Tom Howard, a full-time firefighter since 1993 and an Evanston firefighter since 1999, looks like he’s straight from central casting. He is tall, fit, tattooed and confident.
Firefighters, like most first responders, are active, take-charge, Type-A people. They like helping. Broadly speaking, showing emotion or admitting vulnerability does not come naturally.
“We don’t do sad,” Howard said. “We go right to anger.”
A 2021 multistate study found that firefighters and Emergency Medical Technicians had “significantly higher” rates of suicide compared with the general U.S. population. In 2020 alone, 97 firefighters and 26 EMTs and paramedics died by suicide, according to the Firefighter Behavioral Health Alliance.
Howard, a firefighter assigned to Station 3 on Central Street near Evanston Hospital, is committed to leading cultural change around mental health and peer support.
His official title is Fire Apparatus Operator; he is the one who drives and maneuvers the massive ladder and engine trucks. But he also serves his fellow firefighters as a peer supporter and trainer specializing in suicide prevention education and mental health awareness.
Howard said he values the friendships and camaraderie of the firehouse. With a gregarious personality and an easy ability to make friends, he has always been a helper. He is active in his church and happily married to Pam, a teacher.
In the early 2000s, Howard was volunteering as a church youth leader, working with teens, and noticed profound growth and maturation among kids enrolled in a seminary. He was intrigued, he said, so he researched programs and decided to enroll at Northern Seminary, now based in Lisle.
It took him eight years attending college part-time while working full time, but in 2016 Howard graduated with a master of divinity degree with an emphasis on pastoral care. He sees many similarities between pastoral care and peer support, although he said he does not mention religion when offering peer support unless specifically asked.
Howard said his personal belief is that all first responders, regardless of their ethnic background or religion, need a belief in something – call it faith, or a higher power – to help anchor them, especially after trauma. Without a belief in something, he said, it is easy to become overwhelmed and lose oneself in alcohol, drugs, marital infidelity or other behaviors that court danger and risk.
Successful peer supporters need good listening skills and plenty of empathy, Howard said. What do firefighters who are experiencing trauma after a difficult call need? According to Howard, they need to be able to talk to someone trained to hear their stories, someone who is familiar with their culture, someone who is not judgmental and can keep their secrets.
Howard said he saw this firsthand nine years ago, attending his first meeting to learn about peer support training. He came into the meeting thinking about one recent difficult call he had been on, he said. Listening to the stories of other firefighters from all over the state, he realized, “All of us are carrying these burdens, but none of us are talking about it.”
Over the years he has suggested ideas to his Evanston Fire Department bosses concerning a healthier work environment. In one case, Howard said, he noticed that automatic fire alarm calls would go out to every fire station, even those not assigned to that call. There didn’t seem to be a good reason to wake the other firehouses, and the sharp, sudden alarm bells of a firehouse were stress-inducing. Howard suggested readjusting those alarms.
Kim Kull, Division Chief of Emergency Management at EFD, confirmed the department decided to install a new system that could selectively alert personnel only at the stations called to respond and also adjust the alarm tones, in hopes of reducing firefighter stress and improving sleep cycles.
Firefighters and paramedics have extremely stressful and dangerous jobs. They see suffering that is unimaginably horrible and tragic – pediatric cases are the worst – and often they have to relive the experiences later when testifying in court, Howard said.
Talking with others can help normalize an abnormal situation, he said. It can help change one’s mental perspective, because trauma is isolating.
“I tell the guys when I’m teaching … ‘Look, if you come home and you’ve had a crap night, and your wife goes, “Hey, are you OK?” don’t go “Yeah, I’m fine,” because they know you’re not,'” he said. “‘It’s human nature that your spouse thinks, “It must be me.” You must tell them, ‘I had a bad night.’ You don’t need to give them any of the graphic details. But it’s important to acknowledge, “Yeah, we had a rough call and I’m tired and I’m still processing what I saw.”‘”
One of Howard’s current goals is advocating for better counseling resources beyond peer support and fire department chaplains – those resources can be helpful, but may not be enough, he said.
Howard seeks to increase the number of therapy sessions covered by insurance and to enlist therapists that have the background, training and cultural awareness to hear about the kinds of experiences firefighters will be discussing.
He said more than once he has heard from colleagues who made appointments with therapists on an insurer’s approved list, but then they ended up comforting the therapists, some of whom had been reduced to tears by what they heard.
For the past five years, Howard has served as the Executive Director of Illinois Firefighter Peer Support, a nonprofit organization dedicated to connecting firefighters with trained peer supporters and teaching other firefighters how to be peer supporters. Now he has resigned from that group and is launching a new organization, First Responder Peer Initiative, that will focus on expanding training programs about mental health awareness based on new curricula he’s developing.
Each year all Evanston firefighters are required to undergo a physical examination to make certain they are healthy and able to do their jobs safely. The National Fire Protection Association code changed this year to include an annual behavioral health screening. The screening is broad in scope and looks at more than just depression or post-traumatic stress disorder.
Matt Smith, Division Chief of Training and Special Operations at EFD, confirmed that plans are underway to incorporate behavioral health screening for Evanston firefighters and paramedics, but said it’s too soon to discuss details.
Smith said the importance of behavioral health awareness is incorporated into many of the course and training programs for Evanston firefighters, especially as they move up through the ranks in supervisory roles. He said the EFD provides training, exams and information about physical and mental health to maintain a healthy and productive workforce; to catch emerging situations in time to remedy them; and to give options and encourage firefighters to make healthier choices.
“What we want,” Smith said, “is for people to have a healthy life and career.”