When I came on the job, you simply dealt with the stresses of the stuff that you saw: burned bodies (children included) and severe trauma to the human body (including dismemberment and evisceration). It wasn’t always the gory stuff that got to you, either. Children sitting in highchairs with cockroaches crawling through their food, the stench of some homes, or simply the unkind acts committed toward other human beings were also unsettling.
We dealt with this stuff in many ways-humor, exercise, teasing and hazing, getting away from the crew for a little bit, or simply going home and hugging the kids or kicking the dog! Since the end of World War II and the Vietnam War, there have been numerous studies dealing with stress. Much of what was learned was passed to other professions, including the fire service. Is the information we acquired helpful? I don’t know. I don’t know if anyone really knows. In fact, a few recent studies disavow the effectiveness of critical incident stress management (CISM). I’m not ready to give up on it yet.
We have had a CISM team since the late 1980s. We activate our team (several mental health professionals and a core group of union members) at most fatal fires. The chief or company officers can call for the team to be activated. Participation is not mandatory but is strongly encouraged. No one is forced to sit in on a defusing or debriefing. Members who do not wish to participate, however, must go with their crew to the place where the defusing is being conducted, but they can stay outside of the room.
The team is almost always deployed in fire fatalities, especially when children or multiple fire victims are involved. We have deployed the team for other incidents as well. One incident involved a young girl who was struck by a garbage truck; her body was stuck in the rear dual wheels on the truck. The crew that responded was debriefed, and follow-up sessions were conducted.
In February, we activated our team not only for firefighters but for ironworkers and their families as well when four ironworkers were killed in the collapse of a new bridge being built across the Maumee River in Toledo.
–John “Skip” Coleman, deputy chief of fire prevention, Toledo (OH) Department of Fire and Rescue, is author of Incident Management for the Street-Smart Fire Officer (Fire Engineering, 1997) and Managing Major Fires (Fire Engineering, 2000), a technical editor of Fire Engineering, and a member of the FDIC Educational Advisory Board.
Question: Does your department have access to a critical incident stress management team, and under what circumstances would it be activated?
Steve Kreis, assistant chief, Phoenix (AZ) Fire Department
Response: Our CISM team is probably structured like those in other departments and activated according to the same criteria and processes. We have had this capability since the early 1980s and have used team members for many types of issues involving firefighters. There are clearly times when the expertise provided by these teams is the best care we can provide for our members. But, something we have learned over the years is that there isn’t any substitute for a caring (nice) boss. A battalion chief with a box of donuts or a gallon of ice cream and a caring attitude stopping by the station after a stressful incident has proved in many cases to be the best stress-management process for us.
I’m not saying that a battalion chief can manage every stressful incident we may encounter, but who would you rather see after a stressful incident, a boss carrying food who is concerned about your well-being (and has the organizational clout to provide what you need) or a group of professionals (or peers) that administer a practiced and structured process for managing your well-being? In Phoenix we can provide either service the member desires.
Lynette Jelinek, alternative response coordinator, Glendale (AZ) Fire Department
Response: In April 2002, the Glendale (AZ) Fire Department asked me to help develop and implement a new type of service to the citizens in our community. The fire department had noticed that it had overlooked for years a mechanism for providing assistance to its members after an incident.
On November 1, 2002, we rolled out our new “Alternative Response (AR) Unit,” which serves as an immediate crisis intervention unit (CISM team) that is automatically dispatched to the following types of calls: house fires, automobile accidents, drownings, suicides, homicides, shootings, stabbings, domestic violence, sexual assault, and codes. The program provides immediate crisis intervention and stress management. This assistance could be given to the victim, the family, witnesses, and friends tied to a traumatic event.
The AR team renders support that may be as simple as providing a ride to the hospital or as involved as assisting families whose bereaved members span a wide range of ages to cope with the loss of a loved one in a variety of circumstances. Team members may contact funeral homes or explain the steps about to take place if the medical examiner is called.
As this new concept was being adopted, I noticed a couple of phenomena taking place. First, it wasn’t just first responders who were affected by trauma scenes. The many people involved in and around the immediate area also suffered during these crises. Being automatically dispatched to these scenes gave the AR team a chance to assess the event’s severity, identify and prioritize the crisis customers, and identify the exact type of intervention needed. This is also an excellent opportunity to assess how our emergency responders are doing: Is a peer support team needed, or did the first responders just need defusing? Should a critical incident stress debriefing (CISD) be planned?
