaths within 24-hours of service-related activity, then why not suicide? Suicide, similar to heart disease, is the confluence of many factors, not just one. Like cardiovascular disease (CVD), there is a connection between nicotine dependence and suicide (Dianjiang et al., 2012; Yaworski, Robinson, Sareen, & Bolton, 2011), heredity and suicide (Goldsmith, Pellmar, Kleinman, & Buuey, 2002), anxiety (stress induced or otherwise), and depression. It is important to note that CVD is also directly associated with increased likelihood of suicide, anxiety, and depression (Berman & Pomplili, 2011). In fact, depression is the most common mental illness associated with suicide and the American Heart Association has released a science advisory establishing a link between depression and coronary heart disease (Lichtman et al., 2008). It seems there is a reciprocal relation between depression and CVD in that each may cause the other. Stressors, both on and off the job, result in higher levels of cortisol release and are associated with both depression and CVD (Wirtz, Ehlert, Kottwitz, La Marca, & Semmer, 2013). Those of us in the field certainly know that on the job stress is a reality.
    The article points out the physical evidence of a cardiovascular cause of death and asserts the same cannot be found in the victim of a suicide. This is simply not true. The answer lies in both the biological and social sciences. In functional magnetic resonance (fMRI) imaging studies of those with depression, lesions on the basolateral amygdala have been found to inhibit nerve cell generation (Kirby et al., 2012). Positron emission tomography (PET) scans revel decreased activity in the brains of individuals who are clinically depressed (Hinrichs, 2007). Researchers at Indiana University recently discovered biomarkers that may help predict suicide risk, but this is in the early stage of research (Wood, 2013).
    On the social science end is the psychological autopsy (PA), a method of inquiry into a death that fails to be mentioned. The PA is a systematic process employed in a death investigation where there may be some question as to the manner of death. PA investigators employ knowledge and theories from multiple disciplines including psychology, sociology, biology, epidemiology, and anthropology. While the PA is particularly helpful in cases where the manner of death is equivocal or undetermined, it can also be used when the cause and manner are not in question. In these cases, the PA may be helpful answer questions about why a death occurred. The PA began in 1958 with clinical psychologist and director of the Los Angeles Suicide Prevention Center (LASPC) Edwin S. Shneidman, with his partners Norman Farberow and Robert Litman, first developed a tool to assist the Los Angeles County medical examiner in death investigations (Botello, Noguchi, Sathyavavagiswaran, Weinberger, & Gross, 2013). The goal of the PA is to determine the factors contributing to the death of a person by suicide. This is akin to reconstructing the events of a traffic accident or building collapse (Carey’s examples) in an effort to uncover the root causes and improve overall safety for firefighters.
    In conclusion, we have come along way and emerged from the dark ages in understanding the biological, psychological, and cultural mechanisms that contribute to suicide. Because of its nature, suicide is not a disease but a syndrome caused by a complex mix of factors. A preponderance of research demonstrates this. Like coronary syndromes, the formula varies slightly from person to person. Given the rather arbitrary nature of LODD determination in the case of death from CVD we should view suicide deaths no differently. The argument that including suicides in the LODD dataset would cause inaccurate data is flawed unless it is also argued that other LODD causes, like CVD, should be excluded. A person who loses a battle to depression and other contributing factors is no less honorable than someone who dies from the complications of CVD. I am a public safety professional with two decades of practice as a paramedic and 12 years of experience as a firefighter. I am a person who has survived the suicide deaths of my wife, brother, and several colleagues; as well as a person who has struggled with his own depression and post-traumatic stress disorder. Although I still have a lot to learn, I have earned a master of public health, a master of arts with a thesis on the altitude-suicide correlation, and am now doctoral student with a suicide-related dissertation. My sincere hope is that I can bring my experience and education to bear on this very serious public health issue and work with others to prevent suicide among the general population and among our brothers and sisters in public safety. “Pull yourself up by the bootstraps,” “get over it,” and “suck it up” as pithy anecdotes are a hold over from the unenlightened past. Thank you for hearing what I have to say, thank you to all those who dedicate their lives to helping others, and thank you for helping remove the stigma that is so damaging to those of us who silently suffer.

    Chris G. Caulkins, Managing Researcher
    Sumrith Solutions, LLC
    May 16, 2014

    References

    Berman, A.L. & Pompili, M. (2011). Medical Conditions Associated with Suicide Risk. Washington, DC: American Association of Suicidology.

