By Dr. Anna Courie, Stationwise Advisor
There’s a moment when leaders are wrestling with the needs of their people, when they ask a very sobering question: Are we actually supporting our people the way we think we are?
It doesn’t usually come from a policy review. It usually comes after something bad has happened and when things are going wrong in a station. It can show up with a firefighter who’s not quite themselves; a crew that’s more irritable, more tired than usual; or making more mistakes; or as a close call that didn’t need to be as close as it was. Sometimes, this question arises after a loss of life.
In that moment, the instinct is almost always to act: To do something, anything...maybe to add a resource, bring in training, stand up a peer support team, send out a message that help is available. These interventions can make a difference, but they are often reactive, rather than strategic in approaching the fundamental issues facing fire-fighter well-being:
Fire-fighter well-being is rarely determined by a single program. It is shaped, over time, by the conditions people operate in every day. The schedule they work. The way leadership shows up. The conversations that are safe to have — and the ones that aren’t. The difference between a resource existing and a firefighter trusting it enough to use it. We tend to talk about well-being as if it’s something we deliver but in reality, it’s something the system either produces — or erodes.
Over the last decade, the evidence has only reinforced what many in the field already know. Firefighters are navigating repeated exposure to trauma, disrupted sleep, and sustained physiological strain. Rates of depression, post-traumatic stress, and suicide risk are higher than we should accept as normal (Jahnke et al., 2016; Stanley et al., 2016). Cardiovascular events remain one of the most persistent threats to firefighter health (Smith et al., 2016). And fatigue — chronic, cumulative, toxic fatigue — continues to shape performance and decision-making in ways that are often underestimated until something goes wrong (Violanti et al., 2017; U.S. Fire Administration, 2023).
None of this is new. What is still evolving is how we respond to it.
For a long time, the burden has been placed — implicitly or explicitly — on the individual. The narrative being drummed was: Be resilient. Take care of yourself. Use the resources available. And firefighters, by and large, do what they have always done: they push through their struggle and ignore it until it keeps them from doing the work they were originally called to do.
The discussion needs to go beyond personal resilience. It needs to evolve into a discussion about organizational well-being, readiness, and resilience. But well-being strategy at the organizational level is largely not discussed. Organizational well-being tends to sit in a space of one program after another, which quietly shifts responsibility away from the organization and onto the individual. That’s not sustainable, and it’s not aligned with how the fire service approaches any other form of risk.
We do not tell firefighters to be more resilient in the face of unsafe apparatus. We fix the apparatus. We do not ask them to adapt to broken systems on the fireground. We correct the system.
Well-being deserves the same level of rigor.
The challenge is that organizational systems are harder to see. Culture, trust, fatigue, leadership behavior, and others are not as immediately visible as flames or smoke conditions. They don’t announce themselves as clearly. They accumulate, gradually, until they show up in ways we can’t ignore. This is where organizational assessment becomes essential not as administrative exercise, but as a form of operational awareness.
When departments take the time to look closely at how well-being is supported, the picture that emerges is often more nuanced than expected. Resources may be in place, but underutilized because firefighters don’t trust them or don’t believe they’re truly confidential. Leadership may be committed but not equipped with the skills to recognize or respond to behavioral health concerns in real time. Fatigue may be pervasive, but so normalized that it’s no longer questioned.
These are not failures of intent; they are gaps in alignment.
National efforts over the past decade, from the International Association of Fire Fighters to the National Volunteer Fire Council, have emphasized that access to behavioral health resources alone is not enough. Utilization depends on culture, leadership, and trust (IAFF, 2018; NVFC, 2020). In other words, the presence of support is not the same as the effectiveness of support.
And that distinction matters.
Because without a clear understanding of how these pieces are functioning together, departments are left making decisions based on what they hope is true, rather than what is.
Assessment changes that. It creates a disciplined way of asking: What is actually happening here? Where are we strong? Where are we vulnerable? What are we not seeing?
It also does something equally important: it signals to the organization that well-being is not an afterthought. It is something to be examined, understood, and led with intention.
There is a tendency, particularly in high-performing environments like the fire service, to move quickly to action. To fix, to build, to improve. That instinct is a strength. But without a clear picture of the current state, even well-intentioned efforts can miss the mark. In the end, this is not about adding more programs. It is about ensuring that the system firefighters operate within can sustain them over time.
That requires clarity. It requires honesty. And it requires a willingness to look at what is working — and what is not — without defensiveness.
Firefighters understand the importance of a size-up. It’s ingrained in how they operate. They know that everything that follows depends on getting that first step right. The same is true here. Before building anything new, it is worth asking a simple question:
Do we actually understand the system we’ve already built and how it supports the well-being of firefighters in it?
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Dr. Anna Fitch Courie, DNP, RN-PHNA-BC, is a Stationwise Advisor with more than two decades of healthcare and public health experience. She works with public safety organizations on well-being strategy, assessment, and organizational program design.
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References
International Association of Fire Fighters. (2018). Behavioral health program: Model guidelines.
Jahnke, S. A., Poston, W. S. C., Haddock, C. K., & Murphy, B. (2016). Firefighting and mental health: Experiences of repeated exposure to trauma.
Jahnke, S. A., et al. (2022). Organizational support and firefighter behavioral health outcomes.
National Volunteer Fire Council. (2020). Share the Load: Firefighter behavioral health program.
Smith, D. L., DeBlois, J. P., Kales, S. N., & Horn, G. P. (2016). Cardiovascular strain and firefighter health risk.
Stanley, I. H., Hom, M. A., Hagan, C. R., & Joiner, T. E. (2016). Suicide risk among firefighters.
U.S. Fire Administration. (2023). Firefighter health and wellness.
Violanti, J. M., et al. (2017). Shift work and sleep disorders among first responders.