Second, I noticed that by sending an AR team, our emergency responders could go back in service sooner. The AR team members help the family members, stay with them until their needs are met, and provide resources and referrals. Meanwhile, the firefighters leave the scene and are ready to respond to the next customer with a critical need (essentially a life-saving tactic).
CISM techniques have proved to be effective with the “civilian” populations as well as with the first responders. It is also clear that our community needed some kind of early contact with information and possible interventions, just as the first responders did.
Our AR unit is one of many in the metropolitan Phoenix area. The fire and police departments in Phoenix and fire departments in Mesa, Surprise, Avondale, Tempe, Chandler, Sun Lakes, and Buckeye also have such a unit.
All of the agencies train from the same curriculum of crisis intervention. Part of the strategy is to bring together a group of busy professionals from a variety of services across Maricopa County and have everyone participate under the regional training concept. The Regional Training Advisory Council consists of professionals from police, fire, EMS, clergy, mental health, forensic nurses, victim advocates, Adult Protective Services, Child Protective Services, grief counselors, social workers, and therapists.
The service is staffed completely by volunteers. At Glendale Fire, we have 188. More than 70 are EMT certified (providing basic life support if needed); all volunteers attend more than 100 hours of basic crisis intervention training.
The volunteers come from diverse backgrounds-from the kind, compassionate homemaker who loves to “give back to the community” all the way to the professional with a Ph.D. We also have young motivated EMTs who someday would like to serve as firefighters. This program proves to be a great internship for those interested in the fire service simply because the AR unit is located at a Glendale fire station; it serves as a feeder program for future fire recruits. Our EMTs learn the fire culture while providing crisis intervention service, setting the stage for future service.
We have not had to directly fund the program. Through community partnerships and donations, three vans and tens of thousands of dollars have been donated to the program, along with in-kind donations of clothing, diapers, stuffed animals, snacks, water, and other miscellaneous items.
The concept of CISM has been well accepted in our organization because it provides complete customer care as well as prevention, intervention, and recovery. Most of all, the program has touched thousands of people’s lives at a most traumatic time. You cannot place a value on that; to those folks at that time, our assistance is priceless.
Rick Lasky, chief, Lewisville (TX) Fire Department
Response: It’s amazing that some people and some departments still don’t see a need for CISM. I used to be one of those people years ago. We felt that the only stress management we needed was going to the corner “gin mill” and tipping a few. That was until about 15 years ago; I have been a believer in and a strong advocate of CISM ever since. A CISM team operates through and under the direction of our police and fire personnel, who have been trained in CISM. The team consists of police officers, firefighters, dispatchers, and chaplains.
We consider activating the team in the following situations:
• firefighter fatality or serious injury,
• death or serious injury involving one of our police officers,
• death or serious injury involving the family or a family member of one of our personnel,
• death or serious injury involving a child, or
• just about any “bad” call or whenever company officers or firefighters feel they or their coworkers need it.
I’ve seen some pretty tough firefighters have problems dealing with and working through some issues related to calls to which they responded; in some cases, you did not know they were experiencing problems. You just don’t know. No one is immune from being affected. You’re never “too tough.” Does everybody need it? No. But it’s a great way to take care of your people. We should have provided it years ago.
Ron Hiraki, assistant chief, Gig Harbor (WA) Fire & Medic One
Response: As a smaller suburban fire department, our need for and ability to support a CISM team is limited. A CISM team in Pierce County is available 24/7 through the Countywide Fire Communications Center. Our battalion chiefs would most likely call for the CISM team when our members responded to an emotionally challenging incident.
During the past few years, the types of incidents at which the CISM team has been used include the following: a husband’s killing his wife with a handgun and then shooting himself in front of their children, a SIDS death, the death of a chronically ill patient with whom our members had developed a relationship (as well as with the family members), and the death of a young person in a high-speed motor vehicle crash.