    Botello, T., Noguchi, T., Sathyavagiswaran, L., Weinberger, L. E., & Gross, B. H. (2013). Evolution of the Psychological Autopsy: Fifty Years of Experience at the Los Angeles County Chief Medical Examiner-Coroner’s Office Evolution of the Psychological Autopsy: Fifty Years of Experience at the Los Angeles County Chief Medical.. Journal Of Forensic Sciences (Wiley-Blackwell), 58(4), 924-926. doi:10.1111/1556-4029.12138

    Dianjiang, L., Yang, X., Ge, Z., Hao, Y., Wang, Q., Liu, F., . . . Huang, J. (2012). Cigarette smoking and risk of completed suicide: A meta-analysis of prospective cohort studies. Journal of Psychiatric Research, 46(10), 1257-1266. doi:10.1016/j.jpsychires. 2012.03.013

    Doll, R. (1998). Uncovering the effects of smoking: historical perspective. Statistical Methods in Medical Research, 7(2), 87-117.

    Goldsmith, S. K., Pellmar, T. C., Kleinman, A. M., & Bunney, W. E. (eds.). (2002). Reducing Suicide: A National Imperative. Washington, D. C.: The National Academies Press.

    Hinrichs, B.H. (2007). Mind as a Mosaic: The Robot in the Machine. Minneapolis, MN: Ellipse Publishing Company.

    Kirby, E. D., Friedman, A. R., Covarrubias, D., Ying, C.,Sun, W. G., Goosens, K. A. … Kaufer, D. (2012). Basolateral amygdala regulation of adult hippocampal neurogenesis and fear related activation of newborn neurons. Molecular Psychiatry, 17, 527-536. doi:10.1038/mp.2011.71

    Lichtman, J.H., Bigger, J.T., Blumenthal, J.A., Frasure-Smith, N., Kaufmann, F.L, Mark, D.B., . . . Froelicher, E.S. (2008). Depression and Coronary Heart Disease. Recommendations for Screening, Referral, and Treatment. A Science Advisory From the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research.
    Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Treatment. A Science Advisory From the American Heart Association Prevention. Circulation: Journal of the American Heart Association, 118, 0-0.

    Millard, C. (2011). Destiny of the Republic: A Tale of Madness, Medicine, and the Murder of a President. New York, NY: Doubleday.

    Wilson, J.V.K. & Reynolds, E.H. (1990). Texts and Documents. Translation and analysis of a cuneifnorm text forming part of a Babylonian treatise on epilepsy. Medical History, 34, 185-198.

    Wirtz, P.H., Ehlert, U., Kottwitz, M.U., La Marca, R., & Semmer, N.K. (2013). Occupational role stress is associated with higher cortisol reactivity to acute stress. Journal of Occupational Health Psychology, 18(2), 121-131. doi:10.1037/a0031802

    Wood, J. (2013). Researchers Identify Biomarkers that Could Help Predict Suicide Risk. Psych Central. Retrieved on May 16, 2014, from http://psychcentral.com/news/2013/08/21/researchers-identify-biomarkers-that-could-help-predict-suicide-risk/58705.html

    Yaworski, D., Robinson, J., Sareen, J., & Bolton, J. M. (2011). The Relation Between Nicotine Dependence and Suicide Attempts in the General Population. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 56(3), 161-170.

  • Bill Carey says:

    This comment came from James B. but did not transfer over to the post. -Bill

    As a Firefighter who has been involved with not one but two Firefighter Suicides in the last couple of years, One from my own Department and one from the next town. I have mixed emotions on the subject. I truly believe that a LODD is an honor and should be treated so accordingly. But, even if the Firefighter’s death was not associated with some great feat of bravery that deserves all the LODD bells and whistles, we should not push the emotional sometimes frowned upon subject of LODD suicides under the rug.

    Firefighters do this job because they love it. It is rare in our business that the individual who serves his city, town or community does not love doing the job. We all take great pride in how we respond to calls, how we look in the public’s eye and how we keep ourselves on top of the game. To push away and hide a Firefighter fatality because it was suicide is very wrong.

    When our Firefighter committed suicide, it was hard for our Department to accept two things, why she had done this and why we could not prevent it. We did take a long hard look at ourselves and there was guilt. We needed to justify for ourselves and our surrounding communities how we could honor our fallen comrade for what she had done in the Fire Service and not how she had left this mortal coil. As I sat and began writing the eulogy, it was difficult to put this tragic event out there without putting an emphasis on why we were there; I had to make this about her service and loyalty to the service and nothing else. Yes, we had the big memorial service with many local Firefighters, Family and Trucks, the bells were rung and the pipes played, but we did this for her service, we did this because it was the right thing to do.

    As a Firefighter and a Military Veteran I know there is PTSD and emotional stress from calls, but there also are family problems, job related problems, relationship problems and debt which have nothing to do with the Fire Service. Adding a Suicide LODD to the always growing list of LODD, really does not help us because we cannot learn from it as a Fire Service. Fire Departments have great Critical Incident Post Briefings after the “bad Calls” and these help us at that time, but no real training is ever going to prevent somebody from unfortunately taking their life except for good management and supervision of our Firefighters.

