Firefighter wellness is a very broad subject that includes behavioral health, occupational cancer, exercise and nutrition, sleep, injury prevention and recovery, wellness exams, work-life balance, spirituality, and financial wellness. This article will focus on how to create or enhance your fire department’s wellness program and give you the tools you need to turn that goal into reality.
Taking the Fire Department’s Pulse
The first step in creating or enhancing your department’s wellness program is taking your department’s pulse through an anonymous survey. If completed correctly, the survey results will create the roadmap of priorities that your department should focus on.
Multiple surveys are available online. You could use those surveys as is or create a hybrid survey from multiple resources. Don’t be afraid of creating unique questions pertinent to your department. Key areas your survey should focus on include depression, anxiety, suicidal ideation, sleep, fitness and nutrition, cancer prevention/awareness, medical, and skin exams. Additionally, the survey should provide employees an opportunity to share their thoughts on department wellness through a narrative at the end of the survey.
The survey must be 100% anonymous. A department member peers trust and respect should oversee the survey. The equipment needed includes multiple tablets and a Wi-Fi connection. Ideally, you should take crews out of service to complete their surveys. This will ensure minimal interruptions, allow crews time to think about their responses, and demonstrate that the department takes the survey seriously. Because each group has unique benefits and problems, try to differentiate responses between shift personnel and 40-hour employees. Set two-thirds of all personnel as the minimum response goal for your department. This sample size provides statistically significant data and best provides the current pulse of your department.
The Roadmap and Plan Implementation
After tabulating the survey results, your department’s priorities should be clear. Although the plan can be initiated at this point, it is imperative to realize that your plan won’t be implemented overnight. In executing it, concentrate on the low-hanging fruit initially, the items that usually have little or no cost associated with them. Many of these can be accomplished through policy changes and training. Checking off these items will allow your program to build a good foundation.
Once you have created that foundation, start working toward the high-hanging fruits that may have considerable costs. Although this process can be long and frustrating, it is imperative to stay the course; the result will make a positive impact for all your department’s members.
Defeating Stigma and Changing the Culture
One of the most effective wellness tasks you can perform is in training new recruits. How much better off might you have been if somebody talked to you early on about occupational cancer and behavioral health? Training your recruits on relevant wellness components gives them the opportunity to make educated decisions on what they must do to protect themselves throughout their career.
Defeating stigma and changing the culture throughout your department will probably be the biggest uphill battles. The best way to battle stigma is through training. The subject can be taught internally, but it may be beneficial to bring in a subject matter expert (SME) on the topic. The SME won’t pull any punches, which ultimately validates what you’re attempting to accomplish.
Another way to defeat stigma and challenge the culture of your department is to have a fire department role model on your side. This ideally would be a veteran within the department who has “seen it all” and “done it all.” This must be a highly trusted and respected person, one peers would follow into the gates of hell. The difficulty is finding a veteran who shares your beliefs and is willing to show vulnerability. It’s important to note that vulnerability is not a sign of weakness; being vulnerable and sharing experiences are the essence of strength.
Regarding training, online programs are very popular and can be cost effective. Nevertheless, online training and policy implementation can be difficult because of boredom and too many other distractions. Entertaining firefighters is one way to counter the boredom or the give into the temptation to hit “play” and walk away. If you can make your training a must-see event, your firefighters will participate and learn as they are entertained.
Training
Many fire departments have gotten away from in-person training and have succumbed to virtual training. The result is thousands upon thousands of firefighters are clicking play, walking away, and missing the entire training. Realistically, the only way to keep firefighters engrossed in the training is to keep it entertaining. Creating training that is fun and humorous will keep your firefighters engaged in their online training and get your messages across. I encourage you to give it a shot.
Phone a Friend
You don’t have to do all this work solo and start from scratch. There is an army of wellness coordinators and SMEs who specialize in the components of wellness and have already done the work for you. Reach out to these individuals, and more than likely they’ll be happy to share their information. You’ll be able to pay forward your knowledge to the next generation of wellness coordinators.
