For emergency workers, a routine shift can turn traumatic in a heartbeat.
Sirens scream as they rush to a slaying, a burning building or a highway crash with people trapped in twisted metal. But after the crisis, who helps the helpers?
On-the-job stress can lead to psychological scars and, while there is more support available for those on the front lines than there used to be, the expectation hasn't changed in generations. Don't think about it. Don't talk about it. Don't do anything about it.
Manitoba emergency services unions hope to fix that. They are calling on the provincial government to adopt a law -- much like Alberta's new legislation -- that recognizes post-traumatic stress disorder in firefighters, police and peace officers and emergency medical technicians.
The law means if a doctor or psychologist diagnoses one of these workers with PTSD, it's "presumed" it's due to what happened in the course of the job, "unless the contrary is proven."
Alex Forrest, president of the United Fire Fighters of Winnipeg (UFFW), said he knows of dozens of firefighters who had PTSD, but there faced barriers to speaking out.
"Many of them never came forward and they suffered for years in silence," Forrest said.
After Winnipeg firefighters Capt. Harold Lessard and Capt. Tom Nichols died in a 2007 house fire, those who survived were deeply affected.
"We saw many of our members come forward and seek help, and we got them medical help, but unfortunately, there's probably a good six to eight members who are still suffering the effects of that," Forrest said.
He said those members have been formally diagnosed with PTSD or have shown symptoms of PTSD. "You're dealing with a culture where people believe that they have to deal with it themselves. I've dealt with dozens and dozens of firefighters that have had everything from anger-management issues, to alcohol abuse, to very high divorce rates, that I believe can also be contributed to PTSD on certain levels."
Since 2000, there have been 282 Workers Compensation Board claims approved for PTSD. Of those, 21 have been first responders, such as ambulance attendants, corrections workers, firefighters and police officers.
A spokesman for Labour Minister Jennifer Howard said the department plans to study the Alberta model, but stressed there is a long-standing commitment to ensure emergency responders have supports. "We are one of the only jurisdictions in North America with legislation that ensures there is training in critical incident stress management and access to PTSD support," he said.
More than a decade ago, the Office of the Fire Commissioner created the Manitoba Critical Incident Stress Management Network as a joint initiative with Manitoba Health. There are seven teams in the province. They are made up of professionals from emergency services, police and hospitals as well as mental-health workers and other clinically trained people.
A massive blaze in January 2012 changed the life of city firefighter Chad Swayze. On the job for more than a decade, he was standing outside the gigantic fire at Omniglass, a window and door factory on Sherwin Road, when he and fellow firefighters were thrown back by the force of an explosion.
He suffered a gash to his leg and was banged up, but a heavy emotional weight lingered.
Swayze, 32, said he showed some symptoms of PTSD and had "severe anxiety."
"Some of the symptoms I definitely see in myself, unable to concentrate, unable to sleep... anger." Talking about how he felt with his colleagues was difficult, Swayze said.
"I remember one guy in particular said: 'Get back on that horse, and that's just what we do.' "
Mike Sutherland, Winnipeg Police Association (WPA) president, said he knows of three or four current or former officers who've been diagnosed with PTSD.
The addition of a full-time psychologist to the Winnipeg Police Service last year has helped, he said, because she offers a specialized knowledge of police matters.
Eric Glass, the Paramedic Association of Manitoba's administrative director, said the association doesn't have figures on the number of paramedics who struggle with PTSD.
"Anecdotally, we know PTSD is a very real issue for paramedics, and that there are paramedics in Manitoba who have experienced the symptoms of PTSD as a result of work-related traumatic events," he said.
What is PTSD?
THE Canadian Mental Health Association (CMHA) says PTSD is "caused by a psychologically traumatic event involving actual or threatened death or serious injury to oneself or others."
Such triggering events are called stressors; they may be experienced alone or while in a large group.
The CMHA also said "violent personal assaults such as rape or a mugging, car or plane accidents, military combat, industrial accidents and natural disasters are stressors that have sparked PTSD. In some cases, seeing another person harmed or killed, or learning that a close friend or family member is in serious danger, has caused the development of PTSD symptoms."
Those symptoms can include flashbacks, insomnia and "emotional numbing," the CMHA says.