Health & Wellness: Addressing Overall Well-Being on a Small Budget

An unlimited budget for our department always has been our goal. Well, OK, but I concede that never will happen.

The Duncanville, TX, Fire Department (DFD) serves a bedroom-community of 40,000 citizens in southwest Dallas County. Duncanville only has a few big tax-­producing businesses, so most of the city’s tax base is generated through residential property taxes. So, much like other departments that serve a community that’s Duncanville’s size, we constantly are trying to make ends meet with a limited budget.

The DFD is a career fire/EMS department that has 54 members who operate out of two stations. The department has a run volume of 7,500 per year. The run volume is enough to keep things very interesting for the people who make up the DFD, but is that a volume that can burn out the department’s members?

Mental wellness is at the forefront of any fire/EMS industry conference that you attend right now, so the issue is receiving attention. That said, how do departments prioritize their budget so that mental wellness gets addressed along with equipment, apparatus and training?

Debriefing evolution

I remember the first time that I was involved with a critical incident stress debriefing (CISD).

CISD was starting to gain traction in our area in the mid-1990s. In 1997, I was assigned to the mobile intensive care unit and had a pediatric trauma incident. Several news stations heard of the incident and were at the hospital as we were leaving. When we got back to the station, our chiefs knew that it was a bad call and were trying their best to figure out how to handle it.

After two more calls, an individual arrived to give us a defusing. Later, my partner and I were sent home for the rest of the shift. We went back on next shift and continued operations as normal.

The next week, one of the chiefs stated that there would be a debriefing on the pediatric trauma incident. The debriefing turned out to involve a professor who was conducting research on CISDs.

A week later, my partner and I had a true debriefing from our medical control team. By this time, I had talked about the incident plenty, and I felt that I had no issues with any of what transpired—except, that is, for the process that we went through.

As time went on, the approach to debriefings got better. I went through a few more. Some of them involved single units, and some of them involved multiple companies and multiple jurisdictions.

As I progressed in my career, I was able to relay to younger personnel how good the debriefings were, meaning how it wasn’t a bad thing to have to sit through a debriefing or even to talk in one.

Effective ‘voodoo’

The mental and physical wellness of the DFD’s members has been at the forefront of department’s goals for several years now.

After receiving an Assistance to ­Firefighters Grant (AFG) for physical fitness and acquiring top-notch fitness equipment, the department’s overall fitness increased tremendously. (Formerly, the department’s fitness equipment fell into the category of “what can you bring from home to workout with?”) The crews felt good and looked good. This was the best shape I ever saw the department members in, and it showed.

However, still lingering in the wings was the mental health issues that continually pop up in the news and in fire service social media. What were we doing to address that? We had defusings and debriefings in place through our medical control contract, but what happens after that?

Over the past few years, the DFD has worked closely with its regional partners to be a part of a First Responder Resiliency program. The funding for this program is obtained through a grant.

We also work with the city’s police department to coordinate, including how we can help each other through the city’s resources.

The Employee Assistance Program (EAP) is a valuable resource, and most of the time it’s free of charge. That said, the EAP isn’t for everyone nor every situation. After researching and talking to members who used the program or sought outside counseling (I was surprised at who used these; you might be, too), there still was something missing.

After hearing a presentation at a conference by a psychologist on mental health issues of retirees, I spoke with the presenter after her speech. I inquired whether it would be appropriate for me to have a session. I wasn’t planning to retire, nor did I believe that I had any job-related mental health issues, but the concept that psychologist covered in her presentation intrigued me, and I wanted to know firsthand what the experience would be. (Like other firefighters, one of the things that I wanted to know was whether there was a couch in the office where the session would take place, and would I get to lie down on! There was a couch, but I sat.)

During the session, the psychologist and I discussed a few of the incidents that I could recall that might be lingering in the back of my mind. The one incident that stood out for me was the 1997 pediatric trauma incident. Why did the face of that child still pop up in my mind a full 25 years later at random times—for example, when I was outside mowing the grass in the front yard?

The psychologist put me through Eye Movement Desensitization and ­Reprocessing (EMDR), which, honestly, I found to be a little weird at the time. I followed up the next day with another session and told her, “Whatever voodoo you put on me seems to be working.”

Today, I no longer see the face of that child at random times. Yes, the memory still is there, but now it’s like looking at it through a frosted pane of glass.

After my visits with the psychologist, I reached out to my 20-plus-year tailboard guy, the one who will be brutally honest about anything, to see whether he was interested in going to a session. He said that he was. He had a great experience during the session and highly recommended it.

My next step was to get input from our midpoint personnel. For this purpose, I sent two more to a session at the end of 2021. Once again, great results.

Now, I have buy-in from some influential line personnel on a process that might seem very uncomfortable to others.

Sustained monitoring

The part of the mental health program that involves work with the psychologist isn’t free, and it must come out of the DFD’s budget. Fortunately, the department has some money that it can apply toward this part of the program. After seeing the positive results, it will continue to be in the budget. My plan is to send one or two personnel for EMDR per year on a voluntary basis and to monitor personnel to meet their needs.

Although the DFD hasn’t spent a lot of money from its budget to meet both the physical and mental health needs of its members, the investment is a necessity. I want a strong process in place that will remain long after I’m on that retiree list.

Include line personnel in selection of a process that fits your department. It isn’t one-size-fits-all. Do what’s appropriate for your personnel and your budget.