Policies and Procedures
To advance your campaign for health and wellness, you must create policies and ensure that they are implemented and followed. If you aren’t sure where to start, ask your wellness friends from other agencies to send over their policies. Perhaps one of these will work for you, or you can combine the policies in a way tailored to your agency. Regardless of how the policies are created, they should emphasize creating a peer support and a critical call policy.
Peer support. A peer support policy should include the key components in Table 1.
Critical calls. A critical-call policy can be either stand-alone or included in your peer support policy. It is essential for reducing the effects of critical calls on your members. After a critical incident, an on-duty peer support member can be dispatched to assess the involved crews, who should remain out of service. If necessary, the peer supporter can call a team clinician to evaluate any struggling members. The clinician can advise if it is safe for that member to stay on duty or if he should go home. Ideally, that member would be placed on leave with benefits (LWB). Any member who is sent home should touch base with a clinician before he is cleared to return to duty.
Table 2 shows the incidents that this policy should consider but not be limited to.
Analytics
Analytics can be an essential part of justifying your position. Keeping data within your fire department will be a tough balancing act because you want to have accurate information but you also must maintain confidentially. Creating a spreadsheet will allow you to update your numbers throughout the week. Table 3 lists some of the items that you and your team should document.
The most important part of your analytics is what you did with the above information. This list includes all the referrals that you and your team made to the following: a one-on-one clinician, a group/intensive outpatient program (IOP), a substance abuse facility, an inpatient facility, or a locked-down hospital facility if the member is in crisis.
Forming a Team
If you don’t have a peer team and would like to establish one, Table 4 outlines the steps for doing so.
Confidentially is the most crucial item in peer support. Your members must trust the supporter they’re talking to. The only exceptions to confidentiality are when the members threaten to hurt themselves or someone else or are involved in elder or child abuse or a crime has been committed.
If confidentiality is violated in any other scenario than above, you must remove that peer from your team. A breach in confidentiality can single-handedly implode your team; it may be years before the damage from a single breach in confidentiality is repaired and trust in the program is regained.
Peer Support Coordinator
“Heavy is the head that wears the crown” is also true for the peer support coordinator. The team coordinator can easily fall victim to secondary or vicarious trauma through interactions with department members. Membership in the fire department already shows that you are unselfish and willing to sacrifice yourself for strangers. This is amplified when we deal with our members, who may be close friends. Peer support coordinators must learn to take care of themselves and master coping skills to survive. Every peer support coordinator should heed the following advice: Limit your personal interactions with your members who are seeking peer support, delegate interactions to your peer team members, create an on-call rotation with trusted members of your team to share the load, and set boundaries.
As Chief (Ret.) Patrick Kenny would say, many of us have a difficult time taking our capes off.2 Often, coordinators will ignore their own advice and spiral out of control until they hit rock bottom; that spiral could happen to you if you aren’t cautious.
First Responder-Friendly Resources
Firefighters have a difficult time admitting that they need assistance. Pride, shame, guilt, vulnerability, and fear of being perceived as weak are barriers to obtaining assistance. When a firefighter is finally willing to get assistance, the peer supporter may only have one opportunity to set that firefighter up with the appropriate resource. If a firefighter does not receive the recommended resource, that person will be even more reluctant to seek further assistance.
The peer team coordinator is responsible for evaluating resources and making sure they are appropriately vetted. The resource should specialize in first responders and military personnel and be trauma-trained. Ideally, clinicians should be trained in eye movement desensitization and reprocessing (EMDR), which can assist in processing traumatic memories so that the responder feels safe again.
First responders avoid treatment that is also available to the public. Firefighters don’t want to be associated with the people they have seen while working. First responder resources should include one-on-one clinicians, family clinicians, equestrian therapy, Alcoholics Anonymous meetings, and retreats like Save a Warrior and First Responder Bridge. Resources should also include intensive outpatient programs and residential programs such as the IAFF Center of Excellence and the Rosecrance Florian program.
