By Jacob W. Dowd
Facing a traumatic death in the emergency services is inevitable. How we as firefighters choose to deal with it is a something we have to ask ourselves. If you’re a company officer, it’s your responsibility to ask your crew after a traumatic call if they are OK.
When I hear about suicide, substance abuse, disassociation from friends and family after traumatic calls, or post-traumatic stress, it hurts me to my core. People smarter than me have been trying to figure out how to help responders cope with what they see daily; however, most of the time, we are not willing to seek professional help when we are feeling low or having a hard time. Sometimes, it might just take the officers/leaders to step up and ask the right questions so that if there is a problem it is recognized and can be addressed so we stop suffering alone.
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- UNDERSTANDING POST TRAUMATIC STRESS DISORDER
In 2009, I began my career in emergency services. I sat through my EMT-Basic class with wide eyes and open ears as my instructors told stories and taught me how to save lives in the event of some tragic incident that was inevitable when I got on the “street.” I remember hearing stories from these instructors that stayed with me: There was the 16-year-old who just got his license and hit a tree, killing him and his three friends on the way home from a party. Then there was the time they did CPR on a mother and two infants who had been shot in a drive-by shooting during a homecoming football game. Those were just two of many “war” stories that they would tell us as we moved onto the trauma and triage section of the class.
Looking back, it seems like most of the stories usually resulted in death; even though we were told how the first responders tried everything they could to save the poor souls lost, it always ended poorly. This was my introduction to a career that I was, and still am, passionate about.
Going into the fire academy, we would constantly be taught how to search rooms, locate victims, and then remove them from the danger. We went through every scenario: We pulled “victims” from mutilated cars, burning buildings, collapsed structures, high-rise buildings, farm equipment—all scenarios my fire instructors had been involved in on the “street.” All of it was amazing, every rescue we made in rookie school was a success, and every time the class came together and saved a victim was a win. The only thing that we didn’t think about was that the “victims” we rescued were always plastic dummies. I took notes in class and never really gave a second thought to the fact that my instructors, some with 30-plus years on the job, were trying to prepare us for what we were about to experience.
I was alone on Engine 44 as I rounded the corner of a well-known sharp curve on Wiley Lewis Road. Here I was, a young volunteer jumping out of the driver’s seat at 1:00 a.m., smelling the tell-tale smell of gas, oil, and air bags. We frantically set up the scene lights to illuminate the area and saw an overturned car with the motor in the nearby yard, gear shift still intact. People were gathered around the overturned car, screaming. Never in my life had I felt a rush like I did that night. What I had been taught in the academy came flooding back to me: scene lighting, cribbing under the car to stabilize it, deploying the cutters and spreaders, and stretching the hoseline in case of a fire. Other members showed up, firefighters with years on the job whom I wanted to impress. In my mind, this was it—I was going to be a part of saving a life, snatching someone from the jaws of death.
As crews continued to show up and started to go to work, I was eagerly prying at the driver’s side door with the spreaders, saying, “Hang on, buddy, we are going to get you out!” The door gave that loud pop as the Nader pin broke free from the latch. We reached in and pulled out the lifeless body of a young man about my age, with an open skull fracture, and laid him on the ground.
Being the eager new member, I reached down; felt for a pulse that was absent; and, just like in training, started CPR. Half of this young man’s head was gone. He had left this world and there was no getting him back. All the “salty” members knew it, but they let me continue anyway. This was my first traumatic fatality as a firefighter, and this was not a dummy; this wasn’t EMT class or the fire academy.
Leaving the scene alone, I questioned my actions, wondering if I did everything right. I went back to the station, parked the rig in the bay, and went to bed with a heavy heart. I still have not forgotten his name or that his mother was one of the people gathered around the car. I also never got a call from any of the other firefighters there.
Time has passed since my first traumatic incident. I was hired as a full-time firefighter in 2011, and I have run many calls that have had positive outcomes. Over time, I moved from an engine company to a ladder and then to a rescue company. On the rescue, our main call volume consists of motor vehicle accidents, structure fires, and everything in between. Being sent to the rescue was a reality check. Going from seeing traumatic death occasionally on the engine and ladder to seeing it almost every other shift on the rescue was tough.
