Are you currently (or have you ever been) a Fire Chief or Officer?
* must provide value
Yes
No
How many years have you served as a Firefighter?
* must provide value
How many years have you served as a Chief or Officer?
* must provide value
What type of service are you currently involved in?
* must provide value
Do you have current or prior military experience?
* must provide value
Yes - I am currently Active Duty
Yes - I am currently serving in the Reserves or National Guard
Yes - I previously served in the military (Active Duty)
Yes - I previously served in the military (Reserves or National Guard)
No - I never served in the military but I served as a civilian counterpart in a combat zone
No - I have never served in the military or as a civilian counterpart in a combat zone
Branch?
* must provide value
Air Force
Army
Coast Guard
Marine Corps
Navy
How many years have you been Active Duty?
* must provide value
What is your role?
* must provide value
Branch?
* must provide value
Air Force
Army
Coast Guard
Marine Corps
Navy
How many years have you been serving in the Reserves or National Guard?
* must provide value
What is your role?
* must provide value
Branch?
* must provide value
Air Force
Army
Coast Guard
Marine Corps
Navy
How many years were you Active Duty?
* must provide value
What was your role?
* must provide value
Branch?
* must provide value
Air Force
Army
Coast Guard
Marine Corps
Navy
How many years did you serve in the Reserves or National Guard?
* must provide value
What was your role?
* must provide value
How many years did you serve as a civilian counterpart in a combat war zone?
* must provide value
What was your role?
* must provide value
Have you ever been deployed to a combat zone?
* must provide value
Yes
No
How many times?
* must provide value
What year(s)?
* must provide value
Have you ever been injured while in a combat zone?
* must provide value
Yes
No
What were your injuries?
* must provide value
The following statements are about potential experiences as a Firefighter. Please indicate yes or no if you have experienced this event IN THE PAST 6 MONTHS.
Witnessed a duty related death of a co-worker
* must provide value
Yes
No
How many times?
* must provide value
Co-worker firefighter fire fatality (not witnessed)
* must provide value
Yes
No
How many times?
* must provide value
Experience career ending injury (self)
* must provide value
Yes
No
How many times?
* must provide value
Render aid to seriously injured friend/relative
* must provide value
Yes
No
How many times?
* must provide value
Sudden infant death incident
* must provide value
Yes
No
How many times?
* must provide value
Exposure to hazardous chemicals
* must provide value
Yes
No
How many times?
* must provide value
Serious injury to a co-worker
* must provide value
Yes
No
How many times?
* must provide value
Render aid to seriously injured child
* must provide value
Yes
No
How many times?
* must provide value
Fire incident with multiple deaths
* must provide value
Yes
No
How many times?
* must provide value
Multiple casualty motor vehicle accident (>5 deaths)
* must provide value
Yes
No
How many times?
* must provide value
Third degree burn (self)
* must provide value
Yes
No
How many times?
* must provide value
Multiple casualty motor vehicle accident (1-4 deaths)
* must provide value
Yes
No
How many times?
* must provide value
Fire incident with multiple burn victims
* must provide value
Yes
No
How many times?
* must provide value
Render aid to seriously injured adolescent
* must provide value
Yes
No
How many times?
* must provide value
Render aid to dangerous psychiatric patient
* must provide value
Yes
No
How many times?
* must provide value
CPR/full arrest - family present
* must provide value
Yes
No
How many times?
* must provide value
Render aid to mutilated adult/attempted homicide
* must provide value
Yes
No
How many times?
* must provide value
Treat injured patient who resembles self/spouse
* must provide value
Yes
No
How many times?
* must provide value
Attempted domestic homicide victim
* must provide value
Yes
No
How many times?
* must provide value
Experience head injury (self)
* must provide value
Yes
No
How many times?
* must provide value
Render aid to sexual assault victim
* must provide value
Yes
No
How many times?
* must provide value
Completed gun shot suicide
* must provide value
Yes
No
How many times?
* must provide value
Fracture of extremity (self)
* must provide value
Yes
No
How many times?
* must provide value
Render aid to adult stabbing victim
* must provide value
Yes
No
How many times?
* must provide value
Render aid to gun shot victim of gang violence
* must provide value
Yes
No
How many times?
* must provide value
Adult dead on arrival (DOA) - multiple wound/injuries
* must provide value
Yes
No
How many times?
