The Trigger of Fourth of July Fireworks for Veterans with Christopher Scuderi, DO

The Fourth of July is right around the corner, and although the day is full of patriotic joy and barbecues with hotdogs and corn-on-the-cob, the day may be triggering for veterans when the sky darkens, and fireworks illuminate the sky.

Fireworks may be a colorful, exciting display, but the booming noise may bring veterans back to wartime with firing gunshots and bright light. According to the US Department of Veterans Affairs, 7% of veterans have PTSD at some point in their life.¹ With the stigma or barriers seeking mental health, family physicians are considered the first-line treatment for mental health concerns like PTSD.

Christopher Scuderi, DO, a Jacksonville primary-care family physician and a part of the Millennium Physician Group, is a veteran himself and treats veteran patients who get triggered by fireworks. In an interview with HCPLive, he shared effective strategies to manage PTSD symptoms ahead of the Fourth of July fireworks. He also explained why fireworks trigger negative symptoms for those suffering with PTSD and how people living with PTSD and their loved ones can seek mental health care with their family physician.

HCPLive: What advanced therapeutic approaches can clinicians use to effectively manage PTSD symptoms in patients triggered by fireworks?

Scuderi: One of the things that physicians can do is [provide] some of the resources that are available through the VA to help with patients who have PTSD; the VA has the PTSD Coach mobile; they also have a crisis line.²

The other thing is to know good resources in the community. There's different counselors have specialties in treating PTSD and having relationship with those can be helpful. I work in Jacksonville, [and] we have a lot of veterans being in AV town, and so there are a number of counselors who specialize in PTSD, and this is a great resource for me as a family physician.

HCPLive: Could you share the most effective strategies you have used when treating veterans who are specifically triggered by fireworks?

Scuderi: One is just talking to them about preparing for Fourth of July. [In] some areas of the country there may be fireworks a couple days before and afterwards, [so] prepare them for that… that it may not just be Fourth of July, depending on your neighbors or neighborhood. It helps for a lot of veterans to talk to their neighbors just to anticipate that or not.

The second thing is preparing around the house for it, so having either noise canceling [ear plugs] or having full mirror plugs darkening the room that may help.

The other things that seem to help [is] having some items that may center you around the house, just remind you are in a safe place. Another thing [I] think about [is] what are some techniques that work, personally, to relax me.

These may be different for everyone. For some people, [it] may be breath work. Some of it may be just awareness. [When] one of my signs [shows] I'm starting to get triggered, [I figure out] how…I deal with that before I have a full escalation.

Sometimes, some sensory exercises help. One of these is the 5,4,3,2,1 sensory exercise, where you think about what are 5 things I can currently see, 4 things I can hear, 3 things I could feel, 2 things I could smell, and 1 good or grateful thing that you say about yourself, or some version of that, just to bring you back to the present time Sam in a safe place.

Another thing that helps is talking to veterans [about] practicing positive self-talk that you're safe. Remind yourself, ‘I'm not in an unsafe situation, and that I'm safe—I'm at my house, or I'm at my friend's house,’ and just reaffirming that.

The other things sometimes that may help is changing body temperature, just using an ice cube or a cold shower or frozen vegetable pack on your skin may help when you're starting to have symptoms or feel like you have an exacerbation of your feelings coming on. Cooling down the body may help again, bring you back to the moment and to break that cycle.

HCPLive: Can you elaborate on the psychological and physiological impact of fireworks and veterans with a history of combat, exposure to gun violence, fires, or other traumatic events?

Scuderi: Even though it's a great day of celebration for most Americans, for those that have experienced severe combat-related trauma, or trauma from something else, the loud noises may cause them to feel like they're back in that situation again and trigger those feelings inside, an adrenaline rush that you may be in danger, and so that [that feeling] subconsciously hit the nervous system.

One advantage we have with the Fourth of July is that we know it's a certain time every year. We also see us around New Years in some areas where they celebrate with fireworks. Not only can these strategies be used for Fourth of July, but New Year's, if you live in an area that tends to have fireworks displays, or your neighbors may shoot off fireworks.

HCPLive: How can family members and loved ones provide optimal support to veterans with PTSD in anticipation of events involving fireworks?

Scuderi: A lot of it is just having great communication and understanding [of] what they can do to support that veteran is really important. Sometimes just avoidance can make things worse over time. Maybe work with a veteran on some small levels of exposure, or some safe levels of exposure, and then talk about, what can you do to support them during that time.

The other thing [is] if you have a veteran that maybe has PTSD related to driving events, maybe being a designated driver that night may help too. So that way if there's a lot of noises during driving…that may not cause a veteran to be triggered.

HCPLive: Beyond veterans, what other populations might be adversely affected by fireworks?

Scuderi: Anyone that suffered any type of prior significant trauma related to loud noise, whether it's some type of crash, or some significant event that was associated with loud noises… or extreme light exposure, [who] may also be possibly affected by [the] Fourth of July.

HCPLive: Is there anything else you'd like to highlight about this topic?

Scuderi: I would encourage those who are struggling or maybe feeling like [they are] having trouble coping civilian world because of what [they] face, to go get help. There are some great resources. Encourage veterans to look at this big holiday for our country [as] a great opportunity to get the help that they need.

I would [also encourage them to] talk to their family physician about resources in their own individual community that they may be able to…assist them during this time. This is a great opportunity to bring to light that it's you don't have to suffer in silence anymore.

Veterans Crisis Number: Dial 988 and then press 1

References

1. ^{PTSD: National Center for PTSD. US Department of Veterans Affairs. https://www.ptsd.va.gov/understand/common/common_veterans.asp#:~:text=At%20some%20point%20in%20their,of%20100%2C%20or%206%25). Accessed July 1, 2024.}
2. ^{PTSD: National Center for PTSD. US Department of Veterans Affairs. https://www.ptsd.va.gov/. Accessed July 1, 2024.}