|
Fatal fires and horrific crashes can take a physical toll on first responders. But what’s your plan for the mental anguish that can also follow? By Rory J. Thompson
After most calls, you back the rig into the barn, clean and re-pack your gear, and get ready for the next run. But what do you do after a call that’s not typical, where people have died and your crew has been clearly shaken up by what they’ve seen and had to deal with?
“We had a car wreck one night and we could not avoid using one of the [dead] victims, who was around the tree, as support for the rams,” recalls John Mirando, who was 2nd Assistant Chief at the time of the Rockville Centre Fire Department on suburban Long Island, NY.
“As we opened the rams it crushed his chest flat with the tree until it opened the car enough to extricate the two other living – but in serious danger of dying – victims,” the ex-chief recalls.
“Several of our members did not fare well after this,” Mirando remembers. “The Captain of the Rescue Company arranged for professional help, which was available to help several members cope.”
While the chief did the right thing at the time in working to get the surviving victims out and to the hospital (they both recovered), in doing so his men were exposed to something they couldn’t possibly have imagined as they approached the scene.
“One thing I remember was that the people back at the firehouse afterwards who seemed the most affected were the ones I had to worry about least,” Mirando says. “They got it right out of their systems that night; they showed their emotions when it was over. The more serious problems were with those who walked away seeming OK, but it got to them once they were by themselves. As a result, it lingered longer for them.”
The former chief of the 345-member department realized that night what a lot of other Incident Commanders (ICs) need to learn.
Voice of Experience
“Fire officers have to think about CISD (Critical Incident Stress Debriefing) for all people involved in a fire or rescue scene,” says EMT Tim McAteer. “The people directly involved are important, but sometimes the firefighters who have jobs that force them to stand and watch the scene can be affected even more.”
McAteer should know. He’s an on-call Communications Technician and an EMT-CC with the government’s new Department of Homeland Security. But a few years back, he worked for the U.S. Public Health Service on a disaster medical assistance team, and was one of the first medical people on the scene at Ground Zero on September 11, 2001
“We saw people wandering around like zombies,” he says. “There was one government employee who had seen both planes go into the towers; he wandered around the scene for two days without any type of help or support. We got him to a field hospital and got him counseling right away. We gave him numbers to call for follow-up help,” says McAteer, himself a former fire department Rescue Company captain.
With all the material and rules they need to know about these days, Incident Commanders should be aware that the National Fire Protection Association already has established guidelines for dealing with CISD. Gary Tokle of the NFPA points to his group’s written guidelines that all chiefs and ICs should know about. In the publication’s Fire Protection Division, section A.12.1.2 states: “Fire fighters frequently experience trauma, death and sorrow. Critical incident stress is a normal reaction experienced by normal people following an event that is abnormal. The emotional trauma can be serious. It can break through a person’s defenses suddenly, or slowly and collectively, so that the person can no longer function effectively. Critical incident stress is the inevitable result of trauma experienced by fire service personnel.”
So what can a leader do to help his members cope when they’ve seen or experienced something particularly jarring?
Dr. Ray Shelton is the Clinical Director for the Nassau and Suffolk County (NY) Traumatic Incident Stress Program. His office helps EMS workers after they’ve been involved in a stressful incident.
“What we do is very basic,” Shelton says. “Take a shooting situation, for example. The critical incident team is mobilized. We send two peer counselors to educate the officer. We give him solid information to deal with the problem; we’ll move him into an EAP (employee assistance program) if that’s what’s called for.”
Shelton says his office also holds informational support briefings. “Basically we tell them, ‘This is what you’ve been through, this is what it can do to you;’ This empowers folks to get to a better spot; it opens doors for them.” And, he notes, “Lots of folks deal with it effectively.”
HEADS UP
Dr. John Schorr agrees with Shelton that early intervention is best. Schorr is a professor of sociology at Stetson University in DeLand Fla., and is also a Fellow for the National Memorial Institute for the Prevention of Terrorism, which is federally funded by government’s Homeland Security Department.
“You have to start before the tragedy,” Schorr says, in identifying problem areas to be addressed. “There are things you need to do: for example, pay attention to the internal issues of the Fire Department beforehand. When you respond to something really big, with lots of trauma, sometimes some divisions that existed beforehand will be suppressed. Afterwards, they may well come back and cause organizational problems.”
Schorr speaks from experience. He was part of the team that spoke with and counseled first responders following the attacks on the World Trade Center and the Pentagon, as well as talking to rescue personnel who responded to the United Air Lines crash in Shanksville, Pa., on September 11.