* must provide value
Experience musculoskeletal strain (self)
* must provide value
Yes
No
How many times?
* must provide value
Death of patient after long resuscitation
* must provide value
Yes
No
How many times?
* must provide value
CPR - patient in cardiac arrest
* must provide value
Yes
No
How many times?
* must provide value
Completed suicide hanging
* must provide value
Yes
No
How many times?
* must provide value
Inappropriate dispatch
* must provide value
Yes
No
How many times?
* must provide value
Render aid - attempted suicide/drug overdose
* must provide value
Yes
No
How many times?
* must provide value
Adult DOA - natural causes
* must provide value
Yes
No
How many times?
* must provide value
The statements below are about your combat experiences during deployment. Please indicate yes or no for each statement. If you have been deployed on more than one occasion, answer the questions in regard to the deployment you found most anxiety provoking or dangerous.
I went on combat patrols or missions.
* must provide value
Yes
No
I (or members of my unit) encountered land or water mines and/or booby traps.
* must provide value
Yes
No
I (or members of my unit) received hostile incoming fire from small arms, artillery, rockets, mortars, or bombs.
* must provide value
Yes
No
I (or members of my unit) received "friendly" incoming fire from small arms, artillery, rockets, mortars, or bombs.
* must provide value
Yes
No
I was in a vehicle (for example, a truck, tank, APC, helicopter, plane, or boat) that was under fire.
* must provide value
Yes
No
I (or members of my unit) were attacked by terrorists or civilians.
* must provide value
Yes
No
I was part of a land or naval artillery unit that fired on the enemy.
* must provide value
Yes
No
I was part of an assault on entrenched or fortified positions.
* must provide value
Yes
No
I took part in an invasion that involved naval and/or land forces.
* must provide value
Yes
No
My unit engaged in battle in which is suffered casualties.
* must provide value
Yes
No
The statements below are about the amount of danger you felt you were exposed to while you were deployed. Please read each statement and describe how much you agree or disagree with each statement. If you have been deployed on more than one occasion, answer the questions in regard to the deployment you found most anxiety provoking or dangerous.
I thought I would never survive.
* must provide value
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
I felt safe.
* must provide value
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
I was extremely concerned that the enemy would use nuclear, biological, chemical agents (NBCs) against me.
* must provide value
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
I felt that I was in great danger of being killed or wounded.
* must provide value
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
I was concerned that my unit would be attacked by the enemy.
* must provide value
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
I worried about the possibility of accidents (for example, friendly fire or training injuries in my unit).
* must provide value
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
I was afraid I would encounter a mine or booby trap.
* must provide value
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
I felt secure that I would be coming home after the deployment.
* must provide value
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
I thought that the vaccinations I received would actually cause me to sick.
* must provide value
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
I thought that the tablets I took to protect me would make me sick.
* must provide value
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
I felt that I would become sick from the pesticides or other routinely used chemicals.
* must provide value
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
I was concerned about the health effects of breathing bad air.
* must provide value
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
I thought that exposure to depleted uranium would negatively affect my health.
* must provide value
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
I was afraid that the equipment I was given to protect me from nuclear, biological, chemical agents (NBCs) would not work.
* must provide value
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
I worried about getting an infectious disease.
* must provide value
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
Below is a list of problems that people sometimes have in response to very stressful experiences. Please read each problem carefully and circle the number to indicate how much you have been bothered by that problem IN THE PAST MONTH.
Repeated, disturbing, and unwanted memories of the stressful experience?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Repeated, disturbing dreams of the stressful experience?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Feeling very upset when something reminded you of the stressful experience?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Avoiding memories, thoughts, or feelings related to the stressful experience?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Trouble remembering important parts of the stressful experience?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Blaming yourself or someone else for the stressful experience or what happened after it?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Having strong negative feelings such as fear, horror, anger, guilt, or shame?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Loss of interest in activities that you used to enjoy?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Feeling distant or cut off from other people?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Irritable behavior, angry outbursts, or acting aggressively?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Taking too many risks or doing things that could cause you harm?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Being "super alert" or watchful or on guard?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Feeling jumpy or easily startled?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Having difficulty concentrating?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
Trouble falling or staying asleep?
