Evidence-Based Practices to Enhance First Responder Well-Being and Performance

Introduction

First responders are called into action during terrifying and unpredictable events, and their lives and the lives of the civilians they serve can be placed at risk should they not execute their duties successfully. Although the needs of first responders as a group are highly divergent, it is clear that training must prepare them to function effectively within a maelstrom of stress and danger, protect their psychobiological health after repeated trauma exposure, and persistently contribute to a culture of organizational effectiveness that citizens can rely upon. These are daunting challenges.

A review of the extant literature suggests that there are numerous potential strategies to foster adaptive coping, including well-established procedures among civilians that may prove useful among first responders as well as military personnel (e.g., Southwick 2015; Fava, 2009; Horn 2016). Furthermore, these interventions have been examined across a breadth of styles and formats, ranging from individual meetings to Internet modules (Castro, 2006; Cohn, Weltman, Ratwani, Chartrand, & McCraty 2010; Gonzalez, 2014; Padesky; 2012). There are mounting data that evidence-based approaches to first responder health can indeed translate to better outcomes across a wide variety of performance and health domains (Andersen & Gustafsberg, 2016; Arble, Lumley, Pole, Blessman, & Arnetz, 2017).

Yet the precise nature of these potential interventions remains elusive, not least in terms of causal mechanisms involved in delivering the desired outcomes. Many of the proposed interventions are derived from principles of clinical psychology, which though potent, were rarely developed with the expected, repeated, and professionally-bound stressors and traumas of first responder work in mind. Furthermore, the targets of intervention among first responders may be quite different than those of other populations. For instance, successful treatment of trauma among civilians emphasizes symptom reduction and a decreased avoidance of aversive stimuli. A man who develops an acute stress reaction subsequent to his house burning down could be seen as having been successfully treated when his daily anxiety decreases, his nightmares abate, and his ability to resume cooking meals on the stove is restored. This is highly distinct from a firefighter being treated for a traumatic experience during a fire, which although involving symptom reduction, must also include an ability to utilize his/her training during the next response call. In addition, while civilian clinical interventions are typically confidential affairs quite distinct from workplace awareness, training among first responders necessarily intersects with professional responsibilities and workplace culture.