This is a pre-copyedited, author produced version of an article published as: Blaney, L. & Brunsden, V.

(2015). Resilience and health promotion in high-risk professions: A pilot study of firefighters in Canada
and the United Kingdom. The International Journal of Interdisciplinary Organizational Studies, 10(2), 2332. The International Journal of Interdisciplinary Organizational Studies is available online at:
http://ijiost.cgpublisher.com/ and this article is available at:
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Resilience and Health Promotion in High-risk Professions: A Pilot Study of Firefighters

in Canada and the United Kingdom
Leigh Blaney, Vancouver Island University, Canada
Vivienne Brunsden, Nottingham Trent University, United Kingdom
Abstract: This study, conducted by researchers from Canada and England in collaboration with four fire rescue services,
explored Canadian and UK firefighters experiences of distress, coping, and resilience related to workplace traumatic events.
Questions addressed in the research included: Are firefighters resilient? How do firefighters define resilience? Does stress
education enhance/sustain resilience? A cross sectional, mixed methods study design was used with a qualitative theoretical
drive supplemented with quantitative measures to compare and contrast firefighters phenomenological cross-cultural
experiences. Research outcomes include: a variety of diverse and intricate definitions for resilience reflecting the complexity
of the concept of resilience yet demonstrating cultural commonalities across both countries; a range of reactions to critical
incidents that generally fell into one or more domains: emotional, cognitive, physical, behavioural, and spiritual; a range of
strategies that are implemented to cope with stress reactions - overwhelmingly talking about the incident, reactions, and
coping mechanisms is most helpful; personal and organizational attributes that assist in managing stress and stressful events
within the culture of the fire service; and health promoting strategies for building resilience. The study recommendations,
utilizing a health promotion lens, offer guidance in planning for, and responding to, traumatic events in high-risk professions.
Keywords: Interdisciplinary, Health promotion, Resilience, Firefighters

