Stress First Aid for Wildland Firefighters

Abstract

A version of Stress First Aid for Wildland Firefighters

Full text

0
Stress First Aid for Wildland Firefighters
Student Manual
October, 2018
U.S. Forest Service
Department of Agriculture
National Fallen Firefighters Foundation
National Center for PTSD
Department of Veterans Affairs

20
1
Table of Contents
1. Table of Contents 1
2. Acknowledgements 2
3. Introduction and Overview 3
4. Check 17
5. Coordinate 33
6. Cover 40
7. Calm 48
8. Connect 60
9. Competence 73
10. Confidence 86
11. Summary 100

20
2
Acknowledgements
The principal authors of this Stress First Aid Manual for Wildland Firefighters are: Patricia
Watson, Ph.D., of the National Center for PTSD, Kimberly Lightley, Patty O’Brien, C.J.
Johnson, Jason Virtue, Jennifer Rabuck, Chris Tipton, Vickie Taylor of Prince William (VA)
Community Services/NFFF Behavioral Health Specialist, Richard Gist, Ph.D., of the Kansas
City (MO) Fire Department, Erika Elvander of the Defense Centers of Excellence for
Psychological Health and Traumatic Brain Injury, Captain Frank Leto of the FDNY
Counseling Unit, Captain Bob Martin of the Chicago Fire Department, Captain Jim Tanner
of Prince William (VA) Fire and Rescue, District Chief Don Vaught of the Eugene (OR) Fire &
EMS Department, William Nash, MD, Captain, MC, USN (Retired), Richard J. Westphal,
Ph.D., PMHCNS-BC, Captain, NC, USN (Retired), and Brett Litz, Ph.D., of the Mental Health
Core of the Massachusetts Veterans Epidemiological Research and Information Center at
the VA Boston Healthcare System. Photography acknowledgements to Kari Greer.
The Stress First Aid for Wildland Firefighters Student Manual is an adaptation of the Stress
First Aid for Firefighters and Emergency Medical Services Personnel Student Manual
developed by the National Fallen Firefighters Foundation. The principle authors of the The
Stress First Aid for Firefighters and Emergency Medical Services Personnel Student Manual
are Patricia Watson, Ph.D., of the National Center for PTSD, Vickie Taylor of Prince William
(VA) Community Services/NFFF Behavioral Health Specialist, Richard Gist, Ph.D., of the
Kansas City (MO) Fire Department, Erika Elvander of the Defense Centers of Excellence for
Psychological Health and Traumatic Brain Injury, Captain Frank Leto of the FDNY
Counseling Unit, Captain Bob Martin of the Chicago Fire Department, Captain Jim Tanner
of Prince William (VA) Fire and Rescue, District Chief Don Vaught of the Eugene (OR) Fire &
EMS Department, William Nash, MD, Captain, MC, USN (Retired), Richard J. Westphal,
Ph.D., PMHCNS-BC, Captain, NC, USN (Retired), and Brett Litz, Ph.D., of the Mental Health
Core of the Massachusetts Veterans Epidemiological Research and Information Center at
the VA Boston Healthcare System.
The Stress First Aid for Firefighters and Emergency Medical Services Personnel Student
Manual represents a civilian adaptation of the Combat and Operational Stress First Aid
(COSFA) Field Operations Manual, developed by the Bureau of Medicine and Surgery,
Department of the Navy, in cooperation with the Combat and Operational Stress
Control, Manpower & Reserve Affairs, Headquarters Marine Corps, the Navy
Operational Stress Control, Chief of Naval Personnel, Total Force N1, and the National
Center for PTSD, Department of Veterans Affairs. The principal authors
of the COSFA
Field Operations Guide included William Nash, Richard Westphal, Patricia Watson and
Brett Litz. We are grateful to the military units and bureau listed above for allowing the
adaptation of their work to help our nation’s first responders.

20
3
Introduction and Overview
The stress encountered by wildland fire
personnel is influenced by a number of
factors: the threats the job can present,
the tragic losses which they routinely
witness, the difficult decisions they have
to make, and the cumulative demands
that wildland firefighting places on them.
While these “big ticket” stressors often
draw the most attention, when surveyed,
issues like pay, supervision, interrupted
sleep patterns and relationships with co-
workers get top billing for their effects on
work satisfaction. Added to
these factors, personal issues arising
deployment patterns and from home and
family stressors can result in fire
personnel juggling many competing
demands in a job where the stakes are
high if mistakes are made. Most
firefighters cope with these issues at
different times, but when any
combination of them weighs on the
individual, stress reactions can result.
Stress First Aid (SFA) has been developed
to help reduce the likelihood that these
stress reactions will develop into more
severe or long-term problems. SFA offers a
flexible set of tools for addressing stress
reactions in firefighters and Emergency
Medical Services (EMS) personnel. It can
be used for self-care, or to help co-
workers, company officers, crew leaders
and others offer assistance as a way to
either prevent the progression of stress
reactions, or bridge affected individuals to
other resources.
In wildland fire settings, when SFA is being
used for others, the individuals best
positioned to use SFA
are co-workers, peer
support personnel, mentors, company
officers and
others who have existing
relationships with the affected individual.
Friends and family
members can also play
an important role in the identification of
firefighters who may be in need of stress
first aid.
SFA Aims to Reduce the Risk for Stress
Reactions
•
SFA is used to continuously
monitor self and co-workers
•
SFA is used to recognize
reactions to a wide range of
stressors in one’s work and / or
personal life, and identify who
might be in need of assistance.
•
SFA offers a spectrum of actions
to ensure safety, reduce the risk
for more severe stress reactions,
and promote recovery.
•
SFA monitors the progress of
recovery to ensure a return to
full function and well-being.
•
SFA bridges individuals to higher
levels of care, as needed.
SFA is Guided by a Set of Core
Principles
•
Strong leadership and unit cohesion
are potentially the most powerful

20
4
forces for healing and recovery
available to fire and EMS personnel.
•
SFA promotes recovery from stress
reactions by augmenting, restoring
and leveraging leadership, peer
support and unit cohesion; it never
supplants or competes with them.
•
SFA occurs in natural work contexts,
wherever and whenever it is needed.
•
SFA is individualized to meet the
needs of each person in their
context; there are no one-
size-fits-all
SFA solutions.
•
SFA is never a one-shot straegy. It is
an ongoing process of promoting
recovery from stress reactions,
monitoring progress and adjusting as
needed over time.
•
SFA requires a collaborative team
effort to be most effective.
Firefighters Speak:
“This isn’t about fixing someone, it’s not about
psychology, or, “how can I give someone the
tools to fix themselves?” There is nothing really
to fix; nothing’s broken. It’s more, “these are
things you need to be cognizant of so that you
can make changes in behavior and bet back
into a better track.”!
“
The traditional CISM model calls for folks
coming in from outside the group. That’s why
this model is different - it can be just us. CISM
is more clinical, more formal, and more
detached. The SFA model starts with
introspection, and it fits our culture. It’s like
the stereotypical advice from a grandfather to
grandson. It doesn’t take a PhD to make it
work. Think about the times in your life when
you already have naturally done these things.”
“There are two philosophies about how to
prepare for a critical incident. One is to try to
anticipate everything that might happen, and
to have a plan in place for the most likely
possibilities. The other is to be competent at
what you do and be ready to help when called
upon. I favor latter. If someone comes to me
and I can help, I will help, or I will find someone
who can. I do not have to be someone who is
ready for every scenario. This model builds an
effective team, so I don’t have to try and be
someone I’m not, or fumble around and
perhaps do more harm than good. Rather, I
seek out and surround myself with the right
people for the job.”!
“This model helps people understand that these
are all common reactions so they can be very
well aware. And the seven Cs are not so clinical
or diagnostic. They are more personal,
interpersonal, and tactical.”!!

20
5
Taking Care of Each Other
In the Wildland culture, there is often a gap
between experiencing stress reactions and
seeking help. This culture appeals to “type A”
personalities and those who are problem
solvers and service-oriented. Therefore, it is a
culture that could benefit from learning the
basics of self-care, support for each other, and
good mentoring. SFA can only be as strong as
the determination of the culture to preserve
the health and well-being of each of its assets,
so that they can both serve others and get the
most out of the job for as long as they choose
to be a part of the culture.
Using SFA principles to improve your own self-
care, or with your inner circle of “go to” people
is the ideal use of SFA, but the core actions can
also be used with those you work with and
those who seek the guidance or leaders or
other mentors. The best mentor is one who is
chosen, rather than imposed. If firefighters
could be given a list of folks they can contact to
build their careers, know more, or seek
mentoring, some will be more likely to jump at
the chance to sit down and talk to somebody
who has years of experience. To build a list of
folks who are willing to do that, you could ask
at the district meetings or retirement meetings,
or set up monthly breakfasts to help
firefighters and retirees to connect. Most
seasoned firefighters are more than willing to
talk with a young firefighter wanting to
interact.
Firefighters Speak:
“Assigning people a mentor is not how
mentorships work. Mentors are people that
you trust. Respect is the important component
that makes it easier to trust; not just my
respect for them, it’s their respect for me.
People I consider mentors are people who
were in way higher positions than I was, and
would come in sit down, have a casual
conversation with me, and say “hey if you ever
need anything, give me a shout.” It was a sign
of respect to me that they cared enough to
take the time out and sit down and talk with
me, and then offer their assistance.”
“We usually find a mentor on our own, whether
you call that person a mentor or not. I have
some of those folks who I’ve called for advice.
If I get in bind or I am struggling, I have a
number of folks I can call. I think it’s really
important. The guys I call have been in the
agency for 20-30 years. I’ll call them, ask what
they think, and that’s helped me big time.”
“For me, what made a good mentor was the
older, gruff, rough around edges, firedog.
They’re who I went to, looked up to. They had
gone through fire, and although not trained in
behavioral health, wellness, or self-care, they
got it. Even though they didn’t go through
exactly what I had went through, they knew
what it was like. To me it meant the world, it
meant so much to be in their presence, and to
this day I see my mentors and there’s
understanding. Those who have gone before,
they get it.”

20
6
“After my wife told me she wanted a divorce,
my mentor told me to think about how many of
my peers were happily married. I saw that
many had trouble, and realized that it was part
of the job. I accepted the fact that if I stay as
operator on road 120 days / year, I will not be
married. That opened my eyes immediately.
Later, when we had a child, another mentor
said, you realize that if you stay in this job, you
will have known your son 9 years when he’s 18,
because you’re gone 6 months out of the year.
I got it. It was 4 months later that I had
another job.”
“In the 1990’s my team leader swatted the
canteen out of my hand and said you drink
when I tell you to drink. Now we've realized
that culturally we have to change with the
generational differences, and we also have to
allow people to be responsible for their own
safety, and encourage them to speak up.”
“If a rookie comes up and says something isn't
right to me, they're not going be told to shut
up. I tell them what we're about to do, and the
reasons for what we're going to do.”
“You build confidence and competence in
somebody by giving them the opportunity to
teach, be a mentor, or step up and help
others.”
SFA is Based on a Stress Continuum
Model
!
Stress States clearly lie along a spectrum of
severity and type. They are neither all normal,
transient, and self-limiting, nor are they all
signs of chronic mental illness.
The Stress Continuum Model shown in
Figure 1 was adapted from the model
developed by the United States Marine
Corps leaders as a tool for conceptualizing
the spectrum of stress states.
The
Green
Zone
is the goal of most training and
prevention activities. The
Yellow Zone
is
the one that most people are in when work
and life demands are challenging but
transient, and stress reactions are more
temporary. The
Orange Zone
is the stress
zone in which the risk for failure of role
performance and future mental disorders
becomes significant. Once an individual
goes beyond the normal daily stress
reactions into the more significant Orange
Zone responses, SFA actions may reduce
the likelihood of needing more intensive
intervention (which usually takes place
with
Red Zone
reactions).

