Firefighters Get Help in Dousing Trauma

Their body language--heads down, shoulders slumped--signaled how hard the firemen had been hit by the tragedy they found in a South-Central Los Angeles home gutted by flames.

Two-year-old twins had been trapped in the house when a lighted match ignited bedding and curtains. Their father had tried hard to save them, falling unconscious in the back yard of smoke inhalation.

By the time firemen fought their way into a bedroom and reached the children, one boy was dead; his brother died at the hospital. The sight of the two victims was shocking.

Easing the Stress

Later, away from the scene, two of the firefighters most powerfully affected by the tragedy talked out their feelings in a debriefing session designed to relieve the post-traumatic stress they felt.

“Anything can trigger it,” said Los Angeles Fire Capt. Lorrell Cooper. “The look in the kid’s face. The type of pants the kid’s wearing can be the same as ones your own kid wears. . . . It’s really tough on young officers. You never really overcome it. . . . “

To Russell Boxley, a psychologist hired by the Fire Department to set up its new stress-management program, emotional traumas experienced by firefighters and paramedics in the performance of their duties are like “rocks,” which they unknowingly collect and store.

“They mount and grow,” said Boxley, 45, who interned at UCLA’s Neuropsychiatric Institute and teaches at the California School of Professional Psychology in Los Angeles. “And, all of a sudden, it gets to be too much of a strain, and you start hitting the bottom . . . because you haven’t taken care of these rocks.”

Notification Process

To help members of the Fire Department deal with these emotions, the department recently instituted the Critical Incident Stress Debriefing Program.

Under the program, those affected by physical and emotional turmoil created by particularly traumatic events are encouraged to notify their company commander or paramedic supervisor, who then tells the battalion chief.

If the battalion chief decides that intervention is necessary, he and Boxley will decide what steps to take, including informal defusing sessions at the scene of a “critical incident” or at more organized debriefing meetings with stress team members at the fire station.

Those affected by a traumatic event learn what stress symptoms to look for--emotional numbing, a feeling of isolation, reliving the disturbing event, inability to sleep, anxiety and a questioning of personal values, status and goals.

Boxley, the Bronx-born son of a New York City police lieutenant, said the program probably is “the most developed” of any stress program in the country, including similar approaches in Seattle, Phoenix, Atlanta, Dallas-Ft. Worth and Boston.

Since the Fire Department hired Boxley to work part time about six months ago, he or members of a team of 60 specially trained department volunteers have been called out more than 30 times.

Helmet Is a Symbol

When there is a major incident, Boxley is notified, and whenever possible he turns out, wearing a fire helmet marked “Psychologist.” He thinks that since he is not a trained firefighter himself he needs to establish credibility by being present at various scenes.

Boxley will not talk about specific events that have seriously affected members of the department because those who join in defusing and debriefing sessions are assured absolute confidentiality. But he speaks readily about the problems faced by emergency service workers as a whole.

First, he says, there is a kind of “hot to cold” aspect to their jobs. They are required to be constantly vigilant, ready to perform complicated tasks in emergencies that are sometimes dangerous and emotionally distressing.

“They learn how to shut things off, how to be professional. When they go to work, they turn on the work station,” he said. “They are very pleasant but direct and try to do their job and not get emotionally involved in what’s going on.”

Veteran firefighters and paramedics develop mental “callouses,” Boxley said, but he says they face a basic dilemma in trying to cope--while trying to be strictly professional, they still must be open and responsive to the public.

Looking for Understanding

“You don’t want anybody coming to save your house and property and life to be like a robot,” he said. “You’d like somebody who’d be personable and understanding. But to do that leaves them open to other things.”

And, he said, even the best of defenses may sometimes be inadequate when tested by extraordinarily traumatic events, such as major disasters, on-duty death of a co-worker, life-threatening danger or the death of a child through violence or neglect.

As public safety workers by choice, Boxley said, firefighters and paramedics typically want to help people deal with pain and distress. And sometimes they are extra hard on themselves when things go wrong.

Back at the station house after an incident, he said they often talk over what happened in a spirit of camaraderie that has characterized the fire service for 100 years.

“You talk about what you did, how you did it and how you could have done it differently,” he said. “That’s the nature of their jobs. But sometimes it becomes, ‘It’s my fault that kid died.’ ”

For many people, talking with their peers around the kitchen table is all they need, Boxley said. The stress-management program is not intended to interfere with what naturally happens in a fire house, he says.

But sometimes, more help is indicated, especially in emotionally charged incidents that are determined for whatever reason to be “critical,” either to several members of a unit or perhaps to a single person.

“It brings things back,” he said. “Your own mortality, your vulnerability, your own family. You are a human being and this person lost everything. You identify with that and it becomes very difficult.”

Mostly people deal with the stresses they have and their symptoms disappear in three or four weeks, but sometimes, Boxley said, they last much longer and can be disabling.

“We’re trying to make people aware that post-traumatic stress is out there, and it’s not something that you take lightly,” he said. “It doesn’t mean you are a wimp if you hurt.”

Times staff writers Nieson Himmel and Boris Yaro contributed to this story.