Managing and reducing firefighter stress – a policy-based approach

As firefighters, we are often touted as brave and resilient, sometimes even heroic. But behind the scenes, there is often a different story. Behind those big red firehouse doors and in the privacy of our homes, we sometimes struggle to cope with our stress.

The 2023 What Firefighters Want survey sought to better understand firefighter stress levels, what members are doing to manage their stress, plus what fire departments are doing to help curb member stress.

With 64% of firefighters reporting their stress level as a 7 or higher on a scale of 1-10, it’s clear that stress management is – or should be – a critical issue for individuals and fire departments alike. Unfortunately, when digging into the stress-focused data, some alarming patterns emerge.

Individual stress management

Perhaps the most alarming stress-related statistic: When asked to select from a list of work-related activities they have employed in the past 3 years to manage stress, 41% of survey respondents selected “none of the above.” But why? Today’s firefighters have more stress management tools available to them than ever before.

Failure to manage or reduce stress in the workplace is like a ticking timebomb. Left untreated, job-related stress can lead to depression, withdrawal, substance abuse, relationship discord, even suicide. In fact, firefighters are more likely to die from suicide than in the line of duty. These deaths are preventable through appropriate stress-reduction techniques. (I encourage you to review the Firefighter Behavioral Health Alliance White Paper “Wounds of the Spirit: Moral Injury in Firefighters” and the IAFC VCOS Yellow Ribbon Report “Under the Helmet: Performing an Internal Size-Up” for additional information.)

For some, the first step in reducing stress is accessing the programs available to them. Techniques and tools for managing stress include physical fitness programs and equipment, employee assistance programs (EAPs), peer support, and conversations in both formal and informal settings. The key is their implementation and use. A department could have state-of-the-art fitness equipment, access to peer support and EAP, and a policy for after-action reviews, but if its members aren’t using them, they provide no benefit.

In some departments, these tools and programs are available but go unused because there isn’t clear direction on how, when or why to use them. Making the jump from having the tools to using the tools may require some cultural change, and that change should be supported by policy. A set of comprehensive firefighter health and wellness policies can pave the way to lower stress and improved behavioral health in your department. This all-encompassing approach can provide direction on everything from healthy food choices to stress reduction concepts and resources.

Let’s consider some of the various behavioral health programs, activities and offerings that could be addressed through policy.

Physical fitness

Departments should allow on-duty time for physical fitness. This can include a structured program, such as the one from the Fire Service Joint Labor Management Wellness Fitness Initiative, or a self-paced exercise plan. It is important to outline any restrictions to help prevent physical injury and to maintain readiness and response times, but firefighters need dedicated time and equipment available for exercise during their shifts.

Critical incident stress debriefing (CISD)

As concerning as it is that so many firefighters are doing nothing at work to combat stress, there is some good news in the survey results. Nearly 55% of respondents said they have access to a critical incident stress debriefing (CISD) program. CISD is intended to provide education and emotional support in a group setting, following exposure to or involvement in a traumatic event. When used properly, CISD can help firefighters process these events, thereby reducing some of their stress. However, not all incidents are considered traumatic or critical, so department leaders need to ensure that firefighters are processing other operational stress in healthy and effective ways.

After-action review (AAR)

While CISD is used to help firefighters process significant traumatic incidents, post-incident analysis (PIA), better known by some as an after-action review (AAR), is another helpful tool that can help lower stress following any incident and can be conducted immediately, if needed. When asked what they were doing to combat stress, 38% indicated that they had increased communication with fellow firefighters, and 22% said they had engaged in more AARs or debriefings. Both techniques are effective in reducing stress because, as researchers have found, “talking it out” helps us to clear our minds.

AARs and PIAs give responders an opportunity to discuss the details of an incident from all angles and allow firefighters to hear about what was going on outside of their purview. During a call, firefighters are often focused on the task they are assigned and may be unaware of other operations going on and decisions being made on scene. Many firefighters have questioned why something did or did not occur at a call, only to find out later that there was more to the story than they knew. In addition to being a training opportunity, these sessions can serve as a means to clear the air and inform personnel of the big picture.

