stress first aid...stress first aid for wildland firefighters 90 minute training, 2018 u.s. forest...

Stress First Aid for Wildland Firefighters

90 minute Training, 2018

U.S. Forest Service Department of Agriculture

National Fallen Firefighters Foundation

National Center for PTSD

Instructor Manual

National Advanced Fire & Resource Institute

SFAforWildlandFirefightersInstructorManualTheU.S.ForestServiceDepartmentofAgriculture

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Table of Contents 1. Table of Contents 2 2. Acknowledgements 3 3. Overview 4 4. Slides and Discussion Points 5


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Acknowledgements

The principal author of this Stress First Aid Training Manual for Wildland Firefighters is Patricia Watson, Ph.D., of the National Center for PTSD.

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.

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.


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Overview A. Enabling Objectives

Upon completion of this half-day presentation, participants will be able to:

1. Describe the basic foundation of Stress First Aid.

2. Differentiate between stress reactions andstress injuries.

3. Recognize Orange Zone Indicators.

4. Describe different types of situations in which itwould be appropriate to use each SFA action.

5. Explain why Check must be performedcontinuously and often for every member ofthe organization.

6. Describe the steps that make up the Checkfunction, and why they are analogous tosurveys used in trauma triage and emergencycare situations.

7. Explain the goals of the Coordinate function.

8. Describe the spectrum of both verbal andnon- verbal Cover and Calm techniques.

9. Describe the methods for performing Cover,Calm, Connect, Competence and Confidence, andthe different ways of mobilizing resources foreach.

10. Develop the skill set to implement theSFA model for individuals in crisis.

B. Training Materials Required

1. Attendance Form

2. Course Evaluation Form

3. PowerPoint Slides

4. Stress First Aid for Firefighters andEMS Personnel Student Manual

C. Presentation Notes

To improve the presentation of this material:

1. Present any optional example slides youwould like, or tell real stories to illustrate thecore actions of SFA.

2. Ask trainees to share relevant storiesand situations.

3. Encourage trainees to participate, askquestions, role-play and discuss optional casediscussions in small groups.

4. Draw attention to relevant portions of the SFAStudent Manual during the presentation, andencourage trainees to read the full manual.

5. Show short clips from optional video slides, ordocumentaries, television shows and moviesthat display situations illustrating a need for SFA or scenarios in which SFA- like actions are beingperformed. Afterwards, ask trainees to reportback on what they saw, and how the scenerelates to actual or potential SFA actions.

6. Challenge trainees to apply the skills of SFA tothe optional skill application case.

D. Trainee Support Materials

Watson, P, Gist, R., Taylor, V., Nash, W.P., Westphal, R.J., & Litz, B. (2012), Stress First Aid (SFA) Student Manual For Firefighters and Emergency Medical Services Personnel.

Hobfoll, S. E., Watson, P. J., Bell, C. C., Bryant, R.A., Brymer, M. J., Friedman, M. J., et al. (2007). Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry, 70(4), 283-315.

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Slides and Discussion Points # Discussion Points Slide

1 Introduction

Welcome to Stress First-Aid (SFA) Training.

SFA is a set of supportive actions designed to help you and your fellow emergency responders assist each other in mitigating the negative impacts of stress.

Logistics/Ground Rules

Introduce yourself and the topic.

Inform participants of any additional requirements, rules, location of restrooms, approximate length of class and anything else pertinent for successful module delivery.

Inform participants that as an instructor, you appreciate their input during class.

2 Two Faces of Stress

Stress is both necessary and potentially harmful.

The process of experiencing mild to moderate stress and successfully coping typically builds resilience.

Stress that causes persistent internal distress and functional impairment is harmful.

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# Discussion Points Slide

3 Four Causes of Stress Injury

In firefighting and Emergency Medical Services work, trauma is not the only harmful exposure. Stress injuries can arise from four possible mechanisms or causes:

Life Threat—due to traumatic life-threatening or other situations that provoke terror, horror or helplessness. This type of injury can include experiencing a near-miss or close call.

Loss—grief due to the loss of close comrades, leaders, family members or other cared-for individuals.

Inner Conflict—a “beliefs” injury due to conflict between one's moral/ethical beliefs and current experiences. Inner conflict stress injuries can include acting outside of internal, self-imposed morals or values, an inability to prevent harm to others or somehow contributing to or not preventing harm to a fellow firefighter or EMT.

Wear and Tear—the result of fatigue and accumulation of prolonged stress, including from non-operational sources, without sufficient sleep, rest and restoration.

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4 Stress Continuum Model

Stress First Aid was adapted from the Navy/Marine Corps Combat Operational Stress First Aid (COSFA). The Stress Continuum Model was developed as a visual tool for assessing an individual's stress responses, and forms the foundation for both COSFA and SFA.

Stress responses 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 continuum has four stages: Ready (Green), Reacting (Yellow), Injured (Orange) and Ill (Red). 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 and how they, as individuals, interpret it. During the course of this response, a person’s state can range relatively rapidly from Green to Yellow to Orange and back again.

For many years, the ethos in the fire and rescue culture has been that after a difficult event, personnel should be able to tough it out. This is still the case in many departments, where there is still stigma associated with reacting to stress or exhibiting stress injury behaviors. As a result, people will try to conceal stress reactions from supervisors to avoid medical or psychological intervention.

However, it is usually not possible to keep these behaviors hidden for long from family members, colleagues and friends. When a co-worker recognizes that a fellow firefighter or EMT is in trouble, it is important to break the code of silence. Getting this individual connected with the next level of help as soon as possible may help prevent his or her reaction from progressing into the Red Zone. And once an individual has moved into the red zone, the goal is to help get them into treatment as soon as possible.

5 Stress Continuum Model

The Stress Continuum Model is similar to the fire danger continuum - the goal is the be aware of when a person is entering the “danger zones” and make every effort to mitigate the situation to bring them back to the safe zones.