20
7
Figure 1. Stress Continuum Model
Ready!(Green)
!
Reacting!
(Yellow)
!
Injured!(Orange)
!
Ill!(Red)
!
Definition!
Definition!
Definition!
Definition!
• Optimal
functioning
• Adaptive Growth
• Wellness
• Mild and
transient distress
or impairment
• Always goes
away
• Low Risk
• More severe and persistent distress
or impairment
• Leaves an emotional / mental “scar”
• Higher risk
• Persistent and disabling
distress or loss of
function
• Unhealed stress injuries
• Clinical mental disorders
Features
Features
Features
Features
• At one’s best
• Well trained and
prepared
• In control
• Physically, mentally,
and spiritually “fit”
• Mission-focused
• Motivated
• Calm and steady
• Having fun
• Behaving ethically /
legally
• Feeling irritable,
anxious, or down
• Loss of motivation
• Loss of focus
• Difficulty sleeping
• Muscle tension,
heightened heart
rate, breathing, or
other physical
changes
• Not having fun
• Loss of control
• No longer feeling like normal self
• Stronger emotions like panic, rage,
depression
• Excessive guilt, shame, or blame
• Loss of memory or ability to think
rationally
• Being unable to enjoy previously
pleasurable activities.
• Increased or uncontrollable
physiological reactions, such as
sustained muscle tension and pain,
heightened heart rate, panicked
breathing, or other persistent physical
changes, particularly when reminded of
trauma or loss
• Reactions persist or
worsen over time
• Severe distress or
social or occupational
impairment
• Hopelessness
Causes
Causes
Types
•
Any stressor /
trigger
•
Life threat
•
Loss
•
Inner conflict/turmoil
•
Excessive wear and tear
• PTSD
• Depression
• Anxiety
• Substance abuse
Unfortunately, as with physical injury or
illness, this is not always the best solution.
It is important here to note that 100% of
people will react when faced with stressful
stimuli.
However, the way in which they respond
will depend on how prepared they are for
the stressor event, how they interpret it,
and their resources.
During the course of this response, a person’s
state can range relatively rapidly from Green
to Yellow to Orange to Red and back again.
In the wildland firefighting culture there is
often a stigma associated with reacting to
stress, and
many
will try to conceal stress
reactions.
Additionally, firefighters are often more
attuned to duty, honor, and helping others

20
8
than they are to helping oneself. That
increases the likelihood that getting help
for oneself will be delayed or denied.
Yellow Zone Reactions Versus Orange
Zone Injuries
Firefighters are regularly exposed to
highly stressful situations. As
a result,
many are experiencing elevated stress
levels much of the time. Because they
may more commonly be in the Yellow
Zone rather than the Green Zone, it is
important to clarify the difference
between stress reactions and stress
injuries.
Stress reactions are common and are a
part of developing competence and
confidence as a result of facing life’s
challenges. Most people have sufficient
resources and skills to recover from a
stress reaction with limited outside
assistance.
Stress injuries, on the other hand, can
result from more significant affects to
the mind and brain. These may result
in no longer feeling like your normal
self, feeling out of control, or being
impaired in your work or personal
roles. They typically require activation
of additional resources to facilitate
recovery and growth.
The concept of stress injuries is similar to a
strained versus a broken ankle. When an
ankle or tendon is strained, physical therapy
and use are often prescribed. However, when
there is an injury like a broken ankle, a cast
and rest are needed.
Figure 2 shows four classes of
stressors that place individuals at risk
for enduring stress reactions:
•
Inner Conflict or Turmoil
•
Life Threat
• Loss
•
Wear and Tear
The first three are usually discrete events
that can be experienced either singly or in
c
ombination with each other. The last,
wear and tear, is the accumulation of
stressors from expected or normal life
challenges, both large and small, over a
long period of time.
These four sources of
stress often operate simultaneously and
their effects are cumulative.

20
9
Figure 2. Four Sources of Stress

20
10
Signs of Stress Injuries
The experiences, behaviors, and
symptoms that characterize stress injuries
include:
•
Not feeling in control of one’s body,
behavior, mind, or thinking.
•
Being frequently unable to fall or stay
asleep.
•
Waking up from recurrent or vivid
nightmares.
•
Feeling persistent, intense guilt or shame.
•
Feeling unusually remorseless.
•
Being unable to enjoy usually
pleasurable activities.
•
Displaying a significant and persistent
negative change in behavior or
appearance.
•
Losing grounding in previously held
moral values.
•
Experiencing attacks of panic, anger or
rage.
•
Losing memory or the ability to think
rationally.
Where Stress First Aid Fits Into the
Continuum
SFA is a toolkit of actions intended to fill the
care gap between training, stress
management and prevention at the left end
of the Stress continuum, and clinical care to
the right of the continuum.
Figure 3. Where Stress First Aid Fits Into the Continuum
!

11
Loss:
“This year someone will die. You probably
won’t know them and you’re going to say “that
sucks” If you stay in this career long enough the
next thing you are going to say is “I was just on
that fire.” Another few years you’ll say “I just
worked with that guy.” And another few years
and you’re going to say “ I was just having
dinner at his house with his family.”
“The fires that always hit hardest with me is
when it’s someone’s home. In one fire I caught
myself saying “yep there’s another burned out
house.” It’s easier and safer to not think about
the families. It’s also hard when incidents are in
your own back yard.”
“What pushes us into Orange is the incident
within an incident; people close to us who end
up hurt, either through things we do or don’t
do.”“After a pretty heavy year for the honor
guard, we had another incident and afterwards
sat to talk about what was going on. And there
was just a lot of shortness, a lot of snapping at
each other, and I could tell that they hadn't
recovered from the previous year, so that they
brought stuff from the prior year to this
incident. As were talking, we got another
fatality. All the sudden everybody was popping
up saying, “we're ready. We're ready to go.” I
said, “no way I'm taking you guys. You guys are
all going home today to just be with your
families because you're not right.” In
retrospect, you could see the subtle stuff that
was coming up before, where not everybody
was together, the alcohol intake was increased
more than normal, and more anger that was
going on between members. So now we’re
trying to build capacity to remedy that so we
can have more folks respond to for fatalities.”
“Those of us working with the firefighter we
lost are doing okay except for the visuals. We
have a really healthy group. But the intrusive
visual memories are what are really getting to
people. They quickly pull people from what
they think is a good place, to this turmoil.
People seem okay one day, and then they’re
not okay the next day. It's like climbing an ice
wall. You make progress every day, you latch
in, you make steps, and then the next day you
have a day where you lose 2000 feet of
elevation.”
Life Threat:
“I have had a couple triggers recently, and I feel
the tightness in my chest so I know I’m reacting
to one of those past traumas. I know I need to
get help, and I don’t have to have big words.
The stress continuum model helps me to
communicate how I’m doing without getting
into the emotional/feeling piece.

20
12
Inner Conflict:
“Inner conflict injuries can happen when our
response wasn’t what it could have been and a
person is put in harm’s way.”
“We’re a learning agency, we learn from
incidents and accidents instead of putting
blame on people. We learn from an incident so
we can educate. Even though we don’t point
blame, people carry that.”
“I carry a lot of personal responsibility for
checking in with other firefighters and then I
realize there are thousands we can check in on
and there is no way to do a great job with all of
them. We need to give people permission to be
easy on themselves.”
“I place expectations on myself to be there for
my daughter’s school events. I had to travel at
the same time that she was performing on
stage. To this day I have so much regret that I
missed her singing.”
Wear and Tear:
“
The job in and of itself can be very destructive
to home life, and we don’t do good job of
telling people that upfront. You take an 18
year old, tell them they’re saving the world, let
them see amazing things, develop a sense of
camaraderie. It’s like a drug. They get hooked
on it. I can’t tell you how many people I’ve
worked with who have multiple degrees in
anything but fire, and they are firefighters
because they’re hooked on it. And they’re not
married. They’re all still single or divorced.
They don’t understand the mitigations that
have to be put in play in order to counteract
the stress.”
“The wildland fire community is tight. You can
go anywhere in the States and you are one
person away from knowing someone. I think of
it as a very large fire department. Every year
we are losing firefighters to line of duty deaths
or serious injuries. We are going to memorials
and funerals and burying our brothers and
sisters. In a full career, many of those we know
will die. The cumulative effects and wear and
tear add up, and we also worry about retirees.
Cumulative stress goes hand in hand with
serious injuries and wear and tear.”
“There are familial and institutional stresses
compounding those in the workplace. You
bring with you the baggage related to what has
happened in your family, or related to a conflict
between your personal and professional ethics,
or related to a new policy or guidance from

20
13
above. We’re all affected by these things, and
deal with them daily. Now, pile on a coworker
who gets seriously hurt, and you (as an incident
responder and problem solver), are powerless
to affect a positive outcome. When your job is
all about wielding the power of control, when
you can effect massive change with a simple
order delivered on a radio, and, in this
situation, you can’t affect the change that’s
needed to fix things, it’s really challenging to
accept it.”
“Some of our crews go out back to back, and
there is a different energy and resistance level
from start to finish. There is cumulative
fatigue, less rest, more smoke in your lungs,
and your ability to cope goes down.”
Orange Zone Indicators:
“Substance use is a red flag, but it’s a tricky one
because the baseline is so high to begin with.”
“It’s hard to identify depression within this
system. The masculine expression of
depression is different, like anger, physical
aggression, drinking a lot of alcohol, working
out constantly, and not wanting fire season to
end.”
“No one in WF wants to be the guy who
freezes. My thing is that I can’t think unless I’m
moving. If I’m starting to feel stress
accumulating, I need to get on a treadmill, or
take a walk and let the stuff go out that way.
But if I’m sitting on the fire line with the world
falling down around me, I can’t use that
mechanism to cope with it. I have to be very
aware. So how I choose to react is not to take a
walk. That is not appropriate, even if it is an
instinctive reaction.”
“A pretty clear indicator for me for people in
the orange zone would be going back to their
comfort zone. When stuff is going wrong and
they’re really stressed out, they pick the lint
balls off their sweater, as in: “This is something
I can do, it’s not helping whatsoever, in fact it’s
really causing things to snowball and continue
to get worse around me, but at least it’s not
hurting anyone, at least it’s something.” It’s
because we are “doers” in our profession. And
you might be throwing dirt over and over on
the stump but the structure is burning down
around you. What you’re doing is not helping.
We need to have the presence of mind to say
“sometimes doing nothing is a really good
thing.” That is hard because it’s also admitting
defeat. It’s also like that when we have to
disengage from the fire, drop our shit and run.
That’s the hardest thing to do, because you are
admitting defeat. That’s probably why people
end up in the orange zone. They’re afraid of the
stigma, of admitting defeat, of needing help.”
“People sometimes wish fire season was year
round. They are with friends all year long,
clothed, banked, and can go to lay waste to
nature, or cut, smash, dig, and set things on
fire. And then all of sudden it starts raining or
snowing and they go back to boring, normal
lives, where they have been absent for 6
months, so relationships have become

20
14
strained. If they are laid off they can collect
unemployment, but it can be pretty boring and
unproductive. They excel during fire season,
but get depressed or drink too much in the off-
season. When something bad happens, like a
fatality, accident, or even a significant
social/work conflict, this can be even more
pronounced.”
“It seems like when folks are busy working with
a lot of fires, or people are doing their job, you
don’t notice issues, because they are active and
engaged. But when things slow down, and they
are not mentally or physically engaged, that is
when you start seeing issues. We especially
see irritability, if they are not busy working.”
“I have hired a number of Veterans who have
identified themselves as dealing with some
level of PTSD after having been through some
pretty bad situations. Some handle it really well
and with other folks, there are days or weeks
with no issues, then something triggers how
they operate, and then you see a totally
different person. They can’t get along with
their cohorts, or they start drinking heavily.
Many are already getting help through the VA.
Some have realized that this is probably not the
line of work they should be in and resigned.
Others were able to get treated, and had no
further issues whatsoever. I think it would help
even more if they were able to be supported by
some of our folks who weren’t in military but
who over time have been through stressful
work situations, and are able to identify
triggers and figure out what to do.”
!

20
15
SFA Evidence Support
!
The Core Actions of SFA were derived
from an exhaustive literature review of
elements related to recovery from a
number of different types of adverse
circumstances (Hobfoll et al., 2007). The
five essential elements of immediate and
mid-term intervention that are related to
better recovery from stress are:
1.
Promote a sense of safety.
Maintaining or re-establishing a
psychological sense of safety lowers
the risk of stress injury. Safety can be
relative and it is important to have a
balanced view about the levels of
danger in one’s environment.
2.
Promote calming.
Some anxiety is
normal and healthy. However,
extended arousal of heart rate, blood
pressure and respiration is associated
with disruption of sleep, lack of
hydration, poor decision-making and
long- term health problems.
3.
Promote connectedness.
Social
connected- ness is one of the
strongest protective factors against
stress injury and is linked to
emotional well-being and recovery
following
trauma and adversity.
4. Promote sense of self and collective
efficacy. People who believe that they
have the skills to overcome threat can
handle stressful events, solve their
problems and show greater resilience
during and recovery after stressful
events.
5.
Promote a sense of hope.
Hope is
linked to optimism, faith, and/or the
belief that things will work out in the
best possible way.
SFA strategies are designed to catch the
early warning signs of severe stress
reactions regardless of their cause. It
aims to evaluate needs, get assistance
and support when needed, and assist
firefighters during and after cumulative
stress, significant loss, adversity, inner
turmoil, or exposure to a potentially
traumatic event (PTE). It also promotes
emotionally supportive actions in the
workplace and provides follow-up over
time. For instance, you can help mentor
or coach the stressed individual to
problem-solve ways to repair and /or
prevent stress reactions from increasing.
It can also involve making a plan to
leverage resources that promote
healing, wellness, connection and a
return to fully effective functioning.
SFA has Seven Core Actions
SFA consists of seven Core Actions:
Check,
Coordinate, Cover, Calm, Connect, Competence
and
Confidence.
Figure 4 gives an overview of the
seven actions and how they fit together. The
Core Actions will each be described in more
detail in following sections, and further
illustrated by quotes from wildland
firefighters about of how SFA might be
applied in a wildland firefighting setting.
*Hobfall, Watson, Bell, et al., (2007).
Psychiatry, 70 (4), 283.

