Mental Health Awareness and National EMS Week

May marked two important national awareness campaigns: Mental Health Month and National EMS Week. This month’s CPSE newsletter sought to highlight both of these campaigns.

What’s in this newsletter?

First, you will find two stories on mental health programs: one on a specific program developed by one fire chief who sought to help his colleagues, and one on what our friends in Canada have implemented to meet their need.

Then, you will find a highlight on National EMS Week. This highlight discusses what National EMS Week is and how CPSE is involved.

One CFO’s Campaign

In recent years, the job of the firefighter has changed dramatically. According to the 2015 National Volunteer Fire Council (NVFC) suicide reportSuicide in the Fire and Emergency Services, the profession has transitioned from mainly fire suppression response to calls that include a multitude of crises situations. The Council explains “firefighters are faced with emotional needs that are very unique,” and these firefighters require a support system that is easily available as well as professionals who are qualified and can understand their circumstances.

To do this, the fire and emergency services industry must not only change the way mental and behavioral health is viewed, but also dive into a culture change. This change in culture begins at home, in individual departments. Paul Bourgeois, Fire Chief of Superstition Fire & Medical District (SFMD) in Arizona, discussed with us the system his department is implementing to support employees in their struggles with behavioral health.

Developing a Program

An organizational tragedy at his previous department sparked the desire to develop such a program, called You’re Not Alone (YNA). “We lost a brother in my former organization,” Chief Bourgeois states, “That’s when my friend and I developed YNA. I don’t ever want a firefighter to think they’re alone or there’s no one to turn to.” There are often feelings of shame or guilt when one struggles with mental health, but, as the NVFC states, it is important to stop perpetuating the idea that those who commit suicide are weak or have taken the “easy way out”. “When people are broken,” Chief Bourgeois explains, “we don’t know how to respond.”

But respond is exactly what Chief Bourgeois sought to do.

Upon developing the program in 2011 for the department he was with at the time, Mesa Fire Department, Chief Bourgeois and a friend trained the department’s 450 firefighters in the program. “YNA was an honest and upfront program that brought the issues of firefighter post-traumatic stress disorder (PTSD), suicide, and behavioral health out in the open,” Chief Bourgeois explains. Open discussions of stereotypes and case studies allowed individuals to relate and helped them to internalize the message. “We made it okay to discuss this subject matter,” Chief Bourgeois states, “we made it okay to admit when you’re not okay.”

He then brought that program to SFMD to work with the launch of their first behavioral health program.

Over the course of several years, SFMD worked on developing the foundation for their program. “The effort included recruiting a Fire Chaplain, starting a Peer Support Team, and identifying professional external counseling resources,” Chief Bourgeois told us. However, not just anyone could fill these positions; serious thought was given to who would hold these positions of intense trust. “We knew if we hired the wrong person,” Chief Bourgeois explained, “it could spoil the credibility of our program.” Department members were vital to making these decisions: to develop the Peer Support Team, department members were asked to identify the most trusted and respected organizational members. Those members were then not only brought on to be part of the Team, but then were sent to obtain the best possible training.

This program echoes the Triangle of Hope, developed by Counseling Services for Firefighters, LLC, that NVFC highlights in their 2015 suicide report: clinicians, senior officers, and peer group. Building these relationships and breaking barriers are important in ensuring firefighters are able to safely and confidently manage their mental health. Chief Bourgeois has observed, “the more options employees have, the more likely they are to reach out to one of them.” The resources are also displayed prominently at every District facility, making them readily available.

How do we know these programs are worth it?

“When we launched YNA and shared all our new resources with our employees we saw a big spike in members reaching out,” Bourgeois says. Although names remained confidential, behavioral health providers were able to contact the department to let them know members were contacting them. “We also had several people just come to us and tell us they were reaching out for help,” Bourgeois states. “It was as if people weren’t afraid to admit it anymore. We were very supportive and encouraging, and we’ve had a lot of great feedback from our people.”

While anecdotal feedback, or qualitative feedback, is valuable, data is important in the fire and emergency service industry. Data doesn’t lie.

However, in a March 2012 article “Quantifying firefighter suicide” for Fire Rescue1, Jeff Dill, founder of Firefighter Behavioral Health Alliance, notes that solid data on firefighter suicide numbers is not available. This in itself speaks to the long way the industry has in recognizing the problems of behavioral health. “One of my goals is to begin in the academies,” Dill explained.

Lack of data aside, it is apparent that these programs are needed and are helping those who use them.

Ensuring a Safe Future

Behavioral health will continue to be a concern in the fire and emergency service industry, and it will be a growing concern as it becomes acknowledged more and firefighters continue to seek help. Chief Bourgeois says, right now, “there’s a shroud of doubt because employees don’t inherently know how an organization and its leadership will react when someone has a behavioral health challenge to work through.” It’s important to show your employees you care. Bourgeois believes, “it means a lot to an employee when the employer steps out and communicates support for the behavioral health of its people.”

