Bridging the Gaps

Peer support, as part of a recovery-oriented approach to treatment, is a valuable resource across various clinical and nonclinical populations. Specifically, in fire service, peer support may bridge the gap between firefighters' behavioral health needs and access to professional services. The current chapter summarizes the literature on peer support utility, presents data on barriers to treatment, and describes the roles clinicians can fill in partnering with fire service peer support to enhance the quality and reach of behavioral health services offered to fire service personnel. Finally, future research directions are outlined to continue the conversation about how to improve collaborations between peer supporters, clinicians, and others working to support the needs and strengths of firefighters.

Unique Job Roles and Mental Health Risk Factors Among Emergency Dispatchers

Emergency medical, fire, and police dispatchers are often called the first, first responders. Working in emergency communication centers, they are the first point of contact with medical, fire, and law enforcement resources and the first point of access to public health and public safety systems for millions of callers each year. Emergency dispatchers face unique risks to their mental health, and the roles and responsibilities specific to their work produce stressors not synonymous with those encountered by other first responders and emergency workers. Yet relatively little research has been done to understand the specific mental health concerns of this vital and often overlooked segment of the emergency services profession. The aim of this chapter is to provide an overview of the job-specific tasks and work characteristics that make the emergency dispatcher's job qualitatively different from the jobs of other emergency workers and first responders, then discuss the unique mental health risks associated with their work.

Posttraumatic Stress and Alcohol Use Among First Responders

Developing research suggests that the co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is a significant clinical concern across first responder populations. This comorbidity is difficult to treat and marked by a more costly, complex, and chronic clinical course when compared to either disorder alone. Significant associations between PTSD/AUD comorbidity and various psychological, behavioral, and physical health outcomes among first responder samples have been documented. This chapter provides a theoretical framework and empirical review of the literature relevant to PTSD/AUD in the context of firefighter, police, and other first responder populations (e.g., emergency medical technicians). Future directions, utilizing varied methodologies and assessment tools, and focusing upon varied first responder populations are enumerated to build upon this preliminary, yet clinically meaningful, empirical foundation. This research domain has great potential to inform specialized, evidence-based clinical care for first responders.

“More Than Peer Support: Organizational and Relational Intervention Model”

The chapter describes a replicable and innovative approach designed to assist first responder communities through the mental health challenges they face in their personal and professional lives. The First Responder Assistance Program (FRAP) strives to create a healthy environment, through a unified structure, three tiered organizational and relational intervention approach, inclusive of peer support, peer chaplaincy support, and clinician involvement. The FRAP Model establishes a direct correlation between organizational wellness, and the individual health of its members. It emphasizes a “top to bottom” organizational intervention, with the understanding that no matter how much help is provided to the individual, the environment must be addressed in order to obtain sustainable results. It stresses a “holistic” approach to healing with a focus on post traumatic growth and the systematic building of individual and organizational resilience.

Narrative Therapy to Address Trauma for Emergency Medical Services and Firefighters

First responders, including Emergency Medical Services personnel and firefighters, support community members in times of crisis. When responding to emergencies, first responders often experience both direct and vicarious trauma. Over time, the pace and intensity of a career as a first responder leads to poor health habits and high risk for mental health issues including posttraumatic stress disorder. Due to concern about peer perception and mental health stigma, these professionals are less likely to seek mental health supports to manage and process trauma. This chapter explores Narrative Therapy as an ideal option for mental health treatment of first responder trauma, providing a collaborative approach to therapy using the natural coping strategy of storytelling.

Trauma Management Therapy for First Responders

Mental health professionals are only recently beginning to understand the risks for stress-related disorders experienced by first responders. For example, it is clear that first responders are at increased risk for Post-Traumatic Stress Disorder. Unfortunately, clinicians currently have a limited repertoire with which to treat these disorders. Treatments for PTSD have been developed for use with military patients, for the most part. It is not clear that these treatments are appropriate, and effective, for first responders. In this chapter, the authors describe a pilot study designed to evaluate whether one specific treatment approach creates similar clinical outcomes for first responders as have been observed for a military sample. The results indicate that clinical outcomes for first responders were nearly identical as those obtained with military personnel. The results are discussed in terms of future directions for research in this area.

Disaster Responder Self-Care, Self-Compassion, and Protective Factors

The study examined the relationships among resilience, self-care, self-compassion of first responders. In addition, the study assessed the contributions of protective and risk factors to responders' resilience and disaster response competencies. Five research hypotheses and three research questions were examined with Pearson r correlations, multiple regressions, one t-test, one MANOVA, and post hoc tests, showing significant and meaningful results. In addition, the internal consistency reliabilities of the DRCQ scales were investigated which were strong to very strong. It was hypothesized and shown that there were significant positive relationships among self-care, self-compassion, and resilience. A second hypothesis was retained that the two dimensions of self-care (i.e., self-care practices and physical safety) were predictors of self-compassion. Responders who consciously observed self-care practices fostered and strengthened self-compassion and vice versa.

The First, First Responder

Research on the health and wellness of emergency responders has continued to grow over the past two decades, demonstrating the profound impact of duty-related exposure to stress and trauma on responders' physical and mental health. The majority of this important literature has been conducted with field responders, including police officers and firefighters. As the first, first responder, the health and wellness of 9-1-1 telecommunicators has been largely neglected, despite the high levels of recurrent exposure to duty-related traumatic events among this population. This chapter reviews the current empirical literature on mental and physical health in 9-1-1 telecommunicators, followed by discussion on factors within the 9-1-1 work environment that may be responsible for elevated rates of mental and physical health problems. Prevention and intervention efforts for 9-1-1 telecommunicators are then discussed, followed by research showing the potentially profound impact of poor mental health on 9-1-1 telecommunicator performance.

Changing Hearts and Minds

By the nature of their occupation, first responders witness numerous traumatic events. Most of the time, their training and desire to help others allows them to respond professionally and appropriately. However, there are certain events that, for whatever reason, affect first responders in a more dramatic way, leading to emotional and behavioral changes that affect their interpersonal relationships and occupational functioning. Even if they recognize the need, first responders often are hesitant to reveal their distress and/or seek professional help to superiors, believing that they will be perceived as unfit for duty. In this chapter, the need for administrators to understand and accept the severe impact of traumatic events is discussed. Consistent with the individualized nature of traumatic responses, a tiered strategy of intervention is proposed. Finally, drawing from an occupational health perspective, a model that conceptualizes and responds to exposure to traumatic events as an occupational hazard is discussed.

Swimming Upstream

First responders maintain strong marriages in spite of the potential negative impact of multiple stressors including schedule conflicts, financial strain, and the threat of illness, disability, and death. Patterns of thought and behavior that are beneficial at work, such as vigilance, rapidly establishing control, and shutting off emotional responding cause problems at home, particularly when intensified by trauma. Excessive belief in a partner's heroism and the choice by some responders of dependent romantic partners cause other problems, as does the sometimes culturally sanctioned practice of coping through alcohol use or sexual encounters. Shifts in perspective that reframe common concerns more positively are offered. Departments are encouraged to increase efforts to support spouses and marriages, given the importance of close relationships to health.