Twenty Years of International Research on First Aid: A Bibliometric Visualization of Scientific Outputs.

Although first aid research is a wide-ranging and diverse field within medical science, so far no attempts have been made to provide a holistic view of international scientific outputs in the first aid domain. To determine strategic directions for conducting future studies, it is important to understand the status of the research, including its frontiers and blind spots. This study explored the global landscape of first aid research using bibliometric visualization analysis of relevant literature published within the last 20 years. The search yielded a total of 2,057 relevant papers. There was a trend of increasing annual numbers of publications throughout the 20 year period. The following topics were identified as the mainstream directions of first aid research: cross-sectional studies on attitudes and knowledge of first aid; cardiac arrest and cardiopulmonary resuscitation; bleeding and hemorrhage control; burns, scalds, and their management; envenomations and their management; and systematic evaluation of the scientific evidence. Evidence evaluation is one of the main frontiers of first aid research. Studies concerning first aid for the most common and deadliest diseases, including myocardial infarction and stroke, are not in the scope of contemporary international first aid research. Considering that effective implementation of first aid can reduce morbidity and mortality, it is advisable to advance research on first aid management of major emergencies that are the most common potentially avoidable causes of death.

Developing Training in Response to High-Consequence Infectious Diseases and Preparedness Measures for the Future.

In recent history, outbreaks of high-consequence infectious diseases (HCIDs) have raised health security concerns among the global community. As HCIDs continue to emerge, public health systems around the world experience the burden of implementing adequate preparedness and response measures to ensure the safety and security of their populations. HCID outbreak response efforts have highlighted the need for specialized training in safety and infection prevention and control for frontline workers who may encounter ill patients. The COVID-19 Mission Prep program for National Disaster Medical System personnel and the Deployment Safety Academy for Field Experiences (D-SAFE) program for US Public Health Service officers are 2 examples of virtual training programs that successfully provided foundational education on infection prevention and control and safety as well as deployable just-in-time training during HCID outbreak response efforts. The methods used to develop these training programs can be adopted by other countries to enhance the global outbreak response infrastructure for the next HCID event. The global outbreak response infrastructure demands investments in training as a preparedness measure, which will ultimately lead to safer, more coordinated outbreak response efforts with competent responders.

Strengthening the military stoic tradition: enhancing resilience in military service members and public safety personnel through functional disconnection and reconnection.

This paper addresses operational stress injuries (OSIs) among military service members (SM) and public safety personnel (PSP) resulting from prolonged exposure to potentially psychologically traumatic events (PPTEs). While psychotherapeutic interventions for post-traumatic stress injuries (PTSIs) are well established, there is a significant gap in evidence-based mental health training programs addressing proactive mitigation of negative outcomes from PPTEs. Building on the Functional Disconnection/Functional Reconnection (FD/FR) model, we introduce FD/FR 2, emphasizing early identification and management of psychological risks. FD/FR 2 discusses the practice of emotional suppression, or "pseudo-stoicism," and its potential negative impact on mental health. By integrating authentic Stoic principles, FD/FR 2 offers practical exercises to enhance resilience and well-being, addressing a critical need in current training approaches for military SM and PSP.

Perceived posttraumatic growth: positive change occurring because of or despite the trauma?

BACKGROUND: Some researchers have posited that self-reports of PTG are often illusory, designed to help trauma survivors maintain positive views of the self. We examined whether participants might select an alternative, attractive option to reporting PTG that could similarly help maintain positive views of the self - reporting that the respondent experienced positive growth despite exposure to an adverse event, which we call Positive Change-Despite (PC-Despite). METHOD: In two separate studies, after asking respondents about positive change they experienced following exposure to an adverse event, we then asked about the extent to which they experienced positive change because of the adverse event (PC-Because) or despite the adverse event (PC-Despite). RESULTS: We found that participants rated 40% (Study 1 - undergraduate sample) and 31% (Study 2 - first responder sample) of their positive change as PC-Despite. Further, in both studies PC-Despite scores were positively related to measures of distress and both adaptive and maladaptive coping, suggesting a link with an illusory form of PTG. In contrast, PC-Because was only related to adaptive coping. CONCLUSION: Participants chose an attractive alternative response to reporting PTG at substantial rates, supporting the notion that many self-reports of PTG reflect motivated biases and coping processes.

A Cross-Border Biorisk Toolkit for Healthcare Professionals.

