EP 53: Responding to Our First Responders

First responders, the men and women in the fire services, EMS, and law enforcement, often respond to people experiencing one of their worst days. How does shouldering all that grief affect our first responders?

Episode 53 of the Hope4Med podcast features Chief Lorenzo Gigliotti, who has served 38 years in the fire service, 28 years as a fire chief, and has served in local and state-level roles. Chief Gigliotti possesses an associate’s degree in paramedicine, an undergraduate degree in fire service administration, and a Master’s in business administration. We have an eye-opening conversation about grief, PTSD, and suicide rates among first responders and how counseling and wellness practices have helped to mitigate these effects.


[00:00:00] Dr. JB: Welcome to Hope4Med.

[00:00:04] Hi, everyone. Welcome back to the Hope4Med podcast. I am your host, Dr. JB and today’s featured guests is chief Lorenzo Gigliotti. He served 38 years in the fire service, 28 years as a fire chief, and has served in local and state level roles. Chief Gigliotti possesses an associate degree in paramedicine, undergraduate degree in fire service administration, and a master’s in business administration. Welcome to the show, Chief Gigliotti.

[00:00:36] Chief Gigliotti: Thank you very much.

[00:00:38] Dr. JB: So, let us start from the beginning, please share with my listener, your origin story.

[00:00:45] Chief Gigliotti: Well, I um, I entered the fire service quite some time ago. I retired in December of 2020 and relocated to the Midwest with my wife and my youngest kids. We have family out here in the Kansas City area, and of course we’re avid Kansas City Chiefs fans, go Chiefs. I’ve been a lifelong participant in emergency services, and I still work as a consultant part-time, and still attend conferences, and interactive and engaged in what current trends are in the industry.

[00:01:16] Dr. JB: So what made you decide to go into the fire services?

[00:01:21] Chief Gigliotti: Well, it’s interesting. I originally went to school to be a doctor and was attending school on a, on a football scholarship, I got injured and lost the scholarship, and had to look for a job to stay in school. And I managed to get a job in the fire department and 38 years later, I was still in the fire department. And the closest I got to being a doctor was a paramedic, I served the first 22 years of my career as a paramedic.

[00:01:50] Dr. JB: And so, during a career in the fire department, did you experience symptoms of burnout?

[00:01:57] Chief Gigliotti: You know, I did and it’s interesting, you know, I was like, I came on just long enough ago that, I guess I would have been considered coming on with the old school, the old school group. I’m a part of the baby boom generation, which hopefully doesn’t horribly date me, but I came into the industry before mental health was really considered to be a consideration. You just kind of kept your head down, you ground away, did your job, and the chips kind of fell where they fell, and nobody really tracked what was going on with responder mental health at the time.

[00:02:33] And it didn’t really develop into something of concern or consideration in this industry until much later, probably until the latter 1990s or early 2000s that people really started to pay attention to what was going on with first responders and first responder mental health, and the fact that that is a first responder you could actually suffer from post-traumatic stress, which is very prevalent today. And now there’s mechanisms in which to track what’s going on with, the aftereffects of response with the first responders. So you see that, that data readily available now. Numerous studies have been done since the early 2000s talking about the effects of the job on first responders and I think it really came to fruition following 9/11, in 2001. People really started to really notice what the aftereffects were on first responders as opposed to the daily grind. In that case, you had a catastrophic event that, that had a, a huge impact on one organization, which was the New York Fire Department and the New York Police Department. And ever since then, you started to see mechanisms in place to deal with some of these issues.

[00:03:45] Dr. JB: So can we talk a little bit more about that, can we elaborate a little bit more in terms of what you mean by the mental health effects of the day-to-day work that first responders do?

[00:03:55] Chief Gigliotti: Well, as a first responder, one of the things that you’re exposed to on a regular basis is grief of other people. We respond to incidents, whether it’s the loss of properties, loss of life, or events to people’s lives that are, you know, profoundly disruptive and have a harsh impact on those people and they then offload a tremendous amount of grief. And as first responders have a tendency to absorb that grief from other people, but we don’t have necessarily a mechanism to offload that grief. And so after a while, you start to carry this grief around with you and it starts to affect you as a person. Then you start to see disruptions in, in the way you do your job, impacts on your lifestyle. Then you start to see physical health issues that start to manifest from this, uh, the stress related to this, this type of issue. And ultimately it can lead to the scenario where someone just can’t deal with this grief anymore and then suicide becomes an option, and has become more and more prevalent in the industry, both in fire and law enforcement and in our EMS force.

