Wednesday, November 4, 2015

FF Nation: Fundamental of Stress in the Fire Service: Look, Firefighters Die. Smart Firefighters, Brave Firefighters..


Stress in the Fire Service

Protecting the mental health of fire department personnel

By Matthew Tobia 
Published Monday, June 1, 2015 | From the June 2015 Issue of FireRescue
There are fundamental rules in emergency services: Rule #1 is people die. Rule #2 is sometimes you cannot change rule #1. Although the rules transcend our control, it does not mean that we accept them easily. We carry our losses far more strongly than our saves and the biggest challenge, perhaps, comes in living with the rules—and their impact.
Firefighters are witness to tragic and painful events. Such events are shocking, excruciating, and never forgotten. Throughout our history, there has been an expectation that being a “strong” firefighter has meant ignoring the tremendous toll such events exert on us physically, mentally, and emotionally.
Stress Management
One of the early models of CISM used a broad brush of intervention to help personnel without singling anyone out. Immediately after a “bad” call, emergency responders were placed in a room and encouraged to talk about their observations and feelings in the hopes that such “defusings” would decrease the internalization of emotions that had the potential to lead to post-traumatic stress. The intent was excellent in that it opened a door for us to talk about stuff that we had previously perceived as taboo. Unfortunately, it had the unintentional consequence of exposing fellow responders to stress that they did not experience directly.
Viewing an identical incident through the prism of another responder’s eyes had the potential to create problems where none had existed. Unprepared, some emergency services personnel walked out of defusings feeling worse than when they walked in. CISM teams figured this out and adapted their model of interaction by making themselves available to specific responders rather than adopting a one-size-fits-all model.
Changing Programs
Today, new models are gaining popularity and show promise as the next generation of behavioral healthcare. We should never forget, however, our past. In an effort to extol the virtues of new programs, there have been attempts to indict the CISM model as injurious and numerous CISM teams across the United States have been disbanded based on limited research. Such action is actually having the unintended consequence of leaving many emergency responders with nothing. The challenge is that the perceived negative effects of CISM have caused its abandonment in advance of an effective alternative. Without CISM, some emergency responders have simply stopped seeking help until their symptoms have progressed from critical-incident stress to post-traumatic stress.
Continued Help
There are several important points. First, CISM programs should not be abandoned; they should be modified to ensure that peer assessors are trained to interact one-on-one with their counterparts and determine whether specialized help is needed. If help is needed, it should be provided by clinicians who possess the institutional credibility necessary to be successful. Second, programs like the Stress First Aid program through the National Fallen Firefighters Foundation should be fostered. Third, fire departments should adopt comprehensive behavioral health programs that are not only prepared to respond on a moment’s notice to a critical event but also provide education, training, and ongoing support in between critical incidents. More aggressive steps are necessary to recognize the devastating effects of alcohol and drugs (prescription or otherwise) as a destructive form of self-treatment in the absence of counseling support. Company officers must care so much about their personnel that they can recognize and intervene when necessary to save one of our own. Fourth, programs for responders need to help all responders: career, volunteer, paid on-call, and dispatchers (our first, first responders). From a strictly economic standpoint, the cost of workers’ compensation claims far outstrip the cost of a proactive program meant to intervene prior to the need for a claim. From a moral perspective, it is simply the right thing to do.
When a firefighter falls from a ladder and breaks his leg, we never hesitate to ensure that he gets the help that he needs. When he breaks his spirit, too often we leave him lying in the street—not because we do not care but because we do not know what to do. We can and must do better.

MATTHEW TOBIA 

  • Matthew Tobia is an assistant chief with the Loudoun County (VA) Department of Fire, Rescue, and Emergency Management and is a 27-year veteran of emergