Implementation of the Enhanced Stress First Aid Program in the Fire Service A Case Study
Article Sidebar
Main Article Content
Abstract
Background: Behavioral health is a critical issue in the fire service, with firefighters facing high rates of depression, PTSD, and substance misuse due to repeated trauma exposure. Stress First Aid (SFA), a peer-support intervention adapted from the Marine Corps’ Combat and Operational Stress First Aid framework, offers a promising approach to firefighter mental health. Methods: A mixed-methods evaluation of the Enhanced SFA program (ESFA) assessed implementation, effectiveness, and acceptability through in-person pilot sessions, beta tests, and an online program. Surveys were conducted pre- and post-training, and at 3- and 6-month follow-ups to measure usability, satisfaction, skill application, confidence to intervene, and perceived organizational support. Results: Of 1,500 enrollees, 1,199 completed initial assessments. Participants strongly endorsed ESFA’s relevance and format, with 83% intending to apply learned skills. Confidence to intervene improved from 77% at baseline to 90% at 3-month follow-up. Perceived organizational support also increased. While statistical analysis was limited to descriptive methods due to attrition, the results suggest meaningful engagement with training. Conclusion: ESFA demonstrated high usability and potential for strengthening peer support and intervention confidence. Additional research is needed to assess long-term outcomes, but ESFA offers a scalable foundation for firefighter behavioral health initiatives.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and Permissions
Authors retain full copyright for articles published in JMDE. JMDE publishes under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY - NC 4.0). Users are allowed to copy, distribute, and transmit the work in any medium or format for noncommercial purposes, provided that the original authors and source are credited accurately and appropriately. Only the original authors may distribute the article for commercial or compensatory purposes. To view a copy of this license, visit creativecommons.org
Funding data
-
Movember Foundation
Grant numbers FRCE-2022-0007
References
Anderson, G. S., Di Nota, P. M., Groll, D., & Carleton, R. N. (2020). Peer support and crisis-focused psychological interventions designed to mitigate post-traumatic stress injuries among public safety and frontline healthcare personnel: A systematic review. International Journal of Environmental Research and Public Health, 17(20), 7645.
Campbell, R., & Molis, J. L. (2022). Firefighter injuries on the fireground. National Fire Protection Associaton: Quincy, MA, USA. https://www.nfpa.org/news-blogs-and-articles/nfpa-journal/2024/03/12/firefighter-injuries-report
Carey, M. G., Al-Zaiti, S. S., Dean, G. E., Sessanna, L., & Finnell, D. S. (2011). Sleep problems, depression, substance use, social bonding, and quality of life in professional firefighters. Journal of Occupational and Environmental Medicine, 53(8), 928–933.
Corneil, W., Beaton, R., Murphy, S., Johnson, C., & Pike, K. (1999). Exposure to traumatic incidents and prevalence of posttraumatic stress symptomatology in urban firefighters in two countries. Journal of Occupational Health Psychology, 4(2), 131.
Davis, F. D. (1989). Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly, 319–340.
Edwards, D. L., & Wilkerson, N. D. (2020). Emotional exhaustion and its relationship with suicide risk in emergency responders. Psychiatry Research, 293, 113379.
Eisenberger, R., Huntington, R., Hutchison, S., & Sowa, D. (1986). Perceived organizational support. Journal of Applied Psychology, 71(3), 500.
Fahy, R., Evarts, B., & Stein, G. (2022). US Fire Department Profile 2020.
Fallon, P., Jaegers, L. A., Zhang, Y., Dugan, A. G., Cherniack, M., & El Ghaziri, M. (2023). Peer support programs to reduce organizational stress and trauma for public safety workers: A scoping review. Workplace Health & Safety, 71(11), 523–535.
Groves, R. M., & Peytcheva, E. (2008). The impact of nonresponse rates on nonresponse bias: A meta-analysis. Public Opinion Quarterly, 72(2), 167–189.
Holmbeck, G. N., & Leake, C. (1999). Self-efficacy for interpersonal interactions: Development and validation of a measure. Journal of Counseling Psychology, 46(3), 313–325.
Iverson, K., & Colky, D. (2004). Scenario‐based E‐learning design. Performance Improvement, 43(1), 16–22.
Jahnke, S., Poston, W., Haddock, C., & Jitnarin, N. (2013a). Obesity and incident injury among career firefighters in the central United States. Obesity, 21(8), 1505–1508.
Jahnke, S., Poston, W. S. C., Haddock, C. K., & Murphy, B. (2016). Firefighting and mental health: Experiences of repeated exposures to trauma. Work, 53, 737–744.
Jahnke, S. A., Poston, W. S. C., Haddock, C. K., & Jitnarin, N. (2013b). Injury among a population based sample of career firefighters in the central USA. Injury Prevention, 19(6), 393–398.
Jahnke, S. A., Watson, P., Leto, F., Jitnarin, N., Kaipust, C. M., Hollerbach, B. S., Haddock, C. K., Poston, W. C., & Gist, R. (2023). Evaluation of the implementation of the NFFF stress first aid intervention in career fire departments: A cluster randomized controlled trial. International Journal of Environmental Research and Public Health, 20(22), 7067.
Kirkpatrick, D., & Kirkpatrick, J. (2006). Evaluating training programs: The four levels. Berrett-Koehler Publishers.
Klinger, T., Tschabuschnig, K., Hoffland, M., Ratheiser, V., & Kreiter, C. (2021). Remote training for firefighter group commanders. Educating Engineers for Future Industrial Revolutions: Proceedings of the 23rd International Conference on Interactive Collaborative Learning (ICL2020), Volume 1 23. Springer.
Millegan, J., Delaney, E. M., & Klam, W. (2016). Responding to trauma at sea: A case study in psychological first aid, unique occupational stressors, and resiliency self-care. Military Medicine, 181(11–12), e1692–e1695.
North, C. S., Tivis, L., McMillen, J. C., Pfefferbaum, B., Cox, J., Spitznagel, E. L., Bunch, K., Schorr, J., & Smith, E. M. (2002). Coping, functioning, and adjustment of rescue workers after the Oklahoma City bombing. Journal of Traumatic Stress: Official Publication of the International Society for Traumatic Stress Studies, 15(3), 171–175.
North, C. S., Tivis, L., McMillen, J. C., Pfefferbaum, B., Spitznagel, E. L., Cox, J., Nixon, S., Bunch, K. P., & Smith, E. M. (2002). Psychiatric disorders in rescue workers after the Oklahoma City bombing. American Journal of Psychiatry, 159(5), 857–859.
Proudfoot, S., Hales, T., Struttmann, T. W., Guglielmo, C., Ridenour, M. L., & Noe, R. S. (2006). Fatalities among volunteer and career firefighters—United States, 1994–2004. Morbidity and Mortality Weekly Report, 55(16).
Score, N. P. (2018). Net Promoter Score. Work, 10, 10.
Sliter, M., Kale, A., & Yuan, Z. (2014). Is humor the best medicine? The buffering effect of coping humor on traumatic stressors in firefighters. Journal of Organizational Behavior, 35(2), 257–272.