The COVID-19 pandemic posed significant challenges to public health, exposing first responders to high biosafety risks during medical assistance and containment efforts. The PANDEM-2 study aimed to address these critical biosafety issues by emphasising the importance of frequently updated, harmonised guidelines. This study reviewed scientific publications, lessons learned, and real-world experiences from the COVID-19 pandemic to identify biorisk gaps in three critical areas: (i) patient transportation and management, (ii) sample handling and testing, and (iii) data management and communication by laboratory staff. At the onset of the pandemic, first responders faced several challenges, including the rapid expansion of emergency medical services, conversion of non-medical structures, increased internal and cross-border transport of infected patients, frequent changes in biosafety protocols, and a shortage of personal protective equipment. In response, this study developed a versatile and easily adaptable toolkit, including biosafety guidance and recommendations linked to updated national and international online repositories. It establishes the groundwork for a minimum standard that can be tailored to various pandemic response scenarios, using monkeypox as a fictive test case. The toolkit enables rapid access to updated information via QR codes and mobile devices, improving biorisk response by providing an adaptable and standardised approach for caregivers involved in national and cross-border responses.

Associations between Dietary Intake and Cardiovascular Disease Risk in American Career Firefighters: An Observational Study.

Firefighters have demanding jobs, requiring high levels of fitness in stressful situations for operational readiness, yet many firefighters are at an increased risk of developing cardiovascular disease (CVD). Diet is an important factor contributing to the development of CVD. The purpose of this study was to describe the dietary intake of firefighters and examine the associations between dietary intake and the CVD risk. Forty-six male career firefighters (age = 41.2 ± 11.2 years; BMI = 29.2 ± 4.1 kg/m2; body fat = 21.7 ± 6.1%) enrolled in a fitness-focused wellness program completed a health survey and a fitness assessment. The survey responses and fitness assessment were used to calculate the Framingham CVD Risk Score. Data were analyzed using R, the residual assumptions were verified, and the alpha level was set at 0.05. The results revealed that firefighters consume a standard American diet, with the overconsumption of meat and underconsumption of fruits and vegetables. The average CVD risk approached the upper limit of low risk. The results also indicate that meat servings and preparation fat affect the CVD risk (R2 = 0.21, p = 0.006). The outcomes of this study can inform investigations aimed at improving operational readiness and reducing the CVD risk in firefighters by implementing a holistic approach combining dietary interventions with physical training.

Combinations of First Responder and Drone Delivery to Achieve 5-Minute AED Deployment in OHCA.

Background: Defibrillation in the critical first minutes of out-of-hospital cardiac arrest (OHCA) can significantly improve survival. However, timely access to automated external defibrillators (AEDs) remains a barrier. Objectives: The authors estimated the impact of a statewide program for drone-delivered AEDs in North Carolina integrated into emergency medical service and first responder (FR) response for OHCA. Methods: Using Cardiac Arrest Registry to Enhance Survival registry data, we included 28,292 OHCA patients ≥18 years of age between 1 January 2013 and 31 December 2019 in 48 North Carolina counties. We estimated the improvement in response times (time from 9-1-1 call to AED arrival) achieved by 2 sequential interventions: 1) AEDs for all FRs; and 2) optimized placement of drones to maximize 5-minute AED arrival within each county. Interventions were evaluated with logistic regression models to estimate changes in initial shockable rhythm and survival. Results: Historical county-level median response times were 8.0 minutes (IQR: 7.0-9.0 minutes) with 16.5% of OHCAs having AED arrival times of <5 minutes (IQR: 11.2%-24.3%). Providing all FRs with AEDs improved median response to 7.0 minutes (IQR: 6.2-7.8 minutes) and increased OHCAs with <5-minute AED arrival to 22.3% (IQR: 16.4%-30.9%). Further incorporating optimized drone networks (326 drones across all 48 counties) improved median response to 4.8 minutes (IQR: 4.3-5.2 minutes) and OHCAs with <5-minute AED arrival to 56.3% (IQR: 46.9%-64.2%). Survival rates were estimated to increase by 34% for witnessed OHCAs with estimated drone arrival <5 minutes and ahead of FR and emergency medical service. Conclusions: Deployment of AEDs by FRs and optimized drone delivery can improve AED arrival times which may lead to improved clinical outcomes. Implementation studies are needed.

Sleep disturbances across two weeks predict future mental healthcare utilization.

