This study was supported by a National Research Foundation of Korea (NRF) grant funded by Korean government (MSIT, No. NRF-2020R1G1A1010619).
Firefighters belong to an occupational group that is consistently exposed to psychological challenges, such as post-traumatic stress disorder (PTSD). This study examines firefighters’ perceptions of psychological intervention programs.
Semi-structured interviews were conducted with 12 firefighters who were divided into two focus groups. Qualitative data were analyzed using content analysis.
Six barriers and seven suggestions regarding psychological intervention programs were identified. The barriers were “work overload”, “uncomfortable counseling situation”, “perfunctory programs”, “lack of consulting specialists”, “limited number of participants”, and “lack of replacement workers while attending the intervention programs”. Suggestions to overcome these barriers included developing “sustainable” and “highly accessible” intervention programs “focused on positive aspects of traumatic events”, considering “job characteristics” and “individual psychosocial characteristics”, as well as employing “experts with knowledge of firefighters’ duties”, and “creating a supportive work environment for psychological intervention”.
Based on these findings, the interventions should focus on the positive aspects of traumatic events, with flexibility and practicality, tailored to the individual and occupational characteristics of firefighters.
The consequences of a major disaster are not restricted to individual suffering but affect families and communities and cause national crises [
Firefighters are at high risk for mental health problems, including post-traumatic stress disorder (PTSD), depression, and alcohol abuse. As a result of Korean firefighters who received hospital treatment in 2016 and 2020, the number of firefighters suffering from depression nearly doubled from 364 in 2016 to 650 in 2020. There has also been a steady increase in the number of firefighters who have visited hospitals with PTSD symptoms, from 37 in 2016 to 67 in 2020[
Several diverse psychological interventions are available currently that recognize the importance of mental health management for firefighters [
Psychological interventions for most firefighters in Korea to date have developed and standardized general interventions rather than targeted interventions. In particular, although the Fire Psychology Support Center has been in operation since 2015, effective intervention studies based on understanding of fire officials' duties, trauma characteristics are insufficient, and absence of systematic manuals lead to regional inequality [
Following the COVID-19 pandemic, firefighters are frontline workers who respond to transportation and treat sick patients. This has caused firefighters to fear exposure to COVID-19, which increases the stress on firefighters at work [
The focus group interview is an appropriate methodology for needs assessment and perceptions research. Focus groups can be used to determine program direction or needs, before beginning the program. The focus groups provide a wider range of information to the interview that participants' ideas continue to build on themselves and create synergy, giving way to the unexpected, frankly [
This study is a qualitative study that uses the Focus Group Interview (FGI) method to explore firefighters' perceptions of the psychological intervention programs. FGI is a suitable research method for this study as it provides detailed information about participants' experiences, perceptions, opinions, emotions, and knowledge based on an interview guide composed of open-ended questions [
Twelve firefighters working at fire stations in Busan and Gyeongnam, South Korea, were included in this study. The participants were divided into two focus groups using judgment sampling. Firefighters with trauma experience who have performed emergency medical services for more than 3 years (n=6) and firefighters with more than 1 year of experience in psychological support related work (n=6) were selected. This selection criterion is based on a previous study, according to which post-traumatic stress is the most severe among firefighters engaged in rescue work in South Korea [
Data were collected through semi structured FGIs between April 1~25, 2021. The interviews were conducted in accordance with the procedures of the focus group research method, that is, by clarifying that the purpose of the research would not deviate from the research question. A preliminary questionnaire was created based on previous research [
Interviews were conducted at the study cafe, in compliance with the COVID-19 quarantine rules. Interviewees were telephonically contacted and given verbal explanations outlining the purpose and process of the study. Subsequently, written consent was obtained just before the interview. After obtaining consent from the participants to record the interview proceedings, their personal information such as age, position, work experience, field of work, and current work duration were obtained. Semi structured, open-ended questions were delivered by a facilitator during the interviews. The average duration of interviews per session was approximately 2~3 hours. The interview process and content were recorded in the field notes. Following the interview, a gift was given to each participant.
