# Increasing the Focus on Fire and Emergency Medical Services Behavioral Health

National Suicide Prevention Lifeline. Call or text 988 to reach the 988 Lifeline. 988Lifeline.org.

**Posted: Dec. 15, 2022**

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The stressful conditions fire and emergency medical services (EMS) responders endure are getting more attention as alarming statistics on responder behavioral health are revealed.

Behavioral health is defined by the American Medical Association as care that addresses mental health and substance use disorders, life stressors and crises, and stress-related physical symptoms.
            - The Situation 
            - Background 
            - The Stigma 
            - The First Step 
            - Action Steps 
            - Resources 

## The situation

According to the Firefighter Behavioral Health Alliance, more firefighters die from suicide each year than in the line of duty, and many additional suicides are likely unreported. Statistics from an April 2018 report from the Ruderman Family Foundation show that public safety personnel are 5 times more likely to suffer symptoms of post-traumatic stress disorder (PTSD) and depression than their civilian counterparts, leading to higher rates of suicide. And, a Florida State University behavioral health study that surveyed over 1,000 U.S. firefighters shows that at some point in respondents' careers:
            - 47% considered suicide.
            - 19% made plans for a suicide attempt.
            - 16% went through with a suicide attempt.

Further reading: The Ruderman White Paper Update on Mental Health and Suicide of First Responders (May 2022)

The impact of behavioral health on the fire service is also being recognized nationally. Behavioral health was 1 of 6 critical issues identified at the recent U.S. Fire Administrator's Summit on Fire Prevention and Control for action by the federal government.

## Background

On the job, fire and EMS responders are routinely exposed to incidents involving devastating injuries and tragic loss of life and property. The cumulative effects of these exposures can have a psychological impact. Fire and EMS responders see things that no one should see. As a responder, it's tough to admit that “I got into this to help people; now I need help.”

## The stigma

For many responders, there is a stigma associated with seeking help for mental illness, which is perceived by some as a sign of weakness. Studies have shown that up to 92% of surveyed firefighters indicate this stigma as a reason for their unwillingness to get help.

Many fire and EMS responders have also expressed concern that outsiders, such as psychologists and counselors, would not understand what responders experience on the job and that outsiders may not keep their discussions confidential.

Gary Krichbaum, program manager at the First Responder Center for Excellence, suggests the stigma for many firefighters' characterization of seeking help as “a chink in the armor” is becoming less prevalent with “a new generation that has been positively exposed to mental health support” joining the profession.

## The first step

### National Suicide Prevention Lifeline 988 or 1-800-273-TALK (8255)

If you're thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7 across the United States.

Just talking with someone can be an important start in making things better. There are resource differences between departments; a large city fire department may have a behavioral health unit while a smaller rural department might not, but no matter what size your department, the starting point is to talk to somebody: a friend, a trusted firefighter, a fire service veteran, a person of faith, a doctor.
> 
Early recognition is the key. Peer support is critical to letting someone know they are not alone. Peer support can be that bridge to necessary treatment.
Gary Krichbaum, program manager at the First Responder Center for Excellence

## Action steps

As the need for behavioral health support for fire and EMS is recognized, the fire service should take these steps.
            - 1. Educate all ranks of fire and EMS about risk factors that can lead to declining behavioral health.
            - The International Association of Fire Chiefs' (IAFC's) Volunteer and Combination Officers Section provides recommendations on best practices in behavioral wellness for emergency responders. It offers solutions, recommendations and tools to directly help firefighters and EMS responders cope with:               - Complex PTSD.
              - Compassion fatigue.
              - Acute stress disorder.
              - Gaslighting.
              - Toxic work environments.
              - Learned helplessness.
            - 2. Create a behavioral health program for your fire department.
            - The National Fallen Firefighters Foundation's (NFFF's) “Fire Service Behavioral Health Management Guide” PDF can help you get started. Although not a standard, this guide describes a tiered behavioral health program with 4 components: leadership, firefighters, peer support and clinical support. For each component, there is a section that includes a detailed description of the role of the component and a list of available resources. The NFFF recognizes that not all departments are able to create and manage a complete behavioral health program. To assist departments of all sizes, component resources are divided into 3 knowledge levels: awareness, operations and technician.
            - 3. Advocate for legislation at all levels to authorize behavioral health resources for public safety officers.
            - The Helping Emergency Responders Overcome (HERO) Act is before Congress now. It calls for the development of:               - Resources for educating behavioral health care providers about treating firefighters and EMS personnel.
              - Best practices and resources for identifying, preventing and treating PTSD and co-occurring disorders in public safety officers, including the incorporation of these resources into federal training programs for public safety officers.
              - A public safety officer suicide-reporting system and a grant program for peer-support behavioral health and wellness programs within fire departments and EMS agencies.
> 
Every organization in the fire service, from management to boots on the ground, must make behavioral health a priority so firefighter mental health issues like PTSD, anxiety, depression and suicidal thoughts can be properly addressed.
Gary Krichbaum, program manager at the First Responder Center for Excellence

## Resources

These resources can provide information, assist individuals seeking help for a behavioral health issue, and provide departments guidance for the implementation or enhancement of behavioral health programs.

### Everyone Goes Home

Resources from the NFFF for firefighters and their families, including the “Fire Service Behavioral Health Management Guide”; a behavioral health podcast; and rapid response procedures for member suicide, mass violence incidents, and on-duty fatality, injury or close call.

### Firefighter Behavioral Health Alliance

The Firefighter Behavioral Health Alliance provides workshops to fire and EMS departments and dispatch organizations that focus on behavioral health awareness. The workshops place a strong emphasis on suicide prevention and promoting available resources, such as a directory of behavioral health professionals, a self-assessment tool and a confidential way to report suicide for fire/EMS responders and their families.

### International Association of Fire Chiefs

“Surviving the Job: Emotional Self Care for First Responders” is a prerecorded IAFC webinar that details the challenges of stress, secondhand trauma and burnout in fire/EMS responders and how these can take a toll on physical health, mental health and relationships. It also explores concrete, manageable steps that fire and EMS workers can take to protect themselves and their families.

### International Association of Fire Fighters

The International Association of Fire Fighters (IAFF) offers behavioral health awareness, peer support and personal resiliency training for departments and personnel. The IAFF also offers a members-only program that provides treatment for successful recovery from substance abuse, PTSD and other behavioral health issues.

### National Volunteer Fire Council

The National Volunteer Fire Council's Share the Load Program can assist individuals seeking help for a behavioral health issue as well as fire departments looking to implement or enhance a behavioral health program. It includes a directory of behavioral health professionals vetted by the Firefighter Behavioral Health Alliance, an implementation toolkit, and virtual training on several topics including coping with stress, suicide prevention and emergency responder resilience.

### Substance Abuse and Mental Health Services Administration

The First Responders and Disaster Responders Resource Portal offers tips and online training to help fire/EMS responders learn about the signs of stress and how to manage it.

### USFA/National Fire Academy

The National Fire Academy's “Departmental Wellness Program” training course provides the outline and resources for a fire/EMS department to implement and maintain a wellness program in coordination with the department's health and safety program. Contact your state fire training agency for information on course availability in your state.