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Helping the helpers

Changes proposed to help first responders through PTSD



In February 2010, all eyes were on British Columbia.

Specifically, Vancouver and Whistler.

With over $7 billion spent to bring the Winter Olympic and Paralympic Games to the West Coast, and more than $81 million pledged to Canadian athletes to give them every possible shot at a gold-medal rush in front of the world, the two-week sporting extravaganza was set to be the nation's moment of glory.

But instead of roaring cheers, the Games began with a pall, a moment of silence.

On the morning of Feb. 12, the day of the opening ceremonies, tragedy struck at the Whistler Sliding Centre. Georgian luger Nodar Kumaritashvili, just 21, shot out of the track at 144 km/h and crashed into a pole.

Whistler Medic Terrance Kosikar was on-site as one of the responders aiding Kumaritashvili.

After dashing to Kumaritashvili's side, Kosikar recalled instructing someone to shut the shade at the finish gate to keep the prying public eye off of the horror.

But once Kumaritashvili's fate was clear and tributes poured in from all over the world, the public's priorities returned to the celebration itself, and Kosikar remained a part of it all. Even with a red maple leaf shaved into the back of his head and a smile on his face as viewers tuned in, Kosikar knew he wasn't all right.

Six years to the day later, in memory of Kumaritashvili, Kosikar began flipping a 180-kilogram (400-pound) tractor tire in Function Junction to raise awareness of post-traumatic stress disorder (PTSD) in first responders. And he did it with over 23.5 kg in steel chains draped over his body.

From there, he retreated into the backcountry, flipping the tire for 36 kilometres along the Douglas Trail from Seton Portage to D'Arcy. He finished with a flip through Whistler Village on March 19.

dealing with trauma

Soon after the Games, Kosikar was jobless and homeless, reminded not only of the horrific crash, but trauma he'd suppressed from his earlier years. 

"After that accident, every single thing that I had endured in my life for 10, 15 years in the streets I'm living today again," he says. "I'd forgotten about it. I'd moved on. I became a first responder. I healed. I parked it somewhere. Then this accident triggered my entire life of trauma.

"That accident, as horrific as it was, it triggered things that were 1,000 times worse in my past that I had parked somewhere.

"I still hadn't dealt with or healed that box of injuries, but I didn't know I had those injuries to deal with." 

After an extended drug binge in the fall of 2014, Kosikar says he found himself standing on the Lions Gate Bridge, preparing to jump. But he couldn't do it. After resting and making his way up to his cabin near Seton Portage, he says he felt some rejuvenation being back in nature. Still, he found himself depressed after spending the Christmas season alone.

"On New Year's, still, nobody had called for the whole holidays," he says. "I put the rifle down my throat, in my tonsils. I put my thumb on the trigger and thought 'Fuck, if this doesn't kill me, I'm going to lay here and suffer.'

"So I put it underneath the side of my jaw behind my ear and thought 'Maybe this is the trajectory that will kill me.' I stuffed the barrel into my eye socket and thought 'Is this the way?'

"I was afraid to kill myself."

On New Year's Day 2015, he decided to turn over a new leaf, eventually starting the Breaking the Chains B.C. campaign (www.breakingthechainsbc.com) with a tire he discovered during a trip to the dump with his uncle before Christmas.

"You're not done," Kosikar recalls telling himself. "Done is standing on the bridge.

"You just go because you don't want to go back to where you've been."

Changing attitudes

When Whistler Fire Rescue Service (WFRS) chief Geoff Playfair began his career 35 years ago the pervasive attitude was that responders were expected to be emotionless. They understood they'd regularly witness death and horror as part of the job. That was part of the deal. 

"When I started in this kind of work, back in '81, that's exactly what we said: Just suck it up. Toughen up," Playfair says. "But those attitudes have changed for all the right reasons and we're in a different place today for all the better."

But no matter how much responders are instructed to make the difficult parts of their pasts disappear, some developed Post Traumatic Stress Disorder (PTSD), or another form of mental illness, because of the fear of reaching out for help. Countless first responders suffer in silence. Those who reach out are sometimes met with challenges to access the help they needed.

PTSD is a problem that seems to be increasing as awareness spreads. According to the Ontario-based Tema Conter Memorial Trust — a non-profit organization seeking to raise awareness and provide support to first responders and military members suffering from operational stress and PTSD — 39 first responders and 12 military members committed suicide in 2015. Just one-third of the way through 2016, 15 first responders and five military members have committed suicide.

With those shocking numbers, politicians, fire and police chiefs and others in positions of authority are looking to find ways to face the issue.