A moderator and an observer—with experience in firefighter psychological counseling and FGI research—conducted the interviews. When responses from participants were vague and insufficient for the topic presented, the moderator asked additional questions for obtaining more specific answers. One observer recorded the interviews and took field notes to understand the atmosphere of the group and non-verbal communication during the interview. After performing FGI of one group, analysis was performed immediately. After that, FGI of the other group was carried out to constantly check the saturation status of the study.
The data analysis in this study was conducted based on following process of inductive content analysis suggested by Elo and Kyngas [
The preparation of the researcher to carry out this study is as follows. The two researchers regularly attended courses on qualitative research during their doctoral studies. Both researchers experience with qualitative research. In addition, ongoing participation in qualitative research workshops was intended to increase understanding of qualitative research as a whole.
The validity of the study was assessed through the qualitative research evaluation criteria proposed by Lincoln and Guba [
This study was reviewed and approved by the Institutional Review Board of K University (IRB No. 40525-201404-HR-26-02). All participants were informed about the purpose of the study, research process, confidentiality, and the right to withdraw from participation at any time. Additionally, prior to starting the interview, participants' consent was obtained after explaining that the recordings would be used for research purposes only and would be destroyed at the end of the study. The recorded interview contents were transcribed using a computer program, all personal information related to the participants' identity was deleted, and a separate identification number was assigned to each participant.
As a result of FGI with firefighters, considering their perceptions of psychological intervention programs, barriers and suggestions were identified as a category. There were 6 sub-categories as barriers implementing psychological intervention programs for firefighters: work overload, uncomfortable counseling situation, perfunctory programs, lack of consulting specialists, limited number of participants, and lack of replacement workers while attending intervention programs. To facilitate psychological intervention programs, 7 sub-categories as suggestions were identified: programs focused on positive aspects of traumatic events, programs considering job characteristics, programs considering individual psychological characteristics, developing sustainable programs, appointing experts with knowledge of firefighting duties, developing highly accessible programs using various materials and creating a supportive environment for psychological programs (
The quarantine measures related to the COVID-19 pandemic have put additional work pressure on firefighters, leaving them with little time to participate in psychological intervention programs.
Because of additional work related to COVID-19, everyone is physically overwhelmed; so, I cannot allow myself to participate in such psychological programs. (FGI1, Participant B)
There are a lot of other things besides emergency medical services, such as watering street trees, the firefighting experiment program for kids, and computer work. Therefore, I cannot afford to participate in intervention programs.(FGI2, Participant G)
Most psychological intervention programs are conducted at the fire department. As a result, firefighters' participation in the program becomes noticeable, and they find it difficult to concentrate.
I'm doing consultations in the middle of work; so I don't know when the call will come during the consultation. I'm just trying to wrap this up quickly. (FGI1, Participant C)
It is meaningless to consult in a situation where many people are waiting for a consultation during working hours. (FGI2, Participant G)
In the consultation zone, the siren keeps ringing; I feel like I'm still working rather than consulting. (FGI1, Participant A)
Firefighters expressed the opinion that the intervention programs seem to be more beneficial for the psychological advisors. Moreover, the programs were formal and time consuming.
Even after one year, how was the situation dealt with back then? She asked me like that; I just felt like the whole thing was killing time somehow. That's how I felt. (FGI1, Participant A)
These are just a couple of phone calls. That's all, and they are perfunctory. That's why I think everybody has such negative opinions. (FGI2, Participant J)
In recent years, the importance of psychological interventions for firefighters has been recognized, and efforts are being made to hire professional counselors for firefighters. However, the number of counselors remains insufficient.
Two or three people are elected annually, but there are now almost 5,000 people in the fire department. So, it's difficult for one or two consultants to cover them all. (FGI1, Participant B)
We have a professional counselor here. I wonder if it's possible to see her once a year. It's hard to cover all these people alone. (FGI2, Participant K)
The number of people who can participate in the programs is limited, and the participants are chosen without any psychological consideration.