STUDY OBJECTIVES: Insufficient sleep costs the U.S. economy over $411 billion per year. However, most studies investigating economic costs of sleep rely on one-time measures of sleep, which may be prone to recall bias and cannot capture variability in sleep. To address these gaps, we examined how sleep metrics captured from daily sleep diaries predicted medical expenditures. METHODS: Participants were 391 World Trade Center responders enrolled in the World Trade Center Health Program (mean age = 54.97 years, 89% men). At baseline, participants completed 14 days of self-reported sleep and stress measures. Mean sleep, variability in sleep, and a novel measure of sleep reactivity (i.e., how much people's sleep changes in response to daily stress) were used to predict the subsequent year's medical expenditures, covarying for age, race/ethnicity, sex, medical diagnoses, and body mass index. RESULTS: Mean sleep efficiency did not predict mental healthcare utilization. However, greater sleep efficiency reactivity to stress (b=$191.75, p=.027), sleep duration reactivity to stress (b=$206.33, p=.040), variability in sleep efficiency (b=$339.33, p=.002), variability in sleep duration (b=$260.87, p=.004), and quadratic mean sleep duration (b=$182.37, p=.001) all predicted greater mental healthcare expenditures. Together, these sleep variables explained 12% of the unique variance in mental healthcare expenditures. No sleep variables were significantly associated with physical healthcare expenditures. CONCLUSIONS: People with more irregular sleep, more sleep reactivity, and either short or long sleep engage in more mental healthcare utilization. It may be important to address these individuals' sleep problems to improve mental health and reduce healthcare costs.

Social support utilization's effect on post-traumatic stress symptoms: a Danish cross-sectional study of 383 ambulance personnel.

Introduction: Social support is considered an important factor in prevention of mental illness. However, little is known about the association between ambulance personnel's use of multiple types of social support and post-traumatic stress symptoms (PTSS). This study aims to assess if number of used social support types predicts PTSS for ambulance personnel. Apart from assessing the main effect of social support utilization, we were interested in investigating if social support utilization moderated the effect of frequency of critical events on PTSS. Materials and methods: A total of 383 ambulance personnel completed a survey consisting of validated questionnaires. Hierarchical multiple linear regression analyses were performed to assess the association between frequency of traumatic exposure and utilization of social support and PTSS as outcome variable. Results: Higher number of utilized social support types was associated with higher levels of PTSS (ß = 0.15, p <.001). When serving as a moderator of the association between frequency of exposure to critical incidents and PTSS, social support utilization had a significant and positive interaction effect (ß = 0.26, p = .049). 307 participants had used 2 or 3 types of informal support during the past year, whereas 81 had used 2 or 3 types of formal support. Conclusion: To our knowledge, this is the first study investigating the relationship between utilization of multiple, concurrent social support types and PTSS. This study suggests that to understand the effects of social support among ambulance personnel, it is necessary to assess the utilization of multiple concurrent support types, contributing factors to social support use, and different patterns of social support utilization that constitutes professional life in ambulance work.

Barriers to calling emergency services amongst people who use substances in the event of overdose: A scoping review.

BACKGROUND: North America is grappling with an ongoing drug overdose crisis. While harm reduction measures like take-home naloxone kits, and supervised consumption sites, have helped reduce mortality, other strategies to address this public health emergency are required. Good Samaritan Laws (GSLs) offer legal protection for individuals who report overdoses, yet people who use substances (PWUS) may still hesitate to seek help due to concerns about existing legislation. This scoping review explores barriers preventing PWUS from calling emergency services for overdoses, along with potential solutions and facilitators to address this challenge. METHODS: PRISMA-ScR was used as a guide to conduct this study. Health sciences librarians searched Medline, Embase, PsychINFO, CINAHL, and SCOPUS to identify relevant articles. Six reviewers contributed to screening and extracting the articles through Covidence. Two reviewers performed thematic analysis using NVivo software to identify key barriers and facilitators. RESULTS: An initial search found 6275 articles for title and abstract screening, resulting in 48 studies meeting the inclusion criteria. The primary barrier to calling 911 pertained to concerns about police arrivng with other first responders, especially regarding their presence and involvement at the scene of overdose. This was followed by legal repercussions, including fear of arrest, incarceration, and fear of eviction, amongst others. Some studies noted the lack of knowledge or trust in GSLs as a deterrent to seeking medical assistance. Additional barriers included concerns about privacy and confidentiality, preference to manage an overdose alone/receive help from another peer, confidence in naloxone effectiveness, limited access to cell phones, peer pressure to not call for help, and identifying as Black, Indigenous, or a Person of Colour (BIPOC). Facilitators include increased GSL awareness among PWUS and law enforcement, expanded legal safeguards for 911 callers, reduced police intervention in overdose cases, and enhanced naloxone availability at key access points. CONCLUSION: Despite the good intentions of GSLs, PWUS continue to experience significant barriers to calling emergency services in the event of an overdose. Understanding these barriers and key facilitators is necessary to inform future drug policy and advocacy efforts.