There are various PIA and AAR formats available, but most are intended to generate discussion and answer key questions: What occurred, what was done, what went well, what didn’t go well, and what can be improved? They are not intended to place blame or to ridicule, but instead to improve safety, efficiency and service delivery. AARs can be conducted for large-scale incidents as well as single-company responses. For smaller groups, the discussion can be informal and often happens at the kitchen table, in the apparatus bay, or at the back step of the rig before leaving the scene. When choosing where to conduct the process, officers should ensure that the location is not within earshot of the general public.

If needed, an informal tailboard talk can happen at the company level and be followed by a more formal review. In order for an AAR to be effective following a large-scale incident, the officer in charge or incident commander should prepare for it. This may mean that the full-scale AAR happens at a later date and if that’s the case, an informal debriefing or review should occur at the company level before anyone goes home. This helps reduce stress and might expose a mental or behavioral health risk in enough time to prevent further harm.

Some members aren’t comfortable opening up in a group setting. It can still be beneficial for these members to be present for AARs. Even if someone isn’t a talker, they might find relief in hearing other people talk about things and they may identify with their peers’ words.

Comprehensive wellness services

Aside from the stress that firefighters accumulate on calls, a significant amount of organizational stress occurs due to the nature of the business, and there aren’t always clear-cut solutions. Regardless, having stress acknowledged can be a relief in and of itself.

Almost 54% of surveyed firefighters indicated that they believed that their department leadership recognizes the stressors faced by members, and 50% responded that their department provides useful behavioral health support services. There is room for improvement here, and that improvement can be addressed in a comprehensive wellness program.

Peer support

Both formal and informal peer support can be effective at reducing and managing firefighter stress and preventing stress-related harm. Formal peer support programs are designed to provide mental and emotional support to fire service personnel and are not limited to critical incidents. Some firefighters are more comfortable speaking with a trained peer than they would be in a group setting or with a mental health professional. Non-traumatic work-related and personal stress still need to be dealt with and peer support can be an excellent resource here.

Peer support programs should be backed by policy that outlines how the programs are administered and how peer support team members are selected and trained. Peer support team members must be selected and trained based on their experience, leadership qualities, trustworthiness, and ability to understand mental and behavioral health concepts. Wellness coordinators should ensure that the right candidates are assigned to the team and that their participation in the team is voluntary. Ordering a member to be on the peer support team is not a good practice, even if they seem like a strong candidate. This is not the place to force a person into something they aren’t comfortable with.

EAP

Aside from in-house programs such as peer support, CISD and AARs, nearly 70% of respondents reported having access to an EAP, but only half reported trusting the program. Programs that relate to members’ behavioral and mental health are ineffective if they are not trusted. Mental and behavioral health are highly personal, and employees may sense that they are putting a lot at risk by opening up to an EAP practitioner. EAPs need to be backed by policy, and it must be clear that EAP communication is confidential with limited exceptions as required by law. EAP must never be used punitively or as a corrective measure and that needs to be made clear to all employees. Department leaders should audit their EAP programs to ensure that the EAP provider is equipped to deal with first responder stress and mental health. Just because the provider claims to specialize in first responder wellness does not mean that they are experienced in it.

What firefighters want to help reduce their stress

When asked what changes to their jobs would best reduce their stress, many respondents said they want better support from their leaders – support that can be both formal and informal. One respondent – a company officer in a suburban career department – shared that his operations chief only visits the station when something is wrong, but never stops to say hello or to support the crew. He said, “I’m not looking to be coddled and hugged to death. I would be happy with an occasional ‘well done.’”

Another response echoed that sentiment: “They can start to care about the employees and try to show it. Saying hi would be a good start.”

Formal and in-person employee reviews are important and effective, but informal visits can serve to provide a comfortable and personal environment.

Additionally, many firefighters indicated that a change in leadership would be effective. Toxic leadership is a major contributor to workplace stress, and a change in leadership can help to alleviate toxicity but not without clear communication.

Other firefighters reported wanting clear expectations. Without clear expectations, members are left to figure them out on their own and this adds stress to an already stressful job. As such, leaders need to communicate expectations clearly.

If you are in a leadership position, take time to develop a leadership statement or command philosophy that establishes your expectations and values as a leader. You don’t have to be the fire chief to do this; this can be done by a captain or lieutenant. If you are a fire chief, however, this can be put into policy. This can serve to put your members at ease and reduce their stress level. By outlining your expectations, you relieve them of that responsibility. This can also serve to reduce stress for the leader because their expectations are known.

