Blood has a distinct, coppery scent. If that's what Brandon Dreiman smelled when he stepped off the fire truck, he knew his job wasn’t going to be easy.
He’s dealt with a lot of tough situations over his 17 years as a firefighter and a paramedic for the Indianapolis Fire Department. Dreiman has had to tell families a loved one killed themselves. He remembers wandering an Indiana interstate, picking up pieces of a body thrown from a vehicle. He’s found human remains burnt to furniture after a house fire.
For most people, these are traumatic, once-in-a-lifetime events. This was Dreiman’s daily life, and he’s not alone.
Firefighters and other first responders are at higher risk than most people for developing mental illnesses such as post-traumatic stress disorder, research shows. The people first to the accident scene also face more barriers to medical care, including fear of how they'll be perceived by co-workers should they seek counseling or addiction treatment.
"If you can imagine how horrifically a body can be destroyed, that's what we see," said Dreiman, who has been with the IFD since 2001. "It's just not anything our brains were designed to handle, and that’s as honest as I can be about it."
Dreiman’s been immersed in the first responder world since he was 16, when he started as a junior firefighter in Vincennes. That was the legal age in 1990 to be able to drive an ambulance. By the time he was 18, he was working as an emergency medical technician for an ambulance service.
"It was a small town, just a couple of ambulances,” Dreiman said. It was so small he recognized the house where he responded to his first 911 call. The EMTs were dispatched to a report of a gunshot wound. It was Dreiman’s great-uncle, and he had shot himself in the head with a .22 caliber bullet.
Dreiman remembers holding down his great-uncle’s arms while another paramedic put an IV into the man’s jugular vein. His great-uncle made it to the hospital in critical condition, but died a few days later.
That death weighed on Dreiman a long time. He felt guilty he couldn’t save his great-uncle. It’s a first responder’s job to provide comfort and aid, Dreiman said. When he couldn’t, he felt helpless. To repress those emotions, he would drink.
"There used to be a real 'toughen up, kid' attitude. If this stuff bothers you, you're in the wrong line of work," Dreiman said. "If you reached out for help from a professional, that was considered weakness. But if you went home after a call and drank 10 shots of whiskey … that’s just how we do things."
Coping with trauma through addiction
"There were times when you would leave (your) shift and you'd know which bars were open at 8 a.m.," Dreiman said.
He knows this because he abused alcohol to cope with the trauma of being a firefighter. Dreiman will share his story of recovery Tuesday, Aug. 14, at Side Effects’ upcoming Night of Live Storytelling.
Dreiman doesn’t remember a specific incident that turned him from a regular drinker to an alcoholic. It was gradual.
For years, he’d go home after his shifts and drink as much as he could before he fell asleep. Then he’d get up and do it all over again.
The routine wasn't healthy, but it kept him working. In 2004, he was awarded paramedic of the year. But at home, his marriage was falling apart and so was his mental health after more than a decade of unaddressed trauma.
A random alcohol breath-test changed Dreiman's life and career. He wasn't drunk when he came to work that day in 2012, but his blood-alcohol content after drinking heavily the night before was enough to fail the test.
"I would just drink as much as I could thinking I'm up against the clock," Dreiman said. "It certainly caught up with me that day."
First responders’ mental health
First responders are diagnosed with PTSD up to three times more than the people who call them for help, said Peter Haugen of the New York University School of Medicine. Haugen, a psychologist, treats the first responders called to the scene of the 9/11 terrorist attacks. He also published a review of the few studies on mental health of first responders.
One-third of all first responders face mental health stigma, according to Haugen’s research. He found firefighters worry what they tell their doctors won't be kept confidential, and that seeking treatment will cost them their job.
"They'll be seen as weak or letting down their colleagues, their brothers," Haugen said.
After failing his alcohol breath-test, Dreiman was suspended and went through the Indianapolis Fire Department's employee assistance program. Dreiman wanted to keep his fellow firefighters from repeating his mistakes after he finished treatment and got into recovery.
Dreiman knew there were firefighters like him who struggled with addiction. At some stations, firefighters regularly came back to the station smelling like alcohol, and it was standard procedure to put them to bed.
"You thought you were helping the guy out covering for him, when in fact that reinforces their ability to get away with that behavior and it never address the underlying problem," Dreiman said.
A new support model
The fire department's response to major traumatic incidents wasn’t helpful, Dreiman said. After a station responded to a bad call, a critical incident stress management team would come to the firehouse. The entire staff went over what happened, which forced them to relive the trauma often before they were ready to confront it.
After that group meeting, the incident was never discussed again.
"We really weren't concerned with what firefighters were doing in their off time or the impact of things over the long term," said Kevan Crawley, division chief for health and safety at the Indianapolis Fire Department.
And firefighters, entrenched in a “warrior culture” that valued appearing tough over seeming vulnerable, wouldn’t ask for help even when they needed it, Crawley and Dreiman said.
Now, the IFD has embraced a new model of care. Dreiman coordinates the Indianapolis Fire Department’s peer support program, and he works to reduce the stigma firefighters associate with seeking mental health treatment.
He and his small team still meet with firefighters after bad incidents. They also try to make routine visits to stations around the state. The visits are short – they leave information on resources and the symptoms firefighters might experience after trauma.
Most importantly, they pass out their contact information. Dreiman said calls for help come an hour or two after a visit, or the next day.
"We understand people don’t want to be seen talking to us," Dreiman said. "We make it easy for them to contact us when they feel safe."
In Haugen's research, first responders' top barriers to care are difficulty scheduling appointments and not knowing where to get help. Dreiman said fellow firefighters who connect coworkers with resources and share their own experiences reduce stigma.
"It can make them feel hopeful, like there's something that can be done for them," Haugen said.
Meeting a need
Dreiman said addiction recovery saved his marriage and career. He also sees more firefighters comfortable asking for help.
The department started collecting data this year on concerns firefighters report to the peer support team and the assistance provided. The team is contacted about 20 times a week and has five open cases at any time. An open case is when the team works with the same firefighter more than twice in a week.
These are firefighters who might kill themselves, who need to detox or are have issues in their personal lives that keep them from work.
"Guys that I looked up to in my career when I first came on the job that I would be out there and think, 'These guys are just the ultimate fire fighter' -- I've had them break down and cry about things," Crawley said.
A veteran diagnosed with PTSD, Crawley connects with firefighters through his military experience. He oversees two full-time firefighters who provide mental health resources. He said the station could use more, but doesn't have the funding or support from local government.
Indianapolis officials told the department "we don’t see any return on investment for behavioral health," Crawley said. "It's a fight."
Dreiman’s goal is to give his colleagues resources so when they're ready to get help, they know where to go. But there aren’t many first responders trained to support their fellow firefighters. And Crawley said they can’t make preventative care a priority with a growing caseload.
"We need to be out there getting more involved in wellness, in prevention," he said. "That's what we're trying to prevent, is people falling through the cracks."