Psychological First Aid Officer Eases Emotional Stress of Death and Fire
Does your department have a psychological first aid (PFA) officer? If not, consider the following actual situation:
A fire has spread through a one-family home. After extinguishment, the chief orders salvage and cleanup operations. Mattresses are tossed on the lawn and ripped open, furniture is doused, and piles of books, phonograph records and papers are stirred apart and wet down. The equipment is picked up, the family expresses gratitude for all the help of the department and off you go.
A few days later, you hear how “the fire department utterly destroyed our home.” “They just threw things all over the place -threw my clothes out in the yard.” (But the clothes were burned—a total loss.) “I almost died when I found Jerry’s picture in the garbage.” (But the glass was cracked, the picture dirty and the frame bent.) “You should have seen them looking through my things in the bedroom.” (But there were piles of clothes against the wall and they had to be moved to get to the fire in the wall.)
Why did your good stop turn out to be a public relations disaster in the eyes of the victims of the fire? After all, there was nothing more to be done. Or was there?
How victim sees it
Let’s go back to the scene and watch t he proceedings through the eyes of one victim. The clothes: “There go my clothes. I was going to wear that dress tonight. Please be careful. No, don’t throw it there, I can have that cleaned. It will be good as new, please.”
As a fire fighter who has seen a hundred such dresses, you know that there is no chance for that dress, but your perception and the victim’s perception of the situation are not the same. In fact, the viewpoints are usually the opposite. From a psychological point of view, there are several ideas operating here at one time.
The fire department has taken charge of a house and invaded the territory of the victim. Under normal circumstances, a stranger has no right to go through the personal property of another—except on the fireground (and during police raids with a warrant). The victim feels helpless and ambivalent about the whole thing. On one hand, the person knows that it is necessary to permit this procedure, but on the other hand, there is anger at the department for this intrusion into his personal world. The anger is inevitably suppressed. Later, when the anger surfaces, there must be some outlet. More often than not, the very people who provided help—the fire fighters— become the objects of the anger. Why does this happen?
Transfer of blame
People are usually the cause of fires and in this case, it was a matter of direct cause by one of the occupants. A flammable liquid was spilled near a wood-burning stove and the owner literally burned his house down. Feeling guilty, the owner will seek a person, object or organization upon which he will place the blame.
Technically, this is the use of a defense mechanism called displacement. The individual is unable to handle the entire load of guilt himself, so he transfers it onto another object. As long as there is no harm to the object of the displacement, such a behavior is perfectly normal and acceptable, but too often, the reputation of the department suffers for doing a perfectly good job on the scene.
Are there techniques which may be used by officers to help dispel the emotions of victims and reduce hostility toward the department? Yes. When the fire is limited to property damage, there are a few basic techniques to follow. First, have the mental set that you will treat the property of individuals as though it were your own. Next, permit the victims some decision concerning the disposition of each item.
Have the owners nearby and ask for a decision on this and that. When a person is permitted to buy into the salvage operation he will not feel as helpless. The fire fighter should accept the decisions of the victims, although he may not agree with them. Later on, the decisions will probably change and much of what was saved will be tossed out, but for the present, it is important that the victims have a say in the events of their life. This technique also relieves the emotional stress experienced by the victims by giving them something to do.
The PFA officer should remain in contact with the victims during the operation for several reasons. The officer can explain why certain techniques are being used, such as cutting open a roof (which is not burning) or tearing off perfectly good siding (to check extension) or smashing that large picture window (for ventilation).
The officer can also start people back on the job of reconstructing their lives. Assistance may be given in contacting friends and relatives, securing temporary shelter and food and clothing, contacting the insurance agent, arranging for pictures of the damage, and contacting the utility company and tax department. All of these activities are good for the family to engage in after a fire.
The PFA officer should be different from the investigating officer, although the victims will want to talk about the fire, the cause and the part they played in the event. At this point, the PFA officer should listen, accept what they have to say without making judgments and repeat back to them what he has just heard them say. This approach is a nondirective counseling technique. It permits the subjects to have their views reflected by another person without value being judged.
Provide emotional outlet
The main objectives of the PFA officer should be to support people’s feelings and provide an outlet for the emotions that have been generated. Emotions are irrational but understandable. Don’t be surprised if you are blamed for the whole sorry mess. It’s normal. Be big enough to accept the emotion.
Followup calls to the persons (find out where they are housed temporarily) are helpful even though there may be nothing that can be done immediately. The offer is the important part.
At one fire, the chief returned to the scene a day later to take pictures and found the owner sifting through the rubble. After a few minutes of fire talk, the chief asked if he was looking for anything special. “Yes, I’m looking for my clock.” It did not seem to matter to the man that the whole house was virtually destroyed. He wanted a small brass clock which was the one item in the whole house that had specific sentimental value to him. It was the only thing he had to connect himself with his deceased foster parents who gave him the clock when he was a boy. The chief remembered the item, found it in a pile of salvage and returned it to the owner—some successful PFA.
Death at a fire scene is a whole other problem. Most people are resigned to property losses but not to death. The internal stresses and emotions during such a trauma are deep, irrational and devastating. The first reaction is one of disbelief. The survivors do not believe that death has taken place. It is for this reason that bodies are publicly displayed in funeral parlors.
