NFPA Journal - Spring 2024 - 31

VIEWPOINTS ON FIRE
AND LIFE SAFETY
members-especially if it involves children,
their caregivers, or parents-as
well as other community members
around them in order to be more
comprehensive and impactful in the
work that we do.
How did you get into this work?
I'm a critical-care nurse by trade-
that's my day job as a registered nurse.
I work at the University of Michigan
in the trauma burn center, a verified
Level 1 trauma center as well as a verified
burn center. Most people think of
trauma and burn centers as focusing
on clinical and patient care, but part of
being a Level 1 trauma and burn center
is that we are responsible for the entire
process of care-from a patient's time of
injury through their pre-hospital care,
including our fire service group and first
responders, and on to their hospital care
and rehabilitation. We should also be
part of preventing these injuries-I like
to say I try to work myself out of a job
every day, but apparently I'm not very
good at it. There's a lot of work yet to do.
I got into critical-care nursing
because I wanted to save lives. Then
I started asking how we could do this
work better. So I moved into doing
more training and education. I also did
research to look at better ways to do it.
But I was still looking at areas where
we could make the most difference-
that's when you realize that, rather than
reacting to everything, why don't we
actually chase things upstream and try
to prevent them from even happening?
That's where we get into the work of
reducing and preventing adverse childhood
experiences.
How do you define the term
" adverse childhood experiences " ?
These are potentially traumatic events
and/or things in the environment or
household that happen to children
under the age of 18. It's not normal
bumps in the road like failing a test or
striking out in a baseball game-those
are hard, but we're talking about the
potentially traumatic events that can
happen to a child. Things like neglect,
parents with substance abuse issues,
sexual, physical, and mental abuse,
parents with extensive psychiatric
history, divorce-the really big, potentially
adverse challenges.
Was there a moment that helped
define the potential impact of
those kinds of experiences?
In the mid-1990s, a group from Kaiser
Permanente and the Centers for
Disease Control and Prevention undertook
a series of studies on different
types of potentially adverse challenges
people may have experienced in childhood.
They surveyed about 14,000
adults across the country. People were
asked about potentially traumatic
events they had experienced childhood
and what kind of consequences those
events may have had in adulthood. The
results were absolutely transformative
as far as the impact of those experiences
later in life.
What was almost unbelievable was
how many long-term mental and physical
consequences there can be from
ACEs. To date, there are more than 40
different negative health implications
linked to ACEs. When those initial studies
were conducted in the 1990s, they
found that seven of the top 10 leading
causes of death in the United States
were tied to ACEs. Keep in mind that
there's a dosing component to ACEs,
too-while a single ACE is bad, having
multiple ACEs stacked on top of each
other can lead to additional negative
consequences. What the research found
was that people with four or more ACEs
were somewhere between four and 12
times more likely to have issues with
diabetes, heart disease, cancer, and
smoking, and were prone to a number
of other high-risk behaviors like impulsivity.
In the CRR world, or the injury
and violence prevention world that I
live in, we see how difficult it is for us
to change those behaviors and help
people adopt safer behaviors. It could be
that there was something that occurred
during their childhoods that set them up
mentally and physically to go down this
path and have chronic diseases tied to it.
Why is a child's brain so susceptible
to these adverse experiences?
From a brain science and brain development
standpoint, part of what we're
seeing is that when a child's developing
brain is put under constant stress,
when those adverse experiences just
keep happening again and again, it
hardwires the fight-or-flight response
in the brain. The brain goes into
survival mode and becomes hardwired
to always be in that flight mode. It's
getting fed adrenaline all the time.
How do you connect the implications
of these adverse childhood
experiences to the concerns of
the fire and life safety community,
especially fire departments?
That's a question we need to continue
to ask. As one example, I manage our
youth fire-setting intervention and
prevention program, and we know
there's a strong link between ACEs,
especially abuse, and the behaviors of
youth fire setting. In other public safety
areas, that question hasn't been asked or
explored as much. In the public health
and medical world, we've known for a
while about ACEs and the huge impacts
they can have on people, but that memo
didn't get out to the fire service. Part
of that is because it's hard to look at it,
and it's hard to look at any issue when it
could potentially involve ourselves.
What do you mean?
In the fire service, it's worth asking
what's going on in our departments and
what's happening with our colleagues.
We already know that first responder and
firefighter suicide rates are way too high.
We know people are struggling and we
think we know part of the reason, but I
think we also need to consider ACEs in
those discussions. What has that person
gone through in their childhood, and is
that having an impact in behaviors we
might be seeing now? I think in many
cases it is. Many of us get into the professions
we do because of the experiences
we had-the path I got on was because of
my own ACE experience and wanting to
make a difference in people's lives. A lot
NFPA .ORG/JOURNAL * NFPA JOURNAL | 31
http://www.NFPA.ORG/JOURNAL
NFPA Journal - Spring 2024

Table of Contents for the Digital Edition of NFPA Journal - Spring 2024
