Firefighter Life Safety Initiative 13 – Behavioral Health 

National Fallen Firefighters Foundation


Initiative 13 states firefighters and their family members must have access to counseling and psychological support. The initiative asserts that firefighters, EMS personnel, and their families must have the resources and help available to deal with the various complications that their jobs can bring to their lives, especially issues regarding emotional and psychological stress. The new Firefighter Life Safety Initiative 13 web site contains important resources including the new consensus model for exposure to potentially traumatic events, a research database, and training courses for firefighters that can reduce the impact of potentially traumatic events, and develop peer teams to provide support to stress-injured firefighters. 


IAFF Online Behavioral Wellness Manual

International Association of Fire Fighters, Department of Occupational Health and Safety


The IAFF developed this comprehensive reference manual for behavioral wellness which covers a variety of topics relevant to fire service, including management of health risk behaviors, spirituality, retirement planning, marriage and family issues, reactions to traumatic stress, and understanding mental illness.


NVFC Member Assistance Program

National Volunteer Fire Council and American Addiction Centers


The NVFC and American Addiction Centers have teamed up to provide the National Fire Services Member Assistance Program to all NVFC members and their families. NVFC members and their families can call the free, confidential Member Assistance Hotline any time day or night to help with issues affecting your life, such as alcohol or drug addiction, anxiety, depression, stress, PTSD, relationship problems, work-related concerns, legal problems, financial management difficulties, critical incidents, or psychological problems.


National Institute for Occupational Health and Safety


NIOSH is the federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH has numerous web-based resources available for managing stress in the workplace, including:

Stress at Work booklet

Working With Stress video

Stress Management in Work Place Settings Resources


Your Guide to Healthy Sleep

National Heart, Lung, and Blood Institute


This booklet from NHLBI provides information about important sleep topics such as common sleep myths and practical tips for getting adequate sleep, coping with jet lag and nighttime shift work, and avoiding dangerous drowsy driving. It also includes information on sleep disorders, such as insomnia, sleep apnea, restless legs syndrome, narcolepsy, and some parasomnias.


Depression Information

Medline Plus


Medline Plus is a service of the U.S. National Library of Medicine and the National Institutes of Health. The Depression Section of Medline Plus provides a compendium of resources, tools, and information about this mental health topic.


Emotional Health Center

Everyday Health Media


This online resource center contains information and articles on mental health topics including anxiety, depression, and stress.


Mesothelioma Group 

A Mesothelioma Support Group


Mesothelioma Group is an organization dedicated to increasing awareness about this rare but very deadly cancer. This online resource provides step-by-step guidance, caregiving support, and invaluable information about the disease. 





Learning from a Traumatic Event--Suicide  

United States Forest Service


The Forest Service shares organizational lessons learned from the August 2012 suicide death of a contract employee at Pikes Peak near Colorado Springs, Colorado.


Suicide in the Fire and Emergency Services: Adopting a Proactive Approach to Behavioral Health Awareness and Suicide Prevention

National Volunteer Fire Council


Members of the fire and emergency services face a variety of daily stressors that can have lasting effects on their mental and emotional wellbeing. This report explores various behavioral health concerns and identifies resources and best practices for mental wellness and suicide prevention. The report includes data from a behavioral health survey conducted by the NVFC. A webinar providing an overview of the report and survey is also available.


White Paper: Suicide Surveillance, Prevention, and Intervention Measures for the US Fire Service

National Fallen Firefighters Foundation


This white paper presents the findings and recommendations of the National Fallen Firefighters Foundation Suicide and Depression Summit, which convened on July 11-12, 2011.


Issues of Depression and Suicide in the Fire Service

National Fallen Firefighters Foundation


This report is a summary of the National Fallen Firefighters Foundation’s white paper on the topic of depression and suicide in the fire service, based on the summit on this subject held July 11-12, 2011.


White Paper: Firefighter Life Safety Initiative 13

National Fallen Firefighters Foundation


This white paper provides an overview, best practices, and recommendations pertaining to Firefighter Life Safety Initiative 13 – Firefighters and their families must have access to counseling and psychological support.


The Effects of Sleep Deprivation on Fire Fighters and EMS Responders

U.S. Fire Administration and International Association of Fire Chiefs


This report and accompanying computer-based education program presents background information on normal sleep physiology and the health and performance effects of sleep deprivation. Countermeasures for sleep deprivation are reviewed, which relate to identifying those particularly susceptible to risks of sleep deprivation, individual mitigating strategies, and work-related issues.



Courses and Webinars


After Action Review

National Fallen Firefighters Foundation


The first step in observing stress in firefighters and EMS personnel begins with an After Action Review, where every call and response is discussed. This course discusses the five questions that should be asked in the After Action Review every time firefighters and EMTs perform their duties.


Curbside Manner:  Stress First Aid for the Street

National Fallen Firefighters Foundation


This course presents a new way to approach and care for the citizens that firefighters and EMS personnel encounter every day. The treatment that citizens receive from firefighters and EMS providers can affect their experiences during and after a fire or medical emergency and their capacity to recover and move on in its aftermath.


Dealing with a Line of Duty Death

Firefighters Support Foundation


This 50-minute program presented by first responder psychologist Dr. Ellen Kirschman discusses different aspects of dealing with the line-of-duty death of a firefighter.


Fire Service Suicide and Behavioral Health Concerns

National Volunteer Fire Council


This webinar provides an overview of behavioral health issues facing the fire service, with a focus on firefighter suicide warning signs and prevention. Additionally, the results of the NVFC’s recent behavioral health survey are analyzed.