Our members have heard that some people in the CISM field question the effectiveness of CISM when it is forced on emergency responders as a work group. Our members continue to look into this hypothesis. Battalion chiefs try to ascertain the needs of individual members and make positive suggestions instead of ordering the entire work group to attend a CISD. In addition to the CISM team, we have a department chaplain who is available to help our fire department members or community members. We also have a very good Employee Assistance Program with counselors available to assist our members.
Leigh Hollins, battalion chief, Cedar Hammock (FL) Fire Rescue
Response: We have access to and use a CISM team. It is a countywide team headed by a local EMS captain who has training in this discipline. Other team members include a physiologist and other mental health professionals.
The team is activated with a call to the communications center; the EMS captain is paged and contacts the caller from our department, usually the battalion chief. The “level” of activation can be anything from having a peer counselor talk with those involved in an incident to a full team meeting and debriefing with all involved.
At a recent call to which several of our firefighters responded, a toddler was killed when a TV stand he was climbing fell on him. These firefighters had young children at home; their officer requested that the battalion chief call the team for a peer counselor. The last time we requested a full team response was a couple of years back after a house fire in which four family members were killed-the parents, a toddler, and an infant. The team was most helpful to the firefighters during the original contact and at a later full debriefing. We believe that such a resource is very beneficial to the mental health of our employees.
Robert Shelton, firefighter/EMT-I, Cincinnati (OH) Fire Department
Response: As a former member of the Southwestern Ohio Critical Incident Stress Management Team, I have seen the efficacy of such teams. Every debriefing seems to begin the same way: Responders are reticent to show any type of emotion. They feel they are weak for being affected by this traumatic event, and they don’t want to talk about it. But, once the team has shared its personal experiences as responders and how they relate to the incident at hand, eventually feelings come out, and the debriefing becomes what it was meant to be-therapeutic and a means for dealing with stress, guilt, and other negative factors.
We have no formal procedure for initiating a call for the team or a list of specific circumstances under which it may be called. Some recent events that led to mobilizing the team include a fire in which two badly burned people, one a young child, were rescued; an accident in which a firefighter was run over by an apparatus and lost part of his foot; and a firefighter line-of-duty death. These events are traumatic in and of themselves.
Each group of responders reacted differently. By and large, it has been my experience in observing and listening to people of differing ranks that they want nothing to do with CISD. I have heard it said on more than one occasion, “I’m not talking to a bunch of shrinks.” “There’s nothing wrong with me.” “It’s all a part of the job, no big deal.” And whereas “gallows humor” is one way of dealing with a situation, sometimes there is a need for more. In each of the events related above, the first-alarm companies or people directly related to the event had no choice but to attend. Whether it made a difference for all who attended I can’t say. But some, including me, appreciated and benefited from the debriefing and expressed appreciation for having such a tool at our disposal.
One reason it has been used more and more in my department is that our chief, one of our assistant chiefs, some of our district chiefs, and several officers have been through the training, and some are quite involved in and adept at determining when CISD is needed. And that is the buy-in. A fire administration has to completely buy into the idea of CISD. An administration needs to have a solid involvement in and support for CISD. If the administration does not set an example in this area, there is no buy-in for the rank and file. And the result will be detrimental to the fire service. We will lose good people.
We already have a tremendously stressful job. In this time of international terrorism and global conflict, our jobs place us in harm’s way now more than ever. Nothing is typical anymore. We don’t just fight fires and make medical runs. We ourselves are targets now. As the stress mounts, if we do not have a constructive outlet for dealing with traumatic events, we are going to be losing good people who, had they been able or willing to avail themselves of CISD, may have been able to overcome the effects of an event and remained to serve long, healthful, and fulfilling careers.
Thomas Dunne, deputy chief, Fire Department of New York
Response: We established a CISM program a number of years ago. In a traumatic event a “crisis team” may be activated to provide psychological support to our members. The team is a group of predesignated department personnel who will generally meet with firefighters immediately after an exceptionally stressful incident.
Such incidents would typically include the death or serious injury of an on-duty firefighter or an operation that involved numerous civilian fatalities (such as the Happy Land Social Club fire in 1990, which killed 87 people).
The request for a crisis team response may come from a chief or a company officer. This team is geared to deal with a relatively small group of people. In addition, all firefighters have the option of pursuing individual counseling.
We also maintain a full-time counseling unit. Both the paid and volunteer personnel of the counseling unit performed exceptional work in helping our department through the devastating losses we suffered on 9/11.