When behavioral health is acknowledged as an important component, so many other doors are opened. “If you clearly articulate that you care for your people,” Chief Bourgeois explains, “that you are willing to stand behind them while they work through their life challenges, then you’ve opened the door for improved communication and trust.”

It is human nature to want to fix what is broken, but there are certain things, such as behavioral health, that can be daunting to fix. Chief Bourgeois speaks to this: “Imagine if our system for fixing people was comparable to the process we use to fix apparatus. A broken fire truck doesn’t stay broken if you get it in the shop and get it the attention it needs. It doesn’t stay broken because you have trained professionals working on it. People are the same way. They’ll stay broken if no one intervenes.”

We can see behavioral health programs are vital to ensuring firefighters remain the resilient heroes their communities see them as. Without these programs, there is no outlet for the professionals who devote their time, energy, and soul to ensuring the safety of their communities. The industry is a family, and family looks out for each other. The most important message is this: remember you are not alone.

“It’s okay to admit you’re busted up and broken and that you need help,” Chief Bourgeois pleads. “You’re not alone and people want to help you. If all else fails, call me and I will help you.”

To report a firefighter suicide, report how a firefighter suicide has affected you, to complete their self-assessment, or to learn more about the Firefighter Behavioral Health Alliance (FBHA), visit their website.

How Agencies are Making a Difference

We have looked at how one individual can make a difference in the lives of many and be a change agent to the way the fire and emergency services approach mental health. It is clearly important to have behavioral health resources and programs available to personnel. These individually-developed and implemented programs, though, differ in approach from programs implemented at a higher level. Countries, too, have diverse ways of approaching mental health.

Chief Steve Dongworth and Nancy Snowball of the City of Calgary Fire Department, a CFAI accredited agency, provided insight into Canada’s behavioral health program: the Road to Mental Readiness (R2MR). This program was developed by the Department of National Defence to promote resilience and provide mental health training.

The Program

There are two tracks available for the R2MR training program: employee and leadership. The goal of the employee track is to improve short-term performance and long-term mental health outcomes while reducing barriers to care and encouraging early access to that care. The goal of the leadership track is to provide resources to manage and support personnel experiencing behavioral health concerns and assist supervisors in maintaining their mental health while promoting positive mental health in their employees.

Nancy Snowball, who is leading the CFD’s mental health strategy, told us more about the program: “it was developed by the Canadian Armed Forces for its members, then adapted for civilian police by the RCMP, and then for urban police by the Calgary Police Service.” According to Snowball, “CFD was the first to adapt it for use in the fire service.”

In her May 2016 article for Firefighting in Canada, Laura King explains “most fire-service leaders have no idea how to help a firefighter or colleague who is experiencing more stress than he or she can handle.”

R2MR seeks to be the answer. Snowball stated “the objectives of the training are to increase knowledge about mental health and illness, decrease the stigma attached with seeking help, build personal resiliency, and raise awareness of local resources.”

Addressing the Problem

Chief Dongworth explained that an increase in PTSD claims and member suicide prompted the urgency of integrating the R2MR program in his department. Snowball stated that, while there have been pieces of a behavioral health program in place for years, “in 2014, we decided to look at what could be done on the mental health promotion/injury prevention end of the continuum.”

According to the Mental Health Commission of Canada (MHCC), 45 percent of the Canadian population has the possibility of experiencing some form of mental illness. King cites additional startling numbers from the World Health Organization (WHO) that predict depression will be the number two health condition in the world by 2030. Add in the general nature of the fire and emergency service profession and the stigma surrounding mental illness, and the chances for these professionals to suffer these silent demons is serious.

CFD began piloting R2MR in late 2015-early 2016, according to Snowball, and began to roll it out in mid-2016.

Workload, work-related stress, and work-life management can have a negative impact on not only the physical but also mental health of first responders. One barrier to receiving care and seeking help is the stigma associated with behavioral health. However, R2MR provides good news: mental health concerns can be turned around if identified and treated early; employees who begin to understand stress management can become more resilient, thereby embarking on a path to recovery from their trauma; and individuals can be instructed on how to recognize changes in their own behavioral health.

“I consider programs like R2MR a good way to set a baseline of knowledge across all staff,” said Snowball, “and provide some common language that can be used to describe either their own situation or their concern for others.” However, the overall strategy, Snowball elaborated, is to look at services that are available to members and see if those services meet the current need or if there is more that could (or should) be offered.

Chief Dongworth explains that, in addition to R2MR, peer-based programs and access to psychologists and couples retreats for resilience in relationships are also in place to assist personnel in their struggle with mental health concerns.

“I think it is a good idea for organizations to take a look at the variety of resiliency and capacity-building programs that are available and consider what would work for them,” Snowball stated. “There is a real appetite to address mental health and ill-health in a meaningful way.”

The Impact

As with any information with mental health, the impact can be difficult to measure, simply because confidentiality is key to the success and continuation of mental health support programs. Chief Dongworth, however, said his department has received “significant positive feedback for the R2MR program.”

“We are embedding mental health and safety in our policies,” Snowball stated, “establishing an employee advisory committee to provide regular input, and are tying into mental health awareness campaigns in the community where there is a fit.”

“Anecdotally,” Chief Dongworth explained, “we know that many feel more supported.”

Finding Resources

As our stories have shown, having resources is vital in managing mental health concerns and serve as the first step in overcoming struggles. For resources or information, visit any of the following:

National Fallen Firefighters Foundation

National Volunteer Fire Council

International Association of Fire Fighters

International Association of Fire Chiefs

National Programs on Suicide

Substance Abuse and Mental Health Services Administration

National Center for PTSD

National EMS Week

Sunday, May 21 marked the beginning of National EMS Week and presented an opportunity to honor the men and women who deliver pre-hospital emergency medical care throughout the United States. This vital public safety service is provided primarily by cross-trained, multi-role emergency responders based in fire departments.

The fire service has a rich history of protecting the health and safety of our communities through an emergency response model that includes the delivery of pre-hospital emergency medical care. Fire service-based EMS providers are trained, equipped, and positioned to provide their communities with timely emergency medical care as well as, more recently, Integrated Community Health Care (ICHC) services. Firefighter/EMTs and paramedics respond quickly, professionally, skillfully, and compassionately in communities across the United States 24/7.

At Fire-Rescue-Med, CPSE’s Rick Fagan presented to audience members on “Taking Your EMS Program from Status Quo to Excellence.” This message challenged attendees “to consider whether their EMS program was one where day-to-day activity was conducted in a stagnant status quo environment,” Fagan stated, “or whether their EMS program was one where a dynamic process of continuous improvement was the norm.” Particular emphasis was placed on the importance of community risk assessment, self-assessment, community driven strategic planning, and using Performance Indicators and Core Competencies in multiple CFAI Model Categories and Criteria so quality and improvement can be measured.

In addition, Naperville Fire Department (IL), a CFAI-accredited agency, was awarded the Heart Safe Community Award. This award recognizes fire service-based EMS, and other EMS systems, who use creative approaches to implement and maintain systems to not only treat but also prevent cardiac-related disease within their community. According to the conference attendee booklet, “the Naperville Fire Department has implemented an aggressive campaign of bystander CPR training and public AED placement to improve rapid intervention for sudden cardiac arrest patients.” Additionally, since 2010, NFD’s Community CPR program has trained over 4,200 individuals in bystander CPR and has worked to place AEDs in all NFD vehicles. Additionally, NFD utilizes PulsePoint Respond to notify CPR/AED-certified individuals, of which NFD reports having 1,300 enrolled residents, of a nearby cardiac arrest.


CPSE has a new portal!

Now, you can not only purchase CPSE merchandise online, pay designation and registered agency fees, and register for events, but you will also have an enhanced experience when updating your contact information and resetting your password.

The new portal can be accessed here. A brief overview of how to use the new portal can be found here. All links on the CPSE website have been redirected to the new portal.

To gain access to the system, click on the “Forgot your password?” link, and use the email address you have on file as the Login ID to generate a new password. A follow-up email will be sent with instructions to reset your password.

If you have any questions, contact us at or 703-691-4620. Our office is open 8:30 – 4:30 EDT.

Coming Up

CPSE has several workshops scheduled over the next few months. Register today to reserve your seat at any workshop that meets your needs. Please pass these dates and locations on to colleagues at adjacent fire departments to help us promote these excellent learning opportunities.

For course details and registration, go to our Workshops & Events page.

June 12, 2017
Quality Improvement Through Accreditation
Calgary, AB

June 19, 2017
Quality Improvement Through Accreditation
Murfreesboro, TN

June 19, 2017
DoD Only: Quality Improvement Through Accreditation
Souda Bay, Crete

July 12, 2017
Quality Improvement Through Accreditation
Blue Springs, MO

July 18, 2017
DoD Only: Quality Improvement Through Accreditation
Goodfellow AFB, TX

September 5, 2017
DoD Only: Quality Improvement Through Accreditation
Scott AFB, IL

September 18, 2017
Nurturing Fire Service Leaders Through Mentoring
Charlotte, NC

September 19, 2017
Quality Improvement Through Accreditation
Dayton, OH

October 5, 2017
Exceeding Customer Expectations
Germantown, WI