LIHU‘E — While the horrifying images of destruction following the fires in West Maui on Aug. 8 are seared into the minds of many, few have been as directly affected as the firefighters who battled the deadly inferno.
However, those who heroically stayed behind to battle the blaze now face a health care system that largely does not know how to care for the physical and mental health impacts they’ve suffered.
University of Hawai‘i at Hilo psychology professor and former clinical psychologist Chris Frueh spent about 30 years primarily treating members of the military before focusing more intently on first responders about three years ago after a firefighter reached out about his own health impacts.
After Frueh’s encounter with the firefighter, his team quickly came to a realization — medical research into firefighters’ health is extremely sparse. A 2021 index search of medical journal research found only 499 articles on firefighters published, compared with 15,299 for veterans.
“It’s astonishing to me that there’s a 30-to-1 ratio of research, veterans to firefighters,” Frueh said. “It means we know nothing about the types of injuries and health problems that firefighters develop over the course of a career.”
Despite the immense disparity in research, Frueh noticed many of the symptoms his military patients experienced also appeared in the first responders he treated — both mental and physical.
“For police and firefighters, at the end of the shift you go home, but you go home with all this stuff going on inside your thoughts and inside your body. That’s a really unusual structure,” he said. “A firefigher comes home, and they may have held a dying child that day.”
“And then the respiratory issues, all that crap they’re breathing into their lungs affects their lungs, so (they can get) respiratory illnesses, cancers. There’s a saying in the firefighter community — ‘It’s not if you’re going to get cancer, it’s when you’re going to get cancer.’”
Additionally — and often, causally — firefighters suffer traumatic brain injuries (TBIs) while on the job, with multiple studies showing that approximately 3 out of 4 firefighters report at least one head injury in their lifetime. These injuries can cause a plethora of symptoms, from hormonal imbalances and sleep impairments to impairments in memory and difficulty learning new skills.
Further complicating the matter, these symptoms can often compound one another, creating an even more debilitating experience for those affected.
“A TBI makes your sleep worse,” Frueh explained. “Bad sleep and a TBI makes your hormones worse. If your testosterone is low, you’re going to feel depressed, you’re going to feel low energy. Your concentration is now messed up. So these aren’t really, truly separate injuries — they’re complex, and they’re interrelated.”
Seeing firefighters facing a multitude of health risks with little dedicated clinical help, Frueh and his team adapted his work with military special operators to develop a framework for firefighters in an effort to take a whole-systems approach for first responders. His team hopes their groundwork will help firefighters in Hawai‘i and around the globe, as they manage what the team has dubbed “Firefigher Syndrome.”
“What we want to do is provide a framework for people who are mid-career to late-career to retired to begin to understand their injuries, and to begin to be able to understand how to take care of themselves and how to look for medical care that they may need,” Frueh said.
The team also created a publicly available questionnaire to help firefighters determine whether they exhibit any symptoms of Firefighter Syndrome, allowing them to more successfully find the help they need.
“An individual firefighter can look through it and see, ‘Oh my goodness, I check these boxes,’” Frueh said.
“It can help educate them as to what some of the domains or concerns are, where they are on some of these issues. It can also be used as a way to educate spouses or family members — and, importantly, to review with their health care providers.”
Frueh told The Garden Island that this framework could directly translate to providing valuable health care to first responders in Maui, adding that he’s happy to help however he can, and is willing to visit fire departments to assist with implementation.
Additionally, Frueh stressed that care for Maui’s first responders is everybody’s kuleana, adding that related health effects are likely to last long after the flames are extinguished.
“They’re going to need our help,” he said.
“They’re putting in incredible efforts now, and there may not be a whole lot we’re going to be able to do for them now, today, this week. But in the coming weeks and months, we need to be aware that they are going to need us to help them. They’re going to need more attention. They’re going to need more care.”
First responders interested in the Firefighter Syndrome questionnaire can find a PDF of the document at chrisfrueh.com/firefighter-syndrome.
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Jackson Healy, reporter, can be reached at 808-647-4966 or jhealy@thegardenisland.com.
