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Into the fire: resilience in the face of trauma |
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In September and October 2006, researchers from the University of Birmingham visited 13 watches in Gloucestershire FRS. They asked firefighters to complete questionnaires to help them find out whether they had experienced any ‘Post-Traumatic Growth’ during their time in the service. This article describes the background to the ground-breaking research and unveils the findings and the far-reaching implications for the future
EXPOSURE TO EVERYDAY WORK related trauma, such as attending incidents in which people’s lives are threatened, can put firefighters at risk of developing Post- Traumatic Stress Disorder (PTSD, for example see McFarlane, 1989). PTSD is a recognised syndrome that affects around one in four people who have been exposed to a lifethreatening situation. It consists of experiencing flashbacks, nightmares, intrusive memories, avoidance of things that are a reminder of the trauma, sleep problems and hypervigilance (being constantly on your guard). The focus on the negative impact of trauma is understandable, but it has overshadowed research into positive life changes that may occur as a result of trauma (Linley, Joseph and Loumidis, 2005).
Post-Traumatic Growth
Positive effects of exposure to trauma include reports of personal growth and other positive life changes, and these are called Post-Traumatic Growth (PTG). PTG is a process of developing coping strategies and resources after threatening or traumatic situations, so one can face and cope more effectively with future trauma. PTG includes changes in self, changes in how one sees relationships and changes in spirituality and outlook on life (Tedeschi, Park and Calhoun, 1998). PTG has been reported by paramedics in Australia in response to work-related trauma (Shakespeare-Finch et al, 1999). However, no research on PTG, or what might promote it, has been carried out with a fire and rescue service in the UK.
The Research Study
We visited four fire stations (13 watches in total) within Gloucestershire Fire and Rescue Service. After explaining the study and answering questions, questionnaire packs ere given to those who wished to take part. ne hundred and five firefighters took part age range 19-54 years; 96 males, nine emales). Of the 105 there were 79 irefighters (75 per cent), 19 crew managers (18 per cent), six watch managers (six per cent) and one station manager (one per cent). The range of years of experience with the service was 0.5 – 34 years (mean years of experience = 13 years).
Main Findings
Frequency of traumatic incidents
Just over a quarter of the firefighters (27) reported that they had not experienced an event identified as traumatic in the past 12 months or gave no response to this question but such incidents were reported by 78 firefighters (74 per cent).
Types of callout reported as traumatic
The types of callout perceived as traumatic are shown below and it can be seen that road traffic accidents were the callouts most commonly identified. Some firefighters reported more than one type of callout as the most traumatic.
Positive and negative consequences
Overall, firefighters reported having more positive changes (ie Post-Traumatic Growth) than having negative changes in their outlook on life. Firefighters who experienced one traumatic callout in the last 12 months reported more emotional distress than colleagues who experienced no traumatic callouts or two or more traumatic callouts.
Ways of Coping
When looking at the use of coping strategies, out of the 15 coping strategies that were examined the top five most frequently used by firefighters were positive ones of acceptance (accepting something has happened and learning to live with it), positive growth and reinterpretation (seeing things in a positive light and learning from the experience), humour (laughing about and making fun of the situation), active coping (taking action) and use of emotional support (talking to someone about feelings and seeking understanding).
Relationship between ways of coping and outlook on life
Furthermore, firefighters using the coping strategies of positive growth and reinterpretation, being aware of and letting out emotions and religious coping (prayer, belief in God) were more likely to have Post- Traumatic Growth. Although the latter two coping strategies were less frequently used compared to other strategies they were key factors in promoting Post-Traumatic Growth in the firefighters who used them. On the other hand, firefighters using the coping strategies of mental disengagement (distraction), behavioural disengagement (not dealing with the event, giving up, making no effort to problem-solve the situation) and restraint (not acting too quickly, holding back and waiting) were more likely to have a negative outlook on life.
Implications
The positives outweigh the negatives Overall, firefighters experienced having a more positive outlook on life (Post-Traumatic Growth) compared to having a negative outlook. They were more likely to be using the more positive coping strategies rather than those which are negative. They also reported low levels of emotional distress.
One traumatic callout causes most distress
Firefighters reporting one traumatic callout in the last 12 months reported more distress than those who reported no traumatic incidents and those who experienced two or more traumatic incidents. These findings may suggest something about the process through which firefighters develop resilience over time.