    In my opinion, if a Firefighter suicide is directly contributed to a past incident, then it should be included in the Other category, but as sad and confusing as these type of deaths are, to have a complete category related to suicides in the Fire Service is not beneficial to us as Firefighters.

  • Valerie Schoen says:

    I’m still thinking about whether suicide should be considered a LODD. For those of you who shared your struggle, thank you for your bravery in telling your experience. By being brave in your telling, many of you will risk being ostracized, but you took the risk anyway so that others could learn.

    I want to address this from a cultural and educational point of view. I’m on disability now, part of it due to mental health issues. I’ve had friends and colleagues both attempt and complete this act. As a supervisor/educator in EMS (where I educated police, fire and EMS in a number of topics), it saddens me that not only do many providers harbor prejudices against any psychiatric illness, but others further up the career ladder refuse the education and set the culture that depression, attempted suicide etc. should be looked down upon.

    One example I use is the death of J, one of my paramedics who struggled with depression, in recovery from alcoholism, and as someone who kept trying to do his best. He and I started as friends on a volunteer first aid squad, and over the course of years I became his Supervisor as career paramedics. When he struggled, rather than offering support, most of my staff exhibited their harmful and hurtful prejudices. When he finally killed himself, the staff insisted on putting on a big show complete with honor guard and everything else. Did J’s suicide change anything on the outside? No. In fact, when I wanted to further educate the staff, my supervisor limited me to send out a mailing with an article about EMS suicide. Something did change on the inside, though. I can’t tell you how many of my staff came to me with their mental health issues and told me the got help not only because of J, but because they knew I understood, not just because of my attempt at education, but also because I was open enough to admit–both before and after J’s killing himself–that I had tried to end my own life. I’m not lauding myself here. What I am saying is that despite such a horrible tragedy where the staff was happy to dress like toy soldiers after a death, they behaved just as horribly to other staff members who were potentially on that road to possible suicide. People could not reach out for support from their “colleagues” (and I use that term loosely under the circumstances) for fear of how others would react. In essence, they had to hide.

    I’ve also had other EMS friends die from suicide and far more colleagues than I want to count.

    My point: I don’t care whether we’re EMS, Fire, or a combination of both. We need education for everyone in our professions. We need to change our attitudes from considering suicide an act of cowardice (any one of you who have been there realize it is anything but when you are depressed because at that moment, no matter how well-educated you are, you see no other choices) and a matter of public health. We need a paradigm shift to see depression and other psychiatric illness for what they are: illness that need treatment where the patient does better if they have a support system. We need to ensure that the only mental health care issue safe to discuss is PTSD.

    Again, you got me thinking about whether suicide should or should not be considered a LODD based on the criteria used. Honestly, I don’t know how I feel and what all of you have said here is assisting in me processing my opinion. What I have to stress though, that whether or not we consider a LODD, we need to be educated about suicide/depression and, a fellow humans in contact with these–I’ll say it–extended family members (we do call ourselves brotherhood, sisterhood, family), we can help prevent this tragedy. We pay for smoking cessation, we pay for exercise equipment, we pay for safety training, we pay for other training, we pay for nutritional information. Why can’t we pay to recognize an illness and save a our professional family members’ lives?

    • Bill Carey says:

      Thank you Valerie. This week in Washington, D.C., during National Police Week, support for worker’s compensation benefits due to PTSD was raised to attention by law enforcement unions and organizations. The fire service can do the same if it is serious about it, but as you have shared it first takes having that conversation. Thank you for encouraging the discussion through your own experiences. The parameters are already set, and the subject was one that I was asked about and followed up with a public answer. Agree or disagree, the greater problem is what will you do when your department has to deal with a suicide? It’s best to find out now and plan than wait until it happens.

  • Dave Smith says:

    I recently retired from firefighting after a 29 year career which included 2 municipal departments and 1 Federal department. There are some very good points made in Bill’s article and a number of good replies from both sides of the issue. Generally, I agree with Bill, but the issue is a complex one, requiring an open mind. Nonetheless, I do not believe that suicides should be considered line of duty deaths.

    On the subject of suicides, there is also a very quiet realization that some “legitimate” fire ground deaths may actually be suicides by individuals who may wish to go out with glory and honor. Of course, I will offend some by stating this, but it makes sense when all things are considered. No, my statement cannot be substantiated by facts, but it is quite likely that this does occur from time to time due by troubled individuals who may desire the respect and pageantry of a fire department funeral, as well as the ability to turn a negative event into a more positive experience for their family and friends, including the death benefits. Sometimes you just have to wonder why well trained firefighters get killed or injured performing tasks which violate the most basic fire ground safety principles.