Survivors blame themselves
When a victim is spirited away from a fire scene or auto accident and the survivors do not witness the evidence of the death, there is a period of mixed feelings that follows the event. Hope that everything is OK is mixed with a feeling of despair that the person is dead, and this is further mixed with self-blame for the accident. Officers often report hearing survivors say things like, “Why couldn’t it be me?” Survivors may express total blame for the accident with impossible contingencies like, “If I hadn’t had to go back and get my coat he would have been alive now, I really killed him.”
In providing death information, the PFA officer must be truthful and kind. If the individual is declared officially dead, the survivors are entitled to know. This is difficult for the fire officer because one does not know what to do after the news is broken. You don’t have to say anything at all. Being there is often sufficient enough to share the grief of the survivors. It really is a personal privilege to be there.
As with property damage situations, the department may be blamed for not doing enough. Occasionally rescue efforts are investigated and the competency and procedures of the department members are questioned. This behavior is often an extension of the anger that the survivors need to dispel. It is an occupational hazard of public safety work. It should be noted that survivors may turn the guilt onto themselves so intensely that they feel guilty for being alive. This survivor syndrome may be serious enough to need professional attention.
Therapy for grief
Physical contact with the grieving individual is good therapy. Holding a person’s hand, placing an arm over the shoulder or just sitting next to the individual in a quiet manner may suffice. What is said during these moments is not as important as the process taking place.
On one occasion, a young couple were walking in a stream bed hand in hand. The man slipped away from the woman, fell into a deep pool and drowned. The woman sat in the chiefs truck until the rescue team retrieved the body some 45 minutes later. During that time, she had no doubt that he was downstream hanging onto a tree limb. When she was told that he was found, she asked if he was alive. She refused to entertain the probability of his death. She had to hear it from someone else. After the initial response of tears, there was nothing the chief could say that she would agree with. At this point, a silence reigned and the nonverbal communication of just holding on to her was worth more than all the words in the dictionary.
Denial of death is common to our American society. Ambulances whisk away bodies, nurses don’t want people to die during their shift, and hospitals have false-bottomed carts to remove bodies from rooms unobtrusively. This philosophy of death is unrealistic and is reflected in the euphuisms describing death. A person “passes away,” “goes on a long journey,” “passes on to his reward,” everything except DIE. Consequently, when death confronts the fire fighter, graceful acceptance of the event is largely impossible. The fire fighter needs some PFA also.
Fire fighters also suffer
The other side of the coin at fire and rescue deaths is the toll on the department members. Like a physician who is dedicated to preserving life, the experience of a fire or accident death reflects an apparent failure on the part of the rescue team.
During the operations, there is little need for psychological attention, but afterward a distinct syndrome appears. The fire fighter feels that there is something that should have been done that wasn’t and a feeling of depression may overcome the department member. The PFA officer needs to reassure the member that he did the best possible job under the circumstances. Going over the event may also help the individual sort out the constraints of time, resources—or lack of them, road conditions and all that goes into the making of a traumatic event. The presence of several department members with coffee cups and doughnuts in hand offers mutual support for the people involved. Fire chiefs also need this when they save the basement.
Some apparently strange behaviors are often witnessed while rescue attempts are in progress and to bystanders, they may seem quite inappropriate or even bizarre. Jokes are cracked at the scene. Maudlin comments are made about the victim. Personnel stand around socializing and laughing while waiting for the coroner. A few considerations are in order at this point.
Blocking out reality
Jokes and gallows humor are simply means to displacing the discomfort experienced by the rescue team while facing the event. The pain of the reality of death is kept away temporarily by the joke and the stress is relieved. When burn victims are referred to as “crispy critters,” it is not due to irreverence, but to the stress of the trauma at hand. There are two problems attached to the use of these defense mechanisms.
First, bystanders have a different perception of the occasion and departmental reputation may suffer because of the remarks. Secondly, although the victim may be unconscious and possibly “dead,” he may hear what is going on around him. Many cases have been documented of patients repeating word for word what was said about them on the operating table or at the accident. Victims who have been put under hypnosis are able to recall exact details of the accident even though they were unconscious or intoxicated at the time.
The occasion of a death is a difficult one for all concerned. The death of another becomes a reminder of one’s own mortality, the unwelcomed guest in our culture. The best rule to keep in mind is the rule of empathy. Walk in the shoes of the victim long enough to know how it feels. The PFA officer can perform an important role in fire department operations
Polyurethane Retardant
Chief Theodore Szymanski is an adjunct instructor at the New York Academy of Fire Science and the National Fire Academy. He is a full-time psychology instructor in Ithaca, N. Y.
Highly flammable polyurethane foam can now be made fire-resistant with the application of a new elastomer formulation after processing, The National Aeronautics and Space Administration has announced.
The flame-retardant does not alter the foam’s lightness, flexibility and resilience. When the treated polyurethane foam is exposed to flame, a protective char develops on the foam and combustion stops when the ignition source is removed. In addition, the treatment prevents the formation of molten particles that could drip and ignite adjacent materials.
The elastomer-formulation was developed by Paul Monaghan and Kenneth R. Sidman of Arthur D. Little, Inc., for the Johnson Space Center.
The flame retardant formula is composed of elastomeric binders, a thermally stable source of bromine, metal oxide catalyst/acid accepters, nitrogen-containing curing agents, phosphorus-containing fillers, and hydrated fillers.
