In the first study of its kind in Israel, a whopping 90 percent of operational firefighters in the country were found to have full or partial symptoms of post-traumatic stress disorder, a condition usually associated with soldiers returning from war or terror attack survivors.

PTSD can occur after exposure to serious violence and/or life-and-death situations and is manifested by recurring stress symptoms such as nightmares, insomnia or irrational behavior. Despite the high stress and danger inherent in being a firefighter, the link between the occupation and PTSD had not been previously investigated in Israel.

The study, released on Wednesday, was conducted by Dr. Marc Lougassi of Ben-Gurion University of the Negev, himself a former firefighter. It showed that among the testing sample of 300 active firefighters, 24% suffered full PTSD, 67% showed partial PTSD and just 9% showed no signs of PTSD at all. Firefighters with head injuries, in psychiatric or psychological treatment, with chronic diseases, or taking medications were excluded from the study.

“It is important to note that as far as Israeli firefighters are concerned there has been no documented evidence of PTSD prevalence, despite the fact that they are exposed to additional traumas such as war and terror attacks that add to the traumas they experience in the course of their daily shifts,” Lougassi said in a press release. “These results support the hypothesis that increased exposure to recurring traumatizing events is a significant factor contributing to PTSD development.”

The study also included a series of recommendations for fire departments to take in order to reduce and prevent PTSD among their ranks. These include improved psychological screening to detect individuals more susceptible to PTSD, updated training programs, the establishment of professional units to treat emotionally injured firefighters, increased social support networks for firefighters and their families, and special training for officers to enable early detection of PTSD occurrence.

These recommendations were sent to the Fire and Rescue Services commander, who, according to the university, was working with his staff to implement them into normal operational procedure.