There are a limited number of people who can go to 'Healing Camp', and only one or two people can go there annually. (FGI1, Participant B)
I'm not sure what the criteria are for selecting candidates. Only a few people are assigned based on the order of retirement or appointment, not those who are really needed. (FGI2, Participant L)
There is a systematic difficulty that someone has to take over when others are participating in psychological intervention programs. As a result, participants feel sorry that someone has to replace them when they attend the intervention programs
When I go to the program, the rest of the crew suffers because someone has to come in. (FGI1, Participant C)
If I use that time for consulting, the rest of the firefighters become busy. In the end, these things make us walk on eggshells, which is why I don't want to participate in the program. (FGI2, Participant J)
Participants stated that developing intervention programs based on positive rather than negative experiences is more effective in the long run.
Instead of revealing deep traumas, it is better to gradually build on positive aspects, even for small things, to overcome trauma. (FGI2, Participant H)
I think it will be more effective if we proceed with the growth program focusing on overcoming trauma rather than dwelling on its negative aspects. (FGI1, Participant E)
When I talk about my experiences with PTSD, it's not like the issue is resolved, but at some point, it becomes depressing and harder to talk about. But if someone says, 'I had a tough time, but it was worth it,' there are moments when talking like that can make everything disappear. So, I think it is preferable to concentrate on a truly positive event rather than a negative one. (FGI 2, Participant H)
Since firefighters have different tasks and hours of work, it is necessary to develop an intervention program that considers tasks, hours of work, and work experience rather than implementing a general program.
Firefighters engage in fire, rescue, and emergency operations. They're all different. There are also outdoor and indoor jobs. Would it not be a good idea to put in place a program tailored to each field?.(FGI1, Participant C)
It could be a bigger issue for novice firefighters since it's their first time. I was shocked at first. I'm calm right now. Thus, it is necessary to develop a program based on work experience.(FGI1, Participant F)
The level of trauma exposure and the capacity to cope with trauma vary for each firefighter. Thus, it is necessary to develop programs that consider the personal characteristics of firefighters.
It is a requirement to offer intervention programs depending on the level of trauma experienced by each person. That may be the way an intervention works for me.(FGI1, Participant D)
I think we need to create a program that recognizes the individual capacity of each firefighter to cope with trauma. Given these individual characteristics, I believe we must develop the capacity to resist trauma. (FGI2, Participant K)
Participants said a long term, continuous program is needed instead of a one-time intervention program.
I think it should be steady support that can give hope and courage in the long term, not a one-time event. (FGI2, Participant I)
It's not a short term thing, it seems there needs to be continuous management. (FGI1, Participant F)
To develop an effective intervention program, appointing experts who are familiar with the characteristics of the firefighting job is important. Alternatively, if possible, someone who could give practical advice based on handson experience and who is familiar with the job characteristics could act as an expert.
He came to me for a consultation, but he had no idea what I was doing. So, I did not want to talk about it because his credibility went down dramatically at that time. So, I think the most important thing is to have a clear understanding of our work. (FGI1, Participant A)
I think we need a professional advisor who knows the characteristics of our work while working the same shifts or in the same conditions as we do. (FGI1, Participant B)
I think the firefighters who work in the same center as we are the best people to act as counselors. (FGI2, Participant L)
Firefighters want an intervention program that allows for immediate participation whenever the need arises. For this, it is necessary to use various materials, and anonymity is also considered an important factor to increase accessibility.
During the day, I cannot think of anything because I'm so busy, but at night, I think about it, and I feel terrible. That's why I think I need a program that allows me to consult when I need it, even after work. (FGI2, Participant H)
I think it would be great to have a site or application where you can relieve stress immediately. I think it will be somewhat more effective to have that access. (FGI1, Participant F)
If you use something like the Zoom app and have a counselor as the host from 9 am to 5 pm, I think you can get in and try it whenever you need it. (FGI1, Participant E)
Participants indicate that both a supportive organizational environment and institutional support are needed for the effective implementation of psychological intervention programs. It is necessary to create an organizational atmosphere where one can share psychological difficulties naturally and participate in psychological interventions comfortably.
