This is the first quarterly report on the work of members of the EMS Alliance on Resiliency, a coalition of concerned organizations and experts who have banded together to develop and implement programs designed to reduce emergency personnel stress and suicide. There are currently 37 members from North America and Australia, with others signing on as our mission and its message grows.
NEMSMA’s Global Effort
The National EMS Management Association’s (NEMSMA) Resiliency Program Development Team has been working diligently to advocate for national standards for stress management programs for EMS institutions.
In March, a group of 10 representatives from NEMSMA’s practitioner mental health and well-being committee participated in a three-day Global Paramedic Leadership Mental Health Summit in Warwick, England.
Each participating country at the summit (United States, United Kingdom, Australia, Canada and New Zealand) shares the common factor of having a large number of EMS practitioners who experience mental health concerns, continuing negative stigma and a lack of resources, research and tools to intervene and minimize mental illness and suicide. Delegates shared the programs and tools they currently have in place and also those in development.
Canada, the U.K. and Australia seem to be far more advanced than the U.S., with government oversight and funding at the federal level. These countries differ from the U.S. in that they view EMS as a highly respected profession, one that requires a higher level of education, such as Bachelor’s or Master’s degree.
Canada: A new entity, the Canadian Institute of Public Safety Research and Treatment (CIPSRT) has categorized three different levels of stress: 1) critical stress; 2) organizational stress; and 3) operational stress. Their website, , has an anonymous assessment tool which compares a respondents score to others in the same public safety field. The website also hosts additional articles and resources.
CIPSRT is currently working on a new project that aims to survey the prevalence of operational stress injuries among public safety personnel. Results are expected to be available in Summer 2018.
United Kingdom: Overall, the U.K. has adopted a holistic and collaborative approach for training, advice lines, research, suicide prevention and self-engagement.
One technique used is impact monitoring, which is a mandatory yearly evaluation that looks at how the job has changed the provider mentally. Evaluation sessions last approximately one hour and include a conversation, rather than counseling.
In addition to impact monitoring, a roundtable approach called “Swartz Rounds” involves paramedics, nurses and team members who provide patient care from start to finish.
MIND is a charitable organization that funds mental wellness programs in the UK. Their first responder wellness program, “Our Blue Light” takes an integrated approach.
Efforts have included creating peer support “champions,” organizational leadership training and provider education. Momentum is building around the year-old program; however, there hasn’t yet been any research to empirically demonstrate its effectiveness.
Australia: Australia has had mental health assistance for more than 30 years, implementing processes that have been successful in other countries. This has resulted in Australia being the only country at the summit that has significantly minimized, if not erased, the stigma around mental illness and wellbeing in the workplace.
Queensland Ambulance Service (QAS) has a wellness support program called Priority One, that’s fully integrated into the EMS culture and is centered on the concept of salutogenesis. This is an approach focusing on factors that support human health and well-being vs. factors that cause disease. The program works to maximize an individual’s post-traumatic growth following critical incident stress or cumulative stress.
Priority One has developed effective ways for providers to access services and a robust education/communication component, and fosters a high degree of connectedness between providers and the organization.
Independent evaluation of Priority One has shown that the program is highly effective. QAS is currently concluding a research study examining the prevalence of providers who experienced post-traumatic growth following a traumatic event.
United States: Developing and implementing industry-wide resources is much more challenging in the U.S., where more than 21,000 EMS agencies operate relatively independently.
The coalition of international agencies at the summit agreed that it’s important to move forward with a unified command for mental health resilience vs. disjointed programs and processes.
Although resources and funding is often limited, the group agreed that it doesn’t cost anything for supervisors and peers to ask EMS providers, “Are you OK?” The human connection of letting someone know that support is there when needed should be used and expressed more often.
Participating countries and organizations pledged to continue to work together to build resilience, eliminate stigma, promote self-care, share effective programs, and intiate a holistic approach that includes mental, physical and spiritual avenues.
Lastly, the group agreed to offer continuing education opportunities around mental health and focus more on the topic when it’s covered during the initial certification as well as recertification processes.
For more on this global effort, read the May Management Focus column, “Global Resilience Effort: New international alliance addresses key concerns in EMS” by Vincent D. Robbins, FACPE, FACHE.
NVFC Shares the Load
The National Volunteer Fire Council (NVFC) has partnered with American Addiction Centers to offer a free, confidential Fire/EMS helpline (888-731-3473) that firefighters, EMS providers and their families can call at any time for help with a behavioral health issue.
The program, called “Share the Load,” provides tools, resources and training to help individuals and departments proactively address behavioral health.
In 2017, there were 1,073 calls to the helpline, an increase of 26.5% over the previous year. The NVFC also released the third issue of the program’s newsletter, the Helpletter. Resources, training and tools to address behavioral health issues and implement a department program can be accessed at .
ImageTrend’s Mental Health App
ImageTrend’s commitment to first responder mental health awareness has resulted in the recent launch of CrewCare, a free mobile app for any first responder. ImageTrend is a company with many experienced EMS and firefighter personnel on staff, giving a great appreciation for the mission of the EMS Alliance on Resiliency and JEMS.
CrewCare, introduced in February 2018 at the EMS Today Conference, provides insight on first responder stress and associated factors that may play a role in stress, anxiety, burnout, depression, PTSD and suicide.
The app provides users with a confidential way to look at the stresses they are facing not only on the job, but in their own lives related to family, finances, sleep, mental health, physical health and more.
Users are able to receive instantaneous feedback on their engagement, mood and associated activities. Through charts and graphs, users can see an overall view of their stress over time, as well as how they may compare to other users. The app also provides links to relevant topical resources and national mental health support and crisis contacts.
CrewCare also offers organization-level options that allow personnel to provide anonymous feedback that can recognize department stress and gain insight to inspire positive change.
