National Fallen Firefighters Foundation Behavioral Health Initiatives

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. 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 (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 as research has raised significant concerns about intervention and treatment approaches that have been commonly used with fire service personnel. Ensuring that care is available whenever needed and that the care delivered represents the best practices under current evidence informed standards is the objective of Everyone Goes Home® Initiative 13.

Decision makers in fire and EMS organizations do not typically engage information sources such as the medical journals and technical reports commonly associated with knowledge translating research into practice in health care fields. 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, the International Association of Fie Chiefs, the National Volunteer Fire Council, the National Fire protection Association, the National Association of Emergency Medical Services Physicians, and the 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, Maryland, 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. 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 underway on several critical projects:

  1. A framework and protocol for dealing with occupational exposure to potentially traumatic events has been developed and published. These guidelines represents an evidence informed best practices approach that is designed to be integrated into existing organizational activities. Workshop programs and continuing education materials are under development.
  2. 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 military use and Medical Reserve Corps applications, and National Fallen Firefighters Foundation 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.
  3. 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.
  4. Web enabled, interactive programs for self-help and education on behavioral health impacts have been developed for military and veteran use (see, for example, National Fallen Firefighters Foundation is working with developers of pertinent platforms (such as NCPYSD) to adapt these platforms to provide similar assistance to firefighters and their families regarding behavioral health implications of their duties.
  5. 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 facilitate proactive utilization of its resources by firefighters and their families.
  6. 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 National Fallen Firefighters Foundation 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 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. Learn more about the ongoing projects regarding Everyone Goes Home® Initiative 13 at