[00:05:04] Dr. JB: How prevalent is suicide amongst first responders?

[00:05:08] Chief Gigliotti: Well, I’ll give you some examples, in 2019, fire service experienced 62 line of duty deaths and outside of the 62 line of duty deaths, which were deaths from building collapse or heart attacks or mechanical issues that cause a fire casualty, we saw 119 suicides with firefighters in 2019 team. On the law enforcement side, we saw 155 line of duty deaths in law enforcement whether it be police officers hit by vehicles on highways during traffic stops or shootings or other events, we saw 239 law enforcement suicides. In 2019, we saw 155 line of duty deaths in law enforcement folks and 239 suicides in law enforcement.

[00:05:56] Dr. JB: Wow.

[00:05:58] Chief Gigliotti: What’s interesting–

[00:05:59] Dr. JB: That’s like two times the amount.

[00:06:01] Chief Gigliotti: Yeah, significant, pretty significant. What we don’t have is, we don’t have any data on line of duty death relationship with EMS workers, but what we do have is in 2019, there was recorded 20 suicides related to EMS workers. So to put that in perspective in relationship to diagnosed PTSD, you know, I’ll give you some really quick numbers. There’s roughly 900,000 law enforcement officers in the United States, about 1.1 million fire, a little over a million EMS workers, and about a hundred thousand dispatchers in the country. And out of that, about 35% of law enforcement has been diagnosed PTSD. About 15 to 24% for fire, 20 to 22% for EMS workers, about 18 to 24% for dispatchers. And the reason that we have ranges in there is just different studies.

[00:06:55] So when you look at it, the effects of PTSD on first responders versus the general population, you know, on average, about 30% of first responders suffer from some measurable post-traumatic stress in relationship to say 20% of the general population for instance the same aftereffects, which is pretty extraordinary. And in quantifying that with the suicide rate, about a half a percent of the general population of deaths each year succumb to suicide, whereas with responders and EMS professionals, we’re looking at about 6.6%, which is tremendous.

[00:07:43] Dr. JB: So what do you think is driving these numbers?

[00:07:47] Chief Gigliotti: You know, I think at least my experience has been over the time I have spent at the fire service is that the mechanisms and the procedures and processes for us to deal with the prior conversation we had about shouldering grief and being a repository for the grief of others, the mechanisms to dispense of that didn’t arrive until late. And it wasn’t a recognizable issue until much later in the fire service and in emergency services.

[00:08:24] So today we see peer counseling opportunities where, you know, the organizations to go or there are internal peer counseling group that allows the opportunity to destress their folks after traumatic incidents. Critical incident stress management teams and more. And really, the CISM teams, what we call critical incident, stress management teams, where they, the derivative for them, you know, we did a smart thing in the fire service. We have an adage, we don’t reinvent the wheel, we steal, you know, we borrow from others. And what we found is that healthcare, specifically hospitals, do a tremendous amount of work to developing grief counseling programs and have those programs available to people that work in hospitals. So we approached the medical industry and said, Hey, can we borrow these people and have them set up in a response format so that if we have an organization that goes through a traumatic event to a neutral location and kind of de-tune the situation and help these folks. And we created them and we call CISM teams and that works really well.

[00:09:38] But the key is, is doing the initial training upfront with your supervisory people and people that work in the organization so they can recognize key signs and identifying them when something like that needs to be activated. And then creating the environment that best works for folks to be able to offload this grief and not be put in a situation where they feel like they’re under a microscope or a vacuum in doing so one thing that, that, as a fire chief, you want to know that your folks are healthy and that they’re in good shape, but at the same time, You don’t want to put yourself in a position where just your attentiveness becomes an obstruction, if you will.

