Helping the Helpers

Lessons Learned and Outcomes to Date from

the FirstNet® Health and Wellness Coalition

Dr. Anna Fitch Courie, DNP, RN, PHNA-BC

Director, Responder Wellness, FirstNet Program at AT&T
Vice President, First Responder Health and Wellness,
AT&T First Responder Employee Network

Peter White
AVP, Public Safety, AT&T Public Policy

Michael Hartigan
Director, Public Affairs, FirstNet Program at AT&T

3033 Chain Bridge Rd. | Oakton, VA 22124 | Phone: 571-495-9659 | Email: [email protected]
 “ When I was a boy and I would see scary things in the news,
my mother would say to me, ‘Look for the helpers. You will

”
always find people who are helping.’
Fred Rogers

Quis adiuvat adiutores?

Who helps the helpers?

Abstract:
Historians in America and around the world may well label the early 21st century as the era of mass casualty
events. From the events of September 11, 2001, to multiple mass school shootings in the U.S. to terrorist
attacks in Boston, Moscow, Paris and elsewhere, first responders repeatedly face horrific incident scenes.
Police, fire and medical personnel, emergency managers, and public safety telecommunicators, their
peers, and their families bear the physical and emotional scars of these events. And they struggle daily to
overcome those long-term injuries.

The FirstNet program was one of the two major communications projects1 born from the September 11,
2001, attacks in New York City, Washington, and Shanksville, PA. In February 2012, Congress passed the Middle
Class Tax Relief and Job Creation Act into law, allocating $7 billion and 20 megahertz of broadband spectrum
to establish a standalone broadband network for first responders and create the First Responder Network
Authority (FirstNet Authority). In 2017, the FirstNet Authority awarded AT&T a historic 25-year contract to
build and maintain this network. Public safety now has a reliable, interoperable, and effective network for
response at a moment’s notice to natural and man-made disasters.

As AT&T began to deploy the FirstNet network, leadership realized they could do much more to help the
nation’s police, fire, medical personnel, public safety telecommunicators, and other emergency responders.
So, AT&T established the FirstNet Health and Wellness Coalition (FNHWC or “the Coalition”) to support the
health, wellness, and readiness of America’s first responders and their families.

The Coalition brings together over two dozen national public safety organizations to assess, plan, prepare,
integrate, and evaluate strategies and solutions to support emergency responder wellness. This group
identified needs in the larger public safety/public health infrastructure and learned many lessons along the
way. Most importantly, the group learned that we have much more to discover about the dynamic between
emergency response, chronic stress injuries, individual mental wellness, and community health. This paper
will discuss our collaboration within the Coalition, and the lessons learned from these efforts. We welcome
feedback from readers on how the Coalition can improve going forward.

1
The other project is the Wireless Emergency Alert (WEA) system, which was authorized by Congress and signed into law by President George W. Bush
in 2006 and became operational in 2012.

2
Executive Summary
FirstNet, Built with AT&T is the only nationwide communications network built with and for public safety.
Through its intimate working relationship with public safety, FirstNet leadership recognized the need for
resources dedicated to first responder health and wellness.

The FirstNet Health and Wellness Program (FNHWP) officially launched in May 2020 following FirstNet’s
exclusive support of the International Association of Chiefs of Police Officer Safety and Wellness
Symposium. In order to proliferate these early activities, FirstNet recognized the need to formalize efforts
to support first responder health and wellness efforts through advocacy, identifying available resources, and
building relationships. Guiding the FNHWP is the FirstNet Health and Wellness Coalition (the Coalition), which
is made up of more than two dozen organizations from public safety, academia, and industry to assess,
integrate, and evaluate strategies and solutions to support emergency responder wellness.

It was determined that to better understand the current state of responder wellness and identify priorities,
a formal needs assessment was an appropriate kickoff for the Coalition.

Through data analysis, literature review, a survey of first responders, and reports from various Coalition
members, the FNHWC compiled a responder needs assessment report of its findings to date. This report
highlights the challenges first responders face; opportunities to engage at the individual and agency
level; and critical recommendations for the larger public safety/public health infrastructure. The Coalition
found that first responders are aware of these concerns and are open to changing the status quo. For the
purposes of this paper, we have defined “first responders” as law enforcement, fire, EMS, corrections, public
safety telecommunicators, emergency management, frontline healthcare workers, and those who
support them.

Compared with the general

population, first responders
experience higher rates of
depression, post-traumatic
stress, burnout, anxiety, and
other issues. This leads to
secondary and tertiary health
risks, such as cardiovascular
disease and disordered sleep.
In addition, public safety
departments across the
country are experiencing
widespread morale,
recruitment, and retention
challenges. Additionally,
family members of emergency
responders silently bear the
burden of these impacts.

3
The Coalition found that first responders are aware of these concerns and are open to changing the status
quo. The FirstNet Needs Assessment Survey (FNNAS), conducted from January to March 2021 with 475 first
responders, bears out this analysis. Survey respondents identified areas they believe would improve their
health and wellness, including stress management and physical fitness. They highlighted barriers to personal
and agency improvement. And they made recommendations for how best to engage the public safety
community.

From its analysis, the Coalition makes five key recommendations:

1. Engage public safety leadership
2. Integrate wellness into training throughout careers and beyond
3. Allocate funding for evidence-based solutions locally and nationally
4. Establish standards and technical assistance centers
5. Increase communication at all levels of public safety

Ultimately, the Coalition encourages continued examination and communication across all disciplines and
levels of public safety, to continue learning more about the complex dynamic between emergency response,
chronic stress injuries, individual mental wellness, and overall community health. Additional resources, data,
funding, and collaboration can drive change and provide holistic support to those who serve.

