WHAT IS PTSI?

Post-Traumatic Stress Injury frames the reaction to trauma as an injury rather than a personal failure. Like a physical sprain, a traumatic stress injury can be mild or severe, temporary or persistent. It usually responds to the right care. Calling it an "injury" helps normalize getting help early, just like you would treat a broken bone or a concussion.

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PTSI VERSUS PTSD - THE IMPORTANT DIFFERENCE

• PTSI (post-traumatic stress injury) - A broad term that covers normal and abnormal reactions after exposure to trauma. Includes a cute stress reactions and longer-lasting difficulties. Useful for early recognition and encouraging to help-seeking.

• PTSD (post-traumatic stress disorder) - A clinical diagnosis made by a mental-health professional when specific criteria are met (typically symptoms from certain clusters that persist and cause significant functional impairment, usually for longer than one month.)

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KEY POINT: Experiencing one or two symptoms after a call (bad dreams, replaying the scene, feeling on edge) is not the same as meeting diagnostic criteria for PTSD. Early symptoms can be normal and often improve with time, peer support and self-care.

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TYPICAL SYMPTOM CLUSTERS YOU MIGHT SEE (Range from mild to severe)

• Intrusion: unwanted memories, flashbacks, nightmares, having the scene "pop up" in the head.

• Avoidance: avoiding people, places, smells or conversations that remind you of the event.

• Negative changes in mood/thought: numbness, hopelessness, guilt, blaming yourself, losing interest in things you use to care about.

• Arousal/reactivity: jumpiness, hypervigilance, sleep problems, angry outburst, difficulty concentrating.

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Having a few symptoms briefly after an event is common. PTSD as a diagnosis generally requires multiple symptoms from these clusters, significant distress or impairment, and persistence beyond about one month.

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TIMELINE - WHAT'S NORMAL TO EXPECT

• Immediate (minutes-days): shock, disbelief, strong emotions - normal acutes stress reaction.

• Short term (days-weeks): intrusive thoughts, trouble sleeping, irritability - often improves with support and rest.

• Longer term (weeks-months): if symptoms persist, intensity, or interfere with work/relationships, it may be PTSI progressing toward PTSD and warrants professional assessment.

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RISK FACTORS THAT CAN MAKE PTSI MORE LIKELY

• Multiple exposures to traumatic events (cumulative burden)

• Prior trauma or mental-health history

• Lack of social support or feeling isolated

• Perceived personal threat (close call, death of a child)

• Sleep deprivation, heavy alcohol use or other substance use

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PRACTICAL STATION-LEVEL STRATEGIES (WHAT CREWS CAN DO RIGHT AWAY)

• Peer check-ins: a simple, non-judgmental "how are you really?".

• Tailboard talk: brief, focused conversations after difficult calls - not to force processing, but to let people know support is available.

• Normalize reactions: say out loud that reactions are normal and that getting help is smart, not weak.

• Buddy system: pair up for the next shift - make sure someone notices big changes in behavior.

• Limit exposure: rotate assignments where possible after catastrophic events; avoid unnecessary replaying of the call (video, social feeds) if it fuels distress.

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EVIDENCE-BASED SUPPORTS & TREATMENTS (WHAT WORKS) Click links for CISM and EMDR to learn more

• Peer support and CISM-style interventions can help with early processing (but used properly and respectfully - they are not a cure-all).

• Trauma-focused psychotherapies are first-line treatments for persistent problems: cognitive behavioral approaches (Cognitive Processing Therapy), prolonged exposure, and therapies like EMDR.

• Medication may be helpful for some people to manage severe anxiety or depression - this is decided with a clinician.

• Practical rehabilitation: sleep hygiene, graded return to normal routines, exercise, nutrition, and limiting alcohol.

Note: Treatment choice should be made with a licensed clinician. Early help improves outcomes.

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SELF-HELP STRATEGIES THAT ACTUALLY HELP (STATION FRIENDLY)

• Sleep: prioritize rest after a rough calls - short naps on shift when safe and sleep routines on off-duty.

• Move: even 20-30 minutes of physical activity helps regulate mood and stress hormones.

• Talk to someone who gets it: a trusted crewmate, a mentor or a peer support team.

• Grounding techniques: 5-4-3-2-1 sensory method, controlled breathing, or focused Progressive Muscle Relaxation for moments of panic or flashbacks.

• Limit numbing behaviors: be mindful of alcohol or heavy substances used to "switch off" - they usually prolong recovery.

• Routine: regular meals, hydration, and small rituals (coffee with the crew, family check-ins) restore a sense of safety.

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HOW TO KNOW WHEN TO GET PROFESSIONAL HELP- RED FLAGS

Seek professional assessment if you or a teammate experience any of these:

• Symptoms don't improve after a few weeks or get worse.

• Trouble performing job duties, unsafe behaviors, or repeated near-misses.

• Persistent severe insomnia, panic attacks, or intrusive flashbacks.

• Withdrawal from family and friends, increased substance use or thoughts of self-harm.

• Intense guilt, rage, or an ongoing sense of hopelessness.

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If there are any thoughts of harming yourself or others, treat it as an emergency and get immediate help.

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HOW TO TALK TO A PEER WHO MAY HAVE PTSI - USEFUL PHRASES

"I'm worried about you - you're not the same since that call. Want to sit for a minute?"

"I've noticed you're quiet/angry/tired more than usual. That happens to a lot of us after tough calls."

"Talking about it doesn't mean you're weak - it means you want to be ready for the next call."

"Do you want me to help you find someone to talk with? I'll go with you if you want."

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Avoid minimizing phrases such as "you'll get over it" or pressure them to "man up".

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MYTH BUSTIN

Myth: "If I can handle it, I'm fine." - Reality: Some symptoms are delayed; strength is asking for help.

Myth: "Only veterans of huge fires get PTSI." - Reality: A single event (especially involving a child or colleague) can cause it.

Myth: "Talking about it will make it worse." - Reality: Supported, structured conversations often help recovery.

Myth: "Medication is the only answer." - Reality: Therapy, peer support, and lifestyle changes are powerful and often first-line.

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IF A CALL IS STILL ON YOUR MIND DAYS LATER, THAT'S OKAY. IT'S NOT WEAKNESS. SIT WITH YOUR CREW, SHARE A MEAL, AND REACH OUT. BREAKING BREAD IS HERE TO LISTEN AND CONNECT YOU WITH PEER SUPPORT AND PROFESSIONAL HELP WHEN YOU NEED IT.​​​​