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6 Yellow Zone Reactions vs. Orange Zone Injuries

Firefighters, EMS providers, law enforcement, and telecommunications professionals 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 natural part of developing connectedness, competence and confidence as a result of having faced life’s challenges. Most people have sufficient emotional skills and resources to reset their internal equilibrium over time after a stress reaction, or exposure to a potentially traumatic event (PTE).

Many transient stressors can cause reactions while there are four sources of stress injury. The causes of stress reactions will influence the four sources of stress injury. An individual who has orange zone injuries is more likely to have a combination of wear and tear stress with one of the other three causes of stress injuries. Stress injuries, on the other hand, can cause lasting damage to the mind and brain, and may result in impaired functioning in all domains of a person's life. They also typically require activating additional outside resources to enable the individual to recover and grow from the experience.

The concept of stress reactions compared to stress injuries is similar to that of a strained versus a broken ankle. When an ankle or tendon is strained, physical therapy and use are often prescribed. However, when the injury is a broken ankle, a cast and rest are needed.

Understanding the difference between stress reactions and stress injury behaviors will determine whether or not stress first aid is even needed.

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7 Orange Zone Indicators

To recognize those who need help, you will need to be aware of three Orange Zone Indicators:

1. Recent Stressor Events: An individualwas involved in a situation that has ahigh potential to cause stress injury.Examples include life threat (a closecall or near miss), the loss of someoneor something cherished (such as adivorce, a death, retirement or beingpassed over for promotion) orviolations of the individual’s moralcodes. Recent exposure to a PTE, suchas responding to a multi-fatality fire orexperiencing a line-of-duty death in thedepartment, may be an importantOrange Zone Indicator.

2. Distress: The individual is experiencing significant andpersistently troubling feelings, such as fear, anger,anxiety, sadness, guilt or shame.

3. Changes in Functioning: Significant and persistentchanges in the individual’s physical, mental, social orspiritual functioning seem to be outside of theindividual’s control.

8 Where SFA Fits in the Stress Continuum

SFA was created to fill the care gap between training, stress management and prevention at the left end of the Stress Continuum and clinical treatments available from healthcare providers on the right.

SFA is a set of procedures for the management of stress reactions when someone is moving from the Yellow to Orange Zone, and often into the Red Zone as well. SFA actions can and should be applied by anyone, anywhere.

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9 What Is Stress First Aid (SFA)?

Stress First Aid is: • A flexible framework that gives

guidance on how to quickly assessand respond to stress reactionsresulting from both personal andwork stress

• A way to preserve well-being,prevent further harm, and promoterecovery

• A practical tool to use wheneverneeded for yourself or your peers

10 Why This Model?

• SFA is an evidence informed model

• Each of the stress continuum zoneshas a rich body of knowledge andscience that informs decision-making.

• A color coded continuum allows peopleto bring together the differentcomponents in a way that makes senseand is accessible.

• It addresses the gap between fitnessand illness

• It provides procedures for early care ofstress injuries

• Ultimately, it facilitates further care ifneeded.

• The goal is to have peers and leadersrecognize when an individual mayhave a stress injury, talk with yourpeer about your concern, and helpthem to connect with the next levelof support.

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11 SFA Evidence Support

The Core Actions of SFA are derived from an exhaustive literature review and international expert panel (Hobfoll, & colleagues, 2007). There are five essential elements of immediate and mid-term intervention that are related to better recovery from stress: 1. Promote a sense of safety—safety can

be relative, and it is important to havea balanced view about the levels ofdanger in the world.

2. Promote calming—some anxiety isnormal and healthy. However,extended arousal of heart rate, bloodpressure and respiration is associatedwith disruption of sleep, lack ofhydration, poor decision-making andlong-term health problems.

3. Promote connectedness—socialconnectedness is one of the strongestprotective factors against stress injuryand is linked to emotional well-beingand recovery following traumaticstress.

4. Promote sense of self and collective efficacy—peoplewho believe that they can overcome adversity and/orthreat can handle stressful events, solve their problemsand show greater recovery in stressful times.

5. Promote a sense of hope.—hope maps onto optimism,faith, spirituality, and the belief that things will work inthe best possible way.

12 Essential SFA Skills

There are three essential SFA skills.

1. Recognize when a peer has a stressinjury

2. Act: If you see something, saysomething

• To the distressed person (alwaystry to communicate with thedistressed person first)

• To a trusted Support (Ifcommunicating with thedistressed person is not withinyour role then coordinate with atrusted other)

3. Know at least 2 trusted resourcesyou would offer to a person indistress. This is where you need toknow your organization andcommunity resources.

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13 Functions of Stress First Aid

1. SFA is designed to reduce the risk forstress reactions in fire and rescuepersonnel.

2. SFA is used to continuously monitorstress levels of every member of thedepartment. With SFA, you will beable quickly recognize those who arereacting to a wide range of stressorsin their work and/or personal life,and may need intervention topromote healing.

3. SFA offers a spectrum of one-on-oneor group interventions to ensuresafety, reduce the risk for moresevere stress reactions and promoterecovery.

4. SFA is used to monitor the progressof an individual's recovery, to ensurereturn to full-function and well-being.

5. When needed, SFA bridgesindividuals to higher levels of care.

14 Stress First Aid is NOT

• An event-only intervention. SFAfocuses on people and behaviorsinstead of focusing on events.

• A one-time only intervention. SFA isa way to identify people in distressand provide long-term emotionalsupport.

• A replacement for needed medicalor behavioral health interventions.

• A replacement for preventionefforts.

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15 The Stress First Aid Model

Provide a brief overview of the Stress First Aid Model. The model maps onto the five essential elements in the prior slide.

The model always starts with some stressor, which can occur at work or in the person’s personal life.

A stressor alone is not usually sufficient to consider Stress First Aid. It has to be accompanied by either distress or loss of function due to that stressor.

Two continuous actions have been added to the five essential elements:

• Check, which involves observing,paying attention, and checking in onpeers on a regular basis, so that youknow both their baseline functioningand behavior as well as any changes inbehavior or functioning.

