I have found a concept that may help us identify one of the factors contributing to public safety suicides. Moral injury was first used in 2009 to describe soldiers’ response to their actions in war. It represents “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations” (Litz, Stein, et al 2009).
Physicians adopted the concept when describing the frustration of being unable to provide high-quality care and healing in the context of front-line health care (Talbot & Dean 2018). ZDoggMD provides a passionate description of the physician moral injury situation:
Like public safety workers and soldiers, physicians are experiencing a high level of suicides (Price & Norbeck 2018).
Moral injury occurs for paramedics and firefighters when there is a gap between what they want to do and the conditions that they are confronting. An example is the opioid epidemic, where caregivers are finding themselves resuscitating the same person a couple of times a year with no indication of improvement. Or the person with behavioral health and chronic medical conditions who will not benefit from a transport to an emergency department, but that is your only option.
In some communities, the number of on-duty firefighters has shrunk while the workload has increased. There are disasters and local incidents where paramedics and firefighters are faced with devastating human conditions that they cannot reverse or mitigate, creating a situation described by Litz as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.”
The challenge for company commanders is removing the conditions that create barriers preventing us from doing the right thing for our community. There are no easy resolutions. Some situations are outside the ability of fire-rescue to resolve. What can a company commander do with that situation?
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Litz, B. T., N. Stein, E. Delaney, L. Lebowitz, W. P. Nash, C. Silva and S. Maguen (2009). “Moral injury and moral repair in war veterans: A preliminary model and intervention strategy.” Clinical Psychology Review 29(8): 695-706.
Talbot, S. G. and W. Dean (2018) “Physicians aren’t ‘burning out.’ They’re suffering from moral injury.” STAT.
Price, G. and T. Norbeck (2018) “Physicians are Human Too.” The Physicians Foundation.
Featured image “Los Angeles Fire Department paramedics and Los Angeles Police Department officers respond to multiple people who had fallen ill on Aug. 19 on skid row.” (Patrick T. Fallon/ For The Times) taken from Sharp, Steven (2016 August 25) “Gentrification on skid row? We should be so lucky” Los Angeles Times