Engage
public safety
leadership

Integrate Allocate
wellness into funding for
training throughout evidence-based
careers and solutions locally
beyond and nationally

Establish
Increase
standards
communication
and technical
at all levels of
assistance
public safety
centers

4
Introduction
FirstNet Genesis and the Emphasis on First Responder Health and Wellness
The FirstNet Program at AT&T is the result of a historic 25-year public-private partnership between AT&T
and the First Responder Network Authority. AT&T has been given the responsibility for building out the
telecommunications infrastructure of this standalone, wireless, broadband network for public safety. This
network is designed to help ensure public safety has a reliable and effective network to respond to natural
and man-made disasters at a moment’s notice. FirstNet is more than just a wireless network – it includes
advanced communications services, applications and purpose-built devices. It also provides public safety
interoperability between agencies at the state, local, federal and tribal levels2.

As AT&T began to build out the

FirstNet system, the process naturally
involved close collaboration between
AT&T leadership and countless first
responders from across the public safety
spectrum. Through this intimate working Chair:
relationship, AT&T leadership recognized President,
that a career in emergency response can FirstNet
greatly impact the health and wellness3
of public safety professionals. So, AT&T
began to pursue ways to integrate
public safety health and wellness into Executive
the FirstNet mission. And it launched the Board: Public
FirstNet Health and Wellness Program Safety
(FNHWP) in May 2020 to support first Leaders
responder health and wellness efforts
through advocacy, resources and MEMBERSHIP
relationships. The mission of the FNHWP
is to improve the health and wellness of National Public
first responders nationwide, while also Safety Association
serving as an example of corporate policy C-Level Leaders
engagement in a meaningful yet under-
resourced public health space4.

2
First Responder Network Authority (FRNA). (2020). First responder network authority roadmap. Department of commerce.
https://firstnet.gov/network/roadmap
3
The World Health Organization defines wellness as the optimal state of health of individuals and groups. There are two focal concerns: the
realization of the fullest potential of an individual physically, psychologically, socially, spiritually, and economically, and the fulfilment of one’s role
expectations in the family, community, place of worship, workplace and other settings.
4
Research demonstrates that corporate engagement in public health concerns leads to improvements for the community’s those companies serve,
the wellness of community members, and facilitate a healthy workplace culture. See Bipartisan Policy Center. (2019). Good Health is Good Business.
The Value Proposition of Partnership Between Businesses and Governmental Public Health Agencies to Improve Community Health. https://
bipartisanpolicy.org/download/?file=/wp-content/uploads/2019/06/Good-Health-Is-Good-Business.pdf

5
One strategic arm of the FirstNet Health and Wellness program is the FirstNet Health and Wellness Coalition
(the Coalition). The mission of the Coalition is to integrate responder, industry, community and academic
capabilities to support the health, wellness, and readiness5 of America’s first responders. This effort brings
together over 2 dozen public safety organizations – representing over 5.1 million first responders – to
identify the most critical priorities facing first responders and lend their resources to creating meaningful
solutions.6

The FNHWC Model

1. Establishes a framework to integrate leadership across first responder professions.
2. Assesses/analyzes existing data on first responder health and wellness needs.
3. Identifies key priorities for action.
4. Facilitates action planning in which to address priorities.
5. Evaluates the effectiveness of activities for future planning and activities.7

Assesses/
Evaluates the
Establishes a framework analyzes existing Facilitates
Identifies key effectiveness of
to integrate leadership data on first action planning in
priorities for activities for future
across first responder responder health which to address
action planning and
professions and wellness priorities
activities
needs

This model stems from the Mobilizing Action through Planning and Partnerships (MAPP) process for
community health improvement planning. But we are applying it in an organizational setting rather than a
community.8 Increasing evidence shows that private industry should take an active role in supporting the
needs of the community. This aligns with private industry’s business priorities.9 It also creates an opportunity
for private industry to positively influence the health and wellness of the communities it serves. The
Coalition strives to create a collaborative environment that facilitates positive change.

5
Readiness is the capacity for an emergency responder to execute their job requirements tactically as well as mental, physical, and spiritual readiness
required from ongoing, cyclical, and chronic exposure to traumatic incidents
6
See Appendix A: FirstNet Health and Wellness Coalition Membership
Courie, A. (2020). FirstNet Health and Wellness Coalition Charter. https://www.firstnet.com/content/dam/firstnet/white-papers/firstnethealth-and-
7

wellness.pdf; Courie, A. & Sanati, M. (2021). The FirstNet First Responder Needs Assessment: Driving Towards Targeted Interventions. International
Public Safety Association Journal. 1-14.
8
National Association for City and County Health Officials. (2015). Mobilizing action through planning and partnerships handbook. https://www.
naccho.org/programs/public-health-infrastructure/performance-improvement/community-health-assessment/mapp; Substance Abuse, Mental
Health Services Administration (SAMHSA). (2018). Disaster technical assistance center supplemental research bulletin: First responders: Behavioral
health concerns, emergency response, and trauma. https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-
may2018.pdf
9
Bipartisan Policy Center (2019); NACCHO, (2015)

6
First Responders – Who and How Many
For the purposes of this paper, we have defined public safety and emergency response personnel as those
who serve in the professions of law enforcement, fire, EMS, corrections, public safety telecommunicators,
emergency management, frontline healthcare workers, and those who support them.

Consistent with the Department of Homeland Security and Federal Emergency Management Agency, first
responders are considered emergency response providers and are defined in 6 U.S.C. 101 (6) as: “Federal,
State, and local governmental and nongovernmental emergency public safety, fire, law enforcement,
emergency response, emergency medical (including hospital emergency facilities), and related personnel,
agencies, and authorities.”10

The National Fire Protection Agency estimates 1,115,000 firefighters are currently active in the country. Two-
thirds of that total are volunteers and one third are career firefighters.11 USAFACTS states that in 2019, there
were over 1,000,000 full-time and part-time law enforcement officers employed in the country.12 The National
Institute for Occupational Safety and Health reported that in 2018 there were 241,000 career E.M.T.s and
paramedics with many more volunteer units.13 In addition, the National Emergency Numbers Association14
reported over 100,000 9-1-1 professionals currently working at over 5,700 Emergency Communications
Centers (ECCs, also referred to as public Safety Answering Points). All told, the Department of Homeland
Security15 estimates there are over 3 million emergency response personnel practicing in the United States
today. These data are consistent with the 2021 Bureau of Labor Statistics reporting as well.16

These figures do not include the extended public safety infrastructure of frontline healthcare workers,
including emergency department medics, nurses, and physicians who are often on the receiving end of
casualty transports following man-made and natural disasters. For example, the last National Sample Survey
of Registered Nurses showed over 205,000 registered nurses (RNs) employed in Emergency settings.17 Data
supports that the mental health and wellness concerns facing public safety are similar to those of frontline
healthcare personnel, especially following the COVID-19 pandemic. In this paper, frontline healthcare workers
are included in the population under consideration.