Another key point: Departments need to have policies prohibiting bullying and harassment. This conduct is both toxic and contagious. If you foster an environment where bullies aren’t held accountable or are somehow rewarded, people might respond to that by joining the “winning team.” Harassment policies are required by federal law and should be regularly reviewed to ensure accuracy and applicability. Bullying and harassment aren’t always obvious. Emotional abuse and manipulation fall into this category as well and can be just as damaging as blatant hazing. As with any other policy, these need to be enforced and adhered to. Turing a blind eye to this type of behavior is nearly as bad as participating in it and the expectation for policy compliance increases exponentially as members move up the chain of command.

Some of the survey responses also mentioned inconsistencies and disparity in personnel and human resources practices. Hiring, promotion and termination must be covered by policy. These policies should be approved by legal counsel to ensure compliance with local, state and federal law, and should be written to prevent discrimination, nepotism and favoritism. The impact of these actions can be degrading to morale and function, and both can contribute to increased stress.

Many respondents indicated that increased staffing and reduced call volume would help. These concepts can go hand-in-hand since increased staffing usually leads to a better workload distribution. Neither increased staffing or a reduction in call volume are easy or immediate fixes, however. Increasing staffing can be a complicated process but can be made possible with the right vision and a plan for funding it. For most members, adding staffing and reducing call volume is beyond their scope but for department leaders, these concerns should be addressed.

Firefighters who respond to EMS calls are more stressed than those who don’t. This is understandable because EMS responses expose us to more calls and more frequent traumatic experiences. In departments that provide EMS, medical calls account for two-thirds of their runs. Surveyed firefighters specifically wanted fewer EMS calls and indicated that there is an abuse of the 9-1-1 and EMS systems, contributing to the high volume.

Dealing with the issue of 9-1-1 and EMS system abuse should be handled through collaboration with other agency leaders and community groups. Response policies and guidelines can be established that address how agencies respond together and how system abuse is documented. There are no quick fixes for these problems so in the meantime, firefighters need to find healthy ways to counter their effects.

Policies and procedures can be implemented to address these concerns. Department leaders should take an honest look at what types of EMS incidents their companies are responding to and whether their departments are providing a benefit to the patients or not. If a non-transporting department is responding to medical offices for interfacility transfers or low-priority calls, they may be taxing the system in lieu of their efforts.

Department leaders may also explore redistricting or reassigning responses to different companies for better workload distribution. This might not work everywhere but could be a solution in some communities.

Firefighters said that they need better rest. Policies related to rest periods should address flexibility in rest time based on operational tempo, but firefighters need to accept that sometimes shifts are too busy to allow rest. Because of this, members should also get adequate rest when off duty to ensure they are ready for duty when they return. This is a tiring profession and sometimes we don’t get the breaks we need. Members should report for duty well-rested, and this should be promulgated through policy. Agencies should have policies that manage firefighter readiness and reporting for duty.

Sometimes people just need a break. What does your sick leave policy say about behavioral and mental health? Years ago, people used to joke about “mental health days” when describing the use of sick time for non-medical reasons. With better awareness of behavioral health issues, mental health days are now a reality. If your sick leave policy addresses mental or behavioral health, it should do so in a supportive manner and afford the same benefits as it does for physical health. If it does not specify a distinction between physical and mental health, that is OK, too, as they are really one in the same.

What it should not do is restrict or deny sick leave for mental or behavioral health reasons. A firefighter shouldn’t report for duty with an ankle injury and the same should apply to their mental and emotional wellness. Behavioral healthcare is healthcare and should be handled with the same confidentiality and privacy as any other illness or injury. However, if you or someone close to you is using sick leave for mental health, this indicates a need for more help. Simply taking a day away from your stressful environment is not enough to combat stress, and follow-up treatment is recommended.

Stress support

Policies play a role in the reduction and management of stress. Departments should develop wellness and fitness program policies that support healthy ways to eliminate and reduce stress on the job. With better awareness and more supportive policies, stress can be reduced and managed to provide for a healthier and happier work environment, and to reduce the associated health risks, including suicide. Stress is inherent in the fire service, but the decision to deal with it can be a life or death one.