16
Figure 4. Overview of the Seven Core Actions of Stress First Aid
SFA!FUNCTIONS
!
POSSIBLE!ACTIONS
!
Check
▪
Assess foundational functioning and personality
▪
Assess current level of distress and functioning
▪
Assess immediate risks
▪
Assess need for SFA actions, resources, or higher levels of care
▪
Reassess progress
Coordinate
▪
Decide who else should be informed of the situation
▪
Refer to other resources, further evaluation, or higher care, if
necessary
▪
Facilitate access to other resources or care
Cover
▪
Ensure immediate physical safety of stress-injured person and
others
▪
Foster a psychological sense of safety and comfort
▪
Protect from additional stress (ensure respite)
Calm
▪
Maintain calm presence
▪
Give information or direction that is calming
▪
Reduce physiological arousal (slow heart rate and breathing,
relax)
▪
Reduce intensity of negative emotions such as fear or anger
▪
Listen empathically to individual
Connect
▪
Encourage connection to primary support persons
▪
Help problem solve to remove obstacles to social support
▪
Foster positive crew and/or department social activities
Competence
▪
Help problem-solve strategies to manage stress reactions
▪
Help mentor back to full functioning
▪
Facilitate rewarding work roles and retraining, if necessary
▪
Encourage gradual re-exposure to stressful situations
Confidence
▪
Mentor back to full confidence in self, leadership, mission and
core values
▪
Foster the trust of crew and family members in the individual

17
Check
The first SFA Core Action, Check, involves
paying attention to your own stress levels
and reactions, or to the functioning of
fellow crewmembers. You make the time
to get to know foundational levels of
functioning and behavior, and keep track
of any persistent or significant changes in
behavior that might indicate that a
person is experiencing Orange Zone
stress. Check is essentially a screening
mechanism to determine if stressed
individuals are recovering from a stress
injury on their own, need other
preventive SFA actions, or should be
referred to other resources or higher
levels of care. It is also used to determine
the effectiveness of any SFA actions, and
to ensure continual progress toward
recovery. T
here is a psychological and
emotional “immune system” that gets
formed with a foundation like this.
Many departments already practice
some form of Check on an informal
basis. For instance, crew members
might text or call each other during the
off season, to see how each other is
doing during their “down time,” when
stress injuries are more likely to surface.
Or a senior crewmember may keep
someone who had experienced a critical
incident involved in tasks that allow
them to keep an eye on the
crewmember, or make sure he or she is
involved in activities that help them
regain their sense of purpose or
connection with others.
Within the context of SFA, Checking on
others is an on-going process
performed continuously. When Check is
fully integrated into the normal day-to-
day procedures of a department,
individuals value the function of getting
to know each other on good days, so
that they can know when a person may
be experiencing an Orange Zone stress
reaction. They are better
able to
recognize each other’s red flags and
care for each other
.
The
goals
of Check are to:
1.
Identify baseline functioning.
2.
Identify current level of stress.
3.
Look for indicators of ability to
function.
4.
Determine needs for:
•
SFA actions.
•
Other physical, emotional,
social or spiritual support.
•
Others who need to know.
•
Others who can help.
What is Check?
Figure 5 shows the major components of
Check. The first and most critical task is to
observe
—to look and listen for baseline
functioning, as well as verbal and non-
verbal clues that the individual may be
experiencing a stress reaction that might
benefit from assistance. While observing,
you can also identify current and recent
stressors, and note any distress or
changes in behavior.
If indications of a
possible stress
reaction are present, make an effort
to examine the situation more closely,
through direct one-on-one
interactions, or through collateral
sources. This information
can then be
used to determine what (if any) future
actions are required, based on the
person’s current Stress Zone and a

20
18
better idea of the level of danger, if
any, to themselves and others.
It might be helpful to think of Check as
similar to the first step of Basic Life
Support (BLS).
When learning to
perform CPR on manikin ResusciAnne,
students are instructed to first check to
determine whether or not she actually
needs emergency life support. They ask,
“Annie, Annie, are you okay?” before
beginning CPR
.
Check is looking and
listening for Orange Zone stress
reactions before deciding whether or
not to intervene in the situation, and
what to do next.
Why is Check Needed?
Wildland firefighters are regularly exposed to
high levels of intense and prolonged stress.
These stressors, either independently or
compounded by those experienced in their
personal life and family relationships, can
cause stress reactions
. Fellow firefighters
should continually monitor crewmembers
for stress reactions because:
•
Responders who are impacted by
stress are often the last to realize it.
•
Stigma can be an obstacle to asking
for help in some fire and EMS
departments.
•
Matching needs to available resources
with ongoing assessment.
•
Stress Zones and needs change over
time.
•
Risks from stress injuries may last a
long time and appear normal for an
individual.
Recognizing Who Needs Check
The first step of SFA is recognizing that a
crew member might be experiencing an
Orange Zone stress injury and may need
help. There are three Orange Zone
Indicators (signs that an individual is
experiencing Orange Zone stress), all of
which are important:
1.
Recent Stressor Events:
A
department member was involved
in a situation that has a high
potential to cause stress injury.
Examples include life threat (a close
call or
near miss), the loss of
someone or something cherished
(such as a divorce, a death,
retirement or being passed over for
promotion)
or violations of the
individual’s moral code. Recent
exposure to a PTE, such as
responding to a multi-fatality fire, a
fire with a lot of loss of structures,
or experiencing a line-of-duty death
in the department, may be an
important Orange Zone Indicator.
2.
Distress:
An individual is
experiencing significant and
persistently troubling feelings, such
as fear, anger, anxiety, sadness, guilt
or shame.
3.
Changes in Functioning:
The person
is experiencing significant and
persistent changes in physical,
mental, social or spiritual functioning
at work or home, that seem to be
outside of his or her control.
Monitoring for Orange Zone Indicators is
an important skill to learn and practice. A
company officer or peer may become
aware of increased stress indicators in a

20
19
crew member in different ways, such as
when:
•
A firefighter under severe stress
demonstrates an abrupt change in
behaviors.
•
A department member confides that he
she is experiencing a significant
increase in internal distress, or
alarming changes in his daily
functioning.
•
A co-worker or family member seeks
assistance for a firefighter who is
exhibiting stress reactions.
•
The crew (or part of it) has been
exposed to a multiple-fatality incident,
a LODD or other PTE.
•
Figure 6 gives examples of Orange
Zone indicators that might prompt the
Check function
of SFA.
• Note that the key indicator of possible
Orange Zone stress is the individual’s
response to
events—in particular, a
recent significant
change in level of
distress or personal functioning.
Figure 5: Components of the Check Function of SFA

20
20
Figure 6: Examples of Indicators that Might Prompt the Check Function of SFA
Stress!Indicators
!
Look!
For:
!
Listen!
For:
!
Current Stressors
•
A close brush with death while on an
call or during
training
•
The loss of one or more friends, peers or
leaders by death
or serious injury
•
Events in which an individual’s actions or a
failure to act
may violate deeply held beliefs
or moral values
•
Yellow Zone stress reactions that continue
day after day
for many months
•
“I almost got killed in a motorcycle crash yesterday.”
•
“My son has a serious illness.”
•
“My mom just died.”
•
“My husband just lost his job.”
•
“I can’t believe my wife cheated on me!”
•
“My husband left me, taking the kids and all our stuff.”
•
“I just found out I have heart disease.”
•
“The child who died in the fire reminded me of my
child.”
Level of Distress
•
Pacing or persistent agitation
•
Uncharacteristic outbursts of anger, anxiety, or
fear
•
Uncharacteristic fighting, alcohol abuse or
misconduct
•
Persistent sadness or absence of normal emotions
•
Loss of interest in work, hobbies or socializing
•
Withdrawal from interactions with others
•
“I can’t stop seeing the same scene replayed over and
over again in my mind.”
•
“I keep waking up from the same nightmare.”
•
“I don’t have any energy anymore.”
•
“It was entirely my fault.”
•
“I don’t trust anyone in this department.”
Changes in
Functioning
•
Significant and persistent changes in personality
•
Uncharacteristic poor hygiene or grooming
•
Sudden drop in job performance
•
Persistent forgetfulness
•
Uncharacteristic loss of control of emotion
•
Uncharacteristic problems in personal
relationships
•
“I can’t slow down my heart rate.”
•
“I haven’t slept well in weeks.”
•
“My appetite is gone, and I have lost a lot of weight.”
•
“I am afraid I might lose it and hurt someone.”
•
“I’m drinking more than usual.”
•
“My wife and I are arguing a lot more than usual.”

21
Talking about Stress Reactions
In some cases, acquiring the information
needed to make an accurate assessment
will require discussing the situation with
the individual.
The
OSCAR
communication technique can
be a useful—and easy to remember—tool
for talking to someone about stress
reactions:
Observe:
actively observe behaviors;
look for patterns that are different from
baseline.
State Observations:
focus attention
on the behavior; state just the facts
without interpretations or
judgments.
Clarify Role:
state why you are
concerned about the behavior, and
validate why you are addressing the
issue.
Ask Why:
seek clarification; try to
understand the other person’s
perception of their own behavior.
Respond:
clarify why you are concerned,
and discuss desired behaviors; state
options in behavioral terms.
The OSCAR technique can be used to
survey the individual for Orange Zone
Indicators, and to gather information to
answer the following questions:
•
Which Stress Zone is the individual
currently in and why?
•
Would he or she benefit from any SFA
actions to restore calm; create social
connections; build personal
competence; or enhance self-
confidence?
•
Is referral to any other resource
warranted?
Checking Collateral Sources of
Information
It may also be helpful or necessary to
discuss the situation with co- workers
and/or family members. Again, look and
listen for clues about the three Orange
Zone Indicators:
1.
Current and recent stressors
2.
Indications of internal distress
3.
Evidence of loss of previous
functional capacity or changes
in functioning
Information received from these
collateral sources will either support
or conflict with the information that
was gathered from the
individual.
Either way, it will probably be useful
in making more accurate and sound
decisions about next steps.

20
22
Self-Awareness Stress Indicators
Here are some self-awareness stress indicators
common to Wildland firefighters:
• Fatigue
• Having a hard time focusing
• Being short on the fuse
• Not exercising
• Not doing the things you like
• Watching more television
• Nervous habits that others might point out,
like whistling
• Calling home more often
Check Strategies: Others
Here are a few Check strategies you can use
with others:
• Offer basic resources like food water,
warmth, etc.
• Find the right way to check on someone
without annoying them (i.e.,
writing/texting versus calling).
• Check in on anniversaries
• Begin with a casual two way
communication to get someone talking.
Use active listening and look for words,
non-verbal signs, and cues as to how they
are doing.
• I have made a very conscious effort to keep
tabs on myself. The big stress indicators
for me are fatigue, having a hard time
focusing, being short on the fuse, not
exercising, and not doing the things I like,
but instead staying in and watching
television.”
Checking on Self
“I have made a very conscious effort to keep
tabs on myself. The big stress indicators for me
are fatigue, having a hard time focusing, being
short on the fuse, not exercising, and not doing
the things I like, but instead staying in and
watching television.”
“One guy pointed out that I would whistle
Christmas carols. Finally my supervisor said,
“every time you do that bad things happen.” I
wasn’t paying attention to it. Sure enough,
that was one of my stress indicators.”
“It’s important for everyone to know ahead of
time what they do when they’re stressed.
We’ve had fire leadership classes, where
everyone in half the class watches the rest of
the class and tries to identify stress reactions in
the person who is assigned to them. The
person watching you then says what they saw.
The fire keeps burning things down until you
just can’t take it anymore, and they see those
stress reactions. It’s all a simulated exercise,
but it’s very realistic. And the fact that
someone is staring at you whole time doesn’t
help either. It’s locked in a room so it feels like
you are at an incident command post. Then you
get together one on one with the individual
who was watching you. Before you talk, you
write down what you think was happening to
you and how it might look to observer. Then
the observer says what they saw. I became

20
23
very aware that when I get stressed it feels like
I get two pinpricks of fire on my cheekbones
and I can feel like want to abbreviate
communications and get really direct. And
that's not helpful, so knowing that it is coming,
I can usually short circuit it by purposely
slowing down communications and adding
more words, then that hot sensation will back
off. I learned a lot because I never stopped to
see what I do when I’m under stress. Just to
know what that is going to feel like, and what
feels like inside my head, I am not so freaked
out by it now. To not have pre-loaded that, I
would have just have gone on thinking I’m
fine.”
“I usually don’t call home much, but when
stressed, I catch myself calling home. That is
the sign that I’m stressed. I need a touchstone,
to make sure everything is normal at home,
that the rest of the world is still spinning, which
means I’m okay.”
Checking on Others:
“It’s interesting to me who the wounded
firefighters go to when an incident occurs. A
tribal instinct happens in fire crews. They
circle wagons real tight, and it’s very hard to
get into the circle. They don’t allow anyone in
unless they are an alumni of the crew. The
support that comes from within the culture fits
our culture. For instance, one crew had a
barbeque when a crewmember was in the
hospital on life support, which was perfect –
they know what the family and crew needed,
and they did it right.”
“I use Check with employees regularly – they
don’t even know I’m doing it. If I’m looking at
someone in orange or red I will pursue a line of
questioning if there is two way communication,
and try and get down to what’s going on. Its
active listening. I would never come in to
someone after a stressful incident or event and
say “hey man, how’re you doing?” If I’m asking
a rhetorical question, why ask it? I will instead
start a line of communication, get them talking,
and look for words, non-verbal signs, and cues
as to how they are doing.”
“When folks are having issues after a critical
incident, it helps to take a few minutes and
wind down, take a walk, talk to someone, be
less entrenched, and take a break. People
would come to me, and we would go outside,
walk, and get fresh air. The whole support
network really helped me, and I haven’t had
any lingering issues. If we had that support