The fire service must bear in mind that even under “normal” conditions our work involves continuous exposure to human trauma. Developing a detachment from all this death and suffering allows us to maintain our professionalism and to operate effectively.
At the same time, the strain of this dichotomy can sometimes be the source of problems for our firefighters. Years ago these would have been alien concepts to many of us. However, in the post-9/11 world, every department should establish some form of psychological support for its personnel.
Craig H. Shelley, fire protection advisor,Ras Tanura Area Fire Protection Division
Response: Our department is part of a much larger corporation, which is a leader in the oil industry. The company operates a large full-service hospital as well as smaller clinics throughout the area of operations. Some of the services provided by our medical organization are psychiatric and mental health care. Trained CISM personnel are available in case they are needed. The fire department can contact our medical services and request a response. Recent events have activated such teams for the medical staff at our hospital after a major incident.
My first experience with CISM was after the Oklahoma City Bombing response. While returning from the incident, our task force was delayed at a military airbase because of a fire onboard our transport plane. During the layover, I wandered into a building that happened to be a CISM center for military personnel participating in the recovery efforts at the Murrah building. I had a long (and much needed) talk with a professional counselor during my wait for a new plane to be brought on-line. This counselor was instrumental in preparing me for the greeting with my family. He told me some things that my daughter might be experiencing after she had watched constant news coverage of the “children in the day care.” He gave advice on how to interact with my wife and when and how to talk about my experiences. This counseling was invaluable to me.
On return, the entire task force was mandated to attend a CISD prior to returning to work. I feel that these debriefings and counseling sessions should be mandatory. Many of our firefighters feel that it is not needed, but certain feelings and experiences can remain under the surface and affect our lives as well as our families.
Gary Seidel, chief, Hillsboro (OR) Fire Department
Response: We have a CISM program that includes defusing/debriefing our personnel. Our CISM members our part of a countywide network of resources, which when requested can respond if needed. One of our CISM members also serves as our department chaplain.
We use CISM to educate, prevent, or mitigate the effects from exposure to an unusual event. Our program includes preventive, educational, and informational programs for our employees and, if needed, their families. The program includes on-scene support, advice to the incident command, formal debriefings/defusings, resource referral services, family/significant other support services, emergency management support, support to EAP programs, and community awareness.
Any member who feels the need for defusing or debriefing may request activation of our CISM resources through the company officer or the on-duty battalion chief.
Keith D. Smith, chief, Westfield Washington Township (IN) Fire Department
Response: Our department does not have training for CISM but has easy access to a neighboring team.
That team would be activated for a serious firefighter injury or a fatality, a serious civilian injury or a fatality (especially if children are involved), and special circumstances or at a firefighter’s request. Special circumstances might involve vehicle accidents, which was exactly the case last winter when a car went off the road and we responded. The victims were pierced by a fence rail; the scene was grisly. Our on-scene officer asked for a stress management team. Use of a CISM team is a personal matter, and the department was told the team would become involved only with job-related stress. Counseling for stress issues outside of or not related to responses is done at a wellness center.
Jeffrey Schwering, lieutenant, Crestwood (MO) Department of Fire Services
Response: My department, the St. Louis City Fire Department, and departments in St. Louis County and surrounding counties have access to the regional CISD team, which is activated through Central County Fire Alarm.
Our fire chief would request the team for any incident that has the potential of adversely affecting our firefighters mentally and physically. The CISD team gives our firefighters a way to deal with situations such as vehicle fatalities, fire fatalities, or criminal incidents. We have used the team in the past with positive results.
With 42 fire departments in St. Louis County alone, the CISD team is a tool in our toolbox that can and needs to be put to use to take care of our own. It is not uncommon in today’s world of mutual and automatic aid to have more than one department involved in an incident where the CISD team is requested. The team must be taken seriously by all entities involved, to ensure all members’ mental and physical well-being.
Bill Sault and Bob Feeney, captains, Toronto (ON) Fire Services
Response: We have been involved in our department’s CISM team for several years as volunteer peer counselors. There are presently about 25 members of our joint EAP/CISM team.