Experiencing two or more incidents in succession may enable crews to progressively build up a sense of confidence and capability in coping with traumatic situations. Conversely, a single incident in an otherwise quiet period might have a deeper emotional impact, with more time to reflect and ruminate on distressing memories or images. Thus, resilience might gather a kind of momentum as firefighters are exposed to multiple incidents, perhaps underpinned by positive experiences of mastery (or ‘selfefficacy’: Bandura, 1997) stemming from a job well done.
Helping firefighters to prepare for the emotional impact of distressing incidents such as road traffic accidents would serve to maximise opportunities for PTG. Training crew and watch managers in debriefing and communication skills would be a means to this end, offering the key advantage of empowering the teams on the front line. In addition, an educational component on managing incident-related stress could be incorporated into initial and continuation training for new recruits.
Some ways of coping are linked with more post-traumatic growth
The study showed that some coping strategies (eg positive growth and reinterpretation) were associated with positive changes in outlook (PTG) while others (mental disengagement, behavioural disengagement and restraint) were linked with negative changes in outlook on life. The use of the coping strategies associated with PTG needs to be promoted in order to encourage self-care among firefighters. Coping skills training could be incorporated into the personal development programme from basic training through to crew and watch management and beyond.
The importance of team cohesion at watch level
The generally low levels of emotional distress reported raises the intriguing question of what firefighters are doing to generate such resilience.What was striking on the research visits was the strong sense of team cohesion and mutual support that was evident within the watches. Research indicates that support at work has been found to protect firefighters from the development of Post Traumatic Stress Disorder (Haslom and Mallon, 2003; Corneil et al, 1999). In a UK study, firefighters reported that support came from their colleagues through working as a team (Haslom and Mallon, 2003). In this study, one firefighter suggested that the sense of shared experience among colleagues might best explain this phenomenon. It follows, therefore, that team dynamics at watch level could be a key factor promoting PTG in this workforce. Further research looking at the mechanisms of support from within the watch should further illuminate these initial findings.
References
• Bandura, A (1997). Self-efficacy: The exercise of control. New York:WH Freeman & Co. Ltd.
• Corneil,W, Beaton, R, Murphy, S, Johnson, C, & Pike, K (1999). Exposure to Traumatic Incidents and Prevalence of Post-traumatic Stress Symptomatology in Urban Firefighters in Two Countries. Journal of Occupational Health Psychology, 4 (2), 131- 141.
• Haslom, C, & Mallon, K (2003). A preliminary investigation of post-traumatic stress disorder symptoms among firefighters.Work and Stress, 17 (3), 277- 285.
• Linley, PA, Joseph, S & Loumidis, K (2005). Trauma work, sense of coherence, and positive and negative changes in therapists. Psychotherapy and Psychosomatics, 74, 185-188.
• McFarlane, AC (1989). The Aetiology of Post-traumatic Morbidity: Predisposing, Precipitating and Perpetuating Factors. British Journal of Psychiatry, 154, 221-228.
• Shakespeare-Finch, JE, Smith, SG, Gow, KM, Embelton, G & Baird, L (2003). The prevalence of post-traumatic growth in emergency ambulance personnel. Traumatology, 9 (1), 58-71.
• Tedeschi, RG, Park, CL, & Calhoun, LG (Eds.). (1998). Post-traumatic growth: positive changes in the aftermath of crisis. New Jersey: Lawrence Erlbaum Associates.
The FIRE/Gore Research Excellence Award 2008
FIRE magazine, in partnership with WL Gore and Associates is presenting the FIRE/Gore Research Excellence Award 2008 for the most challenging and captivating research paper at this year’s research event at the Fire Service College on November 12-13. The organisers of the Fire Related Research and Development (RE08) event, in association with FIRE and Gore, will choose from the submitted shortlisted research papers. The winner of the FIRE/Gore Research Excellence Award will be presented with £1,000. This year the Award will be in a different format. We will encourage RE08 researchers to enter the Award once they have been accepted to speak at the conference.
The shortlisted candidates will present the papers at the event and the judging panel will award the prize on the day, based upon previously submitted material and the presentation itself. The Award aims to encourage continued research and development in the UK Fire Service. Any research which in some way has the potential to benefit the UK Fire and Rescue Service will be eligible for consideration.
Dave Frodsham, Product Specialist at WL Gore and Associates, commented: “We are committed to supporting the development of new ideas and innovation in the UK Fire Service and hope that this Award will encourage continued research in the sector.
” For more information about the conference contact: 02476 505262/
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