20
24
network the first time, it really would have
helped. If a team member was struggling more
one day, they removed themselves for a while
and went and did what they had to do. I would
go back and check on them by saying, “are you
okay,” or something simple. They mostly just
needed a break from what they were doing,
rather than having anyone ask how they were. I
think they appreciated me asking though. If
you’re in a fairly connected team environment,
I think it’s okay to do that. If there is less
connection, you have to give it a little bit of
time. It’s situation dependent.”
“I try to be non-intrusive when I check on
someone. I took coffee and donuts over to a
shop and it worked. Sometimes basics are
important – food water, warmth, etc.“
Anniversaries of my incident get to me. There
are so many serious injury cases and line-of-
duty deaths and I wonder who is checking in on
them. Not all fatalities receive the same
attention on anniversary dates.”
“Most times I’ve been more successful at
getting an honest response by setting it up
right. You don’t do it when you have six
engines there. You go to that one engine that
you have doubts about. You might make a big
speech with all of them there, but then you go
to that one separately, and provide them with
option. It’s about saving face. I provide them
with an option: “I’ve been relying on you for six
days now, we’re still in that same pickle, I need
you to be fresh for me, so how about we just
give you an hour off, you guys just take some
time and we’ll put you right back in. If that
works for you, we’ll talk again in 45 minutes
and see if you need more time. I know you can,
but I don't’ want to burn you out, so do this for
me and then we can keep fighting. I know you
can do it but don’t want to burn you out.” It
saves face.”
“Winter is a hard time especially. I haven’t lost
a close friend in fire operations but I have had a
couple who died off duty. Compared to a line-
of-duty death, it seemed like no one cared.
There was no fanfare, there are no benefits, no
memorials. If problems with alcohol or
depression or “extreme living” outside work
create you showing up and not functioning well
socially or otherwise, we should acknowledge
that and ask leaders to think more about that.
We often tend to write off the importance of
personal problems until the person is really at
high risk or at risk of professional
consequences.”

20
25
“Situational awareness is big thing in fire. We
are starting to talk more about human factors
and the importance of tuning into how we
react to stress and how we in interact with
people. We are starting to recognize these skills
as part of what it means to be a good leader.
But, that situational awareness also needs to
include off-duty time and off-season time. It is
time to acknowledge that the consequences of
firefighting and the lifestyle it requires extend
far beyond fire season.”
“We often cover for people. We don’t want to
get involved or overstep into what seems like
someone’s private business. In every situation
in which I lost a friend off-duty the person had
some problems at work beforehand that no
one addressed (e.g., calling in sick to work,
being AWOL, showing up hung over, reckless
behavior on duty, loss of control of emotions at
work, social problems, more risk-taking at work
or sports, etc.) Many people were aware, but
not many people knew how to ask or when to
say something. The behaviors they showed
were notable, but not that out of the ordinary
in our culture. It’s hard to know what is a red
flag because it can look very different for
different people. In many cases, we think that
everything is fine right up until it’s clear that
things are not.”
“It’s incumbent on me to get to know my
employees, to keep tabs on people. I start to
notice changes in behavior, when they act out
of character. If you spend enough time with
people you get to know them. Monitor your
crew, get to know their subtle cues and
behaviors. It’s a full time job to keep in touch
with how people are doing. Sometimes it’s not
possible on fires. People come together for
such a short time and go through
forming/storming/norming/performing, the
normal progression of bringing people together
and making a group out of them. But it is
important to get to know them professionally
and personally, to see how they act when
happy and when upset.”
“By working side by side with a veteran with
PTSD, I knew when he was doing well, and
when wasn’t going to be in the next day. I
could see it in his eyes, a distant stare, and he
was not paying attention. Normally he was
more attentive. He would have delayed
responses, a lack of focus, little things that
were a confirmation of a feeling I had. I would
test him to see how he would respond. There
was also body language; when he was starting
to have problems, he looked like the weight of
the world was on his shoulders, even though
his voice would be upbeat. I started telling him
to take time off to visit family. When he would
come back, he would say thanks for letting me
do that. I really needed to see my dad.”

20
26
“I could see a firefighter’s body language - it
was screaming anger, sadness, and frustration.
I started talking with him and after 5-10
minutes he said, “I just got back from the
hospital, my dad just had stroke, and they don’t
think he is going to survive. I’m not doing well.”
I said, “Man that sucks. Is there anything we
can do for you? Anything you need? Anything
we can do to help him?” I offered to listen if he
needed to talk, and offered help if he needed a
hand, or someone to sit with his dad, or
someone to go mow his grass. Whatever the
problem is, I try to listen a lot. I try not to talk a
lot. I kept the conversation going by asking
questions like, “how old is he? Wow, what a
life,” and tried to spin something positive from
the discussion, just to keep him talking about it,
to continue our conversation. Several days
later, his dad did not die, and he came back and
said, “I appreciate you talking to me. No one
else would even talk with me. You didn’t ask
what was going on, but you were checking in
on me.”
“The groundwork or the foundation that you
lay at the human level is going to make a
difference when it's time to have a hard
discussion or conversation that's way below
the surface. Having something else to engage
people on a personal level outside of the
profession is hugely important. Caring about
your people beyond the task and duty is one of
the key top rated leader characteristics in
research studies.”
“I talk to younger leaders who might have a
better connection to the younger generation
and empower them to work with those guys,
because I know there's definitely that gap
between generations. When my intention is to
provide some stress first aid action but it
crosses, I realize that the folks who are closer in
age and rank may do a better job. It doesn't
raise a threat flag because they're used to
having a normal conversation with them. When
it's with the supervisor they're used to having
you tell them things to do or having disciplinary
actions, so it races at that flag. If you've had
enough normal conversations with people, it's
less likely it is to raise threat that it's about
disciplinary action.”
“We all live in the same area between seasons,
so off-season, at least once a month we all
gather at a place that’s kind of like our own
little place. At other times we get together to
PT, and that's been really great. It's just small
groups of us but I think in my business were all
pretty physical of people, so to see the guys
and gals get together and train together, I feel

20
27
as though, for us, it's actually putting us on
track to go back and engage the next season. I
am keeping an eye on them and getting them
together, just to start feeling that togetherness,
because we break apart, and then come
together. We went from being together,
coming from this incident, in this relationship
together, and then it’s over. So coming
together like this off-season is getting us in line
with where we're going. You sweat together
and you work together as a team, because
ultimately when the season starts, we're
coming together as a hotshot group, and that's
how it’s going to work.”
“One of the key points of check is knowing
your people, and spending a lot of time with
them, both professionally and personally. Then
you can recognize those subtle changes. What
I've done is to start a conversation about
anything except what I think might be bugging
them, and then I actively listen. And once
again I'm talking the floodgates open, and it
goes well.”
“The way we operate is that we're pretty close.
We work together, we live in the same town in
the winter, and we see each other from time to
time in the winter. If I'm not showing up for
hockey, they know something’s going on,
because I love hockey.”
“As a leader, I can tell you all the deaths that
have occurred on my engine. I have overall
responsibility for all firefighters in my district,
so I make sure I have face-to-face time with
each one of them at some point. That's how
the conversations going to start with me. It's
not going to be about their performance on
that call. It'll be about whether they went fly
fishing that weekend. That's probably the most
successful way to check. They don't feel like
you're intruding on their life. But they also
know that I start the season out with
observation. They're all served notice. You
really have to pay attention to your people, and
I want them to pay attention to me. I'm at the
top of the food chain so who's going to tell me
that I'm not acting right. I want that oversight.”
“One of my team members was reported to be
acting out, not normal, and I've known him for
a long time. I couldn't believe that this report
was coming in and so when I went to talk to
him about it, they were obviously some
underlying issues. It took a couple hours of
talking about it, but his biggest fear was that if I
were to let him go that the department would
find out, because he knew he had overstepped
his boundaries. I think I just connected with
him, he trusted me, and I trusted him, because
I've known him for a number of years, so I
could be direct with him.”

20
28
One of the key points of check is knowing your
people, and spending a lot of time with them,
both professionally and personally. Then you
can recognize those subtle changes. What I've
done is to start a conversation about anything
except what I think might be bugging them,
and then I actively listen. And once again I'm
talking the floodgates open, and it goes well.”
“When we sit down to dinner I start just
bringing up general things that happened
during the day and watching everybody. I know
how they like to sit and where their comfort
spot us, and I notice somebody out of their
adjustment. It gives me an ability to use a
group setting to talk about how the day has
gone. It’s a continuous checking.”
“We had a critical incident, and as soon as the
helicopter lifted off the ground I saw the look in
a crewmember’s face that I had never seen
before. I’d work with him for two years and I’d
never seen that look in his eye when that
helicopter lifted, and it only lasted and maybe a
minute, but I knew it had affected him. And the
first question out of his mouth was, “what
could we have done differently?” You have to
watch people for those subtle clues.”
“I usually start with, “how’s it going for you?” I
see if they can offer some information that will
give a lead-in. If that doesn’t work, I try to start
with something positive like, “hey you’re doing
well but it seems like you may be struggling
here, is there anything I can help you with?” It
kind of depends on if you know the person very
well or not. I might say, “I’ve heard what you’re
going through.” Having a specific example
helps.”
I think a lot of this as a use of force continuum.
You start off with more kind language and end
up with pretty dramatic force. Obviously, you
never want to get there if there’s any way to
avoid getting to that lethal force level. I can
think of a time when someone was on a self-
destructive path, and nothing I said or anyone
else that would make a difference. They were
going down a path where they had DUIs and all
kinds of crazy stuff going on. This person did
not want to help, would not seek help, was
offered EAP, offered personal assistance, we
brought in best friends to talk with him, and
the individual just wasn’t interested. Years
later, after they got life their life squared away,
they said they appreciated the persistence
even though they weren’t ready for help, even
though they weren’t ready to accept that help.
They recognized that we didn’t give up. It’s a
hard thing being on the other side of that.

20
29
When you can help, all I can say is be
persistent. This was a good outcome. There are
bad outcomes, where you saw it coming and
couldn’t do anything about it.”
Check Challenges:
“Proximity is our issue. We could all come
together for one big fire and then we all go
home. So we don’t see each other anymore but
we know what we experienced on the fire.
Then we disperse and go home. On a recent
line-of-duty-death, the agency called in a peer
support team for the week following the
firefighter’s death. Thirty days later we went
back to the Forest with a clinician, a fire chief,
and a District Ranger. We talked about
checking in on folks, putting ownership on
leadership to notice when people are deviating
from normal behavior. One particular
firefighter was still struggling with the line-of-
duty-death. I have been in touch with him
since, sending him texts, and asking about how
his kids and the holidays. I identify when he is
engaged with family, has health, and hope. He
may not be out of the orange or red zone but
he has hope and health. When engaging with
his kids, he’s fine, so I am hands off. I also got
him connected to a clinician.”
“One of biggest challenges for our community
is the serious physical or mental injury of a
seasonal employee. During the season, when
we see each other every day, we can keep tabs
on the injured. That changes when crews
disband for the season. The off-season is a time
to revel in the accomplishments of the field
season and to find the relaxation and recovery
that’s needed. There is a rhythm to that
recovery. When faced with recuperation, your
rhythm is disrupted. Often, the injured are
forced to find a ‘new normal,’ that doesn’t
coincide with the healthy rhythm being
enjoyed perpetually by their coworkers. This
results in a sense of alienation that is
destructive to relationships and healthy
rhythm. It takes a dynamic, empathetic crew to
maintain relationships with the injured in the
off-season and efforts often fall short of the
mark.”
“Check” is a lot easier to do when it’s related to
operational stress. You can often recognize in
others that they are getting overwhelmed with
demands on a fire and can jump in to lighten
the load. We are trained to delegate
responsibilities and our ICS system is design up
so that each position is only in charge of 5-7
resources max. This doesn’t always work out,
but we excel at jumping in and helping others,
solving problems, and requesting more
expertise or additional resources when we
need it. But we don’t do so well with personal
stress and physical exertion. Requesting
physical or emotional help is often interpreted
as a sign of weakness. A student in a class once
told me he would “rather be medivaced” than
pass the chainsaw to his saw partner on a hard
hike. While we encourage asking if another
person is okay or if they need help or a break,

