Firefighter Health and Wellness

Prehospital 9-1-1 emergency response is one of the essential public safety functions provided by the United States fire service in support of community health, security, and prosperity. Fire service-based emergency medical services (EMS) systems are strategically positioned to deliver time-critical response and effective patient care. Fire service-based EMS provides this pivotal public safety service while also emphasizing responder safety, competent and compassionate workers, and cost-effective operations.

In doing their work, fire service-based EMS personnel face a variety of challenges, including ensuring personal safety on the job and addressing behavioral and physical health challenges that stem from the job. More systemically, fire service-based EMS faces significant challenges with staffing shortages, as well as reimbursement and other issues affecting departmental finances.

fire rescue


CFSI advocates for a variety of initiatives to help address the financial challenges facing fire service-based EMS, including supporting legislation to extend and increase Medicare add-on payments,  initiatives to provide options for Treatment in Place, as well as a pilot program to examine ways to increase flexibility in the provision of emergency medical services.

physical health

Physical Health and Wellness

Physical health, including cardiovascular health, is of particular importance in the fire and emergency services. CFSI advocates for policies and programs to support physical health in the fire and emergency services, including funding for AFG and SAFER that can be used to establish wellness programs at departments.

During the COVID-19 public health emergency, CFSI worked with other major national fire and emergency services organizations to advocate for access to personal protective equipment, vaccines and other therapeutics, and COVID-19 priority testing and rapid testing. CFSI also joined our partners in advocating to ensure that COVID-19 was listed under Ryan White notification requirements and worked to push the Department of Health and Human Services to improve enforcement of this requirement.


Behavioral Health

CFSI advocates for policies and programs that support the behavioral health of fire and EMS personnel. This includes advocating for funding for the AFG and SAFER grant programs, which can help departments to set up or access behavioral health resources including peer-to-peer counseling programs, treatment programs, and much more.

CFSI also supports legislation such as the HERO Act that will help to fund training for peer counseling, establish behavioral health and wellness programs, increase data collection regarding public safety officer suicides, and more.

Current Legislation

Helping Emergency Responders Overcome (HERO) Act

Summary: The legislation provides funding for peer counseling programs for public safety officers, and collects data on post-traumatic stress among public safety officers to assist in developing best practices and improve measures to recognize, prevent, and treat mental health issues among public safety officers.


  • On the job, fire and EMS personnel are frequently exposed to scenes including traumatic injury and loss of life.
  • The psychological impacts of such exposure can have severe negative effects on fire and EMS personnel.
  • There is a great need for more robust mental health awareness, treatment, and support in the fire and emergency services.

Status: The bills have been introduced in the House and the Senate (H.R.3671/S.1925)

Supporting and Improving Rural EMS Needs (SIREN) Reauthorization Act

Summary: The legislation would reauthorize the SIREN grant program, which assists rural fire and EMS agencies with purchasing the equipment, obtaining the medications, and providing the training necessary to continue saving lives in their communities. 


  • Fire and EMS agencies serve an important function in delivering pre-hospital medical care to ill and injured patients in their communities
  • This is especially critical due to the lack of primary medical care available in communities and the potential delays in patient care due to long transportation distances to a hospital.
  • The minimal tax base in rural communities severely limits the financing of pre-hospital care, meaning fire and EMS agencies routinely face challenges delivering such care to critically ill and injured patients.
  • This legislation will extend the SIREN Grant’s authorization through 2028; it currently expires at the end of September 2023.

Status: The bill has been introduced in the Senate (S.265)

Protecting Access to Ground Ambulance Medical Services Act

Summary: The legislation extends certain reimbursements received by ground ambulance services for transporting patients.  


  • When the Centers for Medicare and Medicaid Services (CMS) provides payments for transporting patients, one portion is based on the zip code where the transport started.
  • These payments, called “Ground Ambulance Extenders,” have existed for nearly 20 years and provide an additional 2%, 3%, or 22.6% payment depending on whether the transport originated in an area designated as urban, rural, or super-rural.
  • These payments are vital to ensuring that departments can recoup costs for services.
  • These add-on payments have been extended several times, including the most recent two-year extension in the FY2023 appropriations package.
  • The bill would extend the payments to 2028 and increase the 2% urban rate to 3.4%; the 3% rural rate to 4.3%; and the super rural 22.6% rate to 26.7%.

Status: The bills are awaiting reintroduction in the 118th Congress.