The Center for Public Safety Excellence and the IAFC’s Metro Chiefs section partnered to develop a series highlighting proven practices of Metro departments accredited by CPSE’s Commission on Fire Accreditation International. Developed by the CPSE Center for Innovation staff, each case study outlines the opportunity the agency faces, the actions they took, the outcomes of their efforts, and provides tips for replication.
A recent article in the iChiefs quarterly magazine details the critical role of the “human” within the emergency services, stating that “regardless of the situation there will always be a human somewhere in the . . . system.” This expands into two important points: emergency response will continue to depend on people; and those people will be exposed to response-related stressors for which they will need support to remain healthy and effective.
With this in mind, every fire department that develops a behavioral health support system for its members should recognize that it’s goal is to provide comprehensive support to its personnel. That is the thought process behind the model that Miami-Dade Fire Rescue has been developing for its members over the past several years, following a catastrophic event where the fire department remained on scene for more than a month.
The opportunity
Just before one-thirty in the morning on June 24, 2021, a twelve-story condominium tower in the Town of Surfside Beach collapsed because of a basement-level structural failure.
The Champlain Towers South collapse killed 98 people, and there were only 4 rescues from the rubble. In the section of the building that suffered less damage, MDFR was able to rescue 35 people in the hours that followed its initial response. This response stretched into days and then weeks, with the last of the 98 victims being recovered 27 days after the collapse.
While this was a single incident, the department recognized that this was a potentially catastrophic event for many of the personnel who responded to and operated during the rescue and recovery. And, while the department had been offering Critical Incident Stress Management (CISM) to all personnel for years, a series of suicides of active members around the same time as the Surfside collapse identified gaps in the department’s provision of behavioral health services.
The action
As a fire service-identified leader in supporting members’ health and wellness, MDFR recognized that any efforts toward improving its support of its personnel would not be linear and would require a “multi-pronged” approach to de-stigmatize and then normalize seeking behavioral health care – that is: create a community of openness that would allow members to seek and receive help as needed.
To do this the department took a few crucial steps, some of which are ongoing:
- Assessed and analyzed current behavioral health processes/practices.
- Researched industry best practices as guides: National Fire Protection Association (NFPA) 1500, Standard on Fire Department Occupational Safety, Health, and Wellness Program, 2021 edition and The International Association of Fire Chiefs (IAFC) and International Association of Fire Fighters (IAFF) Fire Service Joint Labor Management, Wellness Fitness Initiative, 4th edition
- Established a collaborative relationship with community partners including other public safety agencies, as well as behavioral health experts.
- Received top-down support from the department’s senior leadership, demonstrated by:
- Creation of a Health and Safety Division
- Establishment of an Employee Wellness Office (EWO), which includes a clinical coordinator to ensure personal privacy and care continuity.
- Restructured the existing Peer Support Program and formalized and better documented the scope of training received by personnel.
- Hosted a series of “town hall meetings” to receive feedback and information concerning the emotional needs of all personnel.
- Conducted (ongoing) “fire station wellness checks,” which involve staff from the EWO visiting all of the department’s stations, across all three shifts, which serves as both a way to provide information and answer questions in a familiar, comfortable setting.
The outcome
MDFR has completed much of the work to establish new programs, offices, and divisions in support of the behavioral health of its members, and the department remains committed to two fundamental ideas: we care about our people and privacy is paramount.
The department is just beginning to collect and analyze data and statistics related to its provision of wide-ranging behavioral health resources. Currently these are broadly assessed by gathering simple to collect metrics, such as the number of individual users, the total number of contacts made, and the number of phone calls received. As they are able, staff also breaks these data down by the type and kind of the request, the reported issue/concern, and the potential scope of the need.
As with the ongoing station wellness checks, the EWO has continued to push information and training to all staff, to ensure that all personnel are aware of the department’s resources, as well as providing training for personnel. Initiatives and courses have included:
- Applied Suicide Interventions Skills Training (A.S.I.S.T.)
- Suicide Gatekeeper - Question, Persuade, Refer (Q.P.R.)
- Conflict Resolution Seminar
- Yoga for First Responders
- A series of Mental Health Resiliency Classes
- Mental Health First Aid
- CISM/Peer Support training
- Motivational Interviewing
Tips for replication
- MDFR offers these points to consider for any department seeking to improve or begin offering behavioral health resources for its personnel, but emphasizes that ongoing, consistent support is the metric by which any fire department should measure its efforts toward behavioral health:
- Research industry best practices.
- Conduct a needs assessment. Each department should conduct an analysis on what it provides currently, how that is used/perceived by personnel. This assessment may include a Strengths, Weaknesses, Opportunities, Challenges (SWOC) analysis or a similar guided exercise.
- Ensure consistent support from local government, elected officials, the department’s senior staff members and other local non-governmental organizations. This work will help minimize issues/pushback later.
- Work constantly and consistently to de-stigmatize seeking and using behavioral health resources. MDFR, even with its history of health and wellness support, still recognized a huge cultural shift needed to occur within the department. Using peer support members and allowing fellow firefighters to serve as ambassadors for its mental health initiative has helped.
- As a program develops, identify staff needs. There are specialized skills a department may have to hire to fill. Specifically, this may be a care coordinator who serves as a primary point of contact for personnel seeking care and who can assist in managing complex bureaucratic processes.
Additional resources
Shaughn Maxwell, “Leveraging Human Performance and Mitigating Stress Across the Response Continuum,” iChiefs, The Official Magazine of the International Association of Fire Chiefs, March 6, 2024.