10
Department of Homeland Security. (January, 2017), The International Forum to Advance First Responder Innovation, First responder market overview
synopsis. https://www.dhs.gov/sites/default/files/publications/First_Responder_Market_Overview_Synopsis_2017_508C.pdf and First Responders
Defined by the NCHRP - Homeland Security Digital Library (hsdl.org)
11
Evarts, B., Stein, G. P. (2020, February). U.S. department profile. National Fire Protection Association. https://www.nfpa.org/News-and-Research/Data-
research-and-tools/Emergency-Responders/US-fire-department-profile
12
Police Departments, Funding, Stats & Data (usafacts.org)
13
Emergency Medical Services Workers | NIOSH | CDC
National Emergency Numbers Association. (2021). 911 Basic information. 9-1-1 Basic Information - National Emergency Number Association (nena.
14

org)
Department of Homeland Security. (January, 2017), The International Forum to Advance First Responder Innovation, First responder market overview
15

synopsis. https://www.dhs.gov/sites/default/files/publications/First_Responder_Market_Overview_Synopsis_2017_508C.pdf
16
Employment by detailed occupation : U.S. Bureau of Labor Statistics (bls.gov)
https://data.hrsa.gov/topics/health-workforce/nursing-workforce-dashboards
17

7
Confronting a Serious Line-of-Duty Hazard
Those who respond to emergencies on a consistent
basis experience higher rates of depression, post-
traumatic stress, burnout, anxiety, and other issues,
compared with the general population18, with the
prevalence of these conditions only rising since
the COVID-19 pandemic19, the literature shows. The
data seem to paint a clear picture of significant
health risks for those who run towards problems
instead of away from them. Additional research
substantiates the relationship between the chronic
stress injuries first responders experience and
their secondary and tertiary health risks, such
as cardiovascular disease, hypertension, cancer,
metabolic disease, injuries, and others20.

Consequently, there is growing awareness of the

mental, physical, and spiritual stressors facing those
who respond to emergencies.

One of the ever-increasing problems facing first

responders is suicide. Many first responders lose
their lives to suicide every year. In 2020, at least 127
firefighters and 116 police officers died by suicide21.
Mental illnesses such as PTSD and depression
are contributing factors22. We have also learned that death by suicide in this group can often outnumber
traditional line-of-duty deaths. Additionally, nurses and other frontline healthcare personnel have long been
at an increased risk of suicide than the general population23. Suicide risk is significant for populations with
access and means to methods for suicide (for example, firearms and narcotics)24 – an issue that is significant
for all the professions that fall under the umbrella of public safety.

18
Heyman, M., Dill, J., & Douglas, R. (2018). The Ruderman white paper on mental health and suicide of first responders and Substance Abuse, Mental
Health Services Administration (SAMHSA). (2018). Disaster technical assistance center supplemental research bulletin: First responders: Behavioral
health concerns, emergency response, and trauma. https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-
may2018.pdf
Cuccia, A. F., Peterson, C., Melnyk, B. M., & Boston & Leary, K. (2022). Trends in mental health indicators among nurses participating in healthy nurse,
19

healthy nation from 2017 to 2021. Worldviews on Evidence-Based Nursing, 19(5), 352-358.
House, A., Jackson, B., Bartis, J., & Peterson, D. (2004). Emergency Responder Injuries and Fatalities. Technical Report for National Personal Protective
20

Technology Laboratory. RAND Corp. Emergency Responder Injuries and Fatalities: An Analysis of Surveillance Data | RAND
Bar Nissim, H., Dill, J., Douglas, R., Johnson, O., & Folino, C. (2022). The Ruderman White Paper Update on Mental Health and Suicide of First
21

Responders. Ruderman Family Foundation. https://issuu.com/rudermanfoundation/docs/ruderman_white_paper_b6e23ffe50d480/10

22
Heyman et al., 2018.
23
https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12419
Milner A, Witt K, Maheen H, LaMontagne AD. Access to means of suicide, occupation and the risk of suicide: a national study over 12 years of coronial
24

data. BMC Psychiatry. 2017 Apr 4;17(1):125. doi: 10.1186/s12888-017-1288-0. PMID: 28376757; PMCID: PMC5379531.

8
But these existing data also can be misleading. The public safety telecommunications and emergency
management professions do not track suicide rates and mental health risk factors. The process for
systematic surveillance and aggregation of health risk data is disjointed and inconsistent across professions.
And there is no single organization today that systematically tracks the health risk factors facing America’s
emergency response personnel. But the literature seems to document a consistent message that
emergency response providers face health risk factors because of the work they do.

The Centers for Disease Control and Prevention (CDC) is currently working to expand the National Violent
Death Reporting System through the first-year implementation of a Public Safety Officer Suicide Reporting
Module25, and the Federal Bureau of Investigation is implementing a tracking process similar to the
Department of Defense Suicide Event Reporting, albeit more robust26.

But these systems are not integrated and rely on local voluntary reporting. They contain different case
definitions, circumstances, and level of detail that may create additional gaps in reporting and usage.

Regardless, suicide remains a significant risk for emergency responders. If left untreated, the cumulative
traumatic stress injuries of the profession, coupled with additional life stressors, can take a critical toll on
first responders. As one organization remarked, “Life is hard. There is no educational system that is preparing
our responders how to manage the stress of life, the stress of the job, and the stress of being human. This
needs to change27.”

There is increasing need for advocacy, resources, and legislation towards supporting first responders’
mental, physical, and spiritual health to get upstream from the problems they face. First responders must be
able to access confidential and free or low-cost access to mental health screening and treatment services
without fear of losing their employment, license to practice, or any other sort of backlash.

“ Life is hard. There is no educational system that is preparing

our responders how to manage the stress of life, the stress of the

”
job, and the stress of being human. This needs to change27.

The National Violent Death Reporting System (NVDRS) is a federal surveillance system which tracks any violent death (suicide, homicide, deaths of
25

undetermined intent, lethal intervention, and unintentional firearm deaths). Initiated in 2003, NVDRS is now operative in all US states and territories
and relies on death certificates, coroner/medical examiner reports, and law enforcement reports to collect information on fatalities to help inform
prevention efforts. The Public Safety Officer Module of NVDRS launched in January 2022 and is funded through the Helping Emergency Responders
Overcome (HERO) Act.
26
The Law Enforcement Suicide Data Collection Act (2020) established a new data collection tool under the FBI for current and former law
enforcement officers for suicide deaths and attempts. Local law enforcement agencies voluntary generates the case records using an online
reporting portal that is not yet highly utilized.
Goldberg, J. (2022). Posttraumatic Growth Summit. Integration of Posttraumatic Growth into Public Safety proceedings. Boulder Crest Institute for
27

Posttraumatic Growth: Washington, DC.

9
Opportunities for Community Action and Engagement
A systematic review of literature showed that first responders were at a much higher risk for post-traumatic
stress disorder, depression, and suicidal tendencies28,29. This review also showed that first responders are
aware of the mental and physical stressors that contribute to their health and wellness challenges, including
post-traumatic stress, depression, access to mental healthcare, and concerns about drug and alcohol abuse.
In a recent survey, 46% of nurses shared that they are either considering or planning to leave their position
in the next 6 months because” work is negatively affecting their health and well-being”.30 This finding is
consistent with other helping professions and concerns for retention and recruitment extend across
professions.

To further explore these stressors, perceived barriers and potential opportunities for engagement, the
Coalition conducted the FirstNet Needs Assessment Survey (FNNAS or the survey). The Coalition conducted
the survey from January to March 2021 using Survey Monkey™ software. And it invited its associations to
share the link with their membership and distributed through email and newsletters. The Coalition received
consent to the survey from 475 responders and analyzed 368 completed data sets from the professions
of fire (35.3%), law enforcement (22.3%), public safety telecommunicators (16%), emergency management
(14.4%), paramedics (5.2%), and emergency medical personnel (1.4%).

The data gathered by the survey indicated areas in which responders wanted to improve their wellness
through stress management, physical fitness, wellness coaching, and resilience training. These results
support perceptions that first responders see an opportunity to engage in addressing their health and
wellness risk factors, indicating that the population is ready to take action.

The data also identify areas where action can be taken, and areas where responders want to engage, which
makes them more likely to participate in activities to improve their own well-being.

Respondents shared valuable ways to engage first responders

in their health and wellness needs. Specifically, respondents
wanted to see their leadership engaging in health and wellness,
not just speaking to it. One respondent remarked: “Leadership
needs to be involved with this {wellness} at the same level as
other staff and provide funding and participation that shows
their real support.” Additionally, respondents expressed a
desire to attach awards or incentives to health and wellness
engagement.

Respondents to the survey said that programs with

the greatest impact focused on stress management, physical
fitness, life coaching, resilience training, or dealing with anxiety.

Jones, S. (2017). Describing the Mental Health Profile of First Responders: A Systematic Review. Journal of American psychiatric nurses association.
28

https://doi.org/10.1177/1078390317695226
US Marshals Service. (2022). National Wellness Survey Report for public safety personnel. US Marshals Service.
29

American Nurses Foundation, Pulse on the Nation’s Nurses Survey Series: Annual Assessment Survey, November 2022. https://www.nursingworld.
30

org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/annual-survey--third-year/

10
The respondents also shared barriers to engaging in wellness activities, such as insufficient time, work-life
balance struggles, the cost of activities and a lack of awareness of resources. These barriers to engaging in
health and wellness activities are consistent with the perceived barriers in many other populations31,32.

As health promotion practitioners develop engagement strategies to manage first responder health and
wellness needs, they will have to be exceedingly aware of the barriers perceived by first responders. The
demands of shift work and non-traditional work hours present unique challenges to public safety engaging
in traditional wellness offerings. Departments and organizations focused on first responder health and
wellness needs will need to consider the timing and frequency of offerings to meet the various shift
requirements.

An example of success is the effort of some employers in the healthcare industry with healthcare workers
and nurses who work long shifts and face many stress factors. These employers addressed several areas for
health improvement. These include ongoing education, skill development plans, leadership development,
education on stress management skills, team building, and communication improvement exercises. All of
these can be helpful in addressing mental health concerns33,34,35. First responder agencies such as police, fire,
and EMS could use similar improvement programs to increase satisfaction, health, and wellness.

Priorities and Objectives Posttraumatic Stress

Consistent with the background on first responder
health and wellness and the results from the Leadership Depression &
survey, the Coalition identified 7 key priorities Engagement Self Harm
for action: post-traumatic stress, depression
and self-harm, physical fitness, resiliency, stress
management, and family member engagement, Physical
Families Fitness
and leadership engagement. These priorities
have framed the advocacy, programmatic, and Stress
collaborative efforts of the coalition since 202136. Management Resiliency

Perrault, E. K., Hildenbrand, G. M., & Rnoh, R. H. (2020). Employees’ Refusals to Participate in an Employer-Sponsored Wellness Program: Barriers and
31

Benefits to Engagement. Compensation & Benefits Review, 52(1), 8–18. https://doi.org/10.1177/0886368719899209