Each municipality throughout the United States should have some sort of employee assistance program (EAP) for their employees. EAPs that have buy-in and have been vetted by the fire department peer coordinator or the union can be a great asset for the members. However, many EAPs are low bidders and inadequate for your members’ needs. Be aware that EAPs may have a stigma associated with confidentiality because the municipality is paying for it. Firefighters must receive training from trusted peers and be assured that the EAP maintains the confidentiality of all members.
A great way to share these resources is through an app or peer support Web site. Many firefighters are not willing to discuss their difficulties with anyone; with an easily obtainable resource, your members can skip the middleman (peer supporters) and discreetly schedule their own assistance.
First Responder Annual Clinician Program
Many departments have annual medical exams. Bringing in a clinician to evaluate your members will be a “checkup from the neck-up.” An annual clinician program can assist with reducing the stigma regarding behavioral health issues and encourage members to reach out for assistance. The program can be paid for by the municipality, through a grant, or through the department’s union. The clinician program can be broken down as shown in Table 5.
Post-Traumatic Stress (PTS) and Post-Traumatic Stress Disorder (PTSD)
PTS is a normal reaction to any event that threatens violence or loss of life. The firefighter may personally experience the event, see the event happen to someone else, or have direct exposure to adverse details of the event in its aftermath.
PTSD has been around for years under different names. In the U.S. Civil War, it was called “soldier’s heart”; in World War I, it was called “shell shock”; and in World War II, it was called “combat fatigue.” The modern mental health diagnosis of PTSD was first proposed in 1980.4
PTSD is a mental health condition that’s triggered by a terrifying event. Symptoms in each of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition’s (DSM-5’s) four categories in Table 6 must last for more than 30 days to be considered a disorder.
It is recommended you make your firefighters more aware of the signs and symptoms of PTSD. Consider putting on a training or making a flyer that can be hung at the firehouse for awareness.
Our Spouses
Firefighter spouses should be on the front line of assisting their firefighters. Unfortunately, firefighters tend to make this hard; most don’t go home and share what they have been exposed to at work or how they feel about it. Although it isn’t recommended that firefighters share gory details with their spouses, sharing a “PG” version of what the firefighter saw can help process their thoughts and feelings.
Fire spouses must be included in behavioral health trainings, which begin while the firefighter is going through the training academy. Regularly scheduled trainings and events should educate the fire spouses on behavioral health. Spousal awareness of the signs/symptoms of PTSD helps the spouse recognize any changes in the firefighter’s attitude early on, which fosters seeking assistance before it progresses.
It is also impossible to predict how a firefighter will be emotionally when coming home from work. Depending on what that member did during his shift, how he slept (if at all) will affect his emotions and attitudes on his days off. Allowing firefighters to decompress and take a nap will give your family an opportunity to have a present and active off-shift firefighter at home. Napping can be a small investment with huge returns. Numerous first responder authors describe this transition in more detail. Dr. Mynda Ohs describes this as changing from work brain mode to home brain mode. Mike and Anne Gagliano describe this as reentry time. Dr. Kevin Gilmartin describes this as the hypervigilance roller coaster. Other activities that can help your firefighters decompress include working out, meditating, and talking about their day.
Adverse Childhood Experiences (ACES)
ACES can have lasting, negative effects on health and well-being and result in a wide range of chronic diseases, some of which are among firefighters’ leading causes of death: cancer, diabetes, heart disease, and suicide.
Children growing up with toxic stress may have difficulty forming healthy and stable relationships. They may also have unstable work histories as adults and struggle with finances, jobs, and depression throughout life. These effects can also be passed on to their own children.
The ACES quiz is composed of 10 questions that may have applied to you before the age of 18, which focus on the following: physical abuse, emotional abuse, sexual abuse, physical neglect, emotional neglect, mental illness in the home, mother treated violently, divorce, an incarcerated relative, and substance abuse. Experiencing four or more ACES is associated with significantly increased risk for seven out of the 10 leading adult causes of death, including heart disease, stroke, cancer, chronic obstructive pulmonary disease (COPD), diabetes, Alzheimer’s, and suicide. Everyone in public safety is encouraged to take the ACES quiz, available free at americanspcc.org/take-the-aces-quiz/.
