Implementation of the Enhanced Stress First Aid Program in the Fire Service A Case Study
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Abstract
Background: Behavioral health is a critical issue in the fire service, with firefighters facing high rates of depression, PTSD, and substance misuse due to repeated trauma exposure. Stress First Aid (SFA), a peer-support intervention adapted from the Marine Corps’ Combat and Operational Stress First Aid framework, offers a promising approach to firefighter mental health. Methods: A mixed-methods evaluation of the Enhanced SFA program (ESFA) assessed implementation, effectiveness, and acceptability through in-person pilot sessions, beta tests, and an online program. Surveys were conducted pre- and post-training, and at 3- and 6-month follow-ups to measure usability, satisfaction, skill application, confidence to intervene, and perceived organizational support. Results: Of 1,500 enrollees, 1,199 completed initial assessments. Participants strongly endorsed ESFA’s relevance and format, with 83% intending to apply learned skills. Confidence to intervene improved from 77% at baseline to 90% at 3-month follow-up. Perceived organizational support also increased. While statistical analysis was limited to descriptive methods due to attrition, the results suggest meaningful engagement with training. Conclusion: ESFA demonstrated high usability and potential for strengthening peer support and intervention confidence. Additional research is needed to assess long-term outcomes, but ESFA offers a scalable foundation for firefighter behavioral health initiatives.
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Funding data
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Movember Foundation
Grant numbers FRCE-2022-0007
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