Person AL, Colby SE, Bulova JA, Eubanks JW. Barriers to participation in a worksite wellness program. Nutr Res Pract. 2010 Apr;4(2):149-154.
32

https://doi.org/10.4162/nrp.2010.4.2.149
33
Tamers, S., Chosewood, L., Childress, A., Hudson, H., Nigam, J., & Chang, C.-C. (2019). Total Worker Health® 2014–2018: The Novel Approach to Worker
Safety, Health, and Well-Being Evolves. International Journal of Environmental Research and Public Health, 16(3), 321. MDPI AG. Retrieved from http://
dx.doi.org/10.3390/ijerph16030321
Lara Pinho, Tânia Correia, Francisco Sampaio, Carlos Sequeira, Laetitia Teixeira, Manuel Lopes, César Fonseca. (2021).The use of mental health
34

promotion strategies by nurses to reduce anxiety, stress, and depression during the COVID-19 outbreak: A prospective cohort study, Environmental
Research. https://doi.org/10.1016/j.envres.2021.110828.
Wu, A.; Roemer, E.; Kent, K.,; Ballard, D.; Goetzel;, R. (2021). Organizational Best Practics Supporting Mental Health in the Workplace. Journal of
35

Environmental Medicine. 63 (12).

Courie, A. & Sanati, M. (2021). The FirstNet First Responder Needs Assessment: Driving Towards Targeted Interventions. International Public Safety
36

Association Journal. 1-14.

11
There are five key objectives by which this public-private collaboration drives action in
these priorities for emergency responder health and wellness:

COMMUNICATION PROGRAMMATIC SOLUTIONS

Implement strategies to raise What evidence-based programs,
awareness of issues and resources, resources, mental health services,
advocacy, and engagement of and training by nonprofits and for-
these health risk factors inside the profit organizations are available
profession, across all public safety, to first responders? How can we
and for the local communities that engage these organizations to reach
responders serve. responder agencies that have limited
resources and fewer personnel to
drive engagement at all levels in
LESSONS LEARNED AND emergency responder wellness?
BEST PRACTICES How can we recruit and retain first
The Coalition has come to realize responders? How can employers
that the health risks of emergency (both public and private) support
response crosses professions. the health and wellness of their first
While there are unique attributes to responder employees?
each profession, they have much in
common; and can continue to share
their lessons learned and resources COLLABORATIVE SOLUTIONS
developed at the national level to How do we work at the national level
cross pollinate best practices. to think outside the box: engaging
academic institutions, think-tanks,
and other consortia to get ahead of
TECHNICAL SOLUTIONS the health risk factors facing public
The lives of emergency responders safety? How can we get sustained
do not revolve around a 9-5 punch Federal, state and local funding for
clock. The Coalition looks for technical the training, recruitment, and ongoing
solutions that can drive responder payment for more first responders?
engagement in health and wellness
wherever they live, work, or play by
use of evidenced-based mobile health
(mHealth) applications and tools that
are available around the clock.

Consequently, the efforts of the Coalition over the last 2 years have been to drive multiple efforts
in these strategic objectives. The Coalition’s efforts have resulted in allocation of resources, new
partnerships, key collaborations, and summits to address the issue. In addition, the Coalition has driven
messaging, developed training, created technical solutions, and identified gaps in resourcing and
legislation that required additional action.

12
Recommendations and Discussion
As the Coalition has evolved, the membership has made critical recommendations for the profession and for
the nation. The health and wellness challenges facing public safety will continue to erode trust in leaders and
the profession and present a serious issue for the health, safety, and infrastructure of local communities.

In addition to the health risk factors described here, many public safety professions report issues with
retention and recruitment. Morale is low in many departments and responders question the ability to
reclaim the purpose, meaning, and pride in serving their local communities that is at the core of their
identity as a first responder.

Depending on the community, many responders do not feel valued; and there is increasing concern about
retention.37 Survey results from the American Nurses Foundation are shocking. From their Pulse on the
Nation’s Nurses COVID-19 Survey Series: Workplace Survey, June-July 2022, 58% of nurses reported that their
work environment is not healthy and/or positive. Additionally, 60% of nurses reported experiencing bullying
or incivility at work, and a third have experienced an act of violence at work.38 Nurses reported feelings of
being attacked by the patients they serve, and nursing remains one of the most dangerous professions
from a workplace violence standpoint.39 A representative from the National Emergency Number Association
(NENA) reports that some 9-1-1 telecommunications centers have a 70%+ vacancy rate.40 Police, Fire, and
EMS are unable to recruit and retain the responders we need for the safety our communities require. These
data present an alarming picture for the longer term sustainability of community response capabilities.

These issues represent a cause-and-effect cycle

impacting the health, wellness, and readiness
of the American public safety system. However,
engagement and action are robust across
the associations represented at the Coalition.
There are significant efforts we can make in
the near-term. Based on multiple reports and
recommendations from nonprofit organizations,
agencies, and training programs, the Coalition
has identified several key recommendations for
action at the national level.

U.S. Marshals Service. (2022). National Wellness Survey Report for Public Safety Personnel. US Marshals Service.
37

38
American Nurses Foundation, Pulse on the Nation's Nurses COVID-19 Survey Series: Workplace Survey, June-July 2022. https://www.nursingworld.
org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/covid-19-survey-series-anf-
2022-workplace-survey/
39
Addressing The Rise In COVID-Related Violence Against Nurses | NurseJournal.org

40
911 Telecommunications: It’s more than just taking a stressful call (firstnet.com)

13
Lessons Learned and Key Recommendations
As public safety leaders have come together to discuss lessons learned and best practices, they have
come closer to identifying critical gaps in the infrastructure of public safety wellness and made several key
recommendations. These recommendations should be considered for resourcing, policy change, standards
development, and further advocacy across public safety.