[00:10:23] And so you put yourself in that position where, you know, you engage the process, you get the process started, then you kind of step away from it and you let the process happen the way it’s supposed to happen. And, the only result that you expect back or what you expect back in feedback is from the person that leaves your CISM team or your grief counseling team, to give you the nod and say, we’re good. And then you take that at face value, and you move forward and not dwell on the issue. And that’s worked well. I mean, I’ve worked in organizations who’ve had traumatic issues happen, well, I’ve been very fortunate, 38 years, I never experienced on the job, line of duty death, and I never had anybody that was either on a crew or another department I manage, come to the line of duty death, but I’ve, I’ve worked with other agencies that have had those experiences and, worked with them behind the scenes to facilitate what they needed, basically to facilitate organizations to help. And that’s a really important thing.

[00:11:25] And then of course, working in state government, working in the governor’s office in the state of California, that was also emergency services and one of the rules we had there was we were the repository, all the information relating to the line of duty death, we coordinated the investigations and subsequently did all the agency follow-ups to make sure that grief counseling was taken care of and those types of things. And put us in an interesting position because now you’re, you went from just worrying about your own department to worrying, in the case of California, 178 fire dept, the entire state. And so, you were looking at those issues from a much higher, you know, a 40,000 foot perspective as opposed to right there on ground level.

[00:12:08] And so it gave you a real wide angle view of what the fire service look like, at least from the state perspective. Yeah, the state of California, you’re talking 63,000 firefighters in the state and it said 178 fire departments. And any given time, you’re seeing interesting experiences up and down the state, whether it be line of duty deaths or other attributable issues. I know the states are taking measures across the country to identify first responders’ suicides as work-related and reclassify them as the line of duty death, which would make a no different than fire service related cancer and those types of things. And those are all good steps. Good measurable steps.

[00:12:52] Dr. JB: So when there is a mass casualty incidents and you activate these services, how long were they available to the first responders?

[00:13:06] Chief Gigliotti: Well, inherently, we see a multi casually or mass casualty scenario, an active shooter or a large fire event with significant loss of life, the first thing that we train our supervisory people to do is right there in the back of your mind, you have to think that, this is a, this is an event that is going to linger way past the event. It’s not something that would be considered to be the staple of what you would see on a regular basis. You know, majority of the fires we see the fire service were context fires, small kitchen fires, careless handling smoking materials, those types of things. And if you look at national statistics, the number one cause of fire are inherently cooking fires, right behind them is careless handling smoking materials and those types of things. And then you get into other issues.

[00:13:53] So, you know, fires that have significant loss of life are not the norm, it’s not the normal event that we see. Vehicle accidents and things like that, active shooter events, those are all the 10 and 20 year events, they’re not the, the everyday thing that happens. And so when they happen, they have a tendency to be extraordinarily shocking to the system. So, the first step was to train our folks to recognize that this is out of league, this is extraordinary event, and as a result, we need to be cognizant of what the impacts are going to be downstream for our folks and start the ball rolling immediately. And so normally what you would see is a battalion officer is managing the incident. We’ll be making a phone call to the communication center, let’s go ahead and activate systems and get it started. And they would identify then a meeting location as they start to be mobilized with units, those units who go out of service and they would go to that location. And, we would either have someone else on staff or someone else coordinate getting everybody together in that spot.

[00:15:04] And if you were on affected by the incident, you step away, you let the team do its thing. And then the fire chief gets the cursory phone call and associates, you install it, we had this horrific incident, we have our folks in, in, in there with the stress team now, and we’ll let you know when we’re done and then you get the report and it’s done and you kind of move on. And then, you go into a post, you know, post counseling process where you observe these people. You look for people that are taking out of cycle time off, people that have productivity changes, people just don’t look healthy on the job, people that inwardly retract start to exclude themselves from other people, the normal warning signs that something’s going on. And those are usually people that after the fact, you can put them with a peer counselor and the peer counselor make a rec, they recommend, make a recommendation to move them on to extended counseling. But you know, this is, this is new to the business within the last seven to 10 years. And so, and that’s really about as far back as statistics go, looking at post-traumatic stress and suicides in the industry, it was about seven to 10 years and you start to run out of data. The oldest studies I can find go back to about 2010 and in 2010, they were just kind of scratching the surface. And the first real study came out about 2012. That really started to produce numbers and the national fire protection association and the us fire ministry, she started kind of, sort of tracking really about 2012 to 2015, right in that, in that range. And we started to see effective data show up. Law enforcement’s a little bit ahead of us. Law enforcement does a little better job at tracking and police has been, police and law enforcement in general has been very good about teaching numbers.