• Coordinate, which involves alwaysbeing aware of additional resourcesthat you may need to refer to if yourSFA actions aren’t sufficient to make adifference in alleviating stressreactions.

In addition to the two continuous actions, the five elements have been adapted for the SFA model. The core actions of Stress First Aid were given words that all start with the letter “C” in order to make it easier to remember:

• Safety is now Cover. If there is a physical safety risk orthe person’s own perception of risk is endangering theirwell-being, you act to make sure the person is safe orfeels more safe (cover).

• Calm stays the same. In addition to checking andaddressing sense of safety, you also assess if they arecalm, and act to reduce distress if they are not. We knowthat people with post-stress elevated HR, respiration,and BP show greater risk for long term health andmental health problems. This is where calming reducesthe risk for further stress reaction.

• Connect stays the same. We may also assist byfacilitating connectedness. In fact this may be all that isneeded to reduce stress.

• Self-Efficacy is now Competence. This involves helping aperson build or regain their competence for coping andfunctioning.

• Hope is now Confidence. Actions to build a stress-affected person’s confidence may be needed. They mayhave lost confidence in self, peers, leaders, or with hopeand/or faith that things will be okay.

Remind people that stress reactions can be delayed and that they should be ready to respond in the future if stress injury behaviors emerge over time.

The goal of SFA is to move people towards wellness.

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16 How Can You Use SFA?

This slide shows that when you are using SFA, you will always start with CHECK - either through your own observations or being informed about a high risk event, sign of distress, or change in functioning. Then you will be approaching the person to make contact first, to gather information that helps you make a decision about what to do based on the information you gathered.

SFA is not one-size-fits-all. More than one core action can fit different stress reactions, so the decision of how to act will depend first on what type of stress reaction a person is experiencing, but also on a number of other factors, including: • How much time do you have to spend

with this person?• What is the nature of your

relationship?• Which action would bring the greatest

benefit?• Which action would be most

acceptable to the person?• Which action would foster the most

recovery?

Depending on the symptoms and circumstances, you may also be utilizing more than one SFA action concurrently. It is important to keep an open, flexible stance towards Stress First Aid and use it as a framework for remembering the factors that should be considered when someone is exhibiting moderate to severe stress reactions.

17 Transition Slide: Stress First Aid Actions

Say: “We will now discuss in detail the core actions of Stress First Aid.”

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18 Check

The action of Check is different in that it is not triggered by certain situations, but rather should be an ongoing process. This is because people may be unaware of their stress zones and needs, or may not recognize the ways that stress has impacted their lives. Even if the person affected by stress recognizes distress or changes in functioning, the stigma that surrounds such problems can be a powerful barrier to seeking help.

Both the stress zones of individuals and the resources available to help can change drastically over time. A continuous process of assessment is often the only way to match needs with appropriate levels of help each step of the way.

It is also important to remember that the after-effects of stress injuries can be delayed by weeks, months or even years. Those who have been seriously affected by stress at any one point in time will need to be periodically followed up with and reassessed.

a) The first and most importantprocedure of Check is to observe: tolook, listen, see and hear what is goingon with the stressed individual, notinghow he or she is being affected and bywhat. This is not meant to be an intrusiveprocess, but one of awareness andcaring.

b) While looking and listening, it isimportant to keep track of the keyindicators of the Stress Zones that we willlearn about shortly. Special attentionshould be paid to stressor events (both atwork and on the home front) and theinternal distress and changes infunctioning that these events (or theiraccumulation over time) may provoke. IfSFA actions have already been used, weneed to keep track of whether or notthey have been effective.

c) Observing from a distance is not usually enough toreally get to know others. By examine, we mean talkingone-on-one to the person we’re checking and, whenappropriate, asking about how he or she is feeling andfunctioning. We can also gather information from othersources that might be helpful, including from peers andfamily members.

d) The final component of Check is to decide on helpfulinterventions based on this information. We must alsodecide in every case whether anyone is in danger, andmake decisions about Stress Zones and the need forfurther care.

Check often begins with awareness that an individual has been exposed to specific stressors. These stressors may be discrete events or family life difficulties, financial strains or challenges to one’s value systems. Sometimes these stressors may also be an accumulation of small and seemingly insignificant challenges that can add up over time, and have a sizable impact on an individual's stress level.

However, exposure to stressors is not enough to warrant SFA or other direct aid. Most people who experience even intense stressors don’t need help. What triggers the sequence of Checks that initiate SFA are not the events themselves but indications that someone who has been exposed to these events is operating in the Orange Zone.

Then, ask yourself “What are the individual's physical, mental, social, and spiritual needs?” Depending on the answer, it may be appropriate to use Connect, Confidence and Competence, and to identify what resources to mobilize on this person’s behalf, and who else needs to know.

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19 Look, Listen and Feel…

Check is similar to the basics of CPR – look, listen, and get a feel for someone, both their baseline behavior and the way they are when they are reacting to stress.

20 Check: Why Is It Needed?

This slide lists some reasons to utilize Check on a regular basis. As we cover each SFA action, we will discuss potential scenarios in which to use them--for whom and in what circumstances. The action of Check is different in that it is not triggered by certain situations, but rather should be an ongoing process. This is because most people are unaware of their stress zones and needs, and can’t afford to pay attention to such things when focusing on work and the demands of daily life.

When people have been significantly changed by stress—injured by it—they may not recognize the ways that it has impacted their lives. Others, though, may notice if they are paying attention and know what to look for.

Even if the person affected by stress recognizes distress or changes in functioning, the stigma that surrounds such problems can be a powerful barrier to seeking help. Telling others about our problems and asking for assistance is very difficult for most of us.

Both the stress zones of individuals and the resources available to help can change drastically over time. A continuous process of assessment is often the only way to match needs with appropriate levels of help each step of the way.

It is also important to remember that the after-effects of stress injuries can be delayed by weeks, months or even years. Those who have been seriously affected by stress at any one point in time will need to be periodically followed up with and reassessed.