Engage Leaders Integrate Wellness Allocate Funding Establish Communication

Into Training and Resources Standards

Engage Leaders
Information gathered from across multiple organizations, nonprofits, surveys, and dialogue at summits
highlights one significant recommendation: leaders need to be engaged. Within the First Responder Needs
Assessment41 responders report the need for deepening leadership engagement. Responders acknowledge
the value of leaders addressing mental health and wellness, but they report leaders need to go beyond
talking about health and wellness and actually demonstrate and model behaviors of mental health and
wellness practices. This recommendation is consistent with the literature. Organizations that want to see
specific behaviors in their rank and file need to be reinforced and displayed by their mid-level managers and
at the highest levels of leadership.
Reports on lessons learned from the First H.E.L.P.
organization on addressing suicide prevention within
public safety departments also recommend leadership
engagement within trainings themselves.42 Rank and file
responders were more likely to participate in conversations
about wellness, trauma, and struggle when their peers and
leaders were also willing to engage in those meaningful
conversations. Boulder Crest Foundation for post-traumatic
growth also provided recommendations to this effect. Their
programs had more significant impacts and integration of
wellness into the culture of the organizations when efforts
were not just supported at the top, but when leadership
across the department was involved in wellness activities.43

Courie, A. & Sanati, M. (2021). The FirstNet First Responder Needs Assessment: Driving Towards Targeted Interventions. International Public Safety
41

Association Journal. 1-14.

42
Courie, A. (2022). FirstNet Health and Wellness Coalition Meeting Minutes September 15, 2022. FirstNet, Built with AT&T. Dallas, TX.
43
Courie, A. (2022). FirstNet Health and Wellness Coalition Meeting Minutes December 14, 2022. FirstNet, Built with AT&T. Dallas, TX.

14
Integrate Wellness into Training and Education Programs
Wellness needs to be integrated into training and education efforts from entry into the profession and
throughout the life cycle of a responder, including retirement.44,45 Consistently, reports from various
nonprofits and leaders within the profession recommend integration of wellness into the training programs
and education lifecycle of all responders. To change the culture of public safety, wellness needs to be
woven into the very fabric of becoming a responder. For too long, wellness has been perceived as an ad hoc
“nice to have” but not a “must have” of many departments. With increasing stressors, operational tempo,
and workforce shortages, wellness is a critical force multiplier in correcting the current trend of burnout,
depression, PTSD, and loss of responders from the profession due to suicide or attrition. For example, within
nursing, the American Nurses Foundation and partners launched the Well-Being Initiative in the spring of
2020 to provide free multi-modal programs to all nurses.

Training programs and education in wellness skills should start at the onset of learning of the profession
and continue all the way through to retirement. Wellness curriculum should be incorporated at the academy,
training agency, and/or college coursework. The wellness of public safety is inherent in the ability of the
individual to do their jobs and should be a part of how they train to become experts in their field.

Additionally, organizations found that cross-profession trainings were especially valuable. Trainings that
included responders from multiple professions – sworn and unsworn (civilian personnel) – built a sense of
community, shared purpose and common struggles that created deep and meaningful relationships and
understanding. Training plans should be built in such a way that public safety agencies in a geographic area
can share resources and tools that foster cross collaboration. This shared sense of struggle can deepen
relationships that ultimately can assist in improved collaboration even in the middle of crisis response.46
Unfortunately, wellness knowledge, skills, and abilities are not incorporated to the same level as standards
for equipment, uniforms, or operations. This needs to change. Organizations should be responsible for
building policies that incorporate wellness throughout the lifecycle of an emergency responder’s career.

“ . . . a sense of community,
shared purpose and common
struggles that created deep and
meaningful relationships and

”
understanding . . .

44
Courie, A. (2022). FirstNet Health and Wellness Coalition Meeting Minutes December 14, 2022. FirstNet, Built with AT&T. Dallas, TX.
Boulder Crest Institute. (2022). Posttraumatic Growth Summit. Boulder Crest Foundation: Washington, DC.
45

46
Courie, A. (2022). FirstNet Health and Wellness Coalition Meeting Minutes September 15, 2022 and March 2, 2022. FirstNet, Built with AT&T. Dallas, TX.
46
BJA FY22 Grant Awards | Office of Justice Programs (ojp.gov)

15
Allocating Funding and Resources
Agencies need to allocate funding and resources to implement evidence-based solutions at the local and
national level. Currently, grants are available to address responder wellness through various federal entities
(Bureau of Justice Administration,47 US Fire Administration48) and state grants, but they are not always
equally available across all public safety professions. While the grant process fills an important gap for
funding of wellness programs for public safety and should be sustained for those that rely on grants, it lacks
long term sustainability and equality for access amongst first responder groups.

We need to publish training and continuing education standards and recommendations for state and
local administrators that incorporate funding measures to include health and wellness for all emergency
responders. This will allow communities to invest in the wellness of their responders in the same way they
invest in equipment and resources to ensure the safety and health of their emergency response systems
for their municipalities. And we need to educate communities on the need for aiding emergency response
personnel and caring for the health, safety and functioning of the systems on which they rely. The capacity
and well-being of the U.S. health workforce has been under threat for years by an epidemic of burnout, and
the COVID-19 pandemic has exacerbated this systems issue. Now more nurses, physicians, and state and
local public health department employees than ever are considering leaving their professions. Recognizing
that the function of the U.S. health system is at stake, the NAM released the National Plan for Health
Workforce Well-Being in October 2022 to drive collective action to strengthen health workforce well-being
and restore the health of the nation.49

Communities to invest in the wellness

of their responders in the same way
they invest in equipment and resources

Wellness Standards
We need to publish standards on evidence-based health and wellness programs. And we need to make
technical assistance centers available as a resource for implementation. At the current time, many public
safety associations are moving to publish standards for the implementation of robust and evidence-
based wellness programs for various size agencies that are tailored for the health risk factors of the first
responders they serve.50 However, many responders report a lack of awareness of these standards51 and
want more visibility and understanding on what those standards entail. Particularly for mental health

47
BJA FY22 Grant Awards | Office of Justice Programs (ojp.gov)
48
Fire service grants and funding (fema.gov)
49
https://nam.edu/initiatives/clinician-resilience-and-well-being/national-plan-for-health-workforce-well-being/
50
Officer Health and Wellness (theiacp.org); Wellness/Fitness Program Summary (iafc.org); Health and Wellness - APCO International (apcointl.org)
Courie, A. & Sanati, M. (2021). The FirstNet First Responder Needs Assessment: Driving Towards Targeted Interventions. International Public Safety
51

Association Journal. 1-14.

