Life Safety Initiative #13

LSI #13-  Behavioral Health Part 1 of 2

As we become more familiar with the 16 Life Safety Initiatives, we are able to take a more focused look at them individually, so we can spend more time on implementation and less time on familiarization. This article will cover some of the application aspects of Life Safety Initiative #13.  Part 2 will discuss After Action Reviews and offer some options to implement an AAR system in your organization.  But first, it is significant to accentuate the reason why firefighter safety is the paramount priority.

The most common and emotional argument supporting firefighter safety is that we all have loved ones that expect us to return at the end of our tours and at the end of our careers.  However, when we signed up as firefighters, we agreed that we were willing to put our lives at risk in order to save another. That is and will always be our primary mission, even though it might result in us not returning to our loved ones.  Therefore, if we get hurt, injured or killed, our ability to complete the mission is either eliminated or inhibited.  It has negative impact on the rest of our team, reducing their capacity to complete the mission as well.  So if we are truly servants in our fire service, we will recognize and practice that firefighter safety comes first, not just so we can go home, but because of the people we agreed to care for.

Life Safety Initiative #13 states that “Firefighters and their families must have access to counseling and psychological support.”  

Over the past several years, fire service behavioral professionals have researched how effective our behavioral health programs have actually been.  If we take into account our own experiences with critical incidents and managing fire service stress, we are probably not surprised to learn that we have much to improve upon.  While we have come a long way from the “tough it out” days, we still have a long way to go.  

Most of us are familiar with the “Mitchell Model,” likely with our strongest (or only) emphasis being on the critical incident stress debriefing session (CISD).  The Mitchell Model is intended to be utilized in its entirety, pre-emptive to, then through a critical incident.  Unfortunately, we have learned that much of the fire service only utilizes the Mitchell Model in part.  It is intended to be utilized as a full system rather than a pick-and-choose.  A solid argument exists that we tend to focus solely on the debriefing because we are response-minded rather than pre-plan minded.  Furthermore, an inherent defect in CISD is that it treats everyone as if they were traumatized in lieu of a mechanism to identify those that were.  Ultimately, research indicates that debriefings not supported with pre-crisis preparation and follow-up referrals, will actually cause more harm than good.  Findings demonstrate “inert” effects in the best cases.  In worst cases, responders are forced into debriefings that they are not ready for or would not like to participate in; thus ultimately causing more harm than good.  

The nuts and bolts is that the fire service is trending away from a stand alone, unsupported, debriefing as a solution, and more towards a systems approach.  Most of the development has solid foundations in military environments that have shown to be successful. In support of Initiative 13, below is a program overview of what we can expect to see in the near term from the National Fallen Firefighters Foundation.

Psychological First Aid- PFA (How we treat the public we serve): is designed to reduce the initial distress caused by potentially traumatic events, as well as to foster adaptive functioning. PFA can be a critical tool for first responders as they assist adults, children, adolescents and families in the immediate aftermath of emergency situations.  If fire/rescue personnel practice the principles of PFA every day with the people they serve, when the worst happens and they need to take care of one another, they will have better skills to do so.

Behavioral Health Assistance Program-  BHAP: structured program developed by a firefighters to provide access to professional counseling, assessment, and treatment services to their employees and their families. Services should include assistance with a wide range of problems in living and should include referral for competent specialty care where indicated. Intended to replace classic EAPs.

Emergency Responder Stress First Aid- SFA: is a flexible set of tools to care for stress reactions in firefighters. Unlike other acute stress management procedures, SFA was designed specifically to augment the support structures that exist (previously mentioned) for firefighters. The design is intended for peer firefighters that are already familiar with Psychological First Aid to care for one another. The goal of SFA is simply to restore health and readiness after a stress reaction. Manual soon to be released.

Peer Teams- A program of structured non-professional(clinical) assistance provided by a fire department, labor organization, and/or membership organization through which specifically prepared firefighters assist their colleagues in developing and maintaining resilience, addressing difficulties, recognizing when additional help may be warranted, and accessing professional resources when indicated or desired. Next level from PFA and SFA.

Mechanisms to Identify PTE (Potentially Traumatic Events)-  

After Action Reviews, Trauma Screening Questionnaires, Stress First Aid, Peer Support.  These are intended as different tools to be able to determine when and if a firefighter has had a PTE. 

Cognitive Behavior Therapy- CBT:  A type of psychological therapy that is generally short-term and focused on helping firefighters deal with very specific problems, such as those brought on by a traumatic event. During the course of treatment, people learn how to identify and change destructive or disturbing thought patterns that have a negative influence on their behavior.

The Medical University of South Carolina has obtained a Fire Act Grant to develop a website to train clinicians. This will move the issue of untrained clinicians treating firefighters well along.  NFFF strongly advises the use of Trauma Focused Cognitive Behavioral Therapy as the approach utilized by BHAP and other clinicians.

As these programs are released, we can anticipate much more of a structured approach to taking care of our own.  Our culture in the fire service has traditionally been response-minded, so unfortunately, it is the same approach we have taken towards caring for our firefighters.  The potential exists to prevent and treat stress before it reaches considerable difficulty and it is up to identify and implement mechanisms to accomplish that.  As we adapt and further appreciate planning and prevention increasingly more, we can translate that directly to taking care of our best resource, our people. 

Next month we will look at After Action Reviews, how they directly support behavioral health; and, when used within an effective system, how they can exponentially increase our service delivery potential.

Rob Franklin, Battalion Chief

LANCASTER FIRE DEPARTMENT

RFranklin@lancaster-tx.com