How Peer Support Helps Firefighters Cope With Critical Incidents

 "You never know when a firefighter is in need of someone who understands." - MnFIRE Peer Supporter 

After a horrific house fire in which children have perished, a multiple-casualty vehicle accident on a highway, or the line-of-duty death of a fellow peer support firefighter, firefighters must endure more than physical fatigue, their own psychological scarring that may last a lifetime. How do such courageous first responders deal with the unimaginable and return to duty in one piece psychologically? 

The Hidden Crisis in Fire Service Mental Health 

The fire department is struggling with an unprecedented mental health emergency that needs to be addressed promptly. There are at least 100 firefighter suicides annually. The suicide rate among firefighters is 18 per 100,000 versus 13 per 100,000 for the general population, cites the "Ruderman White Paper on Mental Health and Suicide of First Responders. 

These grim statistics demonstrate a profession besieged from within. Firefighters and other rescue workers experience post-traumatic stress at the same rate as military personnel who have returned from combat, writes an August 2016 Journal of Occupational Health Psychology study. It reports that about 20 percent of paramedics and firefighters qualify for post-traumatic stress at some point in their careers versus a 6.8 percent lifetime risk for the general population. 

Studies identify still more disconcerting patterns in certain groups. In this population, 22% of wildland firefighters indicated a history of at least one suicide attempt, and 36.7% indicated current suicidal ideation. Also, according to Aldrich and Cerel (2019), a small percentage above 25% of firefighters thought about suicide, and slightly less than 12% formulated a suicide plan. Streeb et al. (2019) described even greater suicidal

ideation (46.8%), suicide plans (29.2%), and suicide attempts (15.5%) among firefighters. 

The Cumulative Effect of Traumatic Exposure 

SAMHSA says, "High-stress situations, risk of physical harm, and impossibility of a single individual to save all can be overwhelming." In their work, they are most often being called out to deal with critical incidents (i.e., death, suicide, abuse, neglect). These situations expose a high risk for physical or psychological injury to the individual. 

The rate at which these exposures occur is overwhelming. Horan et al. (2021) report critical incidents as a normal part of their work, with 60% of police officers reporting five or more critical incidents in the past year and 75% reporting a critical incident in the past month. In addition, 90% of firefighters reported a critical incident during the year, with 6 on average over the course of a year. 

Today in the fire service, 13% to 16% of firefighters are susceptible to depression, 8% to 26% of firefighters experience posttraumatic stress symptoms, and 30% exhibit signs of addiction. 

Breaking the Silence: The Power of Peer Connection 

In a traditionally stoic and "tough guy" profession, getting help has been stigmatized for decades. Stigma is still a major obstacle to evidence-based treatment in fire service because of the "tough guy" approach. In one study, 23% of firefighters reported that stigma would keep them from utilizing behavioral health services, and 29% reported that utilizing behavioral health services could hurt their reputation. 

This is where peer support comes in as the game-changer intervention. Critical Incident Peer Support (CIPS) is peer-to-peer, or "people of mutual respect" assisting each other, i.e., fire fighter to fire fighter. Shared peer experience creates the early trust and credibility for establishing relationships in which people are willing to share and talk about their responses and concerns following a critical incident. 

Evidence-Based Benefits of Peer Support Programs

Evidence shows the quantifiable effect of peer support interventions. One example is a study of the efficacy of peer support programs among 631 police officers in northern Colorado. Findings indicated that 48.3% had participated in peer support. Among them, more than half reported the assistance directly or indirectly aided them in carrying out their jobs and/or enhanced their home life. 

There is some evidence to suggest that peer support programs have greater levels of participation than Employee Assistance Programs and external mental health resources. These results are in line with the argument that talking over issues with a peer might decrease resistance and stigma concerning professional help. 

A thorough study in Alberta, Canada, after the disaster Fort McMurray fire presented strong evidence for the effectiveness of peer support. Adjusting for confounding, the fire chief and firefighter-reported odds ratios (OR) for peer support were depressive disorder: OR = 0.22, 95% confidence interval (CI), 0.08–0.61; anxiety disorder: OR = 0.45, 95% CI, 0.24–0.82; PTSD: OR = 0.62, 95% CI, 0.37–1.02. 

The Mechanics of Effective Peer Support 

Understanding the Peer Support Model 

Peer support is trained colleagues who are available to listen, mentor or support fellow colleagues experiencing personal or professional issues. Life is a complex journey; throw into this mixture the stress and trauma associated with fighting fires and it can get to be too much. 

The strength of peer support is its availability and commonality. Firefighters are subjected to traumatic stress at very high frequencies and having the help from someone who has experienced much the same can be a life-altering difference. 

MnFIRE peer supporters exist to offer confidential support to those facing personal, emotional or work-related issues, and as a gateway to external professional services. 

The Critical Role of Training and Supervision 

Successful peer support initiatives need more than good intentions—good peer support initiatives need effective training and regular supervision. Peer support has been proved to decrease the prevalence and severity of mental health disorders in firefighters. This

pilot project served two purposes: (1) to evaluate training satisfaction and knowledge, self-efficacy, and skills development of Texas firefighters receiving the International Association of Fire Fighters (IAFF) Peer Support Training, and (2) to explore whether newly trained peer support specialists would utilize monthly phone supervision. 

The findings were promising: Although self-efficacy for detection of mental health problems and therapeutic empathy skills improved dramatically after training, part [of the participants] reported high satisfaction with the training received. 