Playfair says one simple but major shift is to approach mental-health injuries the same as physical ones. A broken leg, for example, can be a mitigating factor in some jobs, but such an employee isn't asked to try to work through the pain.

"We want to recognize that an injury is an injury, whether it's physical or mental," Playfair says. "You deal with the problem and recover, hopefully."

The Paramedic Association of Canada released results of a nationwide survey last August, along with a plea for more support for first responders. The survey broke down the results by province, and Ambulance Paramedics of B.C. president Bronwyn Barter notes the numbers for British Columbia are staggering — 97 per cent of paramedics and dispatchers polled need support for the cumulative impact of multiple traumatic calls, and 94 per cent said the same group needs more support to treat mental-health disorders such as depression and anxiety. Three in 10 said they'd contemplated suicide and two-thirds knew of a fellow paramedic who had contemplated suicide.

Since the findings were announced, Barter says there has been a much more open discussion about mental health both within and outside the profession.

"There is a stigma around PTSD and mental-health injuries and we're happy that the conversations are happening," she says. "As a paramedic, in the last 20 years, there's been a bit of a shift. When I started, there was a stigma where if you had a bad call and you told somebody about it and you were struggling with what happened on that call or with what you witnessed, you don't tell anybody. You keep it to yourself. There was the attitude out there that you never should have signed up for this job.

"People have been suppressing a lot of these things because of the stigma of weakness."

One significant issue is that physical injuries can be less difficult to prove in order to claim workers' compensation. That broken leg, for example, will show up on an X-ray scan and the employee will just have to prove it occurred on the job. Though scientists are working diligently to find physical evidence of the PTSD — a team of researchers from Minnesota believes it found a "fingerprint" for it using brain scans in a report detailed in the Journal of Neural Engineering in 2010. For now, at least, proving the condition exists in addition to being work-related is the responsibility of the sufferer.

But even without a scientific breakthrough, that may all be about to change.

Proposed amendment welcomed

On Feb. 23, B.C. NDP labour critic Shane Simpson (Vancouver-Hastings) introduced a private member's bill into the legislature that would amend the Workers Compensation Act to insert a presumptive clause for first responders. Essentially, any first responder filing a PTSD claim would no longer have to provide proof that it was work-related  — that would be the assumption unless evidence to the contrary was discovered. Simpson has said the purpose of the bill is to reduce wait times, hassle and stress for those who are suffering and in need of help.

"We know today that first responders — including police officers, firefighters, paramedics, 911 dispatchers, sheriffs and corrections officers — suffer PTSD at more than double the rate of the general population," Simpson said when tabling the bill. "This serious mental health challenge first responders face is directly related to their service. We know that, every day, first responders treat those with health emergencies, ensure public safety and protect the citizens of British Columbia. In doing that work on our behalf, they too often face extreme and traumatic situations that most of us could not comprehend."

Alberta and Manitoba have already enacted similar legislation while Ontario and New Brunswick are also considering similar action.

Simpson explains that the bill, which passed unanimously on first reading, would only be for those suffering specifically from PTSD. He hopes to expand the presumptive clause for first responders to other mental-health issues as well.

Due to the inherent natures of the afflictions, even beyond the challenges of providing physical evidence of a mental disorder, people suffering from PTSD and other similar syndromes may have difficulty making a case. Barter explains that with all the potential collateral damage a mental illness can cause, filing a claim can be overwhelming for those who are already struggling to hold their lives together.

"Right now, the onus is on the paramedic or the first responder to say, 'These are my issues' and you've got to prove it to them. You're sitting there with a case worker that says 'Nope, that doesn't sound that bad. This is what you signed up for,'" she says. "These people are, sometimes, by the time they're coming forward thinking, 'I need help,' they're at their weakest because they're lost. (They have) broken marriages, relationships have fallen through with their families and they're at their lowest low.

"They're having a tough time making a case on their own behalf or even being their own best advocate. There's not much left of them to give."

In an email, WorkSafeBC senior manager of government and media relations Trish Chernecki declined to elaborate about Simpson's bill and how changes might be implemented if it makes it into legislation.

As it stands now, she explains, claimants must produce a diagnosis of a mental disorder. She adds that as of July 2012, disorders caused by work-related bullying and harassment are eligible for coverage.

"WorkSafeBC recognizes that first responders face single-incident and cumulative trauma incidents and stressors that may impact their mental health at work," she notes. "WorkSafeBC requires a diagnosis of a mental disorder from a psychologist or psychiatrist."

A centralized mental health clinic is located in Richmond, and there is a 24-hour crisis line — both of which are WorkSafeBC initiatives.