[00:16:55] Say they kind of live those statistics. They actually have a site where you can go and then you can actually put in a year, it’ll give you every, every single bit of information about when to DV deaths, rosters individuals, the organizations they were from the issues that they related to and all the way through. And we’re not quite as sophisticated in the Fire service. I think we’re still catching up. And like I said, EMS is still very weak in that area.

[00:17:26] Dr. JB: And why do you think that is that EMS is weaker in that area then like the fire service?

[00:17:31] Chief Gigliotti: I think that you can attribute some of it, if you look at that and fire and law enforcement, your publicly, publicly managed organizations for the most part, whether you’d be career or voluntourism material, but as a result you have state and federal mandates that require us to report things a certain way. And so international fire incident reporting, as an example, we have to identify civilian and fire service-related casualties, and within the last 10 years or so will they include it in the, the context for fire service related casualties includes line of duty stuff and specifically causal effects of line of duty relationship, whether it be injury or fatality.

[00:18:16] A lot of the EMS industry is private and as a result, the record keeping, and the required reporting is different. And so what you look for is national associations for these types of response agencies, the private companies that are going to report through your association and look for that data in those types of repositories to see if you can find that information. So a lot of the information we have related to EMS are predominantly kind of channeled up through the public agencies that provide EMS-related services. So you’re looking at large fire departments that had an ambulance department and they provide paramedics and teams and whatnot. So we don’t know a lot about the private side of the industry. It sounds prevalent. I know that in some cases, whether you’re private or publicly run EMS agency, the nexus is through a local EMS agency and subsequently for our hospital district. And they may by statute require some mandated reporting, but it’s not, as far as we are in the fire service behind law enforcement and reporting, I think EMS is there with fire. They’re, they’re that far behind us, but they’re catching up. And let us say that the problem is becoming more and more prevalent, and I’m not going to say more– I’m going to say that it’s any more prevalent than it was 20 years ago, and the differences is that now it’s there, we see it. 20 years ago, we weren’t really paying attention. And so now, we’re all taking measures to make sure that it’s on the radar, we see it, it’s reported, we’re able to track it. And then we’re doing the things we can to put effective services in place to help our people.

[00:20:11] Dr. JB: Have you found that there’s a lot of stigma around mental health issues?

[00:20:17] Chief Gigliotti: You know, what’s interesting, when I first came on the job, you went to a bad day, came back and, the general mentality was man up boy, pull up your pants and just go back to work. And, you know, you’d stew on it for a couple of days and you compartmentalize it, put it somewhere, and then you go do your thing. And it’s interesting because the way we work in, in courtesy services is very similar to the way the military works. Fire and police agencies are paramilitary. We took our guidance from the military, the incident management system we use, we stole from the military. The way that we identify rank structures and the way that we operate on a basis using standard operating procedure, all those things that we stole from the military. And the military figured this out 50, 60 years ago or more, actually I think figured out post stress issues and what they need to do with it folks, and how to treat them folks.

[00:21:17] You know, it’s not up to me to sit down and try to figure out what the military does per se, but the reality is instead they kind of started this process and our friends in law enforcement recognize the issues and the way that the military was working with their people and said, we probably need to do something like that and they started to move forward with their process. And that really kind of developed into that whole process of recognition, recognizing people when they were under stress. I think that because of the newness of the issue and its relationship to the general workforce in the country, we’re trying to overcome stigma, you know, It makes people very reluctant to come forward and say, I have an issue. We’ve, we’ve gone to great lengths to introduce programs and organizations, employee assistance programs, as an example, in most cases, we, we maintain insurance programs in our organizations. And one of the benefits that we provide our employees is access to employee assistance and depending on who you use as the employee assistance provider, there’s another level of reporting. But one of the things that as a mandate is that access to EAP is anonymous. As the fire chief, I would get a report and all the report said, out of 100 employees, I had this number of employees that accessed the EAP and they accessed it categorically in these areas, whether it be financial management, marriage counseling, post-incident stress, those types of things.