Stress First Aid for Fire and EMS Personnel 

National Fallen Firefighters Foundation


The NFFF has developed this course to give fire service organization peer team the training they need to support stress-injured coworkers. Stress First Aid is designed to reduce the risk for stress reactions in fire and rescue personnel by enabling peer support personnel to quickly identify those individuals who are reacting to a wide range of stressors in their work and personal lives, and are in need of interventions to promote healing.


When a Child Dies on a Call

Firefighters Support Foundation


This 20-minute program presented by psychologist Dr. Anne Bisek tackles the issues firefighters may face when a child dies on a call and ways firefighters can prepare for and cope with this tragedy.


When to Seek Therapy

Firefighters Support Foundation


This 30-minute program presented by psychologist Dr. Anne Bisek answers questions she has found that first responders frequently have about seeking therapy.





B.E.S.T. Practices and Stress

By Chief Jeff Cash, National Volunteer Fire Council


Published in the December 2009 issue of Firehouse Magazine, Chief Jeff Cash examines the stress first responders face, the difference between ‘good’ and ‘bad’ stress, and ways to manage stress.


Firefighters and Stress Management

By American Addiction Centers for the National Volunteer Fire Council


A look at the stress firefighters face and coping mechanisms that can help to alleviate stress.


A Check Up From the Neck Up

By Billy Hayes for


An overview  of the Everyone Goes Home program’s Firefighter LifeSafety Initiative 13 – “Firefighters and their families must have access to counseling and psychological support.”


Behavioral Health:  Minding Stress on the Job


A medical team from New York discusses their experiences with the FDNY and offer advice that can be applied to all firefighters who are regularly exposed to traumatic incidents.


Firefighter Behavioral Health: Taking Care of our Own

By Fire Chief Mike Thompson for


A look at the behavioral health program at the Spokane Valley Fire Department.



Research Support


Gros, D. F., Strachan, M., Ruggiero, K. J., Knapp, R. G., Frueh, B. C., Egede, L. E., Lejuez, C. W., Tuerk, P. W., & Acierno, R. (2011). Innovative service delivery for secondary prevention of PTSD in at-risk OIF/OEF service men and women. Contemporary Clinical Trials, 32, 122-128.


Hopko, D. R., Armento, M. E. A., Cantu, M. S., Chambers, L. L., & Lejuez, C. W. (2003). The use of daily diaries to assess the relations among mood state, overt behavior, and reward value of activities. Behavior Research and Therapy, 41(10), 1137-1148.


Hopko, D. R., Bell, J. L., Armento, M. E. A., Hunt, M. K., & Lejuez, C. W. (2005). Behavior therapy for depressed cancer patients in primary care. Pyschotherapy: Theory, Research, Practice, Training, 42(2), 236-243.


Hopko, D. R., Lejuez, C. W., & Hopko, S. D. (2004) Behavioral activation as an intervention for coexistant depressive eand anxiety symptoms. Clinical Case Studies, 3(1), 37-48.


Hopko, D. R., Lejuez, C. W., LePage, J. P., Hopko, S. D., McNeil, D. W. (2003). A brief behavioral activation treatment for depression: A randomized pilot trial within an inpatient psychiatric hospital. Behavior Modification, 27(4), 458-469. 


Hopko, D. R., Lejuez, C. W., Ruggiero, K. J., & Eifert, G. (2003). Contemporary behavioral activation treatments for depression: Procedures, principles, and progress. Clinical Pyshcology Review, 23, 699-717.


Hopko, D. R., Sanchez, L., Hopko, S. D., Dvir, S., & Lejuez, C. W. (2003). Behavioral activation and the prevention of suicidal behaviors in patients with Borderline Personality Disorder. Journal of Personality Disorders, 17(5), 460-478.


Lejuez, C. W., Hopko, D. R., Acierno, R., Daughters, S. B. (2011). Ten year revision of the brief behavioral activation treatment for depression: Revised treatment manual. Behavior Modification, 35(2), 111-161.


Lejuez, C. W., Hopko, D. R. , & Hopko, S. D. (2001). A brief behavioral activation treatment for depression: Treatment manual. Behavior Modification, 25. 255-286.


Lejuez, C. W., Hopko, D. R., & Hopko, S. D. (2002). The brief behavioral activation treatment for depression (BATD): A comprehensive patient guide. Boston, MA: Pearson Custom Publishing. 


Lejuez, C. W., Hopko, D. R., LePage, J. P., Hopko, S. D., McNeil, D. W. (2001.) A brief behavioral activation treatment for depression. Cognitive and Behavioral Practice, 8(2), 164-175.


Price, M., Gros, D. F., Strachan, M., Ruggiero, K. J., & Acierno, R. (in press). Combat experiences, pre-deployment training, and outcome of exposure therapy for PTSD in Operation Enduring Freedom/ Operation Iraqi Freedom Veterans. Clinical Psychology and Psychotherapy.


Price, M. Gros, D. F., Strachan, M., Ruggiero, K. J., & Acierno, R. (in press). The role of social support in exposure therapy for Operation Iraqi Freedom/ Operation Enduring Freedom Veterans: A preliminary investigation. Psychological Trauma: Theory, Research, Practice, and Policy.


Strachan, M., Gros, D., Ruggiero, K. J., Lejuez, C. W., & Acierno, R. (2012). an integrated approach to delivering exposure-based treatment for symptoms of PTSD and depression in OIF/ OEF Veterans: Preliminary findings. Behavior Therapy, 43, 560-569.


Strachan, M., Gros, D., Yuen, E., Ruggiero, K. J., Foa, E. B., & Acierno, R. (2012). Home-based telehealth to deliver evidence-based psychotherapy in veterans with PTSD. Contemporary Clinical Trials, 33, 402-409.