I have five young firefighters before me — four men, one woman. They all had been resting for at least five minutes or more. The first firefighter is ex-military, so I expected that they would have a great set of vitals, meaning that they’d be recovering quickly. But their heart is racing, a diastolic blood pressure over a hundred — it’s supposed to be 80. 

I had just taken a class on doing a better job helping rape victims and had learned about the data on the high rates of rapes in the military for men and women. Not only are there high rates of rape, but, to add insult to injury, the military puts a label of "Personality Disorder Discharge” on the records of many rape victims. 

After taking the vitals of the other three firefighters, I start over again with the first one. They drink way too much Red Bull; it’s clearly an addiction. They receive my sleep hygiene lecture and how caffeine chases away restorative sleep.

My asthma patient still has a racing heart and high blood pressure. I remove them from the area and put them in the back of the ambulance where it's warm and away from the fire scene. Sounds, action and flashing lights can keep firefighters in a hyper-vigilant state, which delays their recovery. 

I finish up with the rest of the crew and release them back into service. I return to the ambulance and continue taking vitals, which were still off. Asthma is a huge indicator of childhood trauma. I express my concern about the vitals, and ask a couple of questions. They tell me a bit more about their life; there's depression and anxiety. I decide to do my usual ritual of educating about ACEs. I have a laminated sheet with five of the 10 questions of the original ACE survey on one side, and five on the other. I ask them to read it and tell me how many ACEs they have. Sure enough, they have all of the ACEs on the front page, and I don’t need to continue. 

This is where the reward for my efforts happens. "I'm 19 years old and no one has told me about this,” they tell me. Not even their physician has talked to them about this. I explain that if they are treated for their childhood trauma, their symptoms will be greatly reduced, and they'll have a better shot at a healthier life. 

(To avoid inadvertent identification of the firefighters, pronouns are changed from 'he' or 'she' to 'they'.)