[00:23:02] And all that did, all of that report was intended for this to give me a heads up as a fire service leader, this is the general mental health of my organization in a snapshot. And I, I would take those reports extraordinarily seriously, and I would look at them and compare month to month and identify, whether or not I had any emerging trends and when I had my senior staff meetings and bring my senior staff together and say, I’m noticing a trend in our EAP access, it indicates X, Y, and Z. And then look at my training folks and say, can we bring some training in in the organization and focus on these areas? And it may be, it may sound really interesting, what does, what does financial management have to do with firefighting? But if I have, you know, 20 to 25 folks having financial management related issues that are accessing employee assistance form, which means we have a distraction from the job, because we have an issue that detracting from that. Bring some folks in and offer this to the workforce. It’s not a mandate. It’s not mandatory training. It’s just as, Hey, we’re going to set this up. You have access to it.

[00:24:19] And we’ll bring people in that can talk to you about how to manage full finances And there’s a lot of organizations that will do that. In our case, we worked for our community college district to bring that in one day seminar. And we did that on several occasions. And the, after the after-effect measurement from that was, we saw about a 50% decrease in people accessing EAP for that reason, ’cause something I learned late with six children and three grandchildren, one of the things I learned, my youngest is going through high school, they took away all of those life learning classes that we used to get when we were in school. So the home economics and those types of classes that taught you how to, how to live when you graduated from high school and you want to live on your own, those disappeared. And they’re no longer, they’re no longer provided in public school system anymore. And so there were either a mom and dad or the school of hard knocks, figured out how to do things like manage a bank account and do those things, and then that creates stress on people. Not to detract from the primary topic, the post traumatic thing is a very, very real issue and it’s something we, we continue to strive to figure out what we can do to mitigate it, ahead of time if we can.

[00:25:47] Dr. JB: In the beginning, you mentioned that the day-to-day experience of first responders is traumatic because you’re dealing with people when they’re at their worst or having like the worst day of their life. And every call is another person’s worst day of their life experience. And so, even if it’s not this like mass casually event, but every interaction has a potential to be traumatic for the first responders.

[00:26:17] Chief Gigliotti: It does, post-traumatic stress can be attributed to several factors. One is, you could have that, that significant event, 9/ 11. Another example would be recently in LA county, firefighter came into a fire station and shot folks in the fire station., retreated, being chased by the law enforcement, barricaded himself in the home, started a fire in the house, and they found his body in fire. The impact of the organization, not just those folks centered around that one, one of 177 fire stations that was immediately impacted, but the entire organization, is tremendous.

[00:26:56] Those are life changing, singular events that, they take you from 0 to 60 on the PTSD meter pretty quick. But the other aspect of the job is cumulative stress over time. I’ll give you an example, my former department, seven fire stations we were averaged about six and a half calls per station per day, about 15,000 calls a year. And if you’re on one of those engine companies, you know, running 6 to 10 calls a day and you’re on for, you’re on 24 hours at a time, you’re in– And just to give you a, I guess, to quantify that a little more, the average time on scene for a fire apparatus is about 24 minutes, so if you’re running 10 calls a day, you’re on for 24 minutes, you know, that’s the majority of the shift. Brief interludes with your constituents where they’re having a bad day and their level of drama in the way that they act during that event is going to have an effect on you. And your job as a first responder is to get there, maintain this measurable neutrality, and you’re trying to be the calming effect for this intermittent period of chaos.

[00:28:19] And your being calm and maintaining that calm demeanor is a de-stressor for those people that are going through this issue. Whether it be losing your house to a fire, fatality, medical, whatever the scenario may be that brought you to their location. When you respond at 10, 12, 14, 15, 20 a day, and you do that in the course of 120 shifts a year, it starts to stack up, especially when it’s year in and year out. And in the hierarchy in the fire service, everybody has a little different exposure. The firefighter paramedic is the hands-on guy dealing with the medical issue. The company officer trying to manage his people and scene control. Got the apparatus operator his job is to get you to the incident and home from the incident safely, and in the event of a fire, operate that equipment to make sure that you’re taking care of them, trying to mitigate the issue. So everybody has their own level of cumulative stress that can eventually turn into posttraumatic stress related event, if you don’t have an avenue to get rid of them.