16
assistance, assessment and treatment must be accessible, affordable, confidential, and not endanger the
first responders’ employment or licensure.

Evidence also suggests that organizations that have access to technical assistance are more likely to
implement evidence-based standards and drive towards the outcomes they seek to address in their
specific population. Many associations could develop mobile technical assistance teams that would assess
a department’s wellness capacity, make recommendations for improvement, help implement community
health action plans, and assist in evaluating those efforts to ensure constant quality improvement in the
wellness efforts at the local level. Many well-meaning responders with a desire to shift the culture in their
organizations to one of wellness get “voluntold” or “volunteer” to implement a wellness program with few or
no resources or guidance on how to get started. It can be exceedingly frustrating to build a program without
any sense of where to start or resources available to ensure success. Public safety organizations have an
opportunity to implement a technical assistance model that would ensure consistent, sustainable, and high-
quality wellness programs across their constituents.

Communication
All the public safety organizations agree that
wellness needs to be a part of the broader
discussion both nationally and at the local level.
They have identified a gap in the discussions
happening at the national association level, as
well as in states and local chapters. There needs
to be ongoing, strategic communication of
best practices and lessons learned in wellness
program implementation. And these lessons
need to trickle down to the rank and file across
our nation. One third of respondents in the
FirstNet First Responder Needs Assessment
Survey expressed a desire for departments
to better amplify awareness of programs,
reflecting the need to better communicate
health and wellness opportunities and an
overall wellness message.

Additionally, deepening the conversation on

responder health and wellness creates a shared
language; reduces stigma about the problems
of mental health, depression, anxiety, and PTSD;
and allows for an opportunity for discourse about solutions & promising practices; and provides public
safety with a strong and shared voice.

Communication also helps our local communities understand the impact of disaster response work.
We must do a better job communicating the story of the emergency responder experience to connect
our communities to the impacts of the job. This can lead to an understanding of the need to resource
emergency responder wellness programs appropriately to contribute to the overall health and wellness
of local municipalities. Additionally, this support and understanding can help drive local funding and
collaboration.

17
In the Future
These key recommendations will create the path for systematic improvements within public safety wellness.
An essential component for the success will be consensus amongst stakeholders. Advocates and leaders
in this space will need to collaborate with their unions, communities, governments, families, and people to
ensure activities are supported by key stakeholders.

Conclusion
Collaborating with public safety, disaster response organizations, and community safety infrastructure
facilitates innovation, dialogue, and solutions that will help systematically identify critical gaps in the current
systems to address the health priorities facing emergency responders and frontline healthcare personnel.
By coming together with a united voice and clear understanding of the ways organizations can collaborate
to drive change, we can drive public safety to address issues such as post-traumatic stress, depression, self-
harm, anxiety, stress management, and family member, and leadership engagement.

Community
Safety
Infrastucture

Public
Disaster Safety
Response
Organizations

Innovation + Dialogue + Solutions

18
Appendix A:
FirstNet Health and Wellness Coalition Membership, Contributors to
White Paper and National Public Safety Association Endorsements

NAME ORGANIZATION MEMBERSHIP TYPE

Dr. Anna Courie Director, Responder Wellness, FirstNet, Built with AT&T* FirstNet/Private Sector/
Responder Wellness
Mr. Ed Davis CEO, Edward Davis Company Law Enforcement Consultant
Ms. April Heinze National Emergency Number Association (NENA)* Public Safety
Telecommunications
Chief Bruce Evans National Association of Emergency Medical Technicians (NAEMT)* EMS/EMTs
Chief Jeff Spivey International Association of Chiefs of Police (IACP)* Police Chiefs
Chief Patrick Ridenour International Association of Chiefs of Police (IACP)* Police Chiefs
Chief Shannon Trump National Association of Women Law Enforcement Executives* Law Enforcement
Ms. Kym Craven National Association of Women Law Enforcement Executives* Law Enforcement
Ms. Deb Courtright Public Safety Consultant Field Expert
Chief Deric Weiss Metro Fire Chiefs Association (MFCA)* Fire Chiefs
Mr. Dick Mirgon Public Safety Broadband Technology Association (PSBTA)* Information Officers
Chief Al Gillespie Public Safety Broadband Technology Association (PBSTA)* Information Officers
Dr. Chet Kharod National Association of Emergency Medical Service Physicians EMS Physicians, Prehospital
(NAEMSP)* Staff & Providers
Dr. Jennifer Mensik Kennedy American Nurses Association* Nursing
Dr. Sara Metz Code4Counseling Public Safety Psychology
Chief George Turner Public Safety Commissioner/Police Chief City of Atlanta, Retied
Mr. Mike Varney First Responder Network Authority-Fire First Responder Network
Authority
Mr. Harry Markley First Responder Network Authority - LE First Responder Network
Authority
Mr. Jason Biermann International Association of Emergency Managers* Emergency Management
Ms. Carrie Sperranza International Association of Emergency Managers* Emergency Management
Mr. Jason Rhodes National Association of State EMS Officials (NASEMSO) Emergency Management/
EMS
Sheriff Jim McDonnell Los Angeles, CA County Sheriff (RET) Police/Corrections
Mr. Jim Bugel President, FirstNet, Built with AT&T* FirstNet/Private Sector
Mr. Jim Pasco National Fraternal Order of Police* Police Officers
Mr. John Flynn National Association of Police Organizations (NAPO)* Police Officers
Chief Kathy O’Toole Retired Police Chief/Police Consultant Police Officers/Police Chiefs
Mr. Kevin O’Connor International Association of Fire Fighters (IAFF)* Firefighters