Introduction
This article highlights the study process and key outcomes of resilience research undertaken with
three Fire Rescue Services (FRS) in Canada and one FRS in England. The unique interdisciplinary study
was conducted by a research team from both countries comprised of firefighters from each of the
participating FRS, and academics from psychology and nursing in universities in both countries. Much
previous research into the psychological health of firefighters has focused on possible disease
outcomes such as post-traumatic stress disorder; notably more recent research (Hawker, Durkin, and
Hawker 2011) has begun to look at post-traumatic growth in emergency services. This project sought
cross-disciplinary insights into strengths and capacities of firefighters, and considers resilience to be
foundational to psychological health in the FRS.
The phenomenon of resilience has been suggested as a contributing factor to mental health in
individuals and communities following traumatic events. The aims of this study were to identify
firefighters understanding and definitions of resilience, and to explore firefighter perceptions of
stress and coping. Key questions for the study included: How do firefighters define resilience? Are the
definitions congruent with current theories of resilience? Are firefighters resilient? What coping
strategies are commonly used by firefighters following stressful events?
A large body of the resilience literature focuses on children and adolescents, and there are few
studies on resilience in high-risk occupations. Bonanno and his teams have focused on survivors of the
World Trade Centre disaster (see for example: Bonanno et al 2006; Bonnano, Rennicke, and Dekel
2005) and adults who are bereaved of a spouse (Bonanno, Moskowitz, Papa, and Folkman, 2005),
while other researchers have recently focused on nurses, police, and military (Warelow and Edwards
2007; Paton et al 2008; Adams, Camarillo, Lewis, and McNish 2010). The specifics of the psychological
impact of occupations such as emergency services has been the subject of debate across disciplines
(see for example: Antai-Otong 2001; Barkway 2006; Luthans, Avey, Avolio, Norman, and Combs 2006;
Nucifora, Langlieb, Siegal, Everly, and Kaminsky 2007; Wright 2003); overall there is agreement that
first responders are in high-risk professions but there is no solid evidence about best practices for
mitigating those occupational risks. Historically the variable of interest in stress research has been
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illness or disease such as post-traumatic stress disorder or PTSD (see for example Boals & Schuettler
2009; Bryant and Harvey 1995; Wagner et al 1998) using randomized controlled trials to explore the
illness trajectory; this dominant illness paradigm pervades the literature and is very useful for those
who provide disease treatment, but does not address the evidence of reasonably low incidence of
PTSD in emergency services (Del Ben, Scotti, Chen, and Fortson 2006; Haslam and Mallon 2003) and
the coping capacities of firefighters, nor does it address the dearth of literature on resilience in highrisk professions. Despite calls for paradigmatic shifts to re-look at resilience as more than the simple
absence of psychopathology and to consider cross-disciplinary, strengths-based, positive language
and theory (Murphy, Durkin, and Joseph 2011), strong research links to illness and pathology imbue
resilience studies.
Researchers note resilience is not simply the absence of psychopathology, but a broader, deeper
concept; Tusaie and Dyer (2004) suggest that resilience research requires that a dynamic interactive
approach be taken, and Richardson (2002) notes that the stress research paradigm has shifted from a
reductionist, problem-oriented approach to one that is focused on nurturing strengths. Bonanno
(2004) suggests that we have underestimated the resilience capacity of people, including firefighters,
to survive and thrive in the aftermath of trauma. There have been increasing calls for studies whose
variables of interest include health, resilience, and coping (Atkinson, Martin, and Rankin 2009;
Bonanno, Papa, Lalande, Westphail, and Coifman 2004; Deahl et al. 1998; Jeannette and Scoboria
2008; Seligman and Csikszentmihalyi, 2000) with theoretical drives that consider factors from other
perspectives such as phenomenology, grounded theory, and mixed methods. Figley (2010), and
Bonanno et al. (2005, 2010) insist on the need for increased research into resilience across multiple
contexts and events, research which will underpin evidence-informed occupational health policy and
practice.
The understanding and definition of resilience in the literature is closely linked to the conceptual
framework of health promotion. Health promotion is articulated as a health-focused, strengthsbased concept that facilitates, supports, and educates through participation, collaboration, and
empowerment (Lindsey and Hartrick 1996) and is not an end-point but a process that facilitates
health. Firefighters are notable in their health-focused language; they describe levels and components
of distress (Blaney 2005) instead of symptoms of disease. As well, firefighters describe ways of
coping with work-related stressors that reflect a breadth and depth of health promoting strategies
incorporating social support, personal coping, and meaning-making (Blaney, 2009), endorsing
outcomes that are salutogenic rather than pathogenic (Antonovsky, 1996). Firefighters have been
found to be overwhelmingly supportive of peer-led CISM and trauma support programs (Lawrence
and Barber 2004); outcomes explicated CISM as a framework for a service matrix that includes preincident stress education, group intervention immediately following a traumatic event, and referral
for longer-term mental health care if needed (Blaney 2009; Hawker, Durkin, and Hawker 2011).
Firefight perspectives are key to understanding resilience and coping, and in the development of
strategies to enhance resilience in the FRS.
Research Process
In this study, participant sampling was purposeful and drawn from the FRS in Canada and England
who had previously expressed interest in participating. There were criteria for participation such as
the FRS must be comprised of career/whole-time(C/WT) and volunteer/retained duty (V/RDS)
firefighters, participation must be available to all members of the FRS, each FRS must have a stress
management program such as Critical Incident Stress Management (CISM), etc. All procedures were
approved by the Research Ethics Board at Vancouver Island University which is the principal
2