Source: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
Suicide
Preventing suicide among firefighters is difficult because they do a tremendous job of hiding their inner turmoil. Withdrawal is the most common warning sign of suicide. Raleigh (NC) Fire Department Battalion Chief Dena Ali believes that suicide prevention requires a multifaceted approach that includes the following:
- Upstream strategies. Putting multiple systems in place with the goal of catching any type of behavioral health struggles in an early stage.
- Social support. Anything that leads a firefighter to believing he is loved, cared for, esteemed, and a member of a group that shares a mutual obligation. Social support is a form of resiliency.
- Post-trauma support. The peer support team primarily leads the post-trauma support in fire departments. Peer supporters can discuss options with first responders in the hope of processing their trauma early on before it manifests.
- Destigmatizing help-seeking behavior. Until recently, most firefighters were told that being vulnerable was a sign of weakness. Removing stigma regarding behavioral health is essential, and the best way to accomplish this is with training, policy, and having role models who support behavioral health.
- Company officer training. Training your officers on behavioral health signs and symptoms will allow them to be more aware of issues their crew members may be having and better prepared to discuss them with crew members.
Resilience
Resilience is critical for career longevity and can be defined as taking on adversity and bouncing back, often stronger than before. To build resilience, focus on the following activities: sleep, talking, exercise, nutrition, meditation, journaling, breathing, yoga, and spirituality.
Sleep
Sleep is the foundation of wellness and provides the opportunity for the body to heal. Lack of sleep/circadian rhythm interruption can negatively impact our behavioral health and has been tied to increased cancer, heart disease, and injuries. Sleep at the firehouse can be improved through the following: encouraging naps (seriously), adding red lights in the bunk room, moving your shift change to 0800, elevating the station alert volume, using apparatus- and station-specific tones, and having individual rooms rather than open bunk rooms.
To address sleep at home, it is recommended to set aside time on your first day off, stay away from screens an hour before bedtime, keep the temperature in your bedroom lower, add blackout curtains, use a pink noise machine, and use the bedroom only for sleep and sex.
The department can bring in a sleep specialist to educate your members on sleep hygiene, sleep apnea, and insomnia. The sleep specialist can also provide a take-home sleep test to discover any sleep disruptions and to find ways to improve sleep.
The book Why We Sleep by Dr. Matthew Walker is an essential guide to understanding the power of sleep. Alternatively, firefighters can watch Dr. Walker partake in several TED talks.
Occupational Cancer
Nearly 75% of the IAFF members’ names that were placed on the IAFF Wall of Honor in 2022 were from occupational cancer deaths. Cancer has a latency period of up to 25 years after your initial exposure. It’s essential to do everything in your power to reduce exposures throughout your career. A great way to complete a department self-assessment can be found at firefightercancerconsultants.com/wp-content/uploads/2020/07/The-25_new_7-30-20-alt2.pdf. Check off all the initiatives that your department is currently doing, and you will be left with a list of the items that you need to focus on.
If you ever receive a diagnosis, please remember there is assistance available for you and your family. The Firefighter Cancer Support Network (FCSN) can be reached at (866) 994-FCSN or FirefighterCancerSupport.org. The FCSN can assist you by putting you in touch with a mentor who is a firefighter cancer survivorwho will share his experience and serve as a companion throughout your fight.
The FCSN will also send you a cancer-support toolbox to your home for free. This toolbox includes a tremendously helpful firefighter’s guide to cancer survivorship, informational handouts, and folders/office supplies. The toolbox is also great for keeping all your pertinent cancer paperwork in one place.