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21 Check Tool: “OSCAR” Communication

Many people feel uncomfortable asking others about their stress reactions. We know how to have casual conversations with peers, but when it comes to discussing personal issues or emotions, people often don’t know where or how to start. Another common barrier to accurate assessment is the almost automatic denial of experiencing any stressors, distress, or changes in functioning.

One tool that can be effective in overcoming these obstacles is “OSCAR” communication—a mnemonic (memory device) for the five steps of: 1. Observe2. State Observations3. Clarify Role4. Ask Why5. Respond.

Here’s how it works: you have observed a co-worker keeping to themselves after a stressful event, such as the death or injury of another member of the department.. You approach the withdrawn person and strike up a friendly conversation. After a while, you ask something open-ended like “How are you doing? or “How are you feeling?”

If he or she quickly brushes you off with a denial such as “I’m fine,” you next state your observation, such as “Well, I asked because I noticed you’ve been keeping to yourself a lot lately.” Before the individual has a chance to get defensive, you add—to clarify your role—that you only bring it up because you are concerned, and want to know if there is any way that you can help.

If you can then establish a common perception about the person’s behavior (i.e. he or she admits to isolating more than usual), you next ask why, or maybe simply “What’s going on?”

The final step is to respond with a statement that makes it clear that you both heard and understood what you were told, and that you might have some ideas about what might make the person feel or function better.

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22 Check: Indicators of Severe Stress Reactions I

The experiences, behaviors and symptoms that characterize stress injuries are similar, regardless of the type of injury. They include:

• Not feeling in control of one’s body,emotions or thinking

• Significant and persistent negativechanges in behavior / habits

• Frequently unable to fall or stay asleep• Numb, removed from all feelings• Becoming uncharacteristically more

isolated from others• Excessive inner turmoil• Wanting to avoid any reminders or

triggers related to stress• Significant anxiety about reminders or

places related to an incident

Note: You do not need to read each bullet. Cover the first three. Highlight the importance of role functioning in maintaining safety. Point out that the remaining items contribute to role impairment.

23 Check: Indicators of Severe Stress Reactions II

The experiences, behaviors and symptoms that characterize stress injuries continue on this slide, including: • Becoming obsessive about information

or factors related to an incident• Waking up from recurrent or vivid

nightmares• Feeling persistent, intense guilt or

shame• Feeling unusually remorseless• Experiencing attacks of panic, anger or

rage• Loss of memory or the ability to think

rationally• Inability to enjoy usually pleasurable

activities• Loss of grounding in previously held

moral values

Note: You do not need to read each bullet. Cover the first three. Highlight the importance of role functioning in maintaining safety. Point out that the remaining items contribute to role impairment.

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24 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

ASK: Can you think of any other indicators of stress that might be helpful to be aware of?

25 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 onsomeone without annoying them (i.e.,writing/texting versus calling).

• Check in on anniversaries• Begin with a casual two way

communication to get someonetalking. Use active listening and lookfor words, non-verbal signs, and cuesas to how they are doing.

ASK: Can you think of any other Check strategies that would be helpful?

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26 Coordinate

Coordinating care is something that firefighters and EMTs do all the time. The next core action of SFA is Coordinate, which should come naturally to you. Within SFA, providers consult and collaborate with others, and inform those who need to know. The key components of the Coordinate action are: • To collaborate with everyone who has

a stake in the well-being and future ofthe stressed individual.

• To get assistance from others at anystep in the process in which help isneeded to assess and care forindividuals with stress problems.

• To inform the chain of command to theextent they need to know.

• To refer individuals in need to others who can helpeither in a direct hand-off or through a more gradualconsultation process.

27 Coordinate Strategies

Here are a few Coordinate strategies you can use:

• Coordinate only if needed• Try to find the most acceptable way to

refer someone to EAP or othersupport, rather than telling them totalk to someone

• Be aware of local and nationalresources, such as:• The Wildand Firefighter Foundation• The “You Will Not Stand Alone”

course, a five-day course designedto prepare a unit for a line-of-duty-death or serious injury.

• Peer support teams• Local counselors• Other teams who have been through

similar situations

ASK: Can you think of any other Coordinate strategies that would be helpful?

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28 Cover

This slide shows the primary components of the next SFA action, Cover. To provide Cover means to ensure continued safety. This most often takes the form of standing by a stress-injured person, and remaining available and ready to assist as needed.

The most basic component of Cover is to make the stress-injured person safe in any way you can. When necessary, Cover also encompasses making others safe from the stress-injured person.

Cover is also about encouraging a perception of safety. In situations where there is either real danger or risk surrounding an individual, a greater commitment to organizational safety and order can generate a perception of safety that is important for both affected individuals and their families.

29 Examples of Need for Cover

Here are some real examples of a need for Cover: • A fire with a lot of fatalities caused

firefighters to shift their sense of safetytowards a need to look out forthemselves because they felt theagency was not looking out for them.

• In one fire with fatalities, to protectfirefighters from media or onlookers, asupervisor attempted to limitcrewmembers from leaving the stationand from communicating with others.This caused firefighters to feel mistrustand resentment.

• Even though his crew uses a learningmodel, a firefighter still feels like everyincident is negatively evaluated, as in“how did you screw up?”

• A supervisor set the tone of an unsafesocial environment by cultivating ajudgmental attitude in crew membersfor whoever didn’t fit with theunspoken norms to be cool or tough.

§ After I large fire, there was a video on the Internet withan hours. A few wives found out their husbands werekilled by seeing the video on Facebook.

ASK: Can you think of any other examples that you have seen a need for Cover?

Be prepared to give examples of your own if members of the audience are unable to think of any.

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30 Cover Strategies: Self

Here are a few Cover strategies you can use to make yourself feel more safe:

• Find those people, places, or actionsthat feels safe to you and call on themwhen you need to feel more safe.

