HHS ‘Service to Self’ program promotes first responder resilience

CAPCE-approved online program confronts ‘hero culture’ and shares tools to address mental health challenges


Fire and EMS leaders owe it to their people to make this program a part of a comprehensive mental health and well-being program.

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Resilience is a quality we often think of as inherent to all first responders. While that may be true to some degree, shocking national statistics and heartbreaking personal stories of first responder PTSD and suicide indicate that there is still a long way to go in terms of awareness and resources for responder mental health and well-being.

One great resource comes from a little-known branch of the Department of Health and Human Services (HHS). The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a free one-hour online continuing education program titled “Service to Self,” aimed at helping fire and EMS responders understand their own vulnerabilities and improve their personal and professional resilience. While the program is under the SAMHSA Disaster Technical Assistance Center (DTAC), it is intended to promote resilience on a day-to-day context, not just during or after a disaster event.

Having recently taken the Service to Self program, I can attest to the fact that it is an excellent resource for leaders and administrators as well as field personnel. Plus, the program is accredited by the Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE).

Unsettling statistics

Presented by EMTs and firefighters, the program begins by addressing the hero culture of emergency services, namely the problematic expectation that firefighters and EMS personnel remain stoic in the face of adversity, neither needing nor asking for help. This is compounded by the all-too-common stigma within emergency services that discourages honest discussion about the types of behavioral health issues that are widespread in our profession.

As detailed in the Service to Self program, recent research has helped us better understand the degree to which sleep deprivation, work pressures, threats of physical violence and other stressors weigh on firefighters and EMS personnel. Specifically, up to 84% of first responders have experienced traumatic events in their line of work. Up to 34% have received a formal diagnosis of mental health disorder, such as depression or PTSD – and these numbers are considered strongly under-reported.

Tackling common troubles

The Service to Self program confronts the kinds of acute and chronic occupational stressors experienced by virtually all responders as well as the mental and physical health problems that can result from them. It also discusses common coping mechanisms, both positive and self-destructive, commonly used by first responders as well as mental health issues that can result from poor management, including depression, PTSD, substance abuse and even suicide.

The program raises the kind of important mental health and well-being issues that emergency services organizations need to address proactively. The many younger firefighters and EMTs who present the course make it exceptionally well suited for new EMT, paramedic and firefighter recruit training programs. While some of the content has been covered before, it remains no less relevant to even experienced emergency responders.

A place to start

Fire and EMS leaders owe it to their people to make this program a part of a comprehensive mental health and well-being program. If your organization doesn’t have one, this course may be a place to start. If you already have one in place, you may consider adding this program as a supplement to help individual responders as well as their families, healthcare workers, community leaders, religious leaders and peer support personnel better understand the weights that pull down our firefighters and EMS colleagues. Even more importantly, it helps give them the tools to recognize when things are going wrong and the resources to begin to intervene before it is too late.

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Rom Duckworth is a dedicated emergency responder, author and educator with more than 30 years of experience working in career and volunteer fire departments, hospital healthcare systems, and private EMS. He is a career fire captain and paramedic EMS coordinator for the Ridgefield (Connecticut) Fire Department and the founder of the New England Center for Rescue and Emergency Medicine. Duckworth is recipient of the American Red Cross Hero Award, Sepsis Alliance Sepsis Hero Award, and the EMS 10 Innovators Award in addition to numerous awards and citations for excellence in education and dedication to service. Duckworth is a member of numerous national education, advisory and editorial boards, as well as a contributing author to more than a dozen EMS, fire and rescue books, including the IFSTA Pumping Apparatus Driver/Operator textbook as well as over 100 published articles in fire and EMS journals, magazines and websites. Duckworth has a bachelor’s degree in public safety administration from Charter Oak State College in Connecticut. Connect with Duckworth via RescueDigest.com or RomDuck.com or on LinkedIn.