investigators home university; consent to acknowledge and name the participating FRS and members
of the advisory team was provided; any information that might identify individuals has been removed.
A cross sectional, mixed methods study design was used, driven by a qualitative approach and
supplemented with quantitative measures; three questionnaires were used. The Stress and Coping
Questionnaire (SCQ) which had been co-created with firefighters and used in several previous studies
of firefighters (Blaney 2003, 2006), captured demographic information and narrative perspectives in
answer to questions such as firefighters preferred coping strategies, strategies that are least helpful,
definitions of critical incidents, awareness of CISM and stress education in their FRS, definitions of
resilience, etc. Resilience was measured with the 25-item Resilience Scale (RS-25) (Wagnild and Young
1993; Wagnild 2010); this scale has been used extensively with other populations but never with
firefighters. Coping was measured using the Brief COPE questionnaire (Carver 1997, 2007) which is
one of the most widely used measures in coping research.
Overview of Findings
In total, 575 questionnaire packages were distributed; 266 were returned with useable data, a 46%
return rate. The SCQ showed that demographics were consistent across both countries with the
majority of respondents being male with 12 female firefighters responding a number that is
reflective of the numbers of female firefighters in fire services overall; respondents ranged in age
from 35-44, worked in operations/fire suppression and/or multiple roles such as leadership,
operations, dispatch, with 5-7 years experience although respondents with less than a year and more
than 25 years service were represented, and the majority (58.6%) worked as C/WT with 37% working
in the V/RDS. More Canadian firefighters were aware of CISM education programs; 37% of Canadian
and 29.6% of UK firefighters had used the CISM program following the last critical incident and lack of
trust was frequently cited as the reason for not using the CISM processes.
Firefighters in both countries defined resilience in two parts: an ability to cope, recover, carry on,
bounce back, protect, function, move on, or otherwise deal with stressors, and an immunity or
capacity to withstand challenges utilizing innate capacities such as mental toughness, focused,
positive outlook, reframing events, etc. The diversity and depth of definitions reflects the complexity
of the concept of resilience that is found in the literature, and the hopeful optimistic language used by
firefighters in their definitions is congruent with current literature on post-traumatic growth
(Bonanno et al. 2010; Durkin and Joseph 2009). The definitions also align with resilience literature
that notes resources must be in place to support bounce back (Cocking 2012); resources in the FRS
include a culture of support for one another, formal and informal peer support programs, education
on stress and coping in the FRS, etc.
Generally, firefighters recognize the risks of the job, however Canadian firefighters were better
able to articulate the inevitable normal & expected reactions to stress that are physical, emotional,
cognitive, behavioural, and/or spiritual (Blaney 2009) in nature. Contextually, many Canadian FRS are
responsible for medical aid calls and are trained medical first responders whereas in the UK, medical
calls are largely managed by the ambulance service; medical aid calls with their inherent exposure to
injured adults, children and pets have been noted to be significant stressors for firefighters (Brown,
Mulhern, and Joseph 2002).
Firefighters articulated what works to cope after a critical incident as a range of strategies that
they implement but overwhelmingly they find talking about the incident, their reactions, and their
coping mechanisms to be most helpful; they talk to peers and family most frequently which has
implications particularly for family members as to their readiness and sense of capacity to hear
emotionally laden material from their loved ones. However, verbally ventilating stress reactions and
articulating coping strategies has been shown to be effective in decreasing feelings of distress in
3

firefighters (Blaney 2009) and when done in a supportive and somewhat structured manner is a way
of enhancing social support post-incident. Firefighters use of social support as a primary coping
strategy in times of stress correlates with other research (see for example Blaney 2009; Bonanno
2004; Regehr et al. 2005; Thoits 1995), and supports the need for a matrix of services that includes
firefighter families.
Canadian firefighters more often choose exercise as a way to ventilate stress secondary to
talking about it. Physical and psychological fitness were themes that arose throughout the research
as key to maintaining overall mental health and for mitigating critical incident stress reactions. There
was no correlation with age, gender, length of service, or number of traumatic incidents experienced
in relation to exercise as the chosen coping strategy. Firefighters did however note the relationship
between exercise as a chance to blow off or ventilate stress and lower levels of distress described as
feeling better. As well, some Canadian firefighters noted the need for healthy lifestyle, good eating
habits, balance between work and home indicating an orientation towards overall health
promotion. On the other hand, UK firefighters say humour is the second most effective mechanism
for coping with stressful events. They describe black humour, sick humour, kidding around, and
humorous banter as ways of expressing humour, although some respondents noted they are
uncomfortable with the black humour yet are reluctant to challenge what is seen as a cultural coping
style. As well, many Canadian and UK firefighters note that experience helps after bad incidents Ive
been through this before, I know Ill get through this, been doing this for many years which helps.
Others describe emotionally distancing myself from the event/victims, staying focused and not
getting involved with the victims, focusing on the task at hand, getting the job done. Although
some authors think emotional distancing is a harmful strategy, there is evidence that this in fact may
be an adaptive mechanism (Coifman et al. 2007; Regehr et al. 2002) in the FRS.
Another difference in coping mechanisms between the two countries is the use of alcohol; a
number of UK firefighters stated that going for a beer/drink after work is helpful while others claimed
heavy alcohol use after critical incidents. Those who noted they like going for a beer afterwards may
also be alluding to the social connections that occur when at the pub, and perhaps the change in
mental focus and/or verbal ventilation that occurs when out for a beverage. This is an area that needs
further study; increased alcohol use is not in keeping with other research into coping in the modern
fire service (Blaney 2009; Durkin and Bekerian 2000; McMahon 2010), nor is it congruent with the
experiences of the project advisory team who note a significant cultural shift away from alcohol use in
the FRS in the last five years our service has seen a significant push at all levels away from social
and pub style events to improving or creating fitness centres, participation in fire fit challenges... (G.
Spriggs, personal communication).
Firefighters were also clear about what is least helpful in coping such as not talking, bottling it
up, ignoring it as well as other less helpful techniques such as criticism about the incident,
management critique, and outsiders trying to talk to you about it. These comments are again
consistent with a health promotion orientation to stress in the fire service (Blaney 2009); the FRS is a
high-risk profession yet firefighters have strategies for coping with the stress.
The narrative comments were generally consistent with the Resilience Scale and Brief COPE scores
although differences between the two countries are more evident with the empirical scales. For
example there are significant differences in resilience scores between UK and Canadian firefighters,
indicating an underpinning of resilience in both FRS, but the difference in scores seem to show that
Canadian firefighters better integrate healthier strategies into their lives/practice.
Firefighters are resilient; out of a possible score of 175, firefighters scored between 127 and 141,
considered moderately high (Wagnild 2010). Canadian firefighters scored higher overall than UK
firefighters; the difference in scores between the UK and Canada is statistically significant, but there
4