• When you feel unsafe, distract yourselfby focusing on something near you oryour own breath or thought (i.e.,counting).

• Realize that no one is perfect andeveryone is going to have strengthsand vulnerabilities – be aware of yourown.

ASK: Can you think of any other Cover strategies that would make you feel safer?

31 Cover Strategies: Others

Here are a few Cover strategies for use with others:

• Slowly implement SFA actions into anyorganization so it is normal well inadvance of anything happening.

• Make it a matter of policy to getpeople to cover as soon as possibleafter a difficult fire (i.e., a hotel, or outof the fire camp, or back to family.

• Depending on what a person is doingand how they are responding, adjustcommunication with that person to bemore abrupt or directive if it’snecessary to keep them safe.

• Educate firefighters about thephysiological response to horror or lifethreat, to minimize the shock of theirown potential stress responses.

• After line of duty deaths, assign atrusted family liaison who is also givensupport for the work they do.

ASK: Can you think of any other Cover strategies that would make others feel safer?

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32 Calm

This slide shows the major components of the next SFA action, Calm. You may notice there is some overlap between the concepts that make up Cover and Calm. Procedures that promote one of these two actions often also help with the other.

The major difference is that while the goal of Cover is safety, Calm’s goal is to reduce the intensity of physiological, emotional and behavioral activation.

The first and most basic procedure of Calm is simply to stop, quiet, and cease physical exertion if possible. Some examples of this are to sit down or lie down, put down any items and relax, with the goal of slowing heart rate.

Regaining composure will help to restore cognitive function. The word “compose” means to help to pull back together that which is scattered or fragmented into a more orderly and coherent state. In the Calm function of SFA, we help people compose by drawing their attention away from their frightening and chaotic inner thoughts and feelings, and refocusing them in a calming way.

The next component of Calm is simply to rest—including sleep--for as long as is necessary to return to baseline levels of arousal and physical and emotional function. Pay particular attention to the sleep of a stress-injured person. Sometimes a good night’s rest is the only thing that will restore a stress-injured person to baseline mental and emotional functioning, so make sure they actually get to sleep.

The final component of Calm is soothing, which means to reduce the intensity of destructive emotions like fear and anger, by providing a calm physical presence and listening empathically.

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33 Examples of a Need for Calm

Here are a few real examples of a need for Calm:

• Alcohol is the only thing a crewmember feels he can turn to to calmhimself.

• An experienced sawyer begins to makecareless mistakes and notices hisadrenaline increase when severalothers gather to watch him cut acomplex tree in advance of the fire.

• A firefighter who is tired after fightinga fire for a week feels angry andirritable when dealing with worriedhomeowners who have difficultpersonalities.

• A firefighter who is a veteran becomesirritable and hostile when there isdowntime, and often yells at otherfirefighters about standards and safety.

ASK: What are behavioral indicators for which Calm may be helpful?

ASK: Can you think of any other examples that would signal a need for the Calm action?

34 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 iscalming for you ahead of time so theycan better support you when needed.

• Take a break from stressful situationsfor a short time.

• Realize that there are cycles ofadrenaline that may make you proneto depression at times, and build inrewarding activities to get energizedduring down cycles.

• Try to see things from a higher vantagepoint 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.

ASK: Can you think of any other strategies for calming yourself?

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35 Calm Strategies: Others

Here are a few strategies for calming others:

• Make others aware of the importanceof self-calming strategies.

• The strategies have to fit thempersonally, and fit the wildland culture.

• Ask for help to empower and distractthe other person.

• If possible, get the stressed person tolook at you for a minute, then be veryspecific and detailed about what youwant them to do.

• Use light humor.• Make every effort not to call attention

to someone’s stress in a way thatmight make them feel ashamed.

• Acknowledge possible stressors andthe potential need for support in amatter of fact way ahead of difficultevents, even through humor.

• If a stressed person can’t make goodcognitive decisions, use the person’sname and communicate exactly what isneeded in a calm, methodical voice.

• After line of duty deaths, determinenext steps for each person on a case-by-case basis.

ASK: Can you think of any other strategies for calming others?

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36 Connect

This slide shows the three components of the next SFA core action, Connect. As with all SFA actions, these components designed to be adapted to fit your setting, your personality and the needs at that time of the individual experiencing a stress reaction.

The first component is to simply be with the stress-injured person. This means being present, making eye contact, listening and/or mentoring and empathizing.

The next component is to comfort. This implies accepting the person and his or her reactions, providing encouragement if that is what is needed, or soothing in a way that fits your style and is acceptable to the individual.

The final component is to reduce the stress-injured person’s sense of isolation, which can often occur when Orange Zone reactions make the individual want to isolate, or when he or she feels shame about what is happening. Assisting in such a case may involve helping to improve the person's understanding of the situation and of stress reactions. Often, the SFA provider must help the person to see that stress reactions are understandable and acceptable.

This component also involves correcting misconceptions and misperceptions that will reduce the stressed person's alienation and isolation. This includes clearing up those held by the stress-injured person about his or her own stress reactions, as well as those held by others. Doing so will effectively restore the individual's trust in him or herself, and restore the trust of others. In its simplest form, you can help reduce isolation by simply inviting and including the stress-injured person into department or crew activities.

Research has shown that many people who are experiencing significant stress respond well to being included in an activity, having casual friendly encounters or receiving help and information in strictly practical way rather than directly discussing emotional problems or reactions. This is particularly true of men, and could be because many try to repress their symptoms, and emotional support brings adverse events to their attention again. Individuals suffering from post-traumatic stress may prefer to keep away from this type of emotional support, especially in work contexts.

These Connect strategies are designed to help the stress-injured individual feel that he or she is not alone, there are caring others around and there are ways to stay connected to others. As was previously mentioned, social connectedness is one of the strongest protective factors against stress injury, and is linked to emotional well-being and recovery following traumatic stress and loss.