19
Appendix A:
(continued)

NAME ORGANIZATION MEMBERSHIP TYPE

Ms. Leslyn Stewart Metro COPS*/NOBLE Wellness* Family Members
Mr. Dwayne Crawford National Organization of Black Law Enforcement Executives Law Enforcement
(NOBLE)*
Mr. Mark Reddish Association of Public Communications Officials International (APCO)* Public Safety
Telecommunications
Mr. Mark Spross Association of Public Communications Officials International (APCO)* Public Safety
Telecommunications s
Mr. Otto Drozd National Fire Protection Agency/Metropolitan Fire Chiefs Fire Service
Association*
Assistant Chief Patrick Fale Tualatin Valley Fire and Rescue/Western Fire Chiefs of America* Fire Service
Chief Paco Balderamma Fresno County, CA Police Chief Police Chiefs
Sheriff Pat Labat Major County Sheriffs of America (MCSA) Sherriff/Corrections
Mr. Pat McMonigle FBI Agents Association* Federal Agents
Mr. Reid Vaughan National Volunteer Firefighters Council (NVFC)* Volunteer Firefighters
Chief Rich Martin International Association of Fire Chiefs (IAFC)* Fire Chiefs
Ms. Sherri Martin Fraternal Order of Police* Police Officers
Ms. Trina Sheets National Emergency Management Association (NEMA)* Emergency Management
Mr. Josh Goldberg CEO, Boulder Crest Foundation for Posttraumatic Growth* Academic/Nonprofit
Ms. Rhonda Kelly Executive Director, All Clear Foundation* Academic/Nonprofit
Ms. Karen Solomon President, First HELP* Academic/Nonprofit
Chief Jeff Johnson (Ret) Western Fire Chiefs* Firefighters

*Denotes public safety association endorsement as well as individual.

20
Appendix B:
First Responder Needs Assessment

Table 1: First Responder Needs Assessment Demographics

Age 18-24 25-34 35-44 45-54 55-64 65+ PNTA*
Percentage 1.4% 9.8% 23.9% 35.3% 23.1% 6% 0.5%
Gender Male Female Other PNTA
Percentage 70.7% 28.3% 0.3% 0.8%
Ethnicity A.A./Black Asian Caucasian Latino/ Native Am. Other PNTA
Hispanic
Percentage 2.7% 0% 85.6% 3.8% 0.8% 1.6% 4.9%
Education HS Grad Trade AD BS/BA MS/MA Doctoral/Prof PNTA
Percentage 13% 6.8% 22.8% 35.9% 17.1% 1.9% 2.4%
Marital Unmarried Married Cohabitating Divorced Widowed Separated PNTA
Status
Percentage 12.2% 70.7% 3% 8.7% 1.4% 1.1% 3.0%

Table 2: The top three problems facing public safety

ANSWER CHOICE PERCENTAGE ANSWER CHOICE PERCENTAGE
Access to healthcare 3.0% Lack of health/mental-care workers 9.0%
Access to mental healthcare 22.0% Lack of healthcare insurance 2.2%
Alcohol and Drug Abuse 20.9% Lack of morals or values 1.9%
Anxiety 19.0% Lack of purpose/hope 5.4%
Cancer 15.5% Lack of resilience 5.2%
Cardiovascular Disease 14.9% Line of Duty Death 4.3%
Child Abuse 0.0% Lung disease 0.8%
Communication Issues 11.7% Metabolic problems/obesity 10.9%
COVID-19 17.1% Personal Safety 14.1%
Domestic Violence 3.3% Post-Traumatic Stress Disorder 39.9%
Depression 23.6% Suicide 9.5%
High Blood pressure 9.0% Toxic culture 12.8%
Hostile Work Environment 5.7% Other (please specify) 9.2%
Implicit Bias 9.0%

21
Appendix B:
First Responder Needs Assessment (continued)

Table 3: Programs with the Greatest Impact

ANSWER CHOICES PERCENTAGE ANSWER CHOICES PERCENTAGE
Bias training 7.6% Physical Fitness Training 22.8%
Compassion training 8.2% Relationship Building 5.7%
Cultural Competence 7.1% Resilience Training 20.7%
Alcohol and Drug Abuse 6.3% Professional Development Scholarships 5.4%
Dealing with Anxiety 20.1% Sleep skills 12.8%
How to be a better leader 9.8% Strength Training 3.0%
How to run a 5 or 10K 0.3% Stress Management 50.8%
Leadership training 17.7% Suicide Prevention 9.0%
Healthy nutritional choices 15.5% Therapy Dogs 5.2%
Marriage/Family 13.9% Tobacco Cessation 1.6%
Mindfulness training 13.3% Wellness/Life Coaching 22.3%
Peer counseling programs 19.3% Other (please specify) 1.9%

Table 4: Barriers to engaging activities that enhance health

ANSWER CHOICES PERCENTAGE ANSWER CHOICES PERCENTAGE

Cost of activities (it’s too expensive) 33.4% Not enough time 56.3%
Fear of impact on employment 18.2% Not interested in being healthier 10.3%
Lack of awareness of programs 32.3% Stigma (internal/external) 23.4%/23.4%
Lack of community support 5.7% Times that activities are offered 0%
Lack of culturally competent providers 8.7% Work-life balance 56%
Lack of organizational support 26.1% Other (please specify) 6.3%

22
Appendix B:
First Responder Needs Assessment (continued)

Table 5: Ways to engage first responders in health and wellness

ANSWER CHOICES PERCENTAGE ANSWER CHOICES PERCENTAGE

Amplification of awareness of programs 33.7% Personal Protective Equipment 9.2%
Awards/Incentives 42.7% Podcasts 3.3%
Biometrics/biofeedback 11.4% Retreats 10.1%
Digital applications 6.5% Small group classes 14.4%
Engagement from Leadership 47.6% Sponsored training 24.2%
Fitness testing 14.7% Web-based tools 7.9%
Identify standards for wellness programs 24.2% Web-based training 8.7%
Mobile training 7.3% Webinars 3.8%
Mobile Wellness Centers 11.4% Wellness Symposiums/Conferences 13.0%
Newsletters 1.6% Other 4.3%

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