Building Trust and Maximizing Effectiveness 

The Trust Factor in Peer Support 

Trust is the basis for successful peer support relationships. Recent survey statistics identify troubling confidence gaps: Nearly 66% indicated they were confident in how they could access their peer support team. Yet, of those same respondents, just 35% indicated they trusted EAP as a source of support and only 37% indicated that their peer support teams were well trained. 

This deficit of trust underlines the necessity of thorough selection and thorough training of peer supporters. The method of selecting peer team members has a high impact on the credibility and efficiency of the team. The most usual methods are either volunteering or recruitment, though some departments have been innovative in starting a sort of nominating process. 

Overcoming the Confidentiality Challenge 

Maintaining confidentiality is essential to the continuation and success of a peer support team. No sooner can one's credibility be destroyed than by word coming out that the conversations are not private. 

This is especially true in smaller departments where firefighters may be reluctant to interact with someone on the job that they already think they know too much about. In smaller departments in particular, individuals know one another well, at least reputation-wise. These preconceptions can influence an individual's willingness to interact and be open with a specific person. 

Implementing Comprehensive Wellness Programs

Beyond Crisis Response: Proactive Mental Health Support 

Whereas Critical Incident Stress Management (CISM) units have responded traditionally to unique traumatic events, peer support has something more complete. This is not to say that firefighter peer support replaces CISM teams, but it must complement them. Following a critical incident, CISM units are typically asked to respond within 24 to 72 hours, and typically for one session. 

Peer support groups may be used in conjunction with CISM groups and provide an option for firefighters to gain support on their own time beyond the group setting. Peer support groups may also proactively address responders who are having issues not related to an incident, including family matters, money problems, stress and anxiety, and substance abuse. 

The Four Pillars of Firefighter Wellness 

Every department leader's objective should be a healthy, happy workforce, and the key to achieving that is with a solid wellness program on four pillars: physical health education, behavioral health education, suicide prevention education and firefighter peer support services. 

This comprehensive perspective acknowledges that firefighter mental health goes beyond response to emergency incidents—it includes the entire range of work and life stressors that are experienced throughout a career in the fire service. 

The Future of Firefighter Mental Health: Innovation and Integration 

Technological Advances and Program Development 

The terrain of firefighter mental health assistance is changing. Behavioral health units,  something previously reserved for large city departments such as New York and Boston, are now becoming more prevalent in smaller and mid-sized fire departments. As units become more prevalent, fire departments are adopting new treatment models to reduce stigma. 

Over the past five years, the International Association of Fire Fighters has implemented programs that have certified thousands of firefighters in peer support methods. Independently, in California, a new law will expand confidentiality legislation to peer

supporters and strengthen training for peer support programs at all levels of the fire service. 

Regional Networks and Collaborative Solutions 

Regional peer support networks may be one solution to this problem. For instance, the Ohio Association of Professional Firefighters has created this type of regional network, and the Texas State Association of Firefighters has a corresponding network, as do other states and regions in the nation. 

These regional solutions work around resource constraints while offering the specialized support that smaller departments may not be capable of delivering in isolation. 

Overcoming Implementation Challenges 

Resource Allocation and Sustainability 

Interview participants who indicated that they borrowed mental health program strategies from elsewhere did so, at the very least partially, to prevent "recreating the wheel" and indicated that they gained advantage from the commonality of information. 

The fact is that every department does not possess an identical amount of resources. Other participants indicated that volunteer or part-time firefighters in rural settings typically do not have health coverage or adequate mental health coverage and thus have few treatment options. 

The Value of Leadership Support 

Examples mentioned in interviews ranged from first responders who helped establish a peer support team within their agency or who served in a leadership capacity and advocated for mental health during their time in service. Leadership support at every level, from company officers to fire chiefs - becomes critical to the success of the program. 

The MyOmnia Approach: Holistic Wellness for First Responders

Organizations such as MyOmnia are at the forefront of holistic models for first responder mental health that combine peer support with evidence-based models of wellness. By addressing the seven wholeness domains; Physical, Mental, Social, Spiritual, Purpose and Meaning, Fun and Relaxation, and Vocational and Financial - these programs cover the entire spectrum of influences on firefighter well-being. 

This trauma-informed model acknowledges that while peer support is important, it needs to be part of an overall strategy involving readiness assessment, resilience training, and professional mental health services specially trained to serve first responders. 

Moving Forward: A Call for Comprehensive Action 

The facts are evident: peer support initiatives are a crucial element in solving the firefighter mental health emergency. Yet, their success relies on effective implementation, sufficient training, good leadership support, and alignment with overall wellness programs. 

Through emotional support aside from the conventional medical system, peer support cuts directly into the fire service's culture of silence that has too often led to compounding mental illness and suicide. 

As one of the peer supporters so eloquently put it: "Part of MnFIRE's process is bringing you together with similar people or getting you in touch with a person who has walked in your shoes. Although I'm the peer supporter, the bond goes both ways for me. The fire service is different and not easily explained to people outside of it and this is an excellent time for our service to be a single big family." 

The way forward involves a long-term commitment from fire service leadership, sufficient funding to support training and program development, and ongoing research to continue to refine and enhance these life-saving interventions. Perhaps most importantly, it requires cultural change—a shift from viewing seeking help as a weakness to seeing it as a strength, an act of courage that allows firefighters to keep serving their communities while maintaining their own mental health and well-being. 

The stakes couldn't be higher. Each firefighter protected from suicide, each case of PTSD avoided or treated, and each career saved through strong peer support is not only individual healing but also more resilient fire departments and safer communities. The question isn't whether we can afford to invest in full-range peer support programs, it's whether we can afford not to.

References 

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https://www.apa.org/members/content/firefighters-mental-health 

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