I think the most important thing is to create an environment in which I can get comfortable counseling without putting pressure on my work. (FGI2, Participant I)
I think we need to recognize the importance of the program internally and focus more on it. (FGI2, Participant J)
Regarding the barriers preventing participation in intervention programs, participants indicated additional workload along with firefighting work. Particularly, participants stated that they could not afford to participate in psychological intervention programs due to quarantine measures and additional work caused by COVID-19. They found it burdensome that someone had to replace them while they attended the programs. In fact, for 3 months from March 1, 2020, 34.5% of firefighters in New York City were on sick leave due to a suspected or confirmed COVID-19 outbreak, which reduced the number of emergency medical services personnel to meet the surge since COVID-19 [
Additionally, the participants stated that most psychological interventions were conducted during working hours and at the workplace to increase the participation rate, but it was difficult to concentrate on counseling in a situation in which the call bell would ring anytime, and the atmosphere was formal. This is supported by previous studies showing that a comfortable and private therapy office facilitates counseling [
Further, the number of consulting experts was too small compared to the number of firefighters, and special intervention programs were limited. In Korea, very few psychological counselors belong to the National Fire Agency, and this majorly involves employing external professional psychological counselors [
The number of people who can participate in the programs is limited. For instance, In Korea, only 180 firefighters (9%) participated in the "Stress Relief Program", which was originally planned for 2,000 firefighters, and it was confirmed that only 14.9% of the KRW 1 billion budget was implemented [
Finally, if someone attends a special intervention program in Korea, someone else has to do their job. Therefore, participation requires assistance at the organizational level. Furthermore, participation in such psychological counseling programs should be treated as an official leave of absence, rather than as working hours so that participants can attend without experiencing any pressure.
Regarding the suggestions to develop effective intervention programs, participants said that such programs should focus on positive content. Academia and industry are now turning to new perspectives focused on practical solutions that improve the resilience of workers [
Psychological intervention programs for firefighters should in particular be provided by professionals familiar with the nature of firefighting work. This is because a person familiar with the characteristics of the job can give practical advice. In this regard, Henderson et al. [
Since firefighters have different types of trauma according to their job characteristics, it is necessary to develop an intervention program that considers job characteristics such as fire suppression, first aid, rescue, and internal work rather than implementing a general program. In addition, these programs should consider personal characteristics as well. Novice firefighters were exposed to approximately nine potentially traumatic events during their first 3 years in the fire department, 66% of which occurred while on duty [Gulliver, 2021]. Furthermore, programs should be tailored to account for the differences in each individual's coping strategies. A recent Korean survey evaluated the psychological variables of all firefighters [Kim, Dager, 2018]. Subsequently, high-risk groups were identified and appropriate interventions were undertaken. However, there is a need for more systematic mental health management for firefighters.
The psychological intervention provided to firefighters should be a long-term, ongoing program, not a one-time intervention program. In Korea, psychological support programs hosted by the Fire Department are provided in the form of outsourcing contracts with new companies every year. Therefore, the program lacks continuity, quality control is difficult, and there are also significant regional differences. In Australia, since 2013, MAPS (Mental Agility and Psychological Strength) has been developed for the primary prevention of PTSD in firefighters and its effectiveness has been continuously reported [
Moreover, participants stated that they needed intervention services that were available any time after a traumatic event without restrictions on working hours. Joyce et al. [
Finally, participants emphasized that a supportive organizational atmosphere and institutional support were important for the effective implementation of psychological intervention programs. Firefighters do not often exhibit psychological difficulties in trying to maintain their image of "trust". Moreover, psychological issues within firefighter organizations are not well understood as they tend to hide a negative organizational culture. Consequently, good facilitation strategies are needed to overcome the silence and stigma associated with mental health in the firefighter culture [
In summary, firefighters want "flexible, effective, positive aspects based, and tailored" psychological intervention programs. In other words, although various psychological interventions are provided, these programs must be flexible enough to fit the specific individual and professional characteristics of firefighters. Additionally, the programs must be of practical use to firefighters and should not be perfunctory programs. Finally, there is a need to concentrate on the positive content without continuing to reflect on the negative aspects of traumatic events.
