Do first responders have a predisposition to moral injury?
Predisposition to moral injuries
Myriad contributing factors place first responders in the high-risk category for experiencing potentially morally injurious events (PMIEs). First responders enter the profession with a self-imposed moral imperative to help other people (Smith-MacDonald et al., 2021). Altruistic ideals are not the only reason people enter the field, adrenaline seeking is a common theme in personality traits found in emergency services personnel. Adrenaline-provoking-events are listed as one of the main reasons people enter the field of emergency services (Firmin et al., 2018). The desire to confront high acuity situations and be one of the few who has the technical skill set to solve the problem is also cited as a top reason people enter the ranks of first responders (Smith-MacDonald et al., 2021). First responders often see their career as a “calling,” not simply as a job; they derive purpose and meaning from their vocation and dedicate their lives to their duty to the community (Torres & Gulliver, 2020). Organizations inculcate the duty to the community and fellow first responders by holding oath swearing ceremonies at the completion of recruit training. Before receiving their official badge or shield the recruit swears an oath to protect their community, the Constitution of the United States, and their fellow first responders. (Ricci & Shestokas, 2018).
In addition to the career attractions, salary, schedule, career advancement, data shows a connection between childhood experiences and first responders. One study shows 79% of first responders report having at least one adverse childhood experience (ACE) and 44% of respondents had two or more ACEs (Roth et al., 2022). The link between childhood experiences and a career as a first responder is not likely a casual one. The author suspects research will bear this out, but none has been found that specifically points to a causal relationship.
Besides individual psychological motivations, childhood experiences, and organizational factors, the public are another factor in the predisposition to moral injury. First responders are seen as the people who are called when the public does not know where else to turn. Just call 911 and the dispatchers will send people to solve your emergency. The public has come to expect a team of highly trained professionals to arrive and be able to competently, calmly, assess and manage the emergency (Yarnal et al., 2004).
References
APA Dictionary of Psychology. (n.d.). Retrieved November 1, 2023, from https://dictionary.apa.org/
Bryant, R. A. (2021). Treating PTSD in first responders: A guide for serving those who serve. American Psychological Association.
Cognitive Behavioral Therapy (CBT) for Treatment of PTSD. (n.d.). Https://Www.Apa.Org. Retrieved November 6, 2023, from https://www.apa.org/ptsd-guideline/treatments/cognitive-behavioral-therapy
Copley, L., & Carney, J. (2020). Using Gestalt Techniques to Promote Meaning Making in Trauma Survivors. The Journal of Humanistic Counseling, 59(3), 201–218. https://doi.org/10.1002/johc.12145
Dentry, S., Joannou, M., Bessemann, M., & Kriellars, D. (2017). Project Trauma Support: Addressing Moral Injury in First Responders. Mental Health in Family Medicine, 13, 418–422.
Dowler, L. (2002). Women on the frontlines: Rethinking war narratives post 9/11. GeoJournal, 58(2), 159–165. https://doi.org/10.1023/B:GEJO.0000010835.49706.7a
Firmin, M., DeWitt, K., Ellis, H., Smith, L., & Tiffan, N. (2018). A Qualitative Study of the Motivations and Affiliation Dynamics Involved with a Firefighting Career. American Journal of Qualitative Research, 2(2), 60–73.
Jahnke, S. A., Gist, R., Poston, W. S. C., & Haddock, C. K. (2014). Behavioral Health Interventions in the Fire Service: Stories from the Firehouse. Journal of Workplace Behavioral Health, 29(2), 113–126. https://doi.org/10.1080/15555240.2014.898568
Jitnarin, N., Jahnke, S. A., Poston, W. S. C., Haddock, C. K., & Kaipust, C. M. (2022). Posttraumatic stress disorder (PTSD) and mental health comorbidity in firefighters. Journal of Workplace Behavioral Health, 37(3), 147–168. https://doi.org/10.1080/15555240.2022.2081172
Jones, S., Agud, K., & McSweeney, J. (2020). Barriers and Facilitators to Seeking Mental Health Care Among First Responders: “Removing the Darkness.” Journal of the American Psychiatric Nurses Association, 26(1), 43–54. https://doi.org/10.1177/1078390319871997
Lentz, L. M., Smith-MacDonald, L., Malloy, D., Carleton, R. N., & Brémault-Phillips, S. (2021). Compromised Conscience: A Scoping Review of Moral Injury Among Firefighters, Paramedics, and Police Officers. Frontiers in Psychology, 12, 639781. https://doi.org/10.3389/fpsyg.2021.639781
Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis. European Journal of Psychotraumatology, 11(1), 1729633. https://doi.org/10.1080/20008198.2020.1729633
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003
Murray, E. (2019). Moral injury and paramedic practice. Journal of Paramedic Practice, 11(10), 424–425. https://doi.org/10.12968/jpar.2019.11.10.424
Murray, H., & Ehlers, A. (2021). Cognitive therapy for moral injury in post-traumatic stress disorder. The Cognitive Behaviour Therapist, 14, e8. https://doi.org/10.1017/S1754470X21000040
Partnoff, N. L. (2021). “Who’s Going to Flinch?”: Masculinity in the Fire Service and Barriers to Mental Health Help-Seeking [M.S.W., California State University, Fresno]. https://www.proquest.com/docview/2518686037/abstract/C5A714325A094E54PQ/1
Perls, F. S. (1992). Gestalt therapy verbatim. Gestalt Journal.
Ricci, Frank & Shestokas, David. (2018, June 6). You Swore an Oath—FirefighterNation: Fire Rescue—Firefighting News and Community. https://www.firefighternation.com/firerescue/you-swore-an-oath/#gref
Roth, S. L., Andrews, K., Protopopescu, A., Lloyd, C., O’Connor, C., Losier, B. J., Lanius, R. A., & McKinnon, M. C. (2022). Mental health symptoms in Public Safety Personnel: Examining the effects of adverse childhood experiences and moral injury. Child Abuse & Neglect, 123, 105394. https://doi.org/10.1016/j.chiabu.2021.105394
Schermer, T. W., & Holmes, C. N. (2018). Will to Masculinity: An Existential Examination of Men’s Issues. The Journal of Humanistic Counseling, 57(3), 191–207. https://doi.org/10.1002/johc.12082
Seely, M. R. (2007). Psychological Debriefing May Not Be Clinically Effective: Implications for a Humanistic Approach to Trauma Intervention. The Journal of Humanistic Counseling, Education and Development, 46(2), 172–182. https://doi.org/10.1002/j.2161-1939.2007.tb00034.x
Smith-MacDonald, L., Lentz, L., Malloy, D., Brémault-Phillips, S., & Carleton, R. N. (2021). Meat in a Seat: A Grounded Theory Study Exploring Moral Injury in Canadian Public Safety Communicators, Firefighters, and Paramedics. International Journal of Environmental Research and Public Health, 18(22), 12145. https://doi.org/10.3390/ijerph182212145
Torres, V. A., & Gulliver, S. B. (2020). Firefighters: An Occupational Case Study of Resilience. In S. E. Schulenberg (Ed.), Positive Psychological Approaches to Disaster: Meaning, Resilience, and Posttraumatic Growth (pp. 99–114). Springer International Publishing. https://doi.org/10.1007/978-3-030-32007-2_7
Yarnal, C. M., Dowler, L., & Hutchinson, S. (2004). Don’t Let the Bastards See you Sweat: Masculinity, Public and Private Space, and the Volunteer Firehouse. Environment and Planning A: Economy and Space, 36(4), 685–699. https://doi.org/10.1068/a35317