"This service is confidential and available to injured workers and their family, regardless of the status of their claim. WorkSafeBC also contracts with a team of social workers, located around the province, who are able to provide crisis intervention and mental health support 24/7," she notes.

As soon as a need for help has been identified, Chernecki explains, workers can receive coverage. In some cases, that can be as quickly as the day of an incident.

While workers have a year to file a claim, Chernecki says the board acknowledges there are situations, such as a delayed onset of symptoms that can delay an application and will not necessarily preclude a person from applying.

Getting out in front

It may be trite, but another changing attitude is that an ounce of prevention is worth a pound of cure.

While outright prevention of mental illness will likely remain impossible, some researchers are making the argument that, at the very least, more can be done to equip first responders with information before they get into the profession.

This fall, Simon Fraser University's (SFU) Continuing Studies department will start its First Responders Trauma Prevention and Recovery certificate program.

Larry White, the director of the department's career and professionals program, says the program has been developed over the course of roughly the past two years. Since the online program was announced in January, White says response has been swift and encouraging from members of the first-responder community. Each course will be limited to 30 students and SFU will monitor its waiting lists and open additional sections as needed. More than 70 people already had applied by mid-February.

"We've had lots of positive response from the public generally in the community, but more importantly, from first responders. Some of them are experiencing PTSD, or at least that's what they share with us, and believe this is a potential hazard to some of the challenges they face," White says.

The Tema Conter Memorial Trust developed the curriculum and instructors will all be former first responders, many of whom have had their own experiences with PTSD.

How organizations respond

WFRS has provided direct support to its members for more than two decades, Playfair says. In 1993 he received training in critical stress management and then implemented programming for the organization, as well as the Resort Municipality of Whistler (RMOW) at that time.

"That's a great success story for us, having that program in place over those years and in some ways, in the early days, we were on the forefront of that," Playfair says. "Now, across the province and country, they've followed that recognition.

"The awareness has been built in our department over the last 23 years. We're continuing to have our in-house programs."

Playfair says the critical stress-management program was most recently utilized for all responders after a fatal crash on Highway 99 in mid-December.

 "We have a management plan for workers that are exposed to critical incidents. Out of that, we have a policy, so we have some critical or must-do interventions, so the death of a co-worker would be one that would qualify. In an event such as that, which, fortunately, we've never had to deal with... you'd have an automatic briefing session when the crews finish with the incident and finish their work. That would be managed and a case like that, there would be ongoing follow up management as well," he says.

Whistler Search and Rescue (WSAR) manager Brad Sills explains when his volunteers are exposed to challenging situations, the group will meet afterward and talk out the situation.

"We do post-incident debriefings on every major event. We talk about the management of the thing to make sure that everybody can get rid of the physical anxiety," he says. "It doesn't address the mental capacity of somebody in terms of their feelings."

Sills notes the WFRS has made their counsellor available to WSAR in particularly traumatic events, a gesture the service members greatly appreciate.

In the event his volunteers encounter a traumatic situation as part of their rescues, help is provided through the province's Emergency Preparedness, Response and Recovery program. Sills estimates WSAR receives between 30 and 60 calls a year.

While some of the more horrific incidents are likely to cause trauma or stress, Ambulance Paramedic spokesperson Barter says it's difficult to predict what may or may not affect any given person.

"One call that might impact a paramedic might not impact another one," she says. "(The common stressful calls are) when there's the death of a child or when there's a multi-casualty incident and there's a lot of death. It could be as simple a thing as neglect of a senior citizen, and that's something that can wear on someone as well."

No one is going to show up to their first day of work as a first responder surprised to see some of the dreadful things they see as a matter of course, but Barter says there could still be greater screening before someone is brought onboard.

"When we signed up, it wasn't like they gave you a list of 'These are the types of things you're going to see,'" she says. "There's not a lot of questioning in the interviews. There wasn't a lot of training on the matter. You're kind of thrown into it. Back in the day, there wasn't a lot of support and you couldn't reach out. Over the years, we got very proactive."

She adds respected employees are being trained as "peer defusers" for coworkers and are made available to speak with paramedics after a challenging call, should they choose. The option of talking to a peer is voluntary, as Barter doesn't believe "forced interventions" are effective. If the employee is struggling, the peer asks if he or she would like a referral to a mental-health professional.

While Barter is in a situation where she has people in her personal life she can talk with about an incident that might have bothered her — she's married to a firefighter and her father was an RCMP officer — many first responders don't have someone they can speak to upon returning home.

"You don't want anyone else to be impacted by some of the things you hear and see and smell," she says. "And then you put the brave face on and do it again the next day."

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