“Administrators need to think [in advance] about how they’ll use their staff,” Schorr says. “Most first responders will want to respond. How do you assign who gets to go, and who stays behind to handle routine calls? Include as many as you can; don’t exclude people. As we saw at Ground Zero, they all want to work”
But what about dealing with firefighters after the fact? “You have to monitor the long- and short-term mental and behavioral health problems that may emerge,” Schorr says. But he does note that firefighters tend to be resilient. “In Oklahoma City [following the bombing of the Murrah building], firefighters were less likely to develop problems because of their resiliency and social support, which comes from fellow firefighters and their families.”
Still, there is much that commanding officers can – and should – do before they’re ever faced with a devastating trauma in their department.
“They key in dealing with the after-effects of trauma is in finding someone the firefighters have trust in and the confidence to talk with; They key is in utilizing someone they know,” says Dr. David Baron.
Baron has experience in dealing with traumatic events firsthand. Back in the 1980s, he wrote a detailed scientific paper about the stress issues faced by police officers in Los Angeles. He noted that cops who had been through traumatic situations experienced “lots of denial, marital discord, and they suffered from PTSD (Post-Traumatic Stress Disorder),” he says.
Baron, the Chairman of the Department of Psychiatry and Behavioral Health Sciences at Temple University’s school of medicine in Philadelphia, has seen it all.
“If you take 10 different people exposed to the same incident, you’ll get 10 different responses,” he says. “For example, a week later, some will be OK, but even five years later, others will still be hurting. It all comes down to biological differences, and how people deal with the trauma.”
Signs of Distress
Baron says there are a number of overt and subtle signs that chiefs should watch out for following a traumatic incident.
“Some of the classic signs [of PTSD] are people looking or being more tired, or forgetful. They start making silly mistakes,” Baron says. “This is the result of just not getting a good night’s rest. They start coming in late; using up more sick days.”
This can be a real problem in a firehouse, where everyone needs to be at the top of their game. “They’re under stress and hence are more prone to physical illness,” Baron notes. “Some victims may be suffering from ‘short-fuse syndrome’; little things set them off,” he says. And it can get worse: “They display subtle changes in their personality. For example, a guy who used to be a kidder is suddenly now real serious all the time.”
Such notable changes can affect everyone on the team, and as such must be dealt with. “The impact of the incident makes them enjoy their life less,” adds Dr. Tom Demaria. “They sometimes drink too much, they get edgy with their family; It makes them more vulnerable at another call.”
Demaria is a clinical psychologist in private practice, and the Administrative Director of Behavioral Health Services at New York’s South Nassau Communities Hospital. He is also a team leader with the Nassau County Red Cross Disaster Mental Health trauma counseling program. While he believes counseling can be very helpful, he says that the help must be geared toward the individual.
“There is some controversy over who benefits from a formal debriefing,” Demaria says. “Given the option of being in a formal process or individually, firefighters seem to benefit from being with their brothers. You have to be flexible.”
But Demaria agrees with Dr. Baron that there are obvious signs to look for in stress victims. As just a few examples he cites, “Sleep problems, numbing (not feeling anything), and a robot-like existence; they become the ‘walking wounded.’” And it only gets worse from there.
“In more formal PTSD, they have flashbacks and intrusive thoughts. They experience distressing dreams, nightmares, and they see for themselves a foreshortened future; that is, they start to live for the present only,” he notes.
Demaria also says that the most obvious problem is also the biggest one:
“The No. 1 thing to watch out for is use of alcohol,” he says. “It stops the memories from being processed in the brain, and it affects sleep. Sleep and dreams are important in that they help the mind process, or work through the event. Sleep deprivation caused by alcohol retards the memory of the whole event,” he says.
In spite of the macho culture of the firehouse, it’s important that chiefs recognize the importance of getting help for their people sooner rather than later. While some may be resistant to such help – Dr. Baron notes that denial is big, and many depressed firefighters are urged to “Just suck it up” – there are others to think about.
“Family members living with those suffering from PTSD feel a sense of abandonment,” Dr. Demaria says. “If they’re resistant to getting help, we tell the firefighter, ‘If you don’t want to do it for yourself, do it for your family.’
But the most telling comment of all was heard by Stetson University’s Dr. John Schorr, who worked with the firefighters in Shanksville, Pa., after Flight 93 crashed there on 9/11. When he was wrapping up his work, Schorr asked the firemen what, if any, lessons could be gleaned from the crash and the ensuing cleanup. Schorr says “The firefighters told us: ‘The most important thing to realize is that big things can happen in small places.’” ]
Rory J. Thompson is a veteran firefighter who writes frequently about the fire service. He can be reached at roryjohnthompson@yahoo.com
| 
Trauma, After the Fact 