Perspectives and Experiences of Public Safety Personnel Engaged in a Peer-Led Workplace Reintegration Program Post Critical Incident or Operational Stress Injury: A Qualitative Thematic Analysis.

INTRODUCTION: Public safety personnel (PSP) experience operational stress injuries (OSIs), which can put them at increased risk of experiencing mental health and functional challenges. Such challenges can result in PSP needing to take time away from the workplace. An unsuccessful workplace reintegration process may contribute to further personal challenges for PSP and their families as well as staffing shortages that adversely affect PSP organizations. The Canadian Workplace Reintegration Program (RP) has seen a global scale and spread in recent years. However, there remains a lack of evidence-based literature on this topic and the RP specifically. The current qualitative study was designed to explore the perspectives of PSP who had engaged in a Workplace RP due to experiencing a potentially psychologically injurious event or OSI. METHODS: A qualitative thematic analysis analyzed interview data from 26 PSP who completed the RP. The researchers identified five themes: (1) the impact of stigma on service engagement; (2) the importance of short-term critical incident (STCI) program; (3) strengths of RP; (4) barriers and areas of improvement for the RP; and (5) support outside the RP. DISCUSSION: Preliminary results were favorable, but further research is needed to address the effectiveness, efficacy, and utility of the RP. CONCLUSION: By addressing workplace reintegration through innovation and research, future initiatives and RP iterations can provide the best possible service and support to PSP and their communities.

Design considerations for protective boots for first responders to hazardous materials incidents.

First responder professionals are at high risk for work-related injuries (e.g., extreme temperatures, chemical and biological threats); boots are essential to ensure body protection since they have full contact with the ground in all scenarios. A substantial body of work has investigated the necessity of improvements in protective boots, but there is limited research conducted on boots with fit-adjustable fasteners for secure and adjustable fit within this context. Thus, this study explored the areas for improvement in boot design for the development of form-fitting and yet comfortable boots focusing on two different boot designs, prototype all-hazards tactical boots (lace-up) and rubber boots (slip-on). Findings indicated that the boot design should address participants' concerns with the material choices of boots, specifically with bulkiness, weight, and flexibility. Our findings provide insights into boot material and design choices to improve protective boots for first responders.

Incorporating biofeedback into the Mindfulness in Motion Intervention for health care professionals: Impact on sleep and stress.

CONTEXT: Health care providers (HCP) experience high stress and burnout rates. Mindfulness Based Interventions (MBI) with biofeedback may help improve resiliency but require further research. DESIGN AND STUDY PARTICIPANTS: Aims were to evaluate changes in sleep patterns, nocturnal physiology, stress, mood disturbances, and perceived experience with biofeedback during the Mindfulness in Motion (MIM) intervention. Data from 66 HCP were included after removing those below 75 % compliance with wearable sensors and wellness surveys. Participants were enrolled in MIM, including eight weekly one-hour virtually delivered synchronous group meetings and ∼10 min of mindfulness home practice at least 3 times per week using a mobile application. Participants wore wearable sensors to monitor sleep and nocturnal physiology and completed short daily stress and mood disturbances. RESULTS: According to mixed effect models, no sleep nor physiological metrics changed across MIM (p > 0.05). More time was spent in bed after MIM sessions (8.33±1.03 h) compared to night before (8.05±0.93 h; p = 0.040). Heart rate variability was lower nights after MIM (33.00±15.59 ms) compared to nights before (34.50±17.04 ms; p = 0.004) but was not clinically meaningful (effect= 0.033). Significant reductions were noted in perceived stress at weeks 3 through 8 compared to Baseline and lower Total Mood Disturbance at weeks 3, 5, 6, and 8 compared to Baseline (p < 0.001). CONCLUSIONS: Participating in the MIM with mobile applications and wearable sensors reduced perceived stress and mood disturbances but did not induce physiological changes. Additional research is warranted to further evaluate objective physiological outcomes while controlling for confounding variables (e.g., alcohol, medications).