In this study, focus group interview and qualitative content analysis were applied to examine Korean firefighters' perceptions of psychological intervention programs during the COVID-19 pandemic. The strength of this study is that it presents detailed and clear barriers and suggestions based on interviews of firefighters working in the field. Based on this, it is expected that practical mental nursing interventions for firefighters can be developed. In addition, as a domestic firefighting hospital is scheduled to be established in 2024, it is expected that the main research results will be used as basic data for firefighters' trauma management and holistic nursing. However, it is difficult to generalize the findings from this study because only limited subjects were involved in a city. In a future study, it will be necessary to investigate the perception of psychological intervention for firefighters who have other work than emergency medical services and administrative work.
As a result of conducting FGI to investigate the perceptions of Korean firefighters' psychological intervention programs in the context of the COVID-19 pandemic, six barriers and seven proposals to keep in mind when developing psychological intervention programs were identified. The intervention programs should focus on the positive aspects of traumatic events, with flexibility and practical effectiveness, tailored to the individual and professional characteristics of firefighters.
Based on these results, we propose the following: first, psychological experts should be recruited in firefighting organizations, or, if they are external experts, training should be provided on the characteristics of firefighting work. Second, it is necessary to develop a positive psychological intervention program free from temporal and spatial constraints. Third, a supportive organizational atmosphere and institutional support must be established.
The authors declared no conflicts of interest.
Conceptualization or/and Methodology: Kwak M & Im M
Data curation or/and Analysis: Kwak M & Im M
Funding acquisition: Kwak M
Investigation: Kwak M & Im M
Project administration or/and Supervision: Kwak M
Resources or/and Software: Kwak M & Im M
Validation: Kwak M & Im M
Visualization: Kwak M & Im M
Writing: original draft or/and review & editing: Kwak M & Im M
Firefighters' perceptions of psychological intervention programs.
General Characteristics of Participants (N=12)
Group | ID | Sex | Age (year) | Position | Field of work | Working experience |
Working experience in current field |
||
---|---|---|---|---|---|---|---|---|---|
Year | M±SD | Year | M±SD | ||||||
Group 1 | Participant A | F | 29 | Firefighter Senior | Emergency medical services | 3 | 5.00±2.68 | 3 | 2.92±1.86 |
Participant B | M | 35 | fire sergeant | Emergency medical services | 6 | 6 | |||
Participant C | M | 31 | Firefighter Senior | Emergency medical services | 4 | 4 | |||
Participant D | M | 28 | fire sergeant Fire | Administration | 3 | 1.5 | |||
Participant E | M | 31 | sergeant | Administration | 4 | 1 | |||
Participant F | F | 39 | Fire sergeant | Administration | 10 | 2 | |||
Group 2 | Participant G | M | 31 | Firefighter | Emergency medical services | 3 | 6.92±4.52 | 3 | 3.42±3.32 |
Participant H | F | 31 | Firefighter | Emergency medical services | 3 | 3 | |||
Participant I | M | 39 | Fire sergeant | Emergency medical services | 10 | 10 | |||
Participant J | M | 39 | Fire sergeant | Administration | 12 | 1 | |||
Participant K | M | 39 | Fire sergeant | Administration | 11 | 2 | |||
Participant L | M | 27 | Firefighter | Administration | 2.5 | 1.5 |
F=female; M=male; SD=standard deviation.
Open-ended Question for FGI
Category | Contents | Question |
---|---|---|
Opening questions | Recent traumatic events and associated psychological difficulties | What traumatic events and related psychological challenges have you experienced lately? |
Introductory questions | How to deal with psychological difficulties after experiencing a traumatic event | How do you resolve psychological difficulties once you have experienced traumatic events? |
Transition questions | Current status of the trauma programs for firefighters | What is the structure (number of programs, time, and method) and content of the programs currently addressing the post-traumatic psychological difficulties of firefighters? |
Key questions | Effective program operational plan | In your opinion, what is the most efficient operational plan for the implementation of the psychological intervention program? |
Points to note, taking into consideration the characteristics of firefighting work | What do you think are the important points when considering the characteristics of firefighting operations in order to make the psychological intervention for firefighters effective? | |
Ending questions | Other related queries | Are you referring to anything other than the psychological intervention program for firefighters that we have discussed so far? |