The American Cancer Society (ACS) recently entered a partnership with the IAFF. The ACS has several support items that can also assist your navigation through your cancer diagnosis. The ACS has a 24/7 IAFF-specific helpline that can be reached at (877) 901-7848. The ACS also has a video chat helpline that can be scheduled at americancancersociety.allegiancetech.com/cgi-bin/qwebcorporate.dll?idx=W2G2TA. The ACS also has more than 30 “Hope Lodge” locations through the country. They offer cancer patients and their caregivers a free place to stay.
On receiving a cancer diagnosis, focus on conquering it. This is an opportunity to prioritize what is important and avoid any distractions. Obtaining representation from an attorney to focus on your presumptive cancer case will free you of that distraction and allow you to focus on getting better.
Don’t forget to support your supporters. Your supporters/caregivers are right there for the ride. Make sure they are being taken care of along your journey.
Also, don’t forget your personal mental health. Many firefighters become depressed after obtaining a cancer diagnosis. Firefighters who suffer from PTSD may also question their mortality more than a member of the general public would. Don’t be afraid to talk to a clinician to safely assist your processing throughout your journey.
Reproductive Health
There are currently multiple studies being conducted to learn the effects carcinogen exposures have on the reproductive process for firefighters. These studies also look at potential birth defects of firefighter offspring. Despite the studies being incomplete, it is still recommended to reduce your exposure to carcinogens to protect you and your offspring. Female firefighters should also be allowed to perform restricted duty if they choose when they find out they are pregnant. Policies should be created that would allow this opportunity for pregnant firefighters so they can be safe, their babies can be safe, and they won’t exhaust all their leave.
Exercise and Nutrition
Exercising regularly and eating healthy will assist you throughout your firefighter career and beyond. Exercising at the firehouse can be difficult because of how busy you are or the lack of equipment that is on hand. To counter both of those issues, it is recommended to consider a high-intensity interval training (HIIT) or Tabata program. HIIT is a training protocol alternating short periods of intense or explosive anaerobic exercises with brief recovery periods until the point of exhaustion. Tabata is a form of high-intensity physical training in which very short periods of extremely demanding activity are alternated with shorter periods of rest. The difference between the two is Tabata is basically a higher intensity version of HIIT, with shorter and more rigidly defined workouts. Both types of exercise can use the same type of equipment, which is relatively cheap and portable. You can exercise with your body weight or use these types of equipment:
- Kettlebells.
- Dumbbells.
- Slam balls.
- Sandbags.
- Bands.
- Battle ropes/hoses.
- Jump ropes.
- Heavy bag.
- TRX.
- Mats.
- Stepper.
Yoga is also a great form of exercise that can be practiced on and off duty. Yoga can positively impact our mental health, physical help, mindfulness, and quality of sleep. The uphill battle with yoga is fighting off the attached stigma. The stigma of yoga can be fended off by conducting crew/department yoga at the firehouse. Male firefighters can also choose a more “masculine” version of yoga such as Diamond Dallas Page Yoga (ddpyoga.com).
Another exercise training option is the IAFF Fit to Thrive (F2T) Program, formerly known as Peer Fitness Trainers. This program is designed to support the IAFF/IAFC Wellness Fitness Initiative (WFI). The trainers can assist your firefighters with developing their own wellness/nutrition programs. More information on the program can be found at iaff.org/peer-fitness/.
A great resource for fire departments is Firefighter Functional Fitness by Dan Kerrigan and Jim Moss. This book provides firefighters with the knowledge, mindset, and tools to maximize their fireground performance, reduce their risk of injury, and have a long and healthy career followed by a long and healthy retirement.
Fitness incentives also encourage firefighters to stay in shape. The two incentives that a firefighter will take a fitness test for are usually money and time off. Departments are understandably concerned about the costs of monetary incentives or time off, but when looking at these programs in the long run, the costs are recouped by having healthy/in-shape firefighters on the department who perform better, heal faster, and are less likely to be injured or sick.
It can be an uphill battle trying to eat healthy at the firehouse. Crews are generally at the mercy of the cook and may feel the need to eat whatever is prepared, but firefighters need to take responsibility for their own nutrition. As such, don’t be afraid to bring your own food in. You can still eat with the crew, but you will be eating what you need to eat. Our career also has us up and about at all hours of the night. Try your best to avoid the hospital emergency medical services room snacks or the goodies waiting back at the station during the evening.