was no correlation between age, gender, length of service, type of service (C vs. V), and resilience
scores. Overall, there is a foundation upon which to build/enhance resilience, individually and
organizationally in both countries.
The difference in coping scores is also notable with Canadian firefighters using more adaptive
strategies such as active coping and positive reframing than UK firefighters who tend to disengage;
disengagement is generally considered a less adaptive strategy, but it is used frequently in the
emergency services and may actually be adaptive for firefighters (Bonanno et al. 2004). UK firefighters
use humour adaptively but also use alcohol and other less adaptive mechanisms to cope after critical
events. The coping style profiles therefore suggest that Canadian respondents were generally using
more adaptive, hence ultimately healthier, forms of coping than were the UK respondents. One
explanation may be the proactive, ongoing CISM education provided to the Canadian FRS
participating in this study, resulting in a more overt culture of health. Verbal ventilation or talking is
evident in both the resilience and coping scores for both countries giving further weight to health
promotion, peer support, and CISM programs that support verbal ventilation, resilience, and health.
Other findings noted issues of stigma and vulnerability were evident in a few UK firefighters
comments about stress reactions and critical incident stress being for the weak but also provided
evidence of an overall lack of awareness of the normal and expected reactions that all human beings
have to stressful situations. Stigmatizing vulnerability is not restricted to the FRS but is also prevalent
in other emergency services (Halpern et al. 2008). Outcomes highlight the need for education about
the normal and expected stress reactions that can, through resilience and healthy coping strategies,
be managed by the majority of firefighters; education will also decrease the stigmatization of
vulnerability and help build trust within the organisation (Brunsden, Hill, and Maguire, 2012).
As well, critical incident stress management in a health promotion context is advocated by
firefighters as one vehicle for enhancing resilience (Blaney 2009). Although two different models of
CISM were used by the participating Canadian and UK FRS, in this study firefighters noted the
strengths and gaps of both models. In the UK model, the focus is on the intervention Critical Incident
Stress Debriefing (CISD) which occurs days after the incident, and a process known as the hot
debrief which occurs informally immediately after the incident ends. The strengths of this model
were articulated as: having a process available and available quickly (hot debrief), and having an
opportunity for a more formal chat (CISD) than those that occur naturally over a cup of tea postincident. Challenges with this model include the inclination for both processes to become derailed by
a culture of machismo and/or by a slide into operational discussions; a lack of awareness of available
post-event services; a lack of awareness of normal and expected reactions, with a resulting culture of
stigma associated with perceptions of weakness when experiencing those reactions; and a delay in
service availability (CISD).
The CISM model used by the participating Canadian FRS was founded on Mitchells (1983) model
of CISD but expands upon his later comprehensive model of CISM (Mitchell and Everly 1997) and
visualizes CISM as a matrix of prevention, intervention, and post-vention or follow-up services (Blaney
2003). Preventatively, there is a primary focus on education with a learner-centered curriculum
developed specifically for emergency service providers; education is offered at least annually and
more frequently if there are new recruits or if requested. CISM education comprises three
components: an in-depth (6-day) experiential peer support training program which is offered through
a local universitys continuing education centre; introduction/overview of CISM, a short 15-60 minute
curriculum designed to be delivered by peers to FRS personnel; and family education, recently
developed curriculum that can be delivered by peers to FRS family members. Education is specific to
adult learners and is experiential, conceptual, and health focused (Belknap 2008; Dinkelman and
Schekel 2003; Mangold 2007; McAllister and McKinnon 2009). Examples of the intervention
5