[00:29:28] You know, when we first talked, we talked about finding that work-life balance thing and then those things to, to keep yourself healthy. And this really kind of plays into that, what do you do to eliminate the cumulative stress and move on? We implement organization, social, movement programs. Might sound interesting, but there’s a thing now that’s really kind of taken off in the forest for some fire dept, yoga, believe it or not, where we have providers that come into the fire department and they teach firefighters, basic yoga techniques which includes a little bit of meditation. And it’s an opportunity to put yourself in a, in a situation where you’re getting a little bit of physical exercise, but at the same time you put yourself mentally somewhere else and just meditate. It puts you in a little better spot. We maintain fitness facilities in our firehouses for people who workout. I think that lately if you look at firefighters today compared to firefighters say 30 years ago, firefighters 30 years ago, big strapping knuckle dragging guys, probably a little bit overweight, ate really well, didn’t exercise a lot, but could pick up a car kind of like a whole character. Today, a lot of firefighters in the now, they look like finely tuned athletes. They do a lot to keep themselves in really good shape and put themselves in a little better position that way. And what I find in working out is you eliminate an awful lot of stress. And so, finding ways to take care of you is huge. We’re starting to train our people to really think about that.

[00:31:04] Dr. JB: When do you think that that happened, where we realized that we really need to focus on wellness and finding ways to take care of you?

[00:31:11] Chief Gigliotti: You know, it’s probably within the last 15 to 20 years that we, we started getting really serious, about 20 years ago. And I don’t remember, I can’t remember the name of the study. There was a study done, it was done by the American Health Association or published by American Health Association, one of the journals that talked about line of duty deaths in the fire service and a direct relationship to cardiac events. Yeah, we seem to have a majority of our line of duty deaths were attributable to cardiac, cardiac fitness. And so they started to, the fire service in general, started to look at expanding the scope of what we did and in measuring physical health in creating annual fire department, physicals that had a very, very strong cardiac component. Stress, treadmills, and those types of things that were associated with that full chemistry with blood work, all of that, cancer screening and all of those tests, when cancer became a predominant result of fire service related illness, the reaction to the fire service wants to make sure the cancer screening was included as part of the annual physical process.

[00:32:23] And so, we would identify things, identify the metrics up front, look at things, cholesterol and general blood health and then identifying what needed to happen. So when you would go in and take your annual physical he would do your blood work, they would come back and identify that, you had, was quite, certain cholesterol at this level, your good cholesterol is this, your bad cholesterol is why this is what we need to do to. And then you would get some real brief counseling by the doctor, and, and, and then the only thing that would come back to the organization is stuff in generality, not specific to an individual, they would just come back and it would be very, very similar to that EAP access report, and that we looked at your people. This is what the general cardiac fitness levels for across the board. These were the issues that we identified in blood work, we either did or didn’t have any detectable cancers, those types of things where whether there’s any other physiological issues, mechanical issues, that were constraints, whatever.

[00:33:38] From that, we would go back and identify that and what we would do with, or ongoing fitness and wellness initiatives or departments. That kind of prompted a national approach. So the International Association of Fire Chiefs, you can go to the National Association of Firefighters, put together the national health and fitness initiative, which actually became a program that was marketed to organizations, 300 unions, and you started to see a lot of departments onboard in that process. And this is really prevalent the last 15 years, where it became the carrot at the end of the stick, so to speak. Department would provide you equipment, training and the time and the employees, their contribution to that was participation. And the way to get people to participate like anything, if we were truly military, which the mandate, if you look at my father spent 42 years in the army, so we’ll be looking at my father, as an example, every year, you had to meet certain separate standards. If you didn’t, you were out, was that, you know, you’re fired, you’re gone. In our business, paramilitary, which means reapportioning military, but we’re civilians, you have to be nice. And so it becomes a participated program, it’s voluntary as opposed to it’s being something that’s organization mandated under the threat of some curative action if you don’t. What you try to instill in your people is to understand that if you don’t take care of yourself, you’re eventually going to face, and do you really want to put yourself in that position? And understanding the camaraderie and teamwork and the collegial environment in this business. If you fail, it can be catastrophic to not just you, but those around you given the point that you felt.

[00:35:47] As a result, when you look at, say five around operations, we have a thing called rapid intervention teams or rapid intervention crews, depending on where in the country you are. These are people we set aside for incidents that have adverse environments and we put our people in so that if they get in trouble, we can send this team and extract them. There’s a number of reasons why someone would become in peril and one of those, whether the environment fails and traps them, when we have to go get them out or someone in there mechanically fails and crew is trying to get them out, but they’re having trouble, with the red team and to help them get that person out. The idea is not to put yourself and the organization in that position. And so a lot of us do is to educating and educating folks just the way to take care of yourself and the way to make sure by taking care of yourself, understand how that bleeds into the organization helps you and the organization itself, the healthcare organization.