The organization has the ability to provide local employee assistant programs/support and crisis contacts, department specific questions for the crews and receive an optional report that shows an organization’s strengths and weaknesses related to stress.
At the industry level, CrewCare will be using aggregated, non-identifiable data analyses to create an overall understanding into how we can do better at all levels of first responder mental health. The breadth of information gathered can help us all take action to help reduce stress and improve career satisfaction.
After just seven weeks of its launch date, close to 1,000 individuals downloaded and began using the free app, a sign that this resource is an effective and welcome tool for stress management and reduction.
Strub Caulkins Makes Strides
Since the inaugural meeting of the EMS Alliance on Resiliency, the Strub Caulkins Center for Suicide Research has either completed or made significant progress on the following research, articles and presentations and projects.
Research: Along with co-researcher Dariusz Wolman, PhD, of Eastern Kentucky University, Chris Caulkins conducted a survey of every EMS provider in the state of Minnesota. The analysis is now complete, and it’s anticipated the resulting information will yield several publishable papers.
Findings indicate that the rates of suicidal ideation, planning, and attempts are all significantly higher in the emergency responder population.
The Center has also joined forces with Reviving Responders to perform an inferential analysis on the results of their nationwide EMS survey on EMS responder suicidality and access to mental health resources.
Reviving Responders has already published their descriptive statistics, giving a valuable window into the nature of the problem. This partnership will help make an already excellent piece of work an even stronger study.
Articles: Three articles were published in the first two 2018 editions of Minnesota Fire Chief: The Heavy Psychological Toll on Firefighters, Response to Suicidal People and Deaths by Suicide: Scene safety or stigma?, and Suicidality and Disasters: An ante-, peri-, and post-catastrophe look.
An article on psychological trauma and suicide among EMS providers has also been written and submitted to JEMS for future publication.
Presentations: A presentation on psychological trauma and suicidality among EMS providers was made at the EMS Time Critical Call Conference in Fergus Falls, Minn., in February 2018.
The night before the conference, Caulkins stopped in to Oakes, N.D., where he presented on suicide basics to the Oakes Ambulance Service.
Also in February, Caulkins hosted an online educational session called Suicidology 101 for those interested in learning about the field in hopes of attracting more people to the field of suicidology. There were 26 attendees from around the U.S., most of whom were EMS professionals.
In March, Caulkins accompanied a group of representatives sponsored by NEMSMA, to the U.K. to present on suicidality among EMS personnel.
In April, Caulkins presented research results on rates of responder ideation, suicide planning, attempts, access to means, and suicide deaths at the American Association of Suicidology Conference in Washington, D.C. The next month, Caulkins presented his research at the International Association for Suicide Prevention Asian Pacific Conference in New Zealand.
In February, Chris and board member Brittany Miskowiec presented on suicidality and delivered SafeTalk training to a team of peer support volunteers for the MnFire Intitiative—a non-profit dedicated to supporting firefirefighters with health issues relating to cancer, heart disease, and mental health.
Projects: Caulkins has been actively engaged with a NEMSMA work group in drafting a resilience and resistance program for EMS providers. The Strub Caulkins Center for Suicide Research has accepted an invitation to sit on the emergency responder suicide prevention subcommittee of the National Action Alliance for Suicide Prevention. This is a public-private partnership that’s federally recognized.
The Strub Caulkins Center for Suicide Research, a non-profit 501(c)(3) organization, is available for presentations or research assistance on suicide and related phenomena.
For more information contact Executive Director Chris Caulkins at [email protected]
New Book & Online Training
At the EMS Today Conference in February, JEMS Editor-in-Chief A.J. Heightman, MPA, EMT-P, announced several initiatives to bolster the effort to define and address the problem of stress and suicide.
Philip Callahan, PhD, a paramedic and psychologist, worked with Michael Marks, PhD, from the Veterans Administration, to develop a semester-long resiliency class to support high-risk combat veterans entering the University of Arizona.
The three-credit class focused on 12 positive coping skills to build resilience and foster social support. They experienced great success, with students making statistically significant gains in resilience.
Following the success of the class, Marks and Callahan coauthored First Response Resiliency, a textbook and accompanying workbook that’s been used by a number of agencies.
Since its initial release, the 12 skills have been compressed into eight in an effort to reduce the complexity and training time. Callahan developed a workbook for the new format, and the compressed version showed statistically significant gains similar to the 12-skill version.
Marks has recently completed a book on first responder resiliency that will be available through JEMS/PennWell in Summer 2018. The book, titled Community of One: Building Social Resilience, aims to reduce training complexity that’s involved in teaching the course, and seeks to more closely involve the first reponder’s family. Experts agree that a social support system is critical to successful resilience, and family is most often the primary element of a social support system.
Included with the book is a map of the five coping skills that Callahan developed, based on the 12 and eight-skill course.
Callahan is also working with JEMS continuing education partner Medic-CE to develop Beyond The Call: Mental Health Awareness for First Responders an innovative four-hour online training course where participants will work on issues related to the five resiliency skills: 1) belief; 2) persistence; 3) strength; 4) trust; and 5) adaptability.
Course participants will be partnered with one another during the course; the idea being that their partner will be part of a social support system moving forward. Each of the five skills will be explored by participants, one at time, by examining their own real-life challenges.
Although most work will be done on the participants’ own time, there will also be a classroom component where participants will meet online (anonymously) in real-time. Led by an online facilitator, participants will discuss their shared results and report on how they used the skills.
The approach taken by the course is consistent with evidence-based research as well as the World Health Organization’s 2014 study on suicide reduction, which recommended that developing a sound social support system and positive coping skills would aid war veterans and emergency responders in dealing with adversity.