component of the model include individual and group defusing and group debriefing following
Mitchells protocol but with a heavier emphasis on inquiry into reactions and coping rather than
lecturing about potentially negative outcomes. Also, rather than focusing on describing the incident in
detail with the risk of increasing distress, the defusing and debriefing processes in this model focus on
education about stress reactions by contextualizing them as normal and expected, as well as eliciting
coping strategies (individual and shared) and inviting participants to describe how they will action
those strategies. In the post-vention component of the model, peers are also informed of the
resources external to the FRS that can be accessed in the event that firefighters continue to
experience distress. Also part of post-vention is the family education component, which is 1-4 hours
in length, and offers stress, coping, and resilience information to firefighters significant others.
Overall, the model reflects requirements of firefighters: social support (structured
conversation/verbal ventilation with the group; inquiry-based); information about potential expected
reactions and articulation of personal coping strategies; an opportunity to make/find meaning
through peer conversations; options for follow-up services, and information for families who
frequently are the primary post-incident support. Firefighters from Canada were more aware of the
CISM program in their FRS, and were aware of the frequency of education sessions. The strengths of
the model were articulated as: having a process readily available and accessible either one-to-one or
team support; having a number of trained peer support personnel available to choose from and who
were aware of incidents quickly hence able to reach out to affected personnel in a timely manner;
trust in the peers and the CISM process, and recognition that CISM differs from operational
discussions; experience that CISM works to decrease distress. Challenges with the model were few
with two firefighters (both with less than a years experience) noting that they had not yet had
introductory CISM education.
Recommendations for Action
The study recommendations arose directly from the responses of firefighters, were common to both
countries, and were described in detail in a comprehensive research report provided to each of the
participating FRS. Highlights include: capitalizing on existing resilience resources within the FRS;
operating across all levels of the FRS: individual, hierarchal, organizational, cultural; ensuring
contextual relevance of resilience processes such as health (vs. illness) focus and increasing stress
education opportunities using a health promotion approach; ensuring critical incident stress services
are peer-based and remain stress-focused (not operational); and having a clear plan for evaluation of
stress outcomes, and agreement about what outcomes are relevant to resilience/coping in the FRS.
Specific strategies for actioning the recommendations were discussed in post-research meetings with
each FRS.
It is known that education is foundational to increasing trust, de-stigmatizing mental health, and
building resilience, and this was a consistent theme of discussion and a focus for capitalizing on the
existing resources within the FRS. There are a number of stress education programs available to FRS
globally that are learner-centered, experiential, and transformational, and are based on principles of
teaching/learning and stress management as opposed to organization-specific content; the
curriculum can be shared across the services providing a cost-effective foundation for stress
education. An example of such curriculum is found within the CISM program utilized by the Canadian
FRS participating in this research.
Conclusions

The research questions were answered by this study: overall, firefighters are resilient as
demonstrated by their resilience scores, and they use a variety of healthy coping mechanisms to
address the challenges to psychological health inherent in the FRS. Interdisciplinary research provided
multiple lenses from which to view concepts of workplace health, and allowed for rich analysis and
realistic yet evidence-informed recommendations. Foundational to resilience theory is the focus on
health, strengths, and capacities; firefighter resilience and adaptive coping can be supported and
enhanced. CISM programs, particularly education, are valued but success, and utilisation, of CISM
programs comes with caveats. Immediate future research will include moving beyond the pilot of
this research to include a more in-depth examination of the meaning resilience has to firefighters in
the context of psychological health and safety, a larger sample size across both countries,
examination of the relationship between resilience education and resilience and coping scores, and
examination of the relationship between a peer-led comprehensive CISM program and resilience
scores.
Acknowledgement
Acknowledgement and thanks to the firefighters of Langford, Metchosin, Sooke, and Buckinghamshire
FRS for their participation, as well as to Fire Chiefs Bob Beckett, Stephanie Dunlop, Steve Sorenson,
and Chief Fire Officer Mark Jones for fully supporting this research. Special thanks go to the
firefighters on the advisory team: Geoff Spriggs, Doug Gruchy, Darren Knowles, Garry Brown, and Tim
Parkins who have assisted with all aspects of the study. This research was supported by grants from
the Vancouver Island University Research Awards Committee Research Fund and from Langford,
Sooke, and Metchosin Fire Rescue Services.

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ABOUT THE AUTHOR

Leigh Blaney: Professor, Faculty of Health and Human Services, Bachelor of Science in Nursing
Program, Vancouver Island University, Nanaimo, British Columbia, Canada
Vivienne Brunsden: Principal Lecturer in Psychology, Head of the Emergency Services Research Unit,
Course Leader MSc Psychological Wellbeing & Mental Health, Division of Psychology, Nottingham
Trent University, Nottingham, United Kingdom

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