* must provide value
Not at all
A little bit
Moderately
Quite a bit
Extremely
OVER THE LAST 2 WEEKS, how often have you been bothered by the following problems?
Little interest or pleasure in doing things
* must provide value
Not at all
Several days
More than half the days
Nearly every day
Feeling down, depressed, or hopeless
* must provide value
Not at all
Several days
More than half the days
Nearly every day
Trouble falling or staying asleep, or sleeping too much
* must provide value
Not at all
Several days
More than half the days
Nearly every day
Feeling tired or having little energy
* must provide value
Not at all
Several days
More than half the days
Nearly every day
Poor appetite or overeating
* must provide value
Not at all
Several days
More than half the days
Nearly every day
Feeling bad about yourself - or that you are a failure or have let yourself or your family down
* must provide value
Not at all
Several days
More than half the days
Nearly every day
Trouble concentrating on things, such as reading the newspaper or watching television
* must provide value
Not at all
Several days
More than half the days
Nearly every day
Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual
* must provide value
Not at all
Several days
More than half the days
Nearly every day
Thoughts that you would be better off dead on or hurting yourself in some way
* must provide value
Not at all
Several days
More than half the days
Nearly every day
How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
* must provide value
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
Because of the impact of alcohol use on many other aspects of health, it is important that we ask some questions about your use of alcohol. Your answers will remain confidential so please be honest.
How often do you have a drink containing alcohol?
* must provide value
Never
Monthly or less
2-4 times a month
2-3 times a week
4 or more times a week
How many drinks containing alcohol do you have on a typical day when you are drinking?
* must provide value
1-2
3-4
5-6
7-9
10 or more
How often do you have six or more drinks on one occasion?
* must provide value
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
How often during the last year have you found that you were not able to stop drinking once you had started?
* must provide value
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
How often during the last year have you failed to do what was normally expected of you because of drinking?
* must provide value
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
* must provide value
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
How often during the last year have you had a feeling of guilt or remorse after drinking?
* must provide value
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
How often during the last year have you been unable to remember what happened the night before because of your drinking?
* must provide value
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
Have you or someone else been injured because of your drinking?
* must provide value
No
Yes - but not in the last year
Yes - during the last year
Has a relative, friend, doctor, or other health care worker been concerned about your drinking or suggested you cut down?
* must provide value
No
Yes - but not in the last year
Yes - during the last year
Please respond to each question or statement below about sleep.
In the past 7 days, how often did you stay up most of the night because you could not fall asleep?
* must provide value
Never
Rarely
Sometimes
Often
Always
In the past 7 days, how often was it easy for you to fall asleep?
* must provide value
Never
Rarely
Sometimes
Often
Always
In the past 7 days, how often did you have a lot of trouble falling asleep?
* must provide value
Never
Rarely
Sometimes
Often
Always
In the past 7 days, how often did you stay up all night because you could not fall asleep?
* must provide value
Never
Rarely
Sometimes
Often
Always
In the past 7 days, how often did you stay up half the night because you could not fall asleep?
* must provide value
Never
Rarely
Sometimes
Often
Always
Have you ever been formally diagnosed with Posttraumatic Stress Disorder (PTSD)?
* must provide value
Yes
No
Have you ever engaged in mental health treatment for PTSD?
* must provide value
Yes
No
Type?
* must provide value
When?
* must provide value
Was it helpful?
* must provide value
Yes
No
Have you ever been formally diagnosed with depression?
* must provide value
Yes
No
Have you ever engaged in mental health treatment for depression?
* must provide value
Yes
No
When?
* must provide value
Was it helpful?
* must provide value
Yes
No
The following questions have to do with resources that you may or may not be familiar with or engaged in. For each resource, please indicate if you have ever been told about this resource, and if so, if you have become involved with them. You may or may not have followed up with the resource, but this is asking if you were told about the resources, and whether or not you became involved with them. For those that you became involved with, a few questions will focus on your experience with the resource.
Have you ever been told about Local Peer Support Teams?
* must provide value
Yes
No
Who told you about the Local Peer Support Team?
* must provide value
Did you become involved with the Local Peer Support Team?
* must provide value
Yes
No
Why didn't you get involved with the Local Peer Support Team?
