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Jerry Hartsworm was the kind of firefighter who didn't wait for the alarm.
Nine months ago, when he heard over his pager that a nearby department was responding to a barn fire, he jumped into his truck and headed to the station, knowing his department likely would be called to help.
What happened at the fire left Hartsworm changed.
He was injured, possibly by a falling beam or debris, and found himself lying face-down with flames all around him.
His physical injuries healed, but the mental scars he suffered have left him tormented and unable to work. Adding to the pain is the legal battle he has faced to get the city's insurance carrier to cover his medical expenses and lost wages.
For Hartsworm, 50, who spent four years as a volunteer on the Melrose Fire Department in central Minnesota, life has become a daily struggle.
"Every one of us, when that pager goes off, we know there's a possibility that we're going to die," he said. "And we accept the fact that we could die. But what I cannot accept is the fact that I'm discarded — that I didn't get hurt the right way to be covered."
Firefighters are often thought of as heroes, bravely rushing into a dangerous situation to help others without a thought for their own safety.
But experts say they often pay a mental and emotional price. Post-traumatic stress disorder, depression, substance abuse and suicide are common problems among firefighters.
A 2014 report from the National Fallen Firefighters Foundation found that a fire department is three times more likely to experience a suicide in a given year than a line-of-duty death.
"What they're dealing with is not what the average person who works a 9-to-5 office job is going to see," said Chief Philip Stittleburg, chairman of the National Volunteer Fire Council. "We're finally coming to realize that these sorts of incidents take a toll on you."
(Picture: Volunteer firefighter Jerry Hartsworm of Melrose, Minn., was injured fighting a fire last May.
(Photo: Dave Schwarz, St. Cloud (Minn.) Times)
For volunteer fire departments, which are often found in small towns and rural areas, there's a heightened chance that someone on the department will know the victim of a fire or accident, Stittleburg said.
"That adds a whole additional stress level to the operation," he said.
While career firefighters generally work regularly scheduled hours, volunteers can get called anytime of the day or night. They have to juggle those duties with family and work obligations, Stittleburg said.
"It does take a toll on the family when you're opening the Christmas presents and suddenly, off you go to a call," he said.
Firefighters often don't talk about the emotions of their job because they don't want to show any weakness to their colleagues, the community or themselves, said Jeff Dill, founder of the Firefighter Behavioral Health Alliance.
"We try to handle it ourselves, and unfortunately, that's where the problems come in," Dill said.
After Hartsworm was injured in the barn fire last May, he spent three days in the hospital and two more weeks recovering at home, suffering from headaches and sensitivity to light. Hartsworm's doctor sent him to a neurology clinic in the Twin Cities, where he was diagnosed with a mild traumatic brain injury.
Hartsworm began having nightmares that he was trapped, burning, with no air to breathe, watching other firefighters get killed.
He spent five weeks in a psychiatry program, where he was diagnosed with PTSD. He still struggles with depression and anxiety and hasn't been able to return to his job as a supervisor at a local food-processing plant.
"I fight for my life every day," Hartsworm said. "This is as real as going into a fire every day for me."
Stittleburg's organization and others are trying to reduce the stigma surrounding mental health that exist in many fire departments.
"I think there is awareness, but it is growing at a much slower rate than we would like to see," he said.
Local officials can help by making sure there are employee-assistance programs available and that managers in the fire department are trained to recognize symptoms of stress, Stittleburg said.
"It all boils down to changing the culture of the profession, and that in turn boils down to leadership," he said.
Dill travels around the country presenting workshops on mental health to fire departments. He said attitudes about mental health are changing.
"Fire chiefs are saying, 'We need to pay attention to this,' " Dill said. "People are starting to see the light. And that's what we need, because we're losing too many of our brothers and sisters."
Kirsti Marohn, USA TODAY