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37 Connect: Three Types of Support

The Connect function targets three types of social support:

1. Instrumental support: providingmaterial aid, such as assistance orhelp with daily tasks. Manyfirefighters and EMS providers haveindicated that they prefer this typeof support to emotional support indifficult times.

2. Informational support: providingrelevant information (e.g. advice orguidance) intended to help theindividual cope with currentdifficulties.

3. Emotional support: the expressionof empathy, caring and reassurance,as well as providing opportunities foremotional expression and venting.

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38 Examples of a Need for Connect

Here are a few examples of a need for Connect: • A firefighter’s sense of connection with

fellow crew members falls off when heis not in close proximity in off-season,and he gets depressed.

• A near miss makes crew membersquestion the judgment and skill ofthose involved.

• A firefighter gets ostracized because heyells out in fear when he is hit with afalling branch, which violates culturalnorms about toughness.

• A female firefighter married afirefighter who was gone three monthswhen their daughter was born, and shedidn’t have any family close by. Sheworked full time and took care of thehome front. Hearing that he was inharm’s way and knowing that shewouldn’t hear his voice for another 4-5days was very stressful.

You may have noted from these examples that Connect can be needed at either an individual or organizational level. For instance, an individual firefighter might withdraw from his crew mates after a PTE due to factors such as shame, exhaustion or loss. At the department level, disruption of connectedness can be caused by factors such as blame, lack of confidence in peers or leadership, shame and stigma, overwhelming exhaustion or loss.

When injured by stress, people can feel a sense of being alienated from themselves, like they are a different person. It is also very common for them to feel disconnected from friends or family, for a number of reasons:

• Trust may be an issue. An individualmay have lost trust in him or herself,or be experiencing shame, a feelingthat other were disappointed orbetrayed, or a loss of trust in his orher peers.

• Stress reactions may cause individuals to lack theconfidence and/or competence to make newrelationships, or to rebuild existing relationships.

• Stressed persons may not want to share negativeexperiences or feelings for fear that they won’t beunderstood, or will be a burden to others. Some mayjust be numb or withdrawn, or don’t want to betriggered by talking about events. Orange Zonestressors and/or reactions may cause difficultemotions to surface, such as increased anger orfrustration, that can push others away.

• Individuals may not be getting enough positivefeedback or support from their environment due toOrange Zone stressors such as loss, or lack of access toappropriate supports or resources (e.g. separations,lost contact, new living environment, etc.).

• Other people might need Connect because they feelexhausted and overwhelmed, or are unable to talkabout their feelings and put their experiences intowords.

• Some may be unable to express an increased need forsupport from others for their stress or don’t feel thattheir existing social support networks can or will meettheir needs.

• Some may want to be available to provide support toothers, but are avoiding doing so because they areoverwhelmed, or don't want to trigger their ownstress reactions.

• Finally, stigma is a big obstacle to asking for support..Asking for help can make people feel that they areweak, or that they are unable to handle their lifestress. It may also raise concerns that their disclosurewill affect either their peers’ view of them, or their jobsecurity.

Ask the audience if they can think of any other examples that would signal a need for the Connect action.

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39 Connect Strategies: Self

Here are a few strategies for connecting with others:

• Know the value of good mentors andfriends.

• Surround yourself with people who aregenuine, authentic, and honest.

• Make friends with people you can beyourself with, and talk with about whatbothers you.

• Discipline yourself to haveconversations people who know youwell enough to know when somethingis bothering you.

• Reprioritize your schedule to spendmore time with those who mean themost to you.

ASK: Can you think of any other strategies for connecting with others?

40 Connect Strategies I: Others

Here are a few strategies for helping others connect:

• If someone has retreated because ofan incident, find ways to indirectlyinclude them in projects and createcollaborative opportunities with peers,to get them back into doing somethingmeaningful.

• With introverts, bring them back beingconnected after they recharge,whatever that looks like for them.

• If someone is in the orange/red zoneand resistant to getting support, andthey trust you, don’t be afraid to bemore authoritative in getting them thehelp they need.

• In the middle of intensive stress, keeppeople moving get them engaged inactivities that facilitate talking whileyou do things. For instance, whilemoving, have people briefly report outon successes, loose ends, and theirplan for the next 24 hours.

ASK: Can you think of any other strategies helping others connect?

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41 Connect Strategies II: Others

Here are a few more strategies for helping others connect:

• Depending on your role, don’t beafraid to sit and just listen and becomfortable letting a stressed persontalk. The fact that you’re in the sameculture carries a lot of weight and canbe more helpful than talking to anyoneelse.

• Keep calling, texting, and writingletters to the families and co-workersof fallen firefighters. Regardless if theypick up the phone or not, the fact thatsomeone remembers them on ananniversary date, or on any randomday, is what is helpful.

ASK: Can you think of any other strategies helping others connect?

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42 Competence

The Competence action focuses on enhancing and restoring individual capacities to function and perform in all important life roles, including occupational, personal, and social domains. The term “Competence” is really shorthand for “help restore previous capabilities” or “cultivate personal competence.”

The need for Competence is usually signaled by the loss of an individual's mental, emotional or physical capabilities due to stress exposure. To what extent these capabilities are lost will depend greatly on the situation and the individual involved. When providing Competence, SFA providers do something with (not for) affected individuals or crews to restore previous capabilities or cultivate personal competence.

We know from the research literature that increasing Competence: • Improves functioning and fosters

better connections and supports, aswell as augmenting individual andgroup morale.

• Reestablishes the confidence of othersin the stressed individual.

• Helps to overcome injury to mind,body and spirit.

• Builds resilience.

The first component of Competence is to improve social skills with both family members and peers. These skills are often damaged by stress, which can negatively affect an individual's ability to function with others at home and on the job.

The next component is to augment occupational skills that may have been damaged by stress injury. This may require mentoring, respite and retraining for the stressed individual to feel capable again and to once again gain self-esteem from his or her work. SFA can be employed for stress-related injuries that impair abilities on the job.To grow out of stress-induced decrements in functioning may require developing capabilities. in the same way that physical therapy is a skill set that is used in physical rehabilitation,

The last component is to foster the development personal competence and well-being skills that can help the stressed individual establish self-control, self-modulation, health and restore and improve abilities to cope with life’s challenges.

