By Rose Hoban

In a year when the important role of first responders has become increasingly visible to members of the public, several bills to provide enhanced benefits to public employees such as police, firefighters and EMTs who sustain illness or injury related to their jobs have been introduced at the legislature.

One bill, House Bill 535, addresses an issue that’s been advocated for by firefighters’ organizations for several years, namely, a higher incidence of some forms of cancer experienced by firefighters. Long-term studies conducted by the National Institute for Occupational Safety and Health confirmed that firefighters more often develop digestive, oral, respiratory, and urinary cancers, along with mesothelioma, a cancer that’s related to exposure to asbestos. 

A second bill, House Bill 492, would provide coverage for first responders who suffer trauma on the job, whether they were participants in a traumatic event or they witnessed some of the horrors that humans can inflict upon one another in the course of their workdays. 

And while both bills received favorable treatment in the House Health Committee last week, their fates are likely different, in part because of how the different groups are asking for their coverage to be paid. 

Witnesses to suffering

For half a decade, the advocacy group Blue HELP has been collecting data on law enforcement personnel who take their own lives. According to their records, 645 law enforcement personnel, including corrections and federal officers, have died by suicide since the beginning of 2018.

Law enforcement are not the only first responders to have large numbers of suicides, according to Rep. Donna White (R-Clayton), who is a sponsor of HB 492 and who introduced the bill last week in committee. 

“In 2020, according to Firefighter Behavioral Health Alliance, 97 firefighters 26 EMTs, and one communication specialist, a 911 dispatcher, committed suicide,” she reported. “The Alliance believes those statistics are 65% reporting.”

And those statistics don’t even represent those first responders killed in the line of duty.

“When you drive along the highway and you see a wreck, do you stop?” White asked. “Our police officers are patrolling and they have no choice. They stop. They see decapitations. They see limbs that are missing and they don’t even know where they are in the pile.” 

She went on to describe some of the traumatic scenes witnessed either in person, or sometimes, in the case of 911 dispatchers, over the phone.

“When you do this 365, many times several shifts a day or a week. You don’t get over it. You can’t just brush it away,” she said. 

The bill would allow those responders who have developed post traumatic stress disorder from some of the things they’ve witnessed and experienced to claim workers compensation for their treatment. 

“Every shift, when you see it day in and day out, it does take a toll,” said Rep. Mike Clampitt (R-Bryson City), a retired firefighter. “I’m here to tell you, it does take [a toll] and I never think about it till something like this comes up. And it’s all that scene and all that emotion, everything flows back through me again.”

Personalized treatment 

Treatment for post traumatic stress is complicated and varies according to what works for each person, said Cherene Allen-Caraco, a mental health provider and head of Charlotte-based Promise Resource Network

While many people think of therapy as something that happens while the patient lies on a couch and talks, there are now many forms of therapy specifically geared towards helping people heal from both physical and psychological traumas. 

Some therapies are in the experimental stage, such as those being studied by local researchers who use injections to block nerve pathways to calm the body’s reactivity to stress.

Allen-Caraco, who both practices trauma-focused therapy with clients and has been through the therapy herself said that other forms of trauma therapy involve helping people get in tune with what is happening in their bodies. Once patients identify the places where they are tense, they can then increase their awareness and work toward releasing that tension; that can involve learning deep breathing techniques or movement to reduce muscle tightness. Other forms of therapy use eye movement to defuse the memories of trauma. 

“It could be sensing, so it could be more of a grounding, hearing, smelling, seeing,” she said. “It could be engaging your senses, you’re learning how to regulate your nervous system or calm your nervous system down.” 

She said that it’s important for first responders to have done this work if they’ve experienced trauma in their past. They frequently walk into complicated and tense situations and need to be aware of the unconscious forces playing inside themselves, especially if people’s lives are at stake. 

“What you want to do is be grounded enough in that moment,” she said “You want your thinking brain online, not your primitive brain, you’re not just reacting based on fear and feelings. 

“You don’t want fight flight or freeze to take over.”

The problem, Allen-Caraco said, is that frequently, insurance doesn’t cover enough treatment.

“Sometimes what happens is insurance will pay for three sessions, five sessions, you know, they’re going to pay for very short term treatment,” she said. “It doesn’t mean people are gonna have to do it for years. But to think that we could just cure people in three sessions… there has to be flexibility to choose a modality based on what you’ve experienced. And based on what would work for you.”

Scott Mullins, head of the Professional Fire Fighters and Paramedics of North Carolina, spoke to lawmakers last week to press for the firefighters about the psychological toll his line of work takes on people. “Every year, it just gets worse and worse and worse,” Mullins said. “PTSD and depression rates among firefighters, EMS personnel, and police officers are nearly five times higher than the general population. Even when suicide doesn’t happen, untreated mental illness occurs and it has a great impact on our physical health and impairs decision making.” Screenshot courtesy: NCGA Youtube channel

Higher cancer incidence

In the past, the state’s firefighters have also pushed to be paid through the state workers compensation system to have their cancer treatment reimbursed and to be paid for their time off while they’re sick.  

“North Carolina is the only state in the country who’s not taking care of our firefighters on the issue of cancer,” bill sponsor Rep. Destin Hall (R-Lenoir) told the committee. “We’re the only state again, the only state without any presumptive cancer coverage for our firefighters.”

This year, the Firefighters Fighting Cancer Act of 2021 is finally predicted to pass, because the firefighters and those opposed to the bill in the past have negotiated a way around having reimbursement come via workers comp. 

Spokesman Scott Mooneyham from the North Carolina League of Municipalities said that previously, his organization – and others – opposed paying for these treatments with workers’ compensation.  

“Our organization saw that as both creating a situation where the costs would be undetermined, and it wouldn’t solve the problem,” he said. Even if workers compensation paid the bills, a municipality could still be sued. 

The current bill was hammered out when all of the stakeholders sat down and gave a little. For one thing, Mooneyham said that this year’s firefighter bill includes volunteer firefighters, who were not included in previous years’ bills. 

And this new bill provides a firefighter diagnosed with cancer with a $25,000 lump sum upon diagnosis, as much as $12,000 to cover deductibles, copays and other out of pocket costs and a monthly benefit that’s tagged to the firefighter’s salary. Volunteer firefighters would receive the same lump sum benefits along with $1,500 each month. For both kinds of workers, the benefit tops out at $50,000. 

Mooneyham predicted that the bill would have an easy trip through the legislature and would land on Gov. Roy Cooper’s desk for a signature. 

But the PTSD treatment bill? Mooneyham predicted that HB 492 didn’t have a chance, because it – like previous iterations of the firefighters’ bills – relied on the workers compensation system for reimbursement. 

“There are a lot of interest groups beyond the league that are not comfortable with making substantial changes to the worker’s comp system,” he said. 

“I think that any entity that wants to pass a piece of legislation to provide some type of benefit needs to look beyond the workers’ compensation system, if they want to achieve that. And I think this cancer firefighters bill is evidence of that,” he said. 

“I think that’s where this state is right now.”

Creative Commons License

Republish our articles for free, online or in print, under a Creative Commons license.

Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...