Saving the lifesavers: A behavioral health initiative for rescue workers
It’s well recognized that firefighters and their families must have the resources to deal with the various complications that firefighting can bring to their lives. They must also have help available to deal with the problems in living that all of us sometimes face, regardless of the work we do.
Health and safety standards, such as 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, as research has raised significant concerns about intervention and treatment approaches that have been commonly used with fire service personnel.
Ensuring both that care is available whenever needed and that the care delivered represents the best practices under current evidence-informed standards is the objective of Initiative 13 of Everyone Goes Home, a firefighter life safety program launched in 2004 by the National Fallen Firefighters Foundation.
Decision-makers in fire and EMS organizations do not typically engage information sources such as the medical journals and technical reports commonly associated with translating research into practice in healthcare. Preparing fire service organizations to make fully informed decisions about occupational behavioral health care for their personnel therefore requires deliberate efforts to bring scientists and consumers together.
The National Fallen Firefighters Foundation initiated a systematic approach to knowledge translation as its central objective for the occupational behavioral health initiative of Everyone Goes Home.
The strategic plan for this initiative has employed a consensus process much like that used in developing standards in both medicine and firefighting. It began by bringing together carefully selected researchers whose research programs deal with areas important to occupational behavioral health needs of the fire service.
Those experts worked with a similar number of representatives from key organizations and standards bodies including the International Association of Fire Fighters, International Association of Fire Chiefs, National Volunteer Fire Council, National Fire Protection Association, National Association of Emergency Medical Services Physicians and North American Fire Training Directors 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, in April 2009, examined 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 products of these efforts are being translated into new approaches to delivering evidence-informed behavioral health care to the fire service. Work is now under way on several critical projects:
* A framework and protocol for dealing with occupational exposure to potentially traumatic events has been developed and published. These guidelines represent an evidence-informed best practices approach that’s designed to be integrated into existing organizational activities. Workshop programs and continuing education materials are under development.
* 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.
It has been adapted for use in military and Medical Reserve Corps applications, and NFFF has contracted to develop modules to train firefighters and EMTs in applying its principles to help the citizens we serve and, as a part of active peer programs, to help one another.
* Industry standards for health and safety require that all departments provide a member assistance program, but they do not specify what services should be provided by what level of provider, nor do they provide guidance with respect to protocols for assessment or evidence-based standards of treatment.
Recommendations are being prepared to help departments write specifications for behavioral health programs that will meet their specific needs. Work is also under way on resources to assist potential providers in developing effective proposals and programs to satisfy those specifications.
* Web-enabled, interactive programs for self-help and education on behavioral health impacts have been developed for military and veteran use (see, for example, www.afterdeployment.org). NFFF is working with developers of pertinent platforms (such as the National Center for Post Traumatic Stress Disorder) to adapt these platforms to provide similar assistance to firefighters and their families.
* Web-enabled, interactive resources to help fire and EMS organizations build, prepare and support effective peer-support programs. Building on successful programs and strategies from a variety of departments, this effort seeks to help organizations use peer personnel effectively to support the various objectives of a comprehensive behavioral health program and encourage its proactive use by firefighters and their families.
* If they are to be prepared to provide the highest standard of care, the mental health personnel working with firefighters and their families need cost-effective, accessible ways to acquire skills in current evidence-based treatments. The National Crime Victims Research and Treatment Center at the Medical University of South Carolina developed a well-researched platform to deliver training in Cognitive Behavior Therapy, the current standard of care for conditions such as PTSD and depression, to providers caring for victims of abuse.
NFFF is working with NCVRTC to fund the 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.
A central goal in all the strategies developed under this initiative has been to create Web-based, easily accessible, user-friendly products to help fire service organizations, their members, their families and those who provide services to them. Learn more about the ongoing projects regarding Initiative 13 and the rest of Everyone Goes Home at www.everyonegoeshome.com.