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43 Competence: When Is It Needed?

Briefly comment that generally, there are three signals for the need for Competence: 1. Indications that an individual does not

have the experience or skill level toaddress the demands of his or herposition within the crew or thedepartment.

2. The temporary or persistent loss ofprevious skills or abilities due toOrange Zone stress.

3. The emergence of new life challengeswith which the individual has not yetdeveloped the ability to cope, such asOrange Zone symptoms of distress.

The next three slides will describe these three signals in more detail.

44 Examples of Need for Competence

This slide shows some examples of a need for Competence:

• A firefighter makes a mistake cutting atree, and the tree falls the wrongdirection, causing his saw partner torun. He is shaken and avoids sawing forfear he’ll seriously hurt himself orsomeone else.

• A firefighter who narrowly escapeddying experiences persistent anxietywhich he medicates with alcohol.

• An firefighter veteran who had lifethreat and wear-and-tear stressinjuries loses the ability to stay calmwhen dealing with co-workers.

• The solar eclipse created a situationthat put a lot of stress on peoplebecause it was one that the crews hadno idea how it was going to turn out,and had never dealt with before withthousands of people showing up likethat.

Ask the audience if they can think of any other examples that would signal a need for the Competence action.

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45 Competence: Procedures

The core process for the Competence function of SFA is to take one step backward in order to take two steps forward. As a result, restoring or enhancing Competence in the face of Orange Zone stress can require the following sequence of actions: (1) stop, (2) back up, and (3) move forward again.This slide shows examples of proceduresthat can be used to restore anindividual's sense of competence.:

1. Stop procedures can include:• Providing rest and time to recover

(indicated time off). • Ceasing what isn’t working.• Assessing any functional capabilities

and limitations in occupational,social and personal well-beingspheres.

• Identifying challenges to recoveringfunctional capabilities.

2. Back up procedures can include:• Retraining and refreshing old skills.• Mentoring and coaching in problem-

solving.• Learning new skills• Enhancing wellness through sleep,

nutrition, exercise, meditation,prayer, etc.

One of the key tools you can use to improve competence is partnering with the firefighter in simple problem-solving. We know from the trauma literature that cognitive functioning becomes much more rigid and less creative for people who are experiencing a stress reaction. By forming a partnership with the stressed individual, you will make him or her feel supported, and together you can collaborate creatively in seeing solutions to current difficulties and generating ideas about how to cope.

This will foster a sense of agency--one's ability to take action, be effective, influence one's own life and to assume responsibility for behavior through disciplined, focused thinking about personal needs and wants, and generating solutions. You can be instrumental in helping individuals to get "unstuck" and move towards small, clear steps that will help the individual to tackle problems and feel better about him or herself. In the process of providing Competence, it is important to remind stressed individuals that they can do it, show them that they are not alone, and model behaviors for them what they can do if they get stuck.

This SFA action also includes increasing competence in managing stress reactions. SFA caregivers should become adept at teaching a variety of stress coping skills that are relevant to Orange Zone stress, such as: • Sleep hygiene• Relaxation• Meditation or prayer• Anger management• Goal setting• Problem solving• Nutrition• Physical exercise and conditioningPreparing for reminders and triggers, so that the individualis not taken by surprise and can deal with them when andif they occur..3. Move forward again procedures include:• Practicing new and refreshed skills.• Gradually increasing responsibilities.• Setting achievable goals.

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46 Competence Strategies: Self

Here are a few strategies for building your own sense of competence:

• If you’re under too much stress, dosomething that is easy for you to giveyou a sense of accomplishment.

• Be more disciplined in taking whateverhealthy steps support you in dealingwith stress.

• Regularly reflect on the balancebetween the satisfaction of fulfillingwork duties and the personal sacrificesyou are making. Be prepared to adjustbehaviors and expectations if thatbalance changes over time. ASK: Can you think of any other strategies for building

your own sense of competence? 47 Competence Strategies I: Others

Here are a few strategies for building competence in others:

• If someone is psyching him or herselfout, because they are overthinking givethem simple systematic ways tooccupy their thoughts, like countingrandom numbers, or counting steps.

• Mentor others by figuring out how theperson is going to best learnsomething, and potentially teach thesame strategy to others.

• If someone is struggling to learnsomething, find someone who matchestheir personality, somebody they canrelate to and communicate with, andassign that person to them.

• Start with absolute basics, and providestepped escalation of stress andresponsibility in a calculated manner.

ASK: Can you think of any other strategies for building competence in others?

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48 Competence Strategies II: Others

Here are a few more strategies for building competence in others:

• Give the stressed individualresponsibility little by little, so thatthey are more and more in control, tobuild a past foundation so that whenthey are in a situation where seriousmistakes could happen, they know thatthere is a high likelihood that they willbe okay, and if they’re not, it’s notbecause they didn’t try.

• After mistakes, help the personbecome more competent, to help withshaken confidence. Remind them thateveryone is human, that all reactionsare acceptable in the right context, andhelp them to figure out what theymight do differently in the future.

• As a leader, if your crew’s sense ofduty and commitment lead to over-working, make sure that they'regetting rest, and advocate for them.

• Before you have a conversation with somebody who youthink needs time off, make sure taking time off isfeasible for that individual.

ASK: Can you think of any other strategies for building competence in others?

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49 Confidence

The final SFA action is Confidence, originally derived from the literature on “hope.” Confidence actions are intended to: • Promote realistic hope and build self-

esteem that may have been damagedor lost as a result of stress.

• Promote confidence in core values andbeliefs.

• Bolster pride and commitment.

This slide shows the four components of Confidence:

The first is trust, which can be trust in many things, such as peers, equipment, leaders, self or mission.

The second component is hope, which is often the result of forgiving self or others, or being able to imagine the future in a positive way.