[00:36:53] Dr. JB: And so you mentioned, bringing it back to your personal, that you are a father of six and you have three grandchildren. So how did you do it? How did you balance your work and your home life?

[00:37:10] Chief Gigliotti: Well, the first 20 years I was horrible at it, I’ll be the first to admit that. I can pull my 24 hour shifts at the fire department that I would get off at 12 or 24 hour shift as a flight ambulance helicopter, ambulance service. And if I wasn’t doing that, I was at the community college teaching and if not doing that, I would, early in my career, I would be building construction and construction work. And so, while that’s all happening, my wife was working, kids were in daycare and, you know, I sit back and I take stock of what that first 20 years look like and we missed an awful lot, missed an awful lot. And the horrible news about that is, I can’t get any of that time back. That time’s already gone. So I started to realize that that it became important that you have to take care of yourself, probably within the last 10 years I noticed myself. But I played football. I’m six foot two, and I weigh 235 pounds. I’m still six foot two, amazingly enough, I haven’t shrunk, but now I weigh 180 pounds. The way I got there was nutrition and taking care of myself. I exercise on a regular basis. You know, probably the most exotic thing is tea, green tea, decaffeinated. Should get points from the dock, it’s decaffeinated but… I make time, not just for me, I, I take an hour out of the day to exercise and do my thing and, you know, I used to run. I don’t run anymore. I probably speed walk more than run. It’s actually interesting, I went running the other day and I found out that my time running, my actual average mile was more than my speed walk, I don’t understand how that works for the currently.

[00:39:17] Dr. JB: Well, you don’t stop and like catch your breath as you’re running.

[00:39:23] Chief Gigliotti: I’m always looking for opportunities to be around for the kids identify and it doesn’t have to be some planned event. It’s just being around being available and doing things and making time for those. When you first come into the, into the emergency services, it’s a thrill ride, really is. We get into the environment. It’s a team sport, you thrive on each other and you’re, you’re in the moment, I mean, think about this, when you grow up as a child, you get Hot Wheels and all those things. I had an ambulance, I had a fire engine, I had a ladder truck, these are real exciting. And then when you get to be an adult and you go into emergency services, you get to play with them. And so everyday you go to work, it’s an adventure. And you get to do things that you don’t normally do as a person.

[00:40:28] It seems, it’s like, kind of like in a way– the chief, head coach for the Chiefs said, they asked him about going back to the Super Bowl, you know, once we got into the Super Bowl, what’s it like. This is like chocolate cake, you never want to stop eating it. You want to keep going back. It’s the way it is on his job. You love the job and you love it so much. You just want to keep doing it. And it’s just hard to go home. So when you look at fire, emergency service workers in general, that really thrive in their work environment. The other shift might be eight o’clock in the morning, but they’re leaving at 9:30 and 10 o’clock because they wanted to sit and chat with the ongoing crew, the guys going off, but whenever that scenario, and it’s not, eight o’clock to the punch out, I’m outta here. It’s just not that kind of environment. It’s not just a regular, it’s not a job for sake of the job. It’s something that becomes part of you. And it was hard to detach yourself from that and say, okay, now it’s time to shift gears and become part of another part of my life.

[00:41:37] I need to go home and need to mow the grass. We need to go pick up this thing. We need to go see the kids over here and to be able to take this class or whatever the scenario is that you’re going off duty. And sometimes it’s hard to shift, for me, it was getting off duty at the fire department and go to my own job. And I did that for, I flew with the, the air ambulance service for the first 11 years of my career. And then what happened, I got promoted, when I promoted to battalion chief I worked part time for the year and three years after the promotion, it became too difficult to continue because I had transitioned from a shift position in the fire department to a day job, where I was working Monday through Friday. And working that kind of a schedule, I was only flying on the weekends and I’d always kind of set the weekends aside as the family time. And so this started to really encroach on the family. I finally said, all right, time out, so we’re done flying. And we just started making the weekends family time and then gradually transitioned my self. Everything else, it’s just working in the fire department. And then I had my home life and we did our thing.