Inventory of state workers' compensation laws in the United States: first responder mental health.

We conducted a comprehensive review of state workers' compensation laws in the United States to evaluate the extent to which they support first responders with mental injury. Most state workers' compensation systems divide mental injuries into categories based on their presumed etiology: physical-mental, mental-physical, and mental-mental. Major differences exist among states as to which workers are eligible. Proving workplace causation can be difficult where no traumatic physical injuries exist. Latency periods, time limits, preexisting health conditions, restrictions as to types of condition covered, and complex chains of causation may make this burden, which falls on the claimant, even more challenging. Only nine (9) states enacted presumption of causation laws for mental health conditions to ease claimants' burden of proof. This contrasts starkly with presumption laws for chronic and infectious diseases. State decision-makers should create presumptions that mental health conditions in first responders are caused or significantly exacerbated by their stressful workplaces.

Exploring the Effectiveness of Emergency Medical Services Becoming Active in Fall Prevention: A Literature Review.

Falls, particularly among the elderly, are a prevalent and growing healthcare issue in the United States. Individuals who experience falls face heightened morbidity and mortality risks, along with substantial expenses associated with managing any resulting injuries. First responders frequently respond to 911 calls related to falls, with a significant portion of these cases not resulting in hospital or healthcare facility transfers. As such, many fall victims receive treatment without any preventive measures being implemented. The purpose of this review is to explore the current studies that examine whether Emergency Medical Service personnel can effectively act in fall prevention. While earlier studies present conflicting findings, recent research indicates the potential for preventive strategies that go beyond mere referrals.

A Virtual Reality Simulation to Examine the Relationship Between Post-Traumatic Stress Symptoms and Decision-Making in First Responders.

First responders (FRs) are continuously exposed to critical incidents, considered traumatic events (TEs). This cumulative exposure increases the risk for post-traumatic stress disorder (PTSD). However, there is no evidence about the relationship between PTSD symptoms and emergency decision-making (EDM). The objective of this study was to examine the EDM of FRs during a virtual reality through the simulation of two emergency scenarios to collect data on the reaction time and the number of incorrect decisions. We also assessed PTSD symptoms, TE, and sociodemographics. The sample included 368 Portuguese FRs, were 295 (80.20%) males and 73 (19.80%) females, with a mean age of 33.96 (SD = 9.38). Considering the probable PTSD diagnosis according to the DSM-5, 85 (23.10%) of the FRs met the criteria. These individuals who meet the criteria exhibited higher EDM scores (M = 19.60, SD = 5.99) compared to those without probable PTSD (M = 17.87, SD = .5.66) (F(1, 360) = 5.32, p = .02, partial η2 = .015). We found that TEs had a direct effect on EDM, ß = -.16, Z = -3.74, p < .001), and the pathway of trauma-PTSD symptoms-decision-making an indirect effect, ß = .02, Z = 3.10, p = .002). Individuals exposed to more TEs demonstrated faster and more accurate decision-making in the context of EDM. However, when these individuals developed PTSD symptoms, their decision-making became slower and less accurate. The inclusion of a trauma-informed approach for FRs to prevent individual and job-related consequences is discussed.

'Safety in the Grey Zone': Evaluation of a training program to improve the safety of incident responders on high-speed roads.

INTRODUCTION: Workers operating on high-speed roads (i.e., incident responders and emergency service workers) are at significant risk of being fatally injured while working. An identified gap in current prevention strategies is training focused on developing the skills of workers to effectively communicate and coordinate safety responses when operating on roads. METHODS: This study discusses the development of a program designed to optimize communication and coordination of safety practices at the scene of an incident on a high-speed road. The program is referred to as 'Safety in the Grey Zone.' The goal of the study is to present the results from an evaluation on its implementation across 23 sessions involving 158 participants from 7 incident response agencies in 1 state in Australia. RESULTS: The results of this study provide support for effectiveness in implementing the program as planned. The results also provide preliminary support for effectiveness of the program in achieving its learning outcomes as demonstrated by feedback received from participants following completion of the program. CONCLUSIONS: The findings of this study provide recommendations to consider in the program's future roll-out, as well as suggestions for future evaluations to assess the program's effectiveness in improving the safety of incident responders operating on high-speed roads.