The third component is self-worth, which includes belief in self; an accurate and mostly positive self-image; self-respect or a thinking process that taps a sense of agency or will; and the awareness of the steps necessary to achieve one’s life goals.

The fourth component is meaning, which includes the process of making sense of life; having a sense of purpose or faith; holding a spiritual perspective related to the human condition; or a belief in strong others and/or a higher power who will intervene on the person’s behalf.

All of these functions lead to a sense of confidence – in the self, in others, in life or in spiritual sources of solace.

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50 Examples of Need for Confidence

This slide shows three scenarios in which the Confidence action could be used. In all three cases, SFA actions will involve both leader and caregiver actions at multiple levels of engagement.

• A fire with a lot of fatalities makes acrewmember see that bad thingshappen to great firefighters even whenthey do everything right. He starts toquestion whether fire suppression isworth the risk.

• After a critical incident, a leaderrepeatedly questions the events anddecisions leading up to the event. Hequestions whether he is capable ofleading others in high-risk situations inthe future. He no longer trusts himself.

• A young firefighter has a questionabout risks on the job and the waythings are being done. He becomesunsure whether what they are doing isserving the land or the people. Whilehis crew is really good at putting firesout quickly and efficiently, he oftendisagrees with effects of firesuppression on the land and wondersabout the long-term ecologicalconsequences.

• You see a change in non verbal cues indicating that acrewmember has low self-confidence, such as slouchedposture, the way he is wearing his hat, being hunchedover, not standing at attention with shoulders back, notsquared away like he normally would be, no eye contact,or a change in healthy routines, such as skipping PT.

ASK: Can you think of any other examples that would signal a need for the Confidence action?

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51 Confidence Strategies: Self

Here are a few strategies for building your own confidence:

• Use small triumphs to buildconfidence. If you have self-doubt,read more self-help books or tacticalreports.

• After particularly traumatic situationsor losses, don’t push yourself to“process” the situation in anyparticular time frame, but if somethingtriggers you, give yourself time andspace to think it through, integrate it,talk to someone, have emotions, findways to makes sure it doesn’t causeyou to get stuck in suffering, and / ormake sense of it.

• Use the wisdom gained from hardexperiences to reconfirm your values,make changes in your life, appreciatewhat you value, or help others.

• If you have tried to mentor someone and cannot getthem up to speed, realize that not all personalities fit thisjob, and sometimes you have to walk away.

ASK: Can you think of any other strategies for building your own confidence?

52 Confidence Strategies: Others

Here are a few strategies for building confidence in others:

• If young firefighters are struggling withconfidence, give them tasks that theycan be successful at, solicit theiropinions, set them up for success, orfind some way they can contribute tothe crew.

• If firefighters show severe stress, talkwith them, work with them, give themrelevant reading materials, andconnect them to people who havedealt with similar things. If theycontinue to get triggered, mentor themto consider their options, includingleaving the fire service.

• If a firefighter is feeling bad aboutsome reaction he/she had, help themcounter their guilt by normalizing theirreactions, letting them know that theymade the best decision they couldhave made given what you knew at thetime, and letting them know they arenot alone in experiencing stressreactions.

• If a crew member’s confidence is low, or he/she feels nosense of purpose or contribution to the team, point outa skill they have that does contribute to the team, or oneof their other strengths.

• When stress starts to build up in the crew, explain to thecrew why you’re doing what you’re doing, so they don'tlose confidence in the mission or leadership.

ASK: Can you think of any other strategies for building confidence in others?

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53 Confidence Strategies II

Here are a few more strategies for building confidence in others: • Consider involving other disciplines or

mentors/peers who can implementConfidence either more effectively orin a complementary way to you.

• Improve communication, mentoringand information about mission andacknowledgement of person’s value.

• Make efforts to confront stigma aboutstress reactions

• Foster and support doing things thatwill alleviate and mitigate harmfuleffects of stress.

• Help to re-establish belief in colleagueswho have stress reactions.

ASK: Can you think of any other examples that you have seen where the Confidence action has been used?

54 Growth and Resilience

Confidence actions contribute to growth. The ability to accept what is and what has been, to live in today, and to only occasionally looking in the rear-view mirror of life so as to “repair the future” by moving forward with a sense of purpose and hope, are all strategies that have been shown to be helpful in developing growth and resilience after adversity, loss, and trauma.

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55 Key Point Emphasis

Some key points to emphasize about implementing SFA include: • The tone of any interaction is

collaborative, encouraging, and non-judgmental. It should always fit yourpersonality and style, and shouldlook different for each person whoimplements it and within eachcontext it’s implemented in.

• The timing and context areimportant – what you can achievewith any interaction depends onhow much time you have, where youare, how open a person is to hearingwhat you have to say, and how longafter the incident the conversationtakes place.

• SFA is not meant to address issuesthat require intensive intervention.It is a first aid model, and not meantto deal with lifelong problems,personality issues, serious mentalhealth issues, or complex problems.

• Flexibility and “tiny steps” areemphasized – giving a person asense of accomplishment bybreaking down issues into small,manageable actions, and beingflexible on the advice you give, arelikely to result in more sense ofconnection and accomplishment.

• Mentoring and problem solving are highlighted – yourrole is to provide support and possible assistancehelping someone get back on their feet and managethe tasks that might seem overwhelming to themwhen they’re under a lot of stress.

• Bridge to higher care when indicated – always think interms of referring a person on to EAP or local mentalhealth providers if they are having difficulty adjustingand experiencing strong stress reactions. Effectivetreatments are available and being a bridge to thatcare may be your most helpful SFA action.

56 SFA Resource

Pocketpeer.org has information that has been included in the course from interviewing wildland firefighters about their experiences with stress. There are also structural firefighters, and supervisors.

It also has an app for suicide prevention, which includes video vignettes on how to talk to someone who is suicidal.

stress first aid...stress first aid for wildland firefighters 90 minute training, 2018 u.s. forest...

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