Coping with Catastrophe
*This article written by Dr. Robert Smith was originally published in Fire Chief Magazine in December 2001*
The events of September 11th will prove to be pivotal in our nation's history. The shift in behavior and attitude that will take place in American society will have a significant impact on the attitudes and behaviors of firefighters and fire service managers.
In other words, the fire service will never be the same as it was prior to the attacks. as fire chiefs, we'll be forced to examine the way we conduct operations and how we take care of our brothers, sisters and families. Addressing the psychological and emotional care of our firefighters has become and important aspect of our mission.
The fact that the fire service is a caretaking profession has some bearing on this discussion. Firefighters are trained and socialized to respond to the needs of others, and this mission is an important facet of the firefighter's job. Individuals in other caretaking professions, such as nurses and physicians, also are trained to respond to the needs of others. We know that job stress and burnout are issues that people in caretaking professions should pay attention to. Consequently, we must place a higher emphasis on the psychological and emotional health of firefighters so they are physically and mentally prepared to serve the public.
New questions have developed and are being asked by fire chiefs in response to the attacks. How will we treat a high rise fire? How will we ensure safety on the fireground during a suspected terrorist attack? Will we handle hazmat incidents differently? It's important to note that questions like these now are emotionally charged rather than simply tactical. How can we take care of our firefighters' emotional, psychological and stress management needs as these tactical questions are processed?
Traditionally, fire departments have taken a response approach rather than a managment approach to stress. Often, we're slow to respond until something goes wrong. We send a firefighter to addictions treatment for a drinking problem, or we mandate employee counseling sessions when behavior is problematic. As a result of this strategy, firefighters are forced to resolve their problems in a time of stress while at odds with their employer.
Instead, a managment/prevention approach to stress could better serve the firefighter. Recent events have signaled a need to end the reactive approach. Fire service managers no longer have the luxury of waiting for a problem to occur before responding.
Stress Managment Units
The managment of firefighter stress is complex and multifaceted. The average firefighter encounters stress, not only from critical incidents but also from non-critical incidents, such as personality conflicts within the firehouse, family problems, common hardshops of a long tour of duty or the death of a family member.
My Global Fire Service Stress Managment Model strives to focus on all fire department stress rather than only focusing on stress that is encountered by exposure to a critical incident. As stress is cumulative, it doesn't matter if the particular stressor is critical inicident stress or other more routine firefighter stress.
For example, firefighters tend to be socialized as task-oriented perfectionists. Firefighters will encounter significant stress over failed equipment that hindered a rescue or a department policy that they do not agree with. In short, stress is stress - we can't overlook any of it. The Global Fire Service Stress Managment Model goes beyond Cricital Incident Stress Managment (CISM) and other models while integrating CISM as part of the package.
The Washington Township Fire Deparment Stress Management Unit was developed to address these critical and non-critical issues and to follow the Global Fire Service Stress Management Model. The model seeks to address difficulties early in the problem process, as early treatment is the key to effective managment.
Members of the Washington Township Fire Department SMU are trained in CISM; however, the central focus of the unit is the management of multifaceted firefighter stress. The SMU is composed of one clergy member and two firefighters who are licensed as mental health practitioners to act as trainers, supervisors and facilitators.
The SMU operates in a non-intrusive manner, and the call for response is often initiated by the affected fireighter or by their supervisor. The unit's response can provide support, as well as initiate a possible assessment for further mental health assistance.
The model has several areas of concentration, including stress education, mentoring, unit response guidelines, new recruit education, spiritual care, public relations and assessment. Education includes stress awareness/managment training for the firefighter as well as relationship skills workshops for spouses and families.
One example of the stress management component is the coaching of firefighter and spouse around the single-parent phenomenon of the fire service: The spouse can be left to parent the children without assistance from the firefighter during long tours of duty and beyond, especially if a part-time job is included in that time of absence.
Assessment is a function of the department SMU. All members meet for quarterly training and are introduced to basic stress management skills. The SMU in a fire department must address firefighter stress with an open-minded attitude.
However, the SMU must be a conduit to introduce firefighters into a mental health system that understands the specific needs of firefighters and their families. Too often, firefighters gain access to an unfamiliar mental health system that attempts to treat them like non-firefighters and devalues their coping mechanisms and loyalties. The SMU addresses and can improve this problem.
