First Responder ECHO: Developing an Innovative Telementoring Program

First Responders across the globe suffer from increased rates of post-traumatic stress disorder (PTSD), depression, and compassion fatigue. Because their work environment places them on the front lines of crisis situations nearly every day, first responders experience a significant amount of trauma, which can lead to PTSD and other psychological symptoms. Project ECHO, a successful telementoring program, whose mission is to educate clinicians and other health care providers in rural and underserved communities, will be piloting a First Responder ECHO beginning September 2019. The primary goal of the First Responder ECHO is to improve the confidence and knowledge of First Responders in New Mexico. This First Responder ECHO will include an evaluation component. If the program is successful, the goal will be to expand to other regions of the United States.


First Responder Background
First responders include the firefighters, paramedics and police officers who serve on the front lines every day to protect our country (Benedek, Fullerton, Ursano, 2007). Whatever or wherever the need, our first responders keep America safe. Fire and rescue personnel remain a lifeline for many families across America. In rural towns and counties, they may be the only medical care in the region. Whether it is protecting the public's safety, using life-saving medications or cardiopulmonary resuscitation to save a life or transporting a patient to the closest hospital, first responders save countless lives every day (Faul et al., 2015). How to cite this paper: Katzman, N., Medrano, J., Swift, R., & Menking, P. (2019). First Responder ECHO: Developing an Innovative Telementoring Program. Creative Education, 10, 1982-1987. https://doi.org/10.4236/ce.2019 Over the last decade, there has been an increased recognition that first responders consistently experience increased rates of psychological distress, including depression, PTSD and compassion fatigue as compared to the general population (Brooks et al., 2016;Patterson et al., 2012;Smith et al., 2018;Jones et al., 2018). There have been nine known suicides of New York City police officers in 2019 (accessed August 24, https://www.nytimes.com/2019/08/13/nyregion/nypd-officer-suicide.html). The New York City Police Department is now adding mental health resources to most local precincts and offering counseling to all police officers regardless of rank and duty hours.
One example of increased stress for first responders is the growing opioid crisis. With approximately 130 Americans dying every day from opioids, first responders are called to 911 overdose emergencies at an alarming rate (Rudd et al., 2016). It is now common in many regions of the country for first responders to be deployed to the same call for an opioid overdose with naloxone more than two or three times in the same week (Faul et al., 2017). For first responders, this can lead to compassion fatigue and other psychological feelings of helplessness.
For many first responders, it is not merely the act of providing the naloxone, the antidote to heroin or prescription opioids, which engenders a stress response.
The multitude of other social triggers surrounding these situations can be even more traumatic, including witnessing traumatic conditions like severe filth, unsupervised or abused children, and a sense that there is no way to intervene with these social determinants of health (Bentley, Crawford, Wilkins, Fernandez, & Sudnek, 2013;Milligan-Saville et al., 2018).
Although the rates of anxiety, PTSD, depression, compassion fatigue and substance use remain significant problems for first responders, there is hope that through education and understanding, these issues can be reduced if recognized early and processed adequately. A fundamental problem, however, is that many first responders often receive an unspoken message that they need to quickly "get over" their feelings to demonstrate strength and the ability to move on to the next call. It can be difficult to share traumatic experiences with loved ones at home, and while many first responder systems and organizations integrate ongoing debriefing and rapid availability of counseling services, the culture does not always encourage their utilization. Therefore, first responders may look for other ways to cope. Fortunately, there are now many known protective risk factors and interventions to help first responders to cope with their stressful work environments (Quevillon et al., 2016;Mitchell, 2011

Evaluation
As part of receiving no-cost continuing education credits, participants in the weekly First Responder ECHO will respond each week to a brief set of questions asking them if the program met their educational needs. The very brief survey includes five questions related to how the First Responder ECHO might have improved: 1) self-efficacy; 2) knowledge; 3) practice change; and 4) whether or not the participant is likely to return to the program. The authors plan to study both pre/post quantitative and qualitative components to generate the most robust study results as possible. Some of the quantitative measures will include: anxiety and depression scores, quality of life scales, and a common PTSD tool used for first responders. Other items to quantify are the number of sessions each first responder attended, their comments on the weekly continuing education questions, and participation during the session. Pre and post focus group sessions will also be performed virtually, using the Zoom video-conferencing technology-for the first responders. Focus group sessions will explore issues that cannot be easily identified through the quantitative measures. These will include: reasons for joining the weekly First Responder ECHO sessions, how the First Responder ECHO has changed behavior, thinking practice, etc.

Conclusion
It is our hope that the initiation of this project will serve as a resource to connect first responders to each other and to experts in the field in New Mexico and around the United States. The goals of this First Responder ECHO are to: provide: 1) continued learning of best practices; 2) provide a community of practice for first responders; 3) promote psychological wellness in this critical workforce.
First responders perform such important work which serves all.