Our team is 100 percent volunteer, made up of active and retired members of the Toronto Fire Services and representatives of most divisions and support sections of the department. Our IAFF Local #3888 and the administration endorse and support us, but we work at arm’s length from both. This apparently makes our team unique in emergency services.
Activation of the CISM team is normally through the chain of command. We are traditionally contacted by the district or platoon chief or communications, depending on the situation. However, anyone can request CISM intervention.
We recommend that firefighters go through the chain of command as a courtesy to their fellow crew members to ensure that everyone who may potentially be in need of assistance is aware that support is there.
Once requested, we can usually have a team on-site within a few hours. How many team members respond depends on the nature of the situation and the number of firefighters involved. Normally, we respond only to specific requests, but we would offer our support in certain circumstances that include child or infant fatalities, multiple traumatic fatalities. and the death or injury of an on-duty or off-duty firefighter.
We have access to a health professional. Our department’s coordinating chaplain is also a psychologist, so our training is now done in-house for both the employee assistance program and CISM.
Bob Zoldos, captain, Fairfax County (VA) Fire and Rescue Department
Response: We believe that the successful management of critical incidents involves an inclusive approach to managing incidents and the resulting stressors.
Department personnel who experience a distressing emotional reaction after responding to an incident qualify for CISM assistance. Although different incidents create different reactions, the following are some examples of incidents that may be appropriate for CISM support: the serious injury or death of a department member or other emergency personnel working at or en route to an incident; mass casualties; suicide involving a member of the department; a serious injury or the death of a civilian resulting from department operations-e.g., collision of emergency units responding to a call; death of or violence to a child; loss of life following extraordinary and prolonged expenditures of physical and emotional energy during rescue efforts by department personnel; incidents that attract unusual or extensive media coverage; and incidents in which circumstances are unusually bizarre or trigger profound emotional reactions.
The goal of our CISM program is to minimize the emotional impact of significant incidents on department members. It is designed to aid the firefighters’ resistance to this type of stress; prevent harmful emotional effects or acute stress disorders by intervening immediately after an incident; and prevent long-term effects, such as post-traumatic stress disorder, through the use of follow-up care and employee assistance programs.
Thomas E. Linnenkugel, deputy chief of training, CyFair Volunteer Fire Department, Houston, Texas
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Response: We have access to an established and well-respected CISM team, Blue Bonnet Assistance Center, when it is available. We also have access to a CISM team and chaplains from Fire Fighter Ministries, Inc. Wendy Norris, the ministry founder and president, is part of the Texas State Firefighter and Fire Marshal Association LODD Task Force. She has prepared and teaches the LODD classes statewide and assists with teaching CISM techniques.
We recently called for a debriefing following the death of one of our own killed in an off-duty vehicle accident. Some of our first responders as well as the ambulance crew knew this young man very well; they had recently graduated from the fire academy together. Additionally, Norris was available for some one-on-one counseling a few days later.
Fourteen department members are trained in basic CISM techniques and are working to complete the advanced course. They are available to do peer counseling and immediate defusing and are aware of the signs and symptoms of stress/distress and can advise the command staff of the need for further intervention. Our command staff understands and appreciates the value of CISM and will not hesitate to obtain the help our members need.
Paul Stewart, division chief-training, Central Kitsap Fire & Rescue, Silverdale, Washington
Response: All fire departments in Kitsap County have access to a CISM team. This team is composed of fire service peers from the various fire departments within the county. It takes about 24 hours to set up a debriefing.
The deputy chief can activate the team. Any firefighter can request a CISD immediately after or even during an incident. We have an informal crew meeting immediately to determine if the full CISD team is needed. If it is determined that the team is needed, a date and time are established as soon as possible, and attendance is mandatory for all personnel involved in the incident. Only personnel involved in the incident and the CISD team leader are permitted in the meeting. The team leader is always someone from another department who had no affiliation with the incident.
We’ve had good success with this system. I would highly recommend that jurisdictions without a system in place establish one as soon as possible. It’s too late to set up a team after the incident occurs.
Lindsay Gorrie, deputy captain, NSW (Volunteer) Rural Fire Service, Hawkesbury City, NSW Australia
Response: We have a very active and readily accessible CISM team. The members are firefighters or closely allied with firefighters-that is, in communications or other support groups. All team members have basic firefighter training and undergo extensive training and mentoring before being allowed out on their own (a couple of years total), ensuring that they don’t do more damage than good on their first outing.