Pastoral care is an important aspect of the model. The Washington Township Fire Department has three chaplains; a rabbi and a minister who are certified firefighters and a Catholic priest. Members of our pastoral care staff are trained to function in both the pastoral care role and the peer counselor role. The peer training is important for pastors and mental health clinicians to become involved in and be accepted as part of the organization.
It's been shown that firefighters respond best to other firefighters, as they understand the built-in coping mechanisms developed by those in the fire service. Individuals who attempt to assist firefighters should understand the nature of the occupation and the cohesion of the group. Too often, firefighters are put off by a mental health professional who fails to understand firefighter coping methods. The helper must know how to enable these socialized methods.
Internal public relations is a very large consideration for the fire department SMU. Firefighters depend on the maintenence of confidentiality, loyalty and promt service of the unit. The connection firefighters experience with members of the SMU is tantamount to the unit's success. Unit members are very aware of their image with firefighters and are selected on their merits. The unit also functions as a dimplomatic arm of the fire department administration. Firefighters soon understand that the administration values their ability to function on the job without stress-related symptoms.
Unit response guidelines are an important consideration in the Global Fire Service Stress Management Model. The SMU has responded to conflicts in fire stations, in addition to being called on to assist hospitalized firefighters or firefighters on light duty. At times, SMU members provide a meal or transportation to another firefighter in need. These examples range from simple acts of kindness to the referral for more complecated mental health intervention. The goal of all responses is to enable proper coping and assist the firefighter in the reduction of stress.
New recruit education and firefighter mentoring are additional aspects of the Global Fire Service Stress Management Model. New recruits at the Washington Township Fire Department recieve training in stress managment and coping techniques as a part of their fire academy curriculum.
Each new recruit is assigned a mentor from the SMU. The mentors assist with orienting new recruits to their assignments in a manner that promotes development of appropriate coping techniques and good mental health awareness. In addition, they also teach many of the emotional mechanics of the fire service job. These include getting along with other firefighters in the new environment and the introduction of spouses and family members to the fire service circle.
Many interventiones exist to assist firefighters in this time of stress. The fire service must begin to recognize stress as a cumulative phenomena. Firefighters should learn in advance how to deal with the stress from critical incidents such as the ones in New York, Washington and Pennsylvania. Firefighters who respond to critical inicidents in a lower state of stress have a greater chance of sustaining psychological wellness and avoiding burnout during their career.
Critical Incident Stress Debriefing
A fire department plan for critical incident stress debriefing is essential in the wake of recent events. This should encompass two areas; lower-profile incidents and large-scale critical incidents.
Unfortunately, many departments don't have a plan for handling these types of large-scale incidents. Departments shouldn't depend on outside agencies alone to formulate this plan. A department representative should be involved in the planning stages because fire department managers know their personnel best.
Your department's plan for large incidents should include the following:
1) The lead mental health practicioner should be familiar with the firefighters of your department, their job roles and your organization.
2) The counselor or therapist should have exposure to the fire station environement and should build rapport with the firefighters in your department.
3) The lead counselor should have a license to practice mental health and access to the latest research about the mental healthcare of firefighters.
4) The involvement of a qualified CISM team is essential. The team should be fully trained, experienced and include other firefighters.
5) Firefighters are most comfortable talking to other firefighters. While others may be well intentioned, they may not have the same credibility as a CISM team composed of firefighters trained in CISM.
6) Department chaplains should be involved in the response to a large-scale incident. Fire chiefs should commission chaplains of firefighter-represented denominations prior to tragedy.
7) Fire departments should have stress related material available for both critical incidents and stress prevention. Departments should consider seminars and classes that address stressors other than critical incidents prior to a tragedy. Tragedies can be easier to handle if the fire departments adopt a stance of prevention.
8) Protocols should be developed to direct fire departments to assist families in the event of line of duty deaths or injury. Family care should eb considered when long deployments of firefighters are neccessary. Families could need extra assistance due to the combination effect of an absent spouse and the emotional hardships of worrying about their firefighter family member.
Your department can make a difference. We'll have better prepared and more effective rescuers if we work to reduce stress before large incidents.