It is well-recognized that firefighters and their families must have the resources to deal with the various complications that the occupation can bring to their lives, and to help them cope with life’s problems, which all of us sometimes face, regardless of the work that we do. Health and safety standards (e.g., NFPA 1500) require that assistance programs be made available to ensure that such services are there when needed.

But what form those services should take has become a serious question. Research has raised significant concerns about the intervention and treatment approaches that commonly are used with fire-service personnel. Ensuring that care is available whenever needed — and that the care delivered represents current best practices — is one of the objectives of the National Fallen Firefighters Foundation’s Everyone Goes Home program. Initiative 13 states: Firefighters and their families must have access to counseling and psychological support.

Work on this initiative was conducted using a consensus process much like that which is used in developing healthcare and firefighting standards. It began by recruiting carefully selected researchers whose research programs deal with areas important to the occupational and behavioral health needs of the fire service. Those experts then worked with representatives from key organizations and standards bodies to develop practical ways to deliver state-of-the-art assistance to fire and EMS providers

The first meeting took place in Baltimore in December 2008. Researchers whose work centered on prevention and early intervention related to traumatic stress joined with fire-service health-and-safety representatives to recommend effective strategies to assist personnel exposed to potentially traumatic events. A second meeting was held in April 2009 to examine standards and recommendations regarding comprehensive behavioral health-assistance programs for firefighters and their families. A third session explored the role of peer support systems in promoting health, wellness and safety, and in facilitating effective use of behavioral-health resources.

The result of these efforts is the emergence of new approaches to delivering evidence-informed behavioral healthcare to the fire service. For example:

• A framework and protocol for dealing with occupational exposure to potentially traumatic events has been designed to be integrated into existing organizational activities. Workshop programs already are scheduled and continuing education materials will be released later this year.
• Psychological first aid, an evidence-informed, best-practices model developed under the guidance of the National Center for Post-Traumatic Stress Disorder, with support of the Substance Abuse and Mental Health Services Administration, has become the standard of care for early support. The NFFF contracted to develop modules for training firefighters and EMTs in applying its principles. These will be released as a continuing-education package later this year.
• Industry standards for health and safety require that all departments provide a member-assistance program. Current standards, however, do not specify what services should be provided or identify the level of provider, nor do they provide guidance regarding protocols for assessment or define evidence-based standards of treatment. Revisions have been submitted that would provide both fire departments and the mental-health professionals who serve them with guidance on current evidence-informed best practices for working with fire-service personnel.
• Web-enabled, interactive programs for self-help and education on behavioral-health impacts have been developed for military and veteran use (e.g., www.afterdeployment.org). The NFFF is working with developers of pertinent platforms to adapt these platforms, in order to provide similar assistance to firefighters and their families regarding the behavioral-health implications of their duties.
• Also planned are Web-enabled, interactive resources designed to leverage peer influence in order to support the various objectives of a department’s comprehensive health-and-wellness program — including behavioral health — and to help facilitate proactive use of its resources by firefighters and their families.
• Mental-health personnel working with firefighters and their families need cost-effective, accessible ways to acquire skills in current evidence-based treatments if they are to be prepared to provide the highest standard of care. The National Crime Victims Research and Treatment Center at the Medical University of South Carolina developed well-researched platforms to deliver training in cognitive behavior therapy — the current standard of care for conditions such as PTSD and depression — to military clinicians and providers caring for victims of abuse. The NFFF is working with NCVRTC to fund creation of a similar platform to bring this level of training — focused on fire-service needs and issues — to mental-health professionals working with firefighters and their families.

More information about the ongoing projects regarding Everyone Goes Home Initiative 13 can be found at www.everyonegoeshome.com.

Richard Gist, Ph.D., is assistant to the director of the Kansas City (Mo.) Fire Department and a faculty member of the Department of Preventive Medicine at Kansas City University of Medicine and Biosciences.

• Read the main story, "Stress Busters," to learn how fire officers can identify and manage firefighter's emotional and behavioral issues.