20
30
the culturally encouraged response is “I’m
good” no matter what.”
“In the younger generation there's less
interaction. You come in to do a morning
briefing, and they're all sitting there looking at
their phones. It used to be that we would all sit
around and talk, but now that doesn't happen.
They sit right next to each other and there's no
conversation. It's hard for me to try to get to
that level, because I can't relate at all. That's
been a problem. All of us leaders trying to
figure out how to reach the younger
generation, because a typical question like,
“hey how's everything going?” doesn't
resonate. They can't answer it. It's just
different. So when you ask hey how's
everything going, it's just "fine." It's something
I'm working on, and I'm trying to figure out
how to bridge that gap.”
“Check is a tough one. I wouldn’t want
someone checking on me. It’s hard to do off-
season, since it’s almost normal for people to
feel bored or down during the off-season. It’s
almost the norm in your 20s that you go out to
bars or drink a lot by yourself in this culture.
Autonomy is such a high value, so people don’t
like feeling like they are being checked-up on or
that others are doing something that’s not
really sincere. There are also trust issues.
Reputation is everything in fire, and it can be a
competitive environment. There can be a lot of
mistrust in forest service. And many are not
even aware of when to be concerned, what it
looks like to be in the orange or red zone,
what’s normal. There are some people who
will always resist being checked on, and some
who would like to be checked on.”
“We’re a bunch of judgers. When you go to a
fire, you have not met people, they are
assigned to you for two weeks, and you literally
make snap decisions based on their shirt or
gear. It’s hard to pin down why you’re
choosing to trust that person. It’s hard because
it isn’t rational. When you drive down line and
you see people who will not look you in the
eye, or they’re constantly fiddling with
something on their truck, there are things you
can tell intuitively. There are certain
mannerisms. You know when someone’s with
you and when they’re not. And also when they
are able to handle stress and when it’s time to
switch them out. I’ve been wrong, but I call it
out to get more information: “you’re in great
mood today.” “No I’m not.” I rely a lot on
people’s eyes when I talk to them. Just the
slightest shift in their eyes tells me if wrong, or
if they’re not agreeing with me, if they don’t
want to be open with me, or if they’re holding
something back. So I’ll follow that up with
questions: “Is there something I’m missing?”
“What would you do?” “Do you have any
suggestions?” “You guys feeling good with
this?” “Are you able to handle this
assignment?” “Do you need to step back for a
minute?” “Do you want me to have me rotate
someone in for an hour?””

20
31
“Our culture is not comfortable talking about
things. Check has to be really simple. I could
see some folks being irritated by this and some
being totally okay with it. Especially after line of
duty deaths, it’s important to realize what local
factors are. People are all wired differently, and
outside influences want to direct how the
response goes. I learned after one line of duty
death that the focus should be on checking in
with what the family or crew wants. Then, any
response should be for them. Folks all deal
with it differently. In a similar situation, with
the lessons I had learned, I was able to tell the
crew “the focus should be on helping the family
or crew, this is totally for them,” and people
understood it, which made it totally different.
The family told us what they wanted within
agency policy, we knew what we could do, and
it went a lot better. We also had experienced
mentors helping. They checked on us and
advised us that it’s also important to make sure
that we were taking care of ourselves. That
really helped.”
“Our culture is not comfortable talking about
things. Check has to be really simple. I could
see some folks being irritated by this and some
being totally okay with it. Especially after line of
duty deaths, it’s important to realize what local
factors are. People are all wired differently, and
outside influences want to direct how the
response goes. I learned after one line of duty
death that the focus should be on checking in
with what the family or crew wants. Then, any
response should be for them. Folks all deal
with it differently. In a similar situation, with
the lessons I had learned, I was able to tell the
crew “the focus should be on helping the family
or crew, this is totally for them,” and people
understood it, which made it totally different.
The family told us what they wanted within
agency policy, we knew what we could do, and
it went a lot better. We also had experienced
mentors helping. They checked on us and
advised us that it’s also important to make sure
that we were taking care of ourselves. That
really helped.”
“No matter how much you check on someone,
there are some you can’t get through to. The
person has to want to work on it, or otherwise
there is no point. A few I’ve worked with have
left the job. I watched one individual go
headstrong into self-destructive behavior. I
don’t know what the trigger was, but in 5
months he went from one of my top squad
leaders, to one who was showing up drunk. I
offered him time off, employee assistance,
leave with pay, and leave without pay. Every
olive branch in my capacity to extend to him

20
32
was swatted away, and he continued on with
self-destructive behavior. Despite trying
everything in my power, I watched him spiral
all the way down until he had to quit. He didn’t
want help. He was too good, and too tough.
Three years later, he pulled himself up.”
“Some people who are checking on me are
calling me and it annoys me. I’m not upset
about it, but I’ve never been one to take help
from others. When people are calling me, they
want me to talk and be emotional, and I don’t
like it. I have received handwritten cards or
notes, which are always welcome.”
“It can be difficult to accept help because I
don’t want someone helping me. A buddy of
mine just had a major, life-changing injury and
my inclination is to avoid him, because I’m
projecting what would I want were it me who
was injured; I wouldn’t want someone
inconvenienced by my plight. If I were
debilitated, I can’t imagine a tougher thing to
deal with and I wouldn’t want to have my
situation affect others. I would want a normal
relationship with my friends, and would worry
that because of the injury, that would not be
possible. A more healthy reaction is to accept
that I would need help, not only because it’s
helpful for me, but it also helps those who care
for me and want to help. Because I know this
about myself, I will make myself connect
because I understand that folks would want to
help me if I were injured. Ultimately, I know
that by friend is still him, I’m still me, and we’re
still friends. I just heard from a mutual friend
that my friend who was injured is doing fine
emotionally. He’s laughing and talking as he
always has despite his physical injuries. That’s
a wonderful relief, and it helps me to see that
my own anxiety about being injured and
isolated is unrealistic. It’s not about me, it’s
about him, and about what can we do
together.”
“It’s very difficult for people in my community
to understand when we can’t reach someone.
We don’t understand what stop means, what
quit means. When your legs hurt and you can’t
breathe, and your back is hurting, and your
eyes hurt, you don’t stop. That is something
that is paramount in our culture. We take
chaotic, broken, systems, apply will power,
knowledge, and skill to repair them and
stabilize them. That’s what we do. To admit
that I can’t help someone, somebody doesn’t
want help, is a very tough pill to swallow.”

20
33
Coordinate
The second action of SFA is Coordinate,
which always flows from the Check
function. There are two broad
goals
for
Coordinate:
1.
To inform those who need to know.
2.
To obtain other sources of needed help
or care.
What is Coordinate?
Figure 7 shows the major components of
the Coordinate function of SFA. There are
three actions that may follow, depending
upon the information gathered during
Check:
1.
Collaborate
means forming a
partnership with the affected
individual, to expand resources and
options that may have been
depleted by the situation or their
reaction to it. This action is about
getting the person to the next level
of support, which could be a
mentor, trusted co-worker, trained
peer support member, EAP
provider, etc. The choice of who is
brought in to collaborate is
dependent upon the situation and
existing relationship with the
individual (such as
boss/subordinate, peer counselor/
or fellow crew members).
2.
Inform
implies actively engaging key
individuals who have a need to
know, have the ability to help within
the organization or are able to offer
emotional support. This action is
most effective when it is done in
collaboration with the affected
individual.
3.
Refer
is to bridge the individual to a
higher level of care when indicated. It
is important to remember boundaries
and the limits of your capabilities.
When department members are
suffering stress injuries beyond the
scope of trained peers, they need to
be connected with appropriate
organizational supports and
resources.
Coordinate with Other Sources of Care
and Support
SFA providers may need to refer a crew
member to a higher level of care and to
determine what source of care would be
the best fit. In making these decisions, the
following factors should be considered:
•
How confident are you in your
assessment?
•
How solid is your re the individual?
•
Would this individual benefit from a
form of care other than SFA?
•
Are there other resources available,
such as EAP providers or outside
counselors?
•
How has the individual’s level of stress
changed over time? Is it improving,
staying the same or getting worse?
When in doubt, getting another opinion is
often helpful. Although questions may still
remain
unanswered, in most cases,
getting input from others is the right
thing to do.
Coordination with other sources of care
and support does not end with a referral or
request for help. In cases where an

20
34
individual is connected with other sources
of care, follow up (Re-Check) is important
to make sure he or she is getting the
needed support and appropriate
resources.
Coordinate Strategies
Here are a few Coordinate strategies you
can use:
• Try to find the most acceptable way to
refer someone to EAP or other support,
rather than telling them to talk to someone
• Coordinate only if needed
• Give support and access to contact, but set
boundaries for your own health as well
• Be aware of local and national resources,
such as:
• The Wildand Firefighter Foundation
• The “You Will Not Stand Alone” course,
a five-day course designed to prepare a
unit for a line-of-duty-death or serious
injury.
• Peer support teams
• Local counselors
Figure 7. Components of the Coordinate Function of Stress First Aid

35
Coordinate
Characteristics that make you feel you can talk
to someone:
• A person who is quiet, calm, okay with
silence, who asks questions, who doesn’t
always have to have an answer, and who is
fine with listening.
• A person who can create a mutual
resolution to things as opposed to having
all the answers, fixing things. It’s hard
because we like to fix things, but just
knowing when to shut up and listen.
• Someone who is experienced enough and
has been around enough that they don’t
have to tell you that they have been.
• It doesn't matter if they’re
male/female/young/old. In fact, females
tend to be a hair more competitive with
each other.”
“The forest wanted to use critical incident
stress management after a really bad run of
luck one year – a dozer rollover, a couple of
traffic fatalities – nothing major, but enough
that the hotshot superintendent reached out to
the peer support group in region 3 and they got
someone to come up and talk to crew. They
came in and said, “you don’t need to be here
but we’re going to just give you some
information,” and they were doing it in a very
subtle manner, not singling anyone out
because that’s looked upon as weakness in this
culture. In a group setting the CISM facilitators
ran through a stress debriefing model, gave
resources, told us to watch out for each other
over the winter, to keep talking, that there’s
nothing wrong with anyone, to call our
brothers, and to check in on each other. It was
very conversational and subtle. The way we
talk about that in wildland fire culture is using a
star wars analogy – “you have to have mad Jedi
skills.”
“Whether one-on-one or in a group is situation-
dependent. Some folks operate better one on
one, but it seems like the group seemed to be a
better fit for others. When folks are in a small
group and someone steps up and opens it up,
then people can feel okay to speak up because
of that connection and group cohesion. One on
one some folks might not be okay or be able to
open up. One on one people sometimes feel
their back is against the wall. With groups, it’s
okay if the group facilitator is from the outside,
as long as they are not too overbearing, as long
as there’s some kind of connection. If the
outsider does not have a connection, or are
overbearing, then it is tougher to have that
connection.”

20
36
“I have had luck coordinating with local mental
health professionals in the community who are
willing to provide free services or low-cost
services to firefighters.”
“I have worked with the Wildland Firefighter
Foundation. Their bylaws in the past have not
allowed them to deal with mental health
issues, but that is changing. They may be able
to help expedite some of the help that is
needed.”
“I would recommend testing the system prior
to a problem. Start dialing numbers, and find
out if everyone in the chain knows what to
do. We can test the strategy, and come up
with our work arounds and alternative plans
before there is the immediate need for help.”
“We have a contact list with information, and
options, so you have names of people you
could contact easily.”
“We have invited an EAP representative to
come to our “You Will Not Stand Alone”
class: The person will come with some options
for us. They will come armed with that. Invite
them in, and hopefully they will take a seat at
the table and give us an idea of what resources
we can bring to bear. Sometimes there's no
resolution, but there can be understanding.”
“The vast majority of people you going to run
into our going to be helped by you being a
human being and just having a listening ear -
just knowing somebody cares and has some
simple advice. However, when you run into
things where you don’t know what to say, it is
helpful to have the resources to be able to talk
to a local clinician, mentor, peer teams, or
somebody else who provides stress first aid
and ask them what they think.”
“I have good outcomes and bad outcomes.
Even after referring someone to EAP, they
report that they had a bad exchange with the
counselor, so they’re going to give up now. So,
you say go try a different counselor. But they
are tired too, and don’t have a lot of energy to
get out of what their stuck in. I show empathy
and understanding that it’s a very hard time for
them and exercise a lot of patience. Often that
helps, but I’ve also had to let go, because you
can’t always help somebody that isn’t
interested in helping themselves. Sometimes
you just have to step back a little bit. It’s a
burden on everyone. You, the employee,
everyone that works with them, because they
can see the train going off the tracks. You have
to sometimes step back and say, “you know
what, I tried everything I could, and I can’t do
more.” It’s healthy boundaries. It’s not easy,
because you do get invested. Just remember
that sometimes you can only go so far.”