Annual Exams
The importance of annual medical and skin exams cannot be understated. Early recognition and intervention are the best ways to combat illness and injury from both a physical and monetary perspective. The longer it takes to discover an illness or injury, the more negatively it will impact the quality of life of the firefighter and the financial bottom line for the municipality. Ideally, each department has an annual National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments (soon to be NFPA 1580, Standard for Emergency Responder Occupational Health and Wellness), compliant medical physical. By having an annual exam, past exams can be compared to see if there have been any significant changes.
Most firefighters with insurance can also get an annual medical exam through their family doctor for no cost. Firefighters who opt for this type of exam should schedule it six months after their department physical. This exam will not be as thorough as a department physical, but it can provide important “big picture” health data at a crucial time between the more detailed physicals. Male firefighters should also have their testosterone levels checked on an annual basis.
Skin cancer is another area where departments can make a low-cost impact with high returns. There has been great success finding these cancers when a dermatologist is brought into the department to evaluate its members. The firefighter gets examined while on duty, and the dermatologist will likely receive multiple appointments resulting from the exams. Again, everyone wins, and the cost to the agency is minimized. If you are unable to get a dermatologist group to visit your stations, most insurance policies cover an annual skin exam at a dermatologist. Nonetheless, bringing a dermatologist into the fire department makes it more likely that firefighters will get the exam and receive treatment as early as possible.
Firefighters must realize that part of choosing this profession also means having annual medical and skin exams for the rest of their lives. The chances of premature death are elevated when firefighters choose not to get regular exams.
Spirituality
Spirituality can help build resilience and garner hope regardless of what religion you may believe in. According to the Veterans Administration, “Positive religious coping (e.g., spiritual support, positive religious reframing of stressors, and spiritual connectiveness) can help buffer major life stresses, while negative religious coping (e.g., difficulties and anger with God, negative encounters with other believers, and internal religious guilt and doubt) is frequently associated with worse outcomes.”4
Work-Life Balance
Dr. Donnie Hutchinson specializes in work-life balance in first responders. He stresses that you cannot pour from an empty cup.5 You must fill YOUR cup first! Hutchinson also notes that your family will likely never tell you, “I’m so glad you worked so much.” Work-life balance is all about your priorities in life and considering the big picture. You must remember, “When you say yes to something, what are you saying no to?”
Creating a wellness program within your fire department will take time, money, planning, and a lot of grit. It is neither easily nor quickly built; but its benefits far outweigh the resources put into building it. It is an investment. Municipalities and fire departments commit to implementing these recommendations to give their firefighters the best opportunity for a healthy career serving their citizens and a long and healthy retirement.
References
1. Gasaway, Richard B. (2013) Situational Awareness for Emergency Response. Fire Engineering Books.
2. Kenny, Patrick J. (2020) Taking the Cape Off: How to Lead Through Mental Illness, Unimaginable Grief and Loss. Strategic Edge Innovations Publishing.
3. History.com. (August 21, 2018) PTSD and Shell Shock. history.com/topics/inventions/history-of-ptsd-and-shell-shock.
4. U.S. Department of Veteran Affairs. PTSD: National Center for PTSD. ptsd.va.gov/professional/treat/care/toolkits/clergy/spiritualityResilience.asp.
5. Hutchinson, Donnie. (2016) Lead with Balance: How to Master Work-Life Balance in an Imbalanced Culture. Advantage.
JIM BURNEKA is a recently retired firefighter/paramedic from the Dayton (OH) Fire Department. He has served as Dayton Firefighters Local 136 health and safety coordinator and peer support coordinator and created the department’s wellness program. He has presented on cancer prevention, awareness, and support throughout the United States and Canada. Burneka hosts a monthly firefighter health and wellness podcast called APS Radio for Fire Engineering.
