Stress First Aid for firefighters

Henry Costo was only 20 when he was sent to his first fatal fire.

He raced up to a third-floor apartment on Girard Avenue, where a teenage girl was reportedly trapped. He grabbed her feet, pulled her dead body closer, and realized something was wrong.

There were too many limbs.

Costo turned to his partner to share what he had found: two girls, hugging each other, realizing they would die.

But driving back home, Costo didn't feel a thing.

"I remember thinking, 'There must be something wrong with me. Am I that hardened?' "

Costo, now 58 and executive chief of health and safety at the Philadelphia Fire Department, spent years thinking about the unmet emotional needs of firefighters. On June 6, coincidentally the day after a four-story building collapsed on Market Street, Costo was among the first to implement a training program that teaches first responders how to identify and react to stress in their colleagues. The program, Stress First Aid, aims to prevent disorders like post-traumatic stress disorder, depression, and suicide.

The need for Stress First Aid is real. PTSD may affect up to 37 percent of U.S. firefighters, studies show. In Philadelphia, the last 14 months have brought three suicides and three line-of-duty deaths among 2,200 firefighters.

For chiefs like Costo, those are six deaths too many. "It's a cliche almost, that sense of family and brotherhood. But it's a real phenomenon, a real sense of loss and feeling."

Jennifer Taylor, a public health professor at Drexel University, attended the training and said nonfatal injuries were more common and costlier than line-of-duty deaths.

Most treatments for PTSD involve reliving emotional events. But firefighters often extinguish their own emotions with the same surety as they extinguish fires.

Ken Pagurek, a firefighter who responded to the Market Street collapse, focuses on his positive experiences. "But we all have to lay down and go to sleep at some point," he said. "And when you're by yourself, things can enter your mind."

Stress First Aid seeks to change that culture among first responders. The city Fire Department paid $7,000 for the session, which is inspired by a model used in the military.

The eight-hour session comprised interactive modules. Those invited learned about the "7 Cs" to identify colleagues who need help. For example, they should "Check" for signs of distress because depressed firefighters are twice as likely to be sleep-deprived and thrice as likely to drink hazardously.

Attendees included firefighters, clergymen, police, and members of the Fire Academy's human resource department - all people who could help first responders.

Charles Figley, a psychologist at Tulane University, cautions about the "continuity of care gap." Programs like Stress First Aid rely so heavily on peers they may neglect to have a backup plan.

Meanwhile, Costo eagerly awaits funding before he plans the next session.

"When I train, I learn," said the chief, less hardened today than when he was first on the job.