[00:43:00] So it’s, it’s difficult. It requires, I think some coaching and organizationally we’re, we’re starting to do that when our people on a regular basis, there is a fundamental balance. And again, I come from a different generation, the baby boom generation inherently, you would see 15 and 55% of the time at the job. And so you can figure it out there proportionally what becomes available for homeowners. Today’s generation is different. Our millennial generation has a really different perspective about the work life. They would prefer to spend 10 to 15% at work and the rest of the time doing something else. And part of it, I think is just the nature of in the general workplace. I can do more remotely than I can’t sitting behind the desk or sitting in the building. And so that perspective change that’s also changed the way that we see people coming into emergency services work.

[00:43:57] When I first came on the job and I was trying to, I was testing with different departments trying to get hired, you know, 4,000 or 5,000 people trying to test for two or three jobs. Those days of coming on, we don’t have that kind of recruitment anymore. Now you have four or five jobs and you get six or eight candidates and it’s tough. It’s very tough.

[00:44:17] Dr. JB: Why? Why do you think that is?

[00:44:19] Chief Gigliotti: Well, I think a lot of it is, is that with the, with the current generation, really having an affinity and really kind of moving over to technology, fire and law enforcement work is inherently non-technical in that respect. You know, it’s not, it’s not as much this kind of technology, it’s more physical, and today’s generation they’re, they’re more enamored with the technology and not as much the physicality of the job. And so there’s this reluctance I think you see in today’s generation to really look at those types of industries– and it’s everything building industry, protective services and so on, not so much medicine. Medicine is a little different, depending on where in healthcare you land, there’s a huge shortage in the nation for paramedics. And what I mean by paramedics, I’m not talking about paramedics working in emergency rooms and throughout that side healthcare, transport paramedics, the field program. It’s harder and harder for fire departments and, and even private companies to recruit paramedics so much so that private companies now it’s almost like the, the NFL draft, they, they put out a signing bonus and a lot of other things to try to entice people to come in and even to the point where they are, we’re all off the street and put them into a training program with the bind that they have to do at least three years in the program to pay back their free education they got to become a paramedic and a lot of different things to entice people into the business, where 30 years ago, people running to stand in line to put in an application. It’s really changed.

[00:46:09] So in one respect, we’re trying to make the industry healthier, create a true separation between the work and personal aspects of your life, and create a healthier work environment, which then creates, I think, a healthier work-life balance for people in the long run. And then on the other end, we’re having a huge recruitment problem. You’re trying to bring people into the industry. It’s interesting that, I don’t know if you follow professional sports at all, we had a defensive or offensive lineman in Kansas City that is from Canada. And he actually was drafted by the Chiefs from university in Canada, about 10 years ago, 15 years ago, and in the off season, he would continue his studies in medical school. And two years ago became a doctor.

[00:47:06] Dr. JB: Oh, wow.

[00:47:08] Chief Gigliotti: And right, I think right at the bubble with COVID and he ended up opting out last season or the season before last, he opted out, he spent that whole season, that whole year actually a hospital like an internal candidate treating COVID patients. And, it must be interesting to have a doctor that can move a building, but he spent this time, being worried the doctor’s supposed to carry the offensive line and yeah, so, and when they opted to put him on waivers this last season and he loved the team he went straight back to medicine. And now you see, as the full-time doctor, has bragging rights, super bowl winning team and he played football for 10 seasons.

[00:48:06] Dr. JB: There’s not a lot of doctors who have those types of types of bragging rights, but that’s absolutely, absolutely awesome.

[00:48:13] Chief Gigliotti: So, he still wears his Kansas City Chiefs logo on his doctor’s lab coat, treats patients in Canada and outstanding guy. But again, it’s the  objective in life, something I learned a long time, but you don’t get out of life alive. So you want to maximize the benefit of life while you’re alive, because when you’re no longer alive, there is no benefit to be. So, the way they get there is to find ways to find balance and maintain a balanced lifestyle.

[00:48:52] Dr. JB: Yeah. Who says a doc can’t rap? D O C T O R J B. The greatest doctor to ever touch the mic. The greatest podcast ever broadcasted or prerecorded. Come learn some, each one, teach one. I’m done.