The captain I was assigned to was one of the hardest, funniest, “You better do your job or else” people I had ever met, but he was always fair. On every call, whether it was a simple service call, a multiple-fatality motor vehicle accident, or a three-alarm fire, he would always make it a point to look at every one of us and ask if we were OK. We’d always answer we were OK; sometimes, we were too hesitant to say, “No, we aren’t.” He could always tell if something was “off” with one of us, especially after a bad call, and many times he would wait until the others were out of earshot and he would listen to whatever was on our minds. I know he did it for me, and I am certain he did it for the others on my crew. More often than not, you’d leave the room laughing, and your mind was at ease.
Tips for Talking to Your Crew
Now, as an officer, I find myself faced with this same challenge of seeing my crew members not acting like themselves after a traumatic death call. As officers, we have to pay close attention to our crews to make sure they are dealing with the stress properly and, more importantly, we have to know how to initiate the conversation of checking on our people. Following are some tips for talking with your crew members:
Ask your crew members if they are OK. This sounds simple, but just like the captain who helped guide me multiple times, this simple question can go a long way. When you ask this question in the truck even before leaving the scene, you are opening the chance for a conversation in the truck. You can call this conversation a “debrief.” This is also a chance for you as an officer to look for nonverbal cues, such as prolonged eye contact or lack of eye contact, that indicate something isn’t right. This simple question opens the door for your crew to come to you later to talk one-on-one if they are having a difficult time with a call.
Tell your crew members they did a good job. This is not one of those “every kid gets a trophy” statements. When dealing with these often-horrific scenes, it’s important for your crew to know that they did the job that they are there to do. I know there are going to be hiccups on a call, and sometimes things don’t go as planned. You can address the “mess-ups” later, but it’s equally important to remind them they didn’t cause the incident but were there to help when needed most. Letting them know that you appreciate the work they did goes a long way when dealing with these traumatic events.
Don’t be a one-upper. When members of your crew come to you to talk about an incident, let them do the talking. You’re there to listen and let them get out what is bothering them. One of the worst things you can do is interrupt them and say something like, “Oh, you think that was bad? This one time I had to …” followed by a “war” story of your own. Let those who come to you get out what they need to get out. Silence can be golden for an officer when your crew needs to vent about what they just saw.
Don’t be pushy for someone to talk. All of us deal with things in our own way. You may see crew members not acting like themselves immediately after a call; however, after you ask them if they are good, if they say “yes,” just give them some space. Nobody wants to be forced into a conversation they are not ready to have, and if they can get back on the truck and run the next call, let them have some time to reflect to themselves. Just letting them know you are there if they need you can be enough.
Keep the firehouse/EMS base fun. You control the tempo of the firehouse/EMS base. After one of these traumatic events, especially the next shift, think outside the box to keep your crew from sitting around thinking about the things they have seen or had to do. Training can be fun and enjoyable, but there are other ways of breaking up the tension in the station. You’d be amazed by the fun you can have turning a drop tank into a firehouse swimming pool. Keep your crew happy, and they will be better for it. Idle minds tend to go to dark places.
Know when to ask for outside help. Most departments have contacts of groups or professionals who can assist members who are having a really difficult time in dealing with things they have seen on the job. Whether substance abuse, depression, or suicidal thoughts, you as an officer are in the position to recognize when something is out of your control. Familiarize yourself with these resources. They can really help your crew if things start to build up for you or them; make sure they know this resource is available.
Remember, your end goal as an officer is to make sure your people are taken care of. Making sure we all go home in the same state we came into work that day is what we should all strive for. Everyone on you crew has their own life outside of work; it’s our job to preserve that and not let anyone suffer alone.
Jacob W. Dowd is a captain with Guilford County (NC) Emergency Services Squad Company 250. He has technical rescue, hazmat technician, water rescue, breathing equipment school, TIC school, fire officer ll, and instructor II certifications.