The team can be called for by the individual firefighter, a deputy captain (crew boss), or a brigade captain (station boss). Activation is automatic when a crew responds to a motor vehicle accident or a structural fire involving a fatality. The team is usually also routinely activated when the results of the fire or accident are “messy.”
In the cases mentioned, team members do not come from the same area as the firefighters-no personality issues can color the session(s).
The team has also been used to diffuse the post-burnover tension caused by the near misses experienced in a wildfire. These sessions are frequently run on the fireground by the local team member(s) immediately after the incident. With the changing conditions, this sort of situation is increasing. Of the three incidents I was involved with last year, two as a firefighter and one as a crew boss, two were handled in this manner to great effect. The third was not, and some crew members who responded on that day have found it hard to come to terms with what happened-nothing fatal, just extremely stressful.
In the early days, it sometimes was found that the debriefing methods left bigger wounds than doing nothing at all, but improvements in the methods used have led to much better responses and results. The average age of our firefighters is dropping (around 23), leading to a decreased availability of “life experience,” and there are many more female firefighters (around 30 percent), who occasionally are not prepared for the type of emotional hit experienced on the fireground. If these people stick around after a bad season, they make damned good firefighters, so the more that is done to assist their passage from greenhorn to experienced firefighter, the better!
Overall, I would say that I am very comfortable with the knowledge that the team is there should it be needed.
Scott Worth, captain, Austin (TX) Fire/Rescue
Response: We have our own CISD team within the department. A department member or an officer can activate it if we see signs and symptoms that warrant it. We also have in our SOGs certain situations that require team activation, including critical injury, death of an infant, or multicasualty incidents. Our team has employed the services of a psychologist to assist in debriefing.
Lance C. Peeples, instructor, St. Louis County (MO) Fire Academy
Response: Firefighters in St. Louis County have a CISM team available to them. It is comprised of peers and health care professionals who volunteer their time. Each fire department in the county has its own administrative procedures for activating the team. Typically, the team might be activated for incidents such as the death of a firefighter, death or a mutilating injury involving a small child, or multiple-victim incidents. Most experienced firefighters manage to develop coping mechanisms that help them to deal with the routine emotional trauma they face on a daily basis. However, officers must be alert to those extraordinary circumstances that might require more than just hashing it out around the kitchen table. Considerable effort may have to be exerted by the leaders in the fire station to prevent any stigma from being attached to participation in such a program. The days of abusing our lungs by breathing smoke should be long gone; so should the days of abusing our mental health by misplaced machismo.
Bobby Halton, chief, Coppell (TX) Fire Department
Response: We have four members trained as defusers and debriefers. We also have access to professional counselors from Dallas County. We are very aware of the need to provide quality services to our members for a variety of mental health services. CISD and other mental health services, such as Mental Aspects of Performance (MAP), are part of our mental wellness program.
Our department has at its core a fundamental mental health belief, based on the experience of firefighters from around the country, that strong support networks are the key element. These networks-family, religion, fellow firefighters-are the most important aspect to maintaining one’s mental edge. We support all of these networks, and we believe that we are our brothers’ and sisters’ keepers.
CISD is and will always be all about strong firefighters being aware of where they work and how it can affect them. CISD is about keeping strong, tough firefighters strong. The old image of CISD as soft and whiney is over. CISD is another way we ensure we are always the best we can possibly be for ourselves, our families, and our customers.
Jeff A. Welch, reserve firefighter, Coeur d’ Alene (ID) Fire Department
Response: Our organization has access to a CISM team. The team in our area is very active (relative to requests for debriefings) and covers a very large geographic area. Anyone in our organization can activate the team or request a debriefing by going through proper channels. Management takes a request for CISM services seriously and supports its personnel, including those who may not be affected.
It is also the officers’ responsibility to monitor their crews and ask questions whenever they feel an incident may warrant team activation. As a supervisor, it is also absolutely crucial that you talk to your crews prior to this type of incident. Let them know that during their career, there is a strong possibility that an incident may warrant activation and that even though a response today did not warrant a debriefing, that same type of response may warrant one in the future, depending on stress or personal wellness. ■