Occupational and Personal Challenges During the Opioid Crisis: Understanding First Responders' Experiences and Viewpoints of Clients with Opioid Use Disorder.

OBJECTIVES: This study provides preliminary findings on the experiences of first responders during the opioid crisis and their viewpoints regarding whether clients with opioid use disorder deserve medical rehabilitation. Understanding associations between first responder experiences and viewpoints of client deservedness can help reduce stigma, improve compassionate care, and identify training gaps. METHODS: Analyses were run with data from a nationwide survey of Emergency Medical Services-providers and law enforcement workers collected from August to November 2022 (N = 3836). The study used univariate statistics and ordered logistic regression to understand first responders' experiences and viewpoints on client deservedness, as well as the relationship between the two. RESULTS: Results show a negative correlation between responding to overdose calls and perceiving clients with opioid use disorder as deserving of medical rehabilitation. Law enforcement, males, and conservatives also had negative viewpoints. Conversely, having a friend experience addiction and believing addiction has had a direct impact on respondents' lives predicted increases in client deservedness. CONCLUSIONS: Policy should focus on creating spaces where first responders can have positive interactions with people who use drugs or are in recovery. Better training is needed to help first responders manage on-the-job stressors and understand the complexities of addiction.

Seamless Fusion: Multi-Modal Localization for First Responders in Challenging Environments.

In dynamic and unpredictable environments, the precise localization of first responders and rescuers is crucial for effective incident response. This paper introduces a novel approach leveraging three complementary localization modalities: visual-based, Galileo-based, and inertial-based. Each modality contributes uniquely to the final Fusion tool, facilitating seamless indoor and outdoor localization, offering a robust and accurate localization solution without reliance on pre-existing infrastructure, essential for maintaining responder safety and optimizing operational effectiveness. The visual-based localization method utilizes an RGB camera coupled with a modified implementation of the ORB-SLAM2 method, enabling operation with or without prior area scanning. The Galileo-based localization method employs a lightweight prototype equipped with a high-accuracy GNSS receiver board, tailored to meet the specific needs of first responders. The inertial-based localization method utilizes sensor fusion, primarily leveraging smartphone inertial measurement units, to predict and adjust first responders' positions incrementally, compensating for the GPS signal attenuation indoors. A comprehensive validation test involving various environmental conditions was carried out to demonstrate the efficacy of the proposed fused localization tool. Our results show that our proposed solution always provides a location regardless of the conditions (indoors, outdoors, etc.), with an overall mean error of 1.73 m.

"This is it this is our normal" - the voices of family members and first responders experiencing duty-related trauma in Ireland.

BACKGROUND: Compared to other occupational groups, first responders (FR) experience worse mental health outcomes due to duty-related trauma and occupational stressors. Despite their best efforts, they bring this stress home to friends and family. Consequently, FR and their supporters suffer from increased psychosocial difficulties and experience stigma and other barriers to help-seeking. Prior work offers little opportunity for open dialogue and shared understanding of the repercussions of this occupation for all members of the first responder community. In this qualitative study, we aimed to: (i) explore the lived experience of Irish FR and their family members (FM) related to occupational stressors, and (ii) identify opportunities to engage FM with existing organizational supports available for FR. METHODS: Using a community based participatory research (CBPR) approach, we conducted six focus groups involving a total of fourteen participants comprising FR, organizational representatives, and FM. All focus groups were audio recorded, transcribed, and analyzed using reflexive thematic analysis. FINDINGS: FR and FM shared their experiences of both joining and learning to live as members of the FR community in Ireland. Through our analysis, we identified a main theme of 'crossing thresholds', characterizing their transformative learning experiences. This learning experience includes recognizing the consequences of this new role for them as individuals and for their relationships. Participants also shared how they have learned to cope with the consequences of their roles and what they need to better support each other. CONCLUSIONS: FM are often unheard, hidden members of the first responder community in Ireland, highlighting an unmet need for FR organizations to acknowledge FM role in supporting FR and to provide them with the appropriate training and resources required. Training for new recruits needs to move beyond the tokenistic involvement of FM and encourage knowledge sharing among experienced and novice members. Cultural change is required to support help-seeking among FR and foster a sense of peer support and community among families.