20
37
“Once somebody came up to me and showed
me that they have been cutting themselves. He
said, “I think I need help, I called the suicide
hotline 3 times this week.” I spent a good hour
with him, and we identified some pretty major
life changing events that happened in the last
few weeks and months, years. So, I called the
EAP for him, and the EAP counselor said it
would take time to get the counselor assigned
in the area. I asked if he should go to the
hospital right now, and he said, “I’m out of
here if you do that to me.” I knew a trauma
therapist in the area, and we got him into that
trauma therapist right away. So, we kept him
alive for 24 hours, then we got him through the
EAP process, and got him signed up for three or
four sessions. I also kept texting him and gave
him permission to text me anytime for a week.
They have to be an active participant in their
own rescue but sometimes they’re so blind
they don’t know what that looks like. So, it
helps if you can be available until they get on
their feet. We got him through that hard 48
hours, got him to counseling, and then he went
out on the fire line and had a great summer. I
had to set a boundary of one week of unlimited
texts, then give him the resources he needed,
and then let him get his life back.”
“We do have some great resources to
coordinate with:
a. The Wildland Firefighter Foundation assists
firefighters and their families. It is an
integral piece of our community.
b. The “You Will Not Stand Alone” course is a
five-day course designed to prepare a unit
for a line-of-duty-death or serious injury.
Topics such as Incident Management,
Hospital and Family Liaisons, Death and
Serious Injury Handbook and Benefits are
covered. It arms the agency responsible for
an individual or their family with
knowledge to better coordinate benefits
and resources.
c. We are building a big pool of peer
supporters because it’s often hard to fill
the need. The peer support teams obtain
training from ICISF courses, which include
basic/advanced/suicide prevention, and
strategic response to crisis.
d. Building rapport with local counselors is
pivotal. The local structural fire department
are often available to offer advice on local
chaplains, social workers and clinicians who
are trained to work with first responders
and wildland firefighters.

20
38
Coordinate Challenges
“In this culture, coordinating is a challenge, a
monumental challenge. Coordinate should be
one that is there if you need it, but you
probably aren’t going to need to use it a lot.
The moment you mandate something, we love
our organizations and our hierarchies, but we
hate authority. My boss walked into my office
once after a tough situation and said you need
to go talk to someone about this, and I said, it’s
all good, people are born, people die, I have
closure, I’m good to go, because he cued me
off the wrong way, so I fought it every step of
the way.”
“When you start shoving EAP as an example
down people’s throats, it doesn’t go so well.
The timing was the issue. Not all people are just
going to go right out and ask for help, or even
need it. Just let folks know it’s available, but
EAP might not be the answer. Because of the
culture of the wildland fire agency, folks are
real leery to get that clinical help. Peer help
has seemed to help people more than clinical
help. Being able to have that opportunity with
peer support has really seemed to make a
difference. It’s just being able to let folks have
that connection and being able to talk.”
“There are a many barriers to using EAP,
including:
• EAP information is often pretty hard to
find. It varies region by region, and we
have to be on forest service intranet
computer to find a FS password or access
code, or otherwise we have to call
someone. Not sure how many seasonals
know whether they have access to EAP or
how to use it, especially during the off-
season. It’s not commonly used by
seasonals. Culturally, going to a therapist is
not something that’s accepted for a young,
male firefighter.
• In some areas it takes a month to get an
appointment for EAP. I want to get them
the help they need quickly, without them
changing their mind a month later. There
needs to be something there that's
accessible immediately. This may be the
one moment you have to make an impact.
• It’s sometimes hard to find a therapist
that’s a good fit for what you need. For
instance, if someone is interested in
couples counseling, they call EAP and get a
name or list of names, if they go and it’s
not a good fit or the person doesn’t do
couples counseling, you are back at square
one.
• Some problems are systemic, some regions
work better than others, often on forest
there is some local point of contact who is
the default gateway to a lot of these things,
but for seasonals, who don’t work out of
their supervisor’s office, or have to walk to
the person’s desk in front of their boss, it
gets complicated. And seasonals may not
have insurance.

20
39
• People have no idea how to get substance
abuse treatment, especially in a rural area.
• How and when to find counselor is often
not easy information to find. Employees
often talk to their supervisors. That can be
great but also can be very thin ice
depending on who you talk to and how
they respond. There is a lot of stigma, and
there are a lot of “old school” people in the
FS who see mental health
difficulties/treatment-seeking as a signal of
weakness, emotional instability.
Supervisors don’t always maintain
confidentiality for many reasons, including
a concern that a person might become a
“watch out” situation on the fireline. In
some areas EAP only offers 3 sessions.
• Each region has a different contract for
EAP, so if you go someplace different you
will get a different contract. It's a mystery
for most supervisors on the ground.
• In some regions there are few inpatient
substance treatment facilities so it’s really
hard to enter treatment anonymously.
Coworkers are generally caring but there is
a lot of stigma.
• One person who went to an inpatient
program was told by their boss that they
might try to fire them, which of course was
not permitted. People often view
substance problems and mental health
problems as simply misconduct or bad
behavior, not a health condition.
• We need more education about substance
use and peer support for substance use
moderation / treatment-seeking / recovery.
Alcohol especially is such a huge part of our
culture that sometimes we accept really
high risk use as normal. People who might
be predisposed toward addiction are sort
of set up for problems.”
“When there is a critical incident, we tend to
want to go right to EAP or an HR person in fire
camp and that’s the wrong approach. Those
are unknowns and we don't like unknowns. I
think we like to have that pre-existing network.
You don’t need to know the person you
gravitate towards. It’s the personification of a
person that matters. It is important to have
people who can serve that role embedded in
the organization already. So to teach us to help
each other is really important. We don’t have
to run around with sticker on helmet saying
we’re the EAP PERSON. Just to be able to,
when you look at someone, to feel that thing
that you’re looking for, that’s important.

20
40
Cover
What is Cover?
During operations, every member of the
fire department is accountable for their
own safety, and for that of their fellow
crew members. The SFA action of Cover is
a natural extension of this concept, and
specifically refers to actions that reduce
any threats to safety that may result from
an individual’s reactions to stress. The
goals
of Cover are to:
a.
Ensure the immediate physical safety
of the stress injured person and
others.
b.
Foster a sense of psychological safety
and comfort.
c.
Protect from additional stress.
Cover is used only as needed, when an
individual’s stress reactions are either
impacting safety or the perception of
safety. Figure 8 shows the major
components of Cover. Its
key components
are
stand by
ready to help as needed;
make safe
the environment for the
individual and co-workers if in imminent
danger; and
encourage the perception
of
safety that results from both reduced
danger and greater quiet and order.
Cover and the following SFA action Calm
are analogous in some ways to BLS (CPR).
They are used rarely, can be life-saving
when needed, and can prevent further
harm from occurring until other forms of
help can be obtained.
When is Cover Needed?
Cover is needed when there is a threat
to the safety or perceived safety of
one or more people. These situations
fall into three categories:
1.
The stressed person is in danger
•
The person is in an immediate life-
threat situation; has reduced
situational aware- ness; is not
thinking clearly or is not making
good decisions because of stress.
•
The person has frozen or panicked in
a life-threat situation.
•
The person is impacted by a stressor
in a way that impairs current
functioning.
•
The individual has expressed
thoughts of suicide.*
2.
Others are in danger from the person
Due to stress, the person is behaving in
a way that impacts the safety of others,
for example:
•
While working an accident scene, a
preoccupied crew member does
not remind co- workers of traffic
hazards.
•
A driver freezes or panics while
driving an apparatus with three
firefighters aboard.
•
A previously traumatized crew
member overreacts due to fear of
repeating a traumatic event, such
as a fire officer unnecessarily or
prematurely pulling crews out of a
burning building, reducing the
crew’s ability to save trapped
civilians.
•
A firefighter threatens others.

20
41
*A threat of suicide must always be taken
seriously. It is not your responsibility to decide
if the threat is real. Persons who are
threatening suicide must be taken to an
Emergency Room or to a behavioral health
professional for assessment.
3.
The stressed person has a perception of
danger
•
A firefighter and/or family members
have a perception of danger after a
line-of-duty injury or death of a co-
worker.
How Does Cover Work?
Within the Cover action, SFA providers
promote safety and perceptions of safety by:
•
Making decisions on behalf of
someone who is not thinking clearly.
•
Taking action on behalf of someone
who is not behaving in a safe
manner.
•
Providing authoritative presence to
remove the person from danger.
•
Warning and protecting others who
may not be aware of a danger.
•
Creating an environment of safety to
promote recovery from stress.
When is Cover Needed?
Cover is needed any time a person or crew
feel unsafe and experience stress reactions as
a result of that sense of threat, either in the
immediate environment or in a longer term
way. Depending on the local culture, Cover
can also be needed when family of crew
members are feeling unsafe as a result of the
work experiences of crew members. This need
for cover can manifest in many ways, as
illustrated by these examples:
• A fire with a lot of fatalities caused
firefighters to shift their sense of safety
towards a need to look out for themselves
because they felt the agency was not
looking out for them.”
• In one fire with fatalities, to protect
firefighters from media or onlookers, a
supervisor attempted to limit
crewmembers from leaving the station
and from communicating with others. This
caused firefighters to feel mistrust and
resentment.
• Even though his crew uses a learning
model, a firefighter still feels like every
incident is negatively evaluated, as in
“how did you screw up?”
• A supervisor set the tone of an unsafe
social environment by cultivating a
judgmental attitude in crew members for
whoever didn’t fit with the unspoken
norms to be cool or tough.
• After a large fire, someone posted a video
on the Internet with a few hours, and
spouses of crew members found out their
spouses were killed!by seeing the video
online.

42
Figure 8. Components of the Cover Function of Stress First Aid
How is Cover Implemented?
Any action that quickly increases the safety of
those in danger can be considered a Cover
procedure.
There are an almost limitless number and
variety of non-verbal and verbal options. In
fact, most Cover procedures are intuitive and
are often what people would do instinctively
when faced with a dangerous situation.
When choosing a Cover action, the most
important priorities are to:
1. ensure safety quickly, and
2. take no more autonomy away from
others than is necessary for safety.
In other words, intrude on others as little
as possible and for as short a period of
time as possible.
Non-verbal Cover procedures for enforcing
immediate safety, from least to most
intrusive:
•
Make eye contact.
•
Hold up your own hands in a “stop”
gesture.
•
Apply reassuring pressure on the
shoulder or arm with one hand.
•
Shake or nudge the person
to get his or her attention.
•
Pull or drag the person to safety.
•
If necessary, take physical control of
the person’s body in any way
possible.
Verbal Cover procedures for ensuring
immediate safety, from least to most intrusive:
•
Ask, “Are you okay?”
•
Ask, “Do you need help?”
•
Give directions, telling them what to
do.
•
Suggest an alternate, safer course of
action.
•
Yell a warning to the person about
possible danger.
•
Forcefully command the person to
stop.

20
43
Ways to enforce an environment of safety and
perception of safety:
•
Perform an After Action Review (AAR),
highlighting lessons learned and
problem solving.
•
Give indicated time off for those
needing a break.
•
Mentor individuals who have
experienced negative impacts
regarding concerns about their own
safety or the safety of others due to
their stress reactions.
•
Train personnel on situational
awareness and decision-making
under stress.
•
Enhance both individual and
organizational accountability for
safety by empowering crew members
to monitor situational awareness and
stop unsafe behaviors.
•
Partner up crew members.
•
Directly address all department
members’ concerns for safety after
a line-of-duty injury or death.
•
Set policy about whether videos of
fires can be posted online prior to
spouses being informed about the
fire.
•
Support and educate families who
are concerned about their loved
ones after the line-of- duty injury or
death of a department member.
Cover Strategies: Self
Here are a few Cover strategies you can use to
make yourself feel more safe:
• Find those people, places, or actions that
feels safe to you and call on them when
you need to feel more safe.
• When you feel unsafe, distract yourself by
focusing on something near you or your
own breath or thought (i.e., counting).
• Realize that no one is perfect, and
everyone is going to have strengths and
vulnerabilities – be aware of your own.
Cover Strategies: Others
Here are a few Cover strategies for use with
others:
• Slowly implement SFA actions into any
organization so it is normal well in advance
of anything happening.
• Make it a matter of policy to get people to
cover as soon as possible after a difficult
fire (i.e., a hotel, or out of the fire camp, or
back to family.
• Depending on what a person is doing and
how they are responding, adjust
communication with that person to be
more abrupt or directive if it’s necessary to
keep them safe.
• Let others know that no one is perfect and
let those around you know your strengths
as well as your own vulnerabilities.
• Educate firefighters about the physiological
response to horror or life threat, to
minimize the shock of their own potential
stress responses.
• After line of duty deaths, assign a trusted
family liaison who is also given support for
the work they do.

