NFFF focuses efforts on Life Safety Initiative #13, developing consensus protocol on behavioral health
By Chief Ronald J. Siarnicki

This is the first in a series of seven articles describing a new approach to mental and behavioral health in the fire service. Check back for future articles.

It’s well recognized that firefighters and their families need appropriate resources to deal with the various complications that this occupation can bring to their lives—not to mention the more day-to-day life problems that all of us sometimes face. Further, health and safety standards (e.g., NFPA 1500: Standard on Fire Department Occupational Safety and Health Program) require that assistance programs be made available. But what form those services should take has become a serious question, especially considering that research has raised significant concerns about intervention and treatment approaches commonly used with fire service personnel.

With this in mind, the Everyone Goes Home program’s Life Safety Initiatives includes Initiative #13: “Provide firefighters and their families access to counseling and psychological support.” The objectives of the initiative: to ensure that care is available whenever needed and that the care delivered represents the best practices under current evidence-informed standards.

Bringing the Right People Together
Decision-makers in fire and EMS organizations don’t typically get their information from sources such as the medical journals and technical reports commonly associated with translating scientific research into practice in health-care fields. So preparing fire service organizations to make fully informed decisions about occupational behavioral health care for their personnel requires deliberate efforts to bring scientists and consumers together. The National Fallen Firefighters Foundation (NFFF) initiated such 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, the International Association of Fie Chiefs, the National Volunteer Fire Council, the National Fire Protection Association, the National Association of Emergency Medical Services Physicians, the North American Fire Training Directors and the Federation of Fire Chaplains 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 utilization of behavioral health resources.

Critical Projects Underway
The products of these efforts are being translated into new approaches to delivering evidence-informed behavioral health care to the fire service. And work is now underway on several critical projects, all of which will be carefully explained in a series of articles on FirefighterNation.com over the next few months.

The articles will focus on the following topics:
• 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 (NCPTSD) 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 the 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 it does not specify what services should be provided by what level of provider, nor does it 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 underway 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 (i.e., www.afterdeployment.org). The NFFF is working with developers of pertinent platforms, such as NCPTSD, to adapt these platforms to provide similar assistance to firefighters and their families regarding behavioral health implications of their duties.

• Web-enabled, interactive resources 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 facilitate proactive utilization of its resources by firefighters and their families.

• The 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 a well-researched platform to deliver training in cognitive behavior therapy (CBT), the current standard of care for conditions such as PTSD and depression, to providers caring for victims of abuse. The NFFF is working with the 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.

Final Thoughts
As you can see, this is tremendously exciting work and will, in the end, be a turning point for how we care for each other in the fire service. A central goal in all strategies developed under this initiative has been to create Web-based, easily accessible, user-friendly products to assist fire service organizations, their members, their families and those who provide services to them. I hope you will remain as excited as I am about the development and implementation of Initiative #13 over the next few months. Learn more about the ongoing projects regarding Everyone Goes Home Initiative #13 at www.everyonegoeshome.com.

Chief Ronald J. Siarnicki is the executive director of the National Fallen Firefighters Foundation.

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