* must provide value
I don't believe in mental health services
I don't need help
Cost/Transportation
Work schedule
Children's schedule/school schedule
Childcare
Physical health needs for yourself or family member
Too far from home
Other
Other:
* must provide value
How satisfied were you with the Local Peer Support Team?
* must provide value
Very satisfied
Somewhat satisfied
Slightly satisfied
Slightly dissatisfied
Somewhat dissatisfied
Very dissatisfied
Have you ever been told about mental health services?
* must provide value
Yes
No
Who told you about the mental health services?
* must provide value
Did you become involved in mental health services?
* must provide value
Yes
No
Why didn't you become involved in mental health services?
* must provide value
I don't believe in mental health services
I don't need help
Cost/Transportation
Work schedule
Children's schedule/school schedule
Childcare
Physical health needs for yourself or family member
Too far from home
Other
How satisfied were you with mental health services?
* must provide value
Very satisfied
Somewhat satisfied
Slightly satisfied
Slightly dissatisfied
Somewhat dissatisfied
Very dissatisfied
Have you been told about Employee Assistance Programs (EAP)?
* must provide value
Yes
No
Who told you about EAP?
* must provide value
Did you become involved in EAP?
* must provide value
Yes
No
Why didn't you become involved with EAP?
* must provide value
I don't believe in mental health services
I don't need help
Cost/Transportation
Work schedule
Children's schedule/school schedule
Childcare
Physical health needs for yourself or family member
Too far from home
Other
How satisfied were you with the EAP?
* must provide value
Very satisfied
Somewhat satisfied
Slightly satisfied
Slightly dissatisfied
Somewhat dissatisfied
Very dissatisfied
Have you been told about pocketpeer.org - online resources and apps to address mental health concerns among firefighters?
* must provide value
Yes
No
Who told you about pocketpeer.org?
* must provide value
Have you used pocketpeer.org?
* must provide value
Yes
No
Which resources have you used?
* must provide value
Why haven't you used pocketpeer.org?
* must provide value
Were you satisfied with pocketpeer.org?
* must provide value
Very satisfied
Somewhat satisfied
Slightly satisfied
Slightly dissatisfied
Somewhat dissatisfied
Very dissatisfied
What are some overlapping stressors that you see with being a firefighter and military service member?
* must provide value
What are some different stressors experienced by Firefighters and military service members?
* must provide value
How are the job-related regulations and/or expectations similar for Firefighters and military service members?
* must provide value
How are the job-related regulations and/or expectations different for Firefighters and military service members?
* must provide value
What procedures are in place to address these similarities or differences (e.g., trainings, manuals)?
* must provide value
What are some strengths of Firefighters having current or prior military experience?
* must provide value
Is there a difference in strengths based on type of service (career, volunteer, wildland, military)?
* must provide value
Yes
No
Please explain:
* must provide value
What are some challenges of Firefighters having current or prior military experience?
* must provide value
Is there a difference in challenges based on type of service (career, volunteer, wildland, military)?
* must provide value
Yes
No
Please explain:
* must provide value
Are the differences in the behavioral health needs of Firefighters/service members who served overseas versus domestically?
* must provide value
Yes
No
Please explain:
* must provide value
Are there differences between Firefighters who are/were reservists versus active duty?
* must provide value
Yes
No
Please explain:
* must provide value
What differences do you notice with Firefighters in the National Guard?
* must provide value
What differences do you notice specifically with female Firefighters with military backgrounds?
* must provide value
How does leadership address or discuss the overlapping behavioral health concerns that might be present with Firefighters that have served in the military?
* must provide value
Does PTSD diagnosis impact hiring veterans?
* must provide value
When vets get preference for hire in some places, does this affect the company (division of people, etc)?
* must provide value
What resources, trainings, or other materials are you aware of that discuss overlapping behavioral health needs of Firefighters and military service members?
* must provide value
What behavioral health resources are available to wildland Firefighters, specifically?
* must provide value
What resources and/or support are available to family members of Firefighters with military backgrounds?
* must provide value
What resources are available specifically for family members of wildland firefighters, given the potential that they are alone for up to six months at a time?
* must provide value
How might it be important to educate chiefs and company officers responsible for managing military veterans?
* must provide value
How would you recommend delivering this information (e.g., manual, trainings)?
* must provide value
What recommendations would you give to departments that are looking to hire Firefighters who have current or prior military experience?
* must provide value