    Heart attacks and other medical issues have a cloudy side as well, especially in some situations, including those mentioned by Bill. This is especially true in volunteer departments which do not differentiate between active and non-active membership status. In some situations, it is not uncommon for older members to respond to fires and virtually do nothing except hang around the scene as a spectator, regardless of whether or not they are wearing turn out gear. This is especially true at larger incidents where it is not uncommon to have members in their 70′s or 80′s respond. Of course, some in that age bracket are able to contribute as drivers or in other ways, but then again, there are those who do nothing whatsoever. Every now and then, we hear about one of these members who slip on ice or suffer other injuries or medical issues, including cardiac problems. Whether they die or not, there is often a great rush to attribute these events to the performance of fire ground duties. We have all seen or heard of examples which illustrate this, but few people ever question the circumstances and often try to make sure that “Old Joe’ gets the benefits he deserves as a 50 year member. Like suicides, situations like this, provide little meaningful data to help develop training and policy to deal with the real problems that need to be addressed.

    • Bill Carey says:

      Thank you Dave. It is important that when we discuss this, we are able to separate the pageantry from the details. Honor all however you wish, I say, but be careful about what deaths we are trying to learn from and make the most impact on with change when we read the yearly reports.

  • Chief Jim O'Neill says:

    Lots said here regarding this topic. Some I agree with and some I do not. What I do agree with is, bottom line, suicides should NOT be considered LODD. There are other criteria which I believe should not be classified as LODD’s as well but that is for another day and another topic. Stay safe out there.

  • Jason Ortman says:

    Chris Caulkins framed it very well….I am actually pretty disgusted that we are having this discussion….there is more then ample evidence of psychological stress and impact of the job….which has a physical impact on the brain….we even have higher then average rates of depression, substance abuse, divorce and yes suicide.

    There is presumptive legislation for cardiac issues and cancer….oh that’s right we don’t want to admit that psychological issues are real and happening in our profession.

    I know that as one stated we are trying to get LODD numbers down…but shouldn’t we really look at it critically and take care of the problem or problems and each other.

    First step in fixing a problem is owning up to it and admitting it.

    Take a look into the Fire Fighter Behavioral Health Alliance…good training…good info

  • David O' Connor says:

    Excellent article Mr. Carey. Very thought provoking. Obviously also a very divisive topic but that can also be a good thing as it stirs debate.
    Here is a scenario that some of the people who have lambasted you for broaching this subject might want to consider….
    Bob is a fireman. His wife of twenty years leaves him. Bob is heartbroken and takes his life. Should Bob’s death be considered a LODD?
    Mike is a fireman. Mike is killed in a flashover while searching the second floor of a home for two trapped children. Mike’s death is no more of a LODD than Bobs ?

    • Bill Carey says:

      Thank you David.
      In my opinion, and using the current definitions and parameters, Bob’s death does not qualify for on-duty death status and memorial inclusion; Mike’s does. The matter isn’t whether or not one death is valued or considered more than another but on the details and existing guidelines. This goes back to what was written about the skewing of the data. All emotion aside, as it should be when discussing facts and figures, Bob’s death would have very little statistical value other than adding to the total number of LODDs. I don’t want in insinuate that your last sentence shows me valuing one death over another but if that is the case, I’ll add this; the fire service as a whole already shows which deaths it values, if that is the proper word. Almost yearly we see the sharing on social media of LODD reports of firefighters killed while fighting a fire or making a search. When was the last time anyone saw a NIOSH report shared on the anniversary of a firefighter who died due to stress/overexertion within 24 hours of his shift that included at least one emergency response?

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Backstep Firefighter

“To provide a point of critical thought about certain acts and events in the fire service while incorporating behavioral education and commentary in a referenced format.”
Comments
Bill Carey
Wanted: Honest Discernment in Our Fire Service Discussions
Thank you Shawn.
2014-09-09 10:58:45
Bill Carey
Wanted: Honest Discernment in Our Fire Service Discussions
Thank you Trey. It would be valuable for all of us to do a follow-up later or a look at one of your trainings and how departments are applying the new research and testing the new tactics for themselves. Bill
2014-09-09 10:58:32
Shawn Royall
Wanted: Honest Discernment in Our Fire Service Discussions
Bill, Thanks for saying exactly what many of us want to but don't have an outlet for.
2014-09-09 03:30:10
Trey Smith
Wanted: Honest Discernment in Our Fire Service Discussions
Bill, thank you for your feedback. I would invite you to contact me to learn more about FPM.
2014-09-08 22:20:52
Ron Ayotte
Wanted: Honest Discernment in Our Fire Service Discussions
Buckets, not puckets... 1st day back at work after vacation, and all the coffee I had today hasn't kick started the brain into gear!
2014-09-08 19:55:41
Author Unknown
The Part We Forget
The Part We Forget
The Real Problem With Ray Rice
The Real Problem With Ray Rice
Techno:  Could Be Time
Techno: Could Be Time
Labor: Leave Ray Rice Alone
Labor: Leave Ray Rice Alone

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