44
What are Potential Obstacles to Cover and How are they Overcome?
Because the Cover function of SFA is often used in difficult and stressful situations, it may be
useful to consider in advance obstacles to its use and ways to mobilize resources to overcome
them. (Figure 9)
Figure 9. Potential Obstacles to Cover and How to Overcome Them
Potential!Obstacles!to!Cover
!
Mobilize!Resources!to!Overcome!Them
!
•
You!are!not!thinking!clearly!or!behaving!safely
!
•
Get!help
!
•
You!are!occupied!keeping!yourself!safe
!
•
Get!yourself!safe!first,!then!attend!to!others
!
•
You!cannot!acquire!or!hold!the!person‘s!attention!and!trust
!
•
Involve!other!leaders,!trained!peers!or!family!members
!
•
The!person!remains!anxious!even!after!being!removed!to!
safety!and!mentored!
about!realistic!ongoing!and!future!
risk
!
•
Consider!peer!support!or!Employee!Assistance!Program!
involvement
!
•
The!person’s!family!is!concerned!about!their!safety!after!a!
line-of-duty!
death
!
•
Find!ways!to!involve!peer!support!teams!to!reassure!family
!
•
Include!this!topic!in!an!After!Action!Review
!
•
Mentor!the!firefighter!or!EMT!in!ways!to!address!their!family’s!
concerns
!
Cover: Self
“Cover is intangible. I don’t know how you
know how to make yourself safe, other than
just knowing that a person or place seems like
they can offer it. The safe type of person on
the job is someone who makes eye contact. I
feel something when I look at someone, that
connection. It’s either there or it’s not.”
“Internally, I cover myself by focusing on
breathing, or focusing on an object. When the
Granite Mountain Hotshots died in 2013 in
Yarnell, Arizona, they brought the boys back to
Prescott. All nineteen hearses were coming
through town as there was an immense
procession from Phoenix to Prescott. I went
and stood amongst the Granite Mountain
Hotshot alumni. As the news came that the
nineteen hearses were in close proximity and
approaching Prescott, I needed to find cover. It
was the most intense experience to witness
and hear the family’s reactions as the fallen
firefighters passed by. With 19 hearses passing
in front of me, I needed something to keep
myself from collapsing. There was an American
flag straight across the street, so I started
counting the stars. I made myself focus on the
stars with open focus/situational awareness of
what was going on around me. You can do it
with breath, but to me the American flag was
what saved me.”

20
45
Cover: Others
“One way Cover is achieved is by showing
vulnerability yourself and by knowing your
employees. SFA needs to start well in advance
of anything going on. You slowly implement it
into any organization so it is normal. We talk,
drop our guards, and show our vulnerability. It
has to begin well in advance of anything
happening.”
“We find our safety with our family and friends
back home. When I was in a pickle, I don’t
usually call home much, but I caught myself
calling home. And now it’s easier with cell
phones and Facebook.”
“In a facilitated learning analysis (FLA) that was
very contentious, with 65 to 70 people in the
room, we wore our oldest muddy jeans (the
accepted uniform) and only one person took
notes for us, on sticky pads so everyone could
read them. We just wanted to know if there
was anything to learn from the situation, but it
took 7-8 hours, with yelling back and forth. We
had to go through and entire evolution of
communication in order for everyone to feel
safe to speak. Had I worked with all those
individuals prior to this, the FLA would have
taken 1-2 hours. Fortunately, at the end the
guys were high fiving and everyone was good.”
“Cover is one thing we do, whether the crew
requires it or not, once the initial job of
someone who is injured or killed on the fireline
is handled logistically. We make it a matter of
policy to get them to cover. We may get them
to a hotel, or out of the fire camp, or back to
family, or get someone they trust to be liaison
for them so they don't have to deal with a
responding, distant bureaucracy. The agency
administrator provides a family liaison that acts

20
46
as an intermediary and can say to the agency,
“Despite what you want, the family isn’t ready
for that now, or they don’t want it. This is what
they need.” The liaison becomes a barrier
against the chaos of diffuse assistance, and
gives the individual cover from the chaos. He or
she provides clarity and efficient logistics
support, which provides cover immediately.
Over the long run they are the communications
intermediary. They provide the check, the
coordination, and they perform a lot of the
seven Cs on behalf of the individual. We also
have to provide cover for the liaison, because
sometimes they care so much that they put
their own needs aside to provide the best care,
which can create problems in their own
personal life.”
“I think it’s really important for people to
understand the physiological response to
horror or life threat, to minimize the shock of
your own stress response. I was not a rookie
firefighter, and I was strong and confident. But
when the foreman said, “pull your shelter,” the
switch went off and I didn’t have any
movement in my body, and I lost bodily
functions. A crewmember handed me my
shelter and we started running down the hill. It
is the most tremendous gut wrenching guttural
sound you make when you’re about to die. And
then you totally freeze and don’t care at all
about the situation around you. I was totally
dissociated from the fire. The foreman saw that
and came back to me and used strong profanity
and hit me on the head. What I remember him
yelling is “get mad!” So I found my mad, and I
dove off the hillside and down into the
drainage and made it out. It was an extreme
account of cover, but it was very effective, and
very necessary.”
“After action reviews (AARs) are a good way to
check on people, and also a good way to make
my crew safe. We've all been through good
AARs and bad AARs. The good ones are where
there are more multiple hats in the room,
instead of the person who's always doing the
same job. If you're in a hotshot crew, maybe
bring the dispatcher in and have them be part
of the AAR or have a line officer come in and
say this is why I made the decision I did. That
gives people the opportunity to learn what is
going through the mind of the decision-maker,
and get a different perspective. You can bring
that into a better education of AAR. Ultimately
it's execution and facilitation that determines
whether AARs have lasting benefits to the
unit.”

20
47
“I don't like to do AARs every day for
everything, because it just becomes repetitive.
After major events, I'll let a lot of the guys run
the AAR, let them talk, let them have a
discussion about what they think went right.
But I've been on the end of some pretty bad
stuff, we just sat down and it's just day after
day after day after day of AARs for everything,
and it's just horrible. It just turns negative. You
can do it on different scales. On those days
where you're mopping up, maybe you don't
need to bore all your commitment
crewmembers with it, but it's just that open
dialogue, “did anything happen today that we
need to talk about?” Maybe you don't need to
have the exact AAR questions, but you do have
quick questions. It's how you talk about it. I
asked every day, “How did things go today?
Anything we need to discuss? OK, let's go eat.”
The question needs to be asked. But it's all
about how you execute it. If you're not having
that open dialogue every shift, or every
transition period, whatever it is, something is
going to get missed. When something bad does
happen or something big does something, if
your structure already has that open dialogue
in place, then you plug in the crew members,
and it makes it a lot more feasible for them to
communicate comfortably back-and-forth.”
“If a person has high-risk behavior, you will
probably address that person individually to get
a pulse check of what's going on: “I'm hearing
that you're driving like this are not doing thing
safely.” Hopefully you're going to draw out
with active listening what is at the root of
problems with the crew.”
“There is a use of force continuum in
communications. So depending on a person’s
nonverbal behavior, on what they are actually
doing and how they are responding, you adjust
your communication with that person. One of
the examples is an audio clip from a flight
service station of a VFR pilot who can’t see
anything, and the plane starts rolling. This guy
working in the FSS gets a call for mayday and
starts off very low key tempo, not
understanding the severity, and by the end of
it, this guy is screaming into the radio, “Help
me help me help me!” There is a time and
place for me to be more abrupt and directive, if
there is danger, or if it is a re-occurring thing.
Also in terms of efficiency, sometimes you need
to be abrupt.”

20
48
Calm
What is Calm?
The SFA action of Calm works by slowing
down and reducing stress reactions in both
the body and mind. This promotes the
recovery
of normal mental and physical
functioning, and suppresses excessive
physiological arousal. Actions that promote
Calm
quiet
the body by slowing down or
stopping major muscular activity and
reducing heart rate and level of alertness.
They
soothe
intense and distressing
emotions such as fear, anger, guilt or
shame. Calm actions help
compose
scattered mental focus by redirecting
attention outwardly, away from anxiety
and internal states of distress. And finally,
Calm may be achieved by providing
rest
to
help promote recovery and healing.
Figure 10
shows the major components of
Calm
When is Calm Needed?
Calm is needed when intense stress has
interfered with an individual’s ability to
reduce his or her physiological activity
level or emotional intensity. Typically,
there are three categories of situations
that require Calm:
1.
When physiological arousal level
remains too high, as demonstrated by:
•
Loss of physical control.
•
Excessive motor activity.
•
Hyperactivity or hypervigilance.
2.
When cognitive functioning is
disorganized, one or more of the
following is usually noted:
•
Rapid, pressured speech (talking too fast).
•
Reduced situational awareness and
decision-making capacity.
•
Flight of ideas (thoughts flit from one
topic to another).
•
Not responding appropriately to
directions or questions.
•
Freezing in place.

20
49
3.
When negative emotions are out of
control, as characterized by:
•
Poorly controlled fear, anxiety or panic.
•
Poorly controlled depression or anger.
•
Intense guilt or shame.
Situations where Calm is needed can vary
considerably. Some examples for need for
Cover are:
• Alcohol is the only thing a crew member
feels he can turn to, to calm himself
.
• An experienced sawyer begins to make
careless mistakes and notices his
adrenaline increase when several others
gather to watch him cut a complex tree in
advance of the fire
.
• An experienced sawyer begins to make
careless mistakes and notices his
adrenaline increase when several others
gather to watch him cut a complex tree in
advance of the fire
.
• A firefighter who is tired after fighting a fire
for a week feels angry and irritable when
dealing with worried homeowners who
have difficult personalities.
• A firefighter who is a veteran becomes
irritable and hostile when there is
downtime, and often yells at other
firefighters about standards and safety
.
How Does Calm Work?
The Calm function of SFA depends on the
interconnectedness of the mind, brain and
body in order to work. It promotes
recovery and healing through by:
•
Reducing muscular activity.
•
Reducing mental and emotional effort.
•
Slowing heart rate.
•
Reducing levels of stress chemicals
in the blood and brain.
•
Decreasing the intensity of negative
emotions like fear and anger.
•
Increasing positive emotions like a
sense of safety and trust.
•
Increasing the capacity of the
individual for self-control.
•
Restoring mental clarity and focus.
How is Calm Implemented?
Like Cover, Calm is performed as needed
through a wide range of non-verbal or
verbal procedures. Its application should
always
be tailored for the specific situation
and person being assisted. Here are some
ways to immediately calm an individual
who is experiencing intense stress that is
interfering with functioning:
Non-verbal procedures for inducing
immediate Calm, from least to most
intrusive:
•
Establish a confident, calm,
authoritative physical presence.
•
Make eye contact.
•
Stay with the person.
•
Do not show fear, anger,
impatience or disgust.
•
Provide reassuring physical touch, if
appropriate and not threatening.
Verbal procedures for inducing immediate
Calm, from least to most intrusive:
•
Use repetitive, soothing phrases, such
as “Easy now…” or “It’s okay…”
•
Reassure of current safety and
support, such as “I’m here with
you…” or “You’re safe now…”
•
Provide encouragement “You can
do it…” or “There you go…”
•
Give a calming directive, such as

20
50
“Slow down…” or “Try to relax.”
•
Get the individual’s attention by
saying “Look at me!” or “Listen to my
voice!”
Longer-term procedures for inducing Calm
•
Reduce chaos on the scene.
•
Get the individual to focus on your
directions by asking to be briefed on
what is happening.
•
Give clear information on what is
needed, and specific instructions on
what to do next.
•
Take charge, but elicit and accept
feedback from the stressed
individual.
•
Distract the person by having them
focus on your questions or
directions, or encouraging them to
think about something else.
•
Stay focused on yourself and your
own stress level, to avoid escalating a
sense of chaos and anxiety.
•
Coach the person in slow-breathing.
Calm procedures for use with angry
individuals
•
Distract: ask for help with a task or
suggest taking a break, such as
walking away to calm down, or doing
something else for a while.
•
State clearly that you or someone
else will be available when he or she
returns.
•
Defuse: ask the individual to look at
the situation in a different way, see it
from another’s viewpoint or suggest
that they talk to a friend or loved one
•
Distance: separate those who are
angry at each other, or keep them
otherwise engaged.
•
Deter: when feeling uncomfortable or
threatened, don’t be afraid to ask for
assistance.
Calm procedures for those who are
bereaved
When a fellow crew member has
experienced a loss of any kind, either on
or off the job:
•
It is often best to say nothing. It’s all
about providing a supportive presence.
Stay present, stay quiet and listen.
•
Don’t try to make a bereaved individual
feel better because there is no better
way to feel at the moment. Just be
there.
•
When a person does want to talk
with you about the loss, don’t feel
compelled to talk. There are no
“magic words.” Listen and be
supportive in the most appropriate
way.
•
Check in to connect and assess
progress periodically over the
following week and months.
Ways to influence longer-term Calm
•
Listen carefully to distressing
thoughts, feelings, and memories.
•
Ask what you can do in the moment
to help, or what he or she thinks
would help.
•
Provide information about mission,
skills strategies that serves to make
the individual feel more informed
and in control.
•
Conduct an AAR that focuses on
lessons learned and brainstorm
solutions to deal with similar

20
51
problems in the future.
•
Maintain a culture of learning from
all missions, rather than judging or
punishing for mistakes made.
•
Discourage and stop rumors.
•
Let crew members know that you
have or others have experienced
similar stress reactions in the past.
•
Engage others who have been
through similar situations to act as
mentors.
•
Make informal and formal peer
support accepted part of the
culture.
What are Potential Obstacles to Calm
and How Are They Overcome?
Like Cover, Calm actions are most often put
to use in already stressful situations. It can
be helpful to identify specific obstacles to
its implementation in advance and to
consider
ways to mobilize resources to
overcome them. (Figure 11)
Figure 11. Potential Obstacles to Calm, and How to Overcome Them
Potential!Obstacles!to!Calm
!
Mobilize!Resources!to!Overcome!Them
!
•
You!are!not!yet!calm!yourself
!
•
Use!calming!techniques!on!yourself,!which!will!allow!
you!to!provide!similar!!
assistance!to!others!
!
•
You!are!too!distracted!or!busy!to!attend!to!the!person!in!need
!
•
Get!help
!
•
You!are!surrounded!by!too!much!noise!and!chaos
!
•
Get!to!a!safer,!quieter!place!if!possible
!
•
Another!person!is!increasing!the!individual’s!stress!with!
their!loud!and/or!!
frantic!behavior
!
•
Direct!others!away!from!the!stressed!person!if!they!are!not!helping
!
•
You!cannot!acquire!and!hold!the!person’s!trust!or!attention
!
•
Engage!and!involve!others
!
•
The!person!fails!to!calm!down!after!using!all!available!non-verbal!
and!verbal!
techniques
!
•
Consider!peer!support!and/or!BHAP!involvement
!

52
Calm Strategies: Self
Here are a few strategies for calming yourself:
• Engage in regular physical activity.
• Spend time with family and close friends
and let them know what is calming for you
ahead of time so they can better support
you when needed.
• Take a break from stressful situations for a
short time.
• Realize that there are cycles of adrenaline
that may make you prone to depression at
times and build in rewarding activities to
get energized during down cycles.
• Try to see things from a higher vantage
point and see a broader perspective,
literally and figuratively.
Disciplining yourself to take care of yourself
with small rewarding activities is called
behavioral activation. It will not make you feel
better the first time, but over time it will help
give balance out and you a buffer for other
stressful experiences. Like getting good
nutrition, it makes you stronger, similar to how
eating well and taking a good multivitamin can
give you more energy over time. Eventually, it
will start making you feel like there are some
things in the world that can get you activated it
or get you to smile.
Calm Strategies: Others
Here are a few strategies for calming others:
• Make others aware of the importance of
self-calming strategies.
• Ask for help to empower and distract the
other person.
• If possible, get the stressed person to look
at you for a minute, then be very specific
and detailed about what you want them
to do.
• Use light humor.
• Make every effort not to call attention to
someone’s stress in a way that might
make them feel ashamed.
• Acknowledge possible stressors and the
potential need for support in a matter of
fact way ahead of difficult events.
• If a stressed person can’t make good
cognitive decisions, use the person’s
name and communicate exactly what is
needed in a calm, methodical voice.
• After line of duty deaths, determine next
steps for each person on a case-by-case
basis.

20
53
Calm: Self
“There are things you have to do in order to
bring yourself back into this bar of normalcy.
Like Jeff Gilmartin says in his book Emotional
Survival for Law Enforcement Officers, you go
on a giant swing from adrenaline to depression.
There are things that you have to do in order to
claw fight and drag yourself back to normalcy.
Things like hobbies. “Use tas” “I use ta hunt,
fish, spend time with wife.” You have to turn
them into “I’m going tos.” After I let everything
out, I started doing things again, like learning
how to fly fish. I started making an effort to
make work not get in the way of spending time
with my son and wife.”
“What works for me is to pull myself out of the
situation for a bit. I do something simple, like
driving down road, sleeping in an area where
no one else is. I have gone out on my own, not
very far, still sleeping with the same crew, but
not with all the crews sleeping together. We
went out on our own, and made some
separation. We didn’t have to go very far out,
just a little isolated, but it helped immensely. If
we’re out working on line and we go to spike
camps, it seems to make big difference, versus
driving all the way back to a big camp to sleep
and eat. Crews seem to do much better when
they don't’ have to drive all the way back to
camp on remote roads.”
“To calm myself, I like physical activity, exercise
motion, and having my family and close friends
is good. I have a good female friend up street.
She seems to know when I need to talk. Those
are the things you absolutely cherish.”
“Self-awareness is good for Calm. We have
these 14-day assignments, plus travel. On day 8
I am aware that there is always this funk that
wants to set in. It’s not really complacency.
Maybe it’s a combination of exhaustion,
complacency, feelings of being overwhelmed,
and fatigue. That's when I have to be on guard,
because I don’t want anything bad happening
on day 8. So I try to mix up any routine that I
have. I don’t stand in the same place at
morning briefing. I wait until after the briefing
to have coffee. I put on fresh socks, any little
thing I can do, just to get past it.”

20
54
Calm: Other
“We had a prescribed burn that was going
wrong, and it was the first time the line officer
who was in charge had been in charge. I
needed her to not be doing anything else so I
had her sit in the truck and write down
everything she heard on the radio. It was being
recorded at dispatch, but it made her feel
purposeful. You could see in her writing - when
she started, her writing was illegible, and as
time went on, she was able to capture more of
the facts and details. She was able to come
back and be more centered, make better
decisions, and help inform the system. That
simple movement to reduce anxiety was good
for her.”
“There was a guy who would start picking the
lint off his sweater when he was anxious. I
would say, “just look at me for a second.” I
would get him to stop doing what he was doing
and focus just for that second, and say, “here’s
what I need you to do,” then be very specific
and detailed. It was great. He could get right
back there and focus. Something needed to jog
him out of his funk.”
“Humor is a very safe to Calm down with
firefighters. Being self-deprecating always
works, because you’re the butt of it, not
anyone else, although you have to be careful
because you don't’ want to undermine your
own leadership.”
“Asking for help is a good way to calm people.
Saying, “in order to get through this, I’m really
going to need you to “x, y, and z.” I can’t do it
by myself, if you could just help me out here
that would be great.” It’s empowering. It
appeals to all the parts of us that are doers,
fixers, and movers.”
“Helping people to rest and sleeping is a huge
issue. In the worst case we put 16 hours in, and
we don't’ do a good job letting folks rest and
recuperate. We expect folks to get rest but we
don’t provide a good context for it. It will vary
depending on where you are. Some
environments we work in, we go back to a
camp, which is the worst place to get rest, with
generators going, outside distractions, and
sleeping on the ground. We can’t sleep in bed
in every single place, but when we expect
people to get good rest, they can’t. Some
camps have provided sleep trailers, we were
able to go in and get rest, because it was quiet.
When a person works the night shift, during
the day they are not good (providing quiet
sleeping areas) and folks are not able to sleep.
So we have to get better at providing a good
environment. One that is quiet, and not
distracting. Otherwise, folks will not be
mentally fit. The body is not wired for that.”

20
55
“From an operational perspective, when
someone is not doing well, whether their head
is not in the game, for whatever reason, I will
find a less arduous, less hazardous task for that
individual to accomplish. It’s not trying to be
manipulative or deceptive. I know these
people, if I tell them I know you’re tired, go sit
in crew hall, they will say, I’m good to go. But if
I say “we’re in tight spot, I need someone I can
trust sitting with the rig, can you be my guy
today. Catch some zz’s if you want, but keep
the radio turned up and make sure you’re
ready to roll.”
“People reach a freak out point. When they
do, my crew laughs at me and says, “Okay, here
comes Mr. calm again.” The more chaotic
things get, the calmer I become in my
communication.”
“Stress is a really good thing in some instances.
There is optimized stress for optimized
retention when you’re learning, so we apply
stress to the appropriate level, and then you
see that retention and people really start to get
it. When I’m training people on the aviation
side and see the trainee get to the point where
I’m starting to see some serious stress
indicators, beads of stress on forehead, saying
wrong thing, on the next mission I ask them to
evaluate me. It’s giving them break. I bring
them right to tipping point, and then they get
to decompress and evaluate me – from the
aviation side it really fits in. We do that quite a
bit.”
“On the line, if a person is really having
problems, the thing that’s taught is to get the
person off the line and give them some water,
get them to sit in the shade, it is such a
common approach that it feels humiliating to
be that person, even thought that is probably
what needs to happen. Any time you’re singled
out it feels like you did something wrong and
everybody knows and is watching, it feels bad.
There are good leaders who are tuned in can
pull it off without humiliating the person. It’s
really situational. Some examples are being
able to sit without being in front of group,
being assigned a task, or having the whole
group be given a break. Sometimes people will
be assigned to a job like being a lookout.
Depending on the leader, it can be risky to ask
for an easy job. Good leaders can read their
employees and ask them to take a walk to
patrol the line or to do an easy but useful task
that can give them a break. They keep track of
how tired people are, and try to distribute
things that way.”

20
56
“People who don’t have hobbies or identities
outside of fire often struggle during the off-
season or if they get injured. It seems like
people who thrive are those who are invested
in their families, have side careers or creative
outlets like woodworking, hunting, home
improvement, brewing, and physical activities
like ski-patrol.”
“Peer to peer, calming can be hard to do
because of the hotshot mentality. It’s easy to
shame people by implying you think they’re not
competent. Things can be really competitive.
Humor is a big calming influence. People’s
morale will go in tank sometimes, like when it's
raining and people don’t want to be there. It’s
helpful if people just acknowledge potential
stressors. It has it be on your radar instead of
expecting people to suck it up and deal with
their own stuff. Acknowledge that it could be
necessary to have some help.”
“The nature of the job that we do is chaos
punctuated with equilibrium. On a 14 day
assignment, you know there are times when
it’s going to be chaos, you’re just trying to take
your next breath, but we desire the calm that’s
going to come when the incident stabilizes. It’s
something we’re all quite used to, we’re
accustomed to that rhythm. We force the
opportunity for calmness by mandating an end
to the assignment before you return to duty in
the form of R&R.”
“It’s been helpful for me to learn about the way
the body goes into flight, fright, freeze or
fainting when the brain perceives danger. The
more I talk about myself freezing and losing
bodily functions, the more I hear stories from
others that it’s very common place. It should be
known before you go into life threat situations,
so that you’re not shocked by our body’s
response to extreme threat.”
“Substance abuse masks wounds. I don’t drink
as much when I’m around fellow firefighters. I
go home and I drink. It gives a momentary
feeling of relaxation and relief, but if I drink too
much, it has a negative impact, and I don’t feel
relief anymore. It’s not like I don’t know what
I’m doing, I’m very aware – and I see others in a
similar way, drowning feelings or trying to
sleep. I really think total wellness has to start
young, creating programs for younger
firefighters to empower them at a young age.”
“In the Orange to Red Zone, those who have
really gone deeply into their stress reaction and
can’t make good cognitive decisions are in a
danger zone. In one fire, the town was about

20
57
to burn down if we lost the road. We had lost
the road but we were still trying to pick it up.
We were trying to pick up a spot in the
firestorm. In my earpiece I heard the
superintendent say, “we’re leaving, it’s time to
go.” One firefighter, who is usually calm,
screamed into radio “we’ve got this – we’re
going to pick it up.” That firefighter was in the
Orange Zone. He was not making good
decisions. The superintendent, in a calm,
methodical voice, said the firefighter’s name
and then, “we have lost division, we’ve pulled
back to town, it is time to go.” At that
moment, the firefighter snapped out of it, spun
back around and went back.”
“Our crew experienced a fatality, and the crew
was allowed to stay. Others were allowed to go
home. Sometimes it helps for people to stay
around and see what normal looks like, to see
someone who is coping well. For some people
it's very comforting to see other people who
were involved in the situation, and be able to
huddle and see how they are. For other people,
they can actually make them feel worse if they
were severely affected. I really think it is to be a
case-by-case. Usually the person has a sense if
they need to go home, but if they don't and
you see them really struggling, know the
person well enough to know that they need a
task or something to do away from the
situation or tell him or her to go home to get
well rested sure what's coming. For some
people it may be the fifth thing that's
happened that year, as well as things that
happened in their childhood. There may be a
whole historical background contributing to
how they're reacting today.”
“After a really bad fire with a line of duty death,
we brought everyone home and let them rest
over the weekend. Then with the support of
our forest superintendent, forest FMO, and
district FMO, we decided we wanted to give
some control back to the crew. So we went to
each crew member individually and asked them
if they wanted sick leave, or to go back to work.
There were a few guys who went back to work
for 3 to 4 days. We sent them back to districts
they had already worked in, where they
were surrounded by their friends. Then we
came back together and sat around a picnic
table and went through and said, “There are
about 10 different options for us right now.”
We talked with every person, gave each one
every option, and then gave them whatever
they needed, to support them. In the end, most
of them wanted to stay together on light duty.
There were some people who wanted to go out
and cut with a chainsaw with their friends. It
worked out pretty well, doing it on a case-by-
case basis. We did it independently, rather than
bring it to the group. We didn't want

20
58
groupthink. They came out with what they
wanted and we honored that. They are people,
not machines. They're human beings, so we
treat them like that and it goes along way.
They're all different. You can still meet the
needs of the organization and meet their needs
at the same time. Just treat them like your
brothers and sisters. They do extraordinary
things so we should act with extraordinary
compassion with them.”
“Preparing people ahead of a very stressful
experience can be very calming as well. Before
a memorial we walk the new ones in the honor
guard through their role in the event. It calms
them because they felt they then have a sense
of control over that one piece.”
“I spend a little bit of quiet time with them,
redirecting them with a question to get them
off of what just happened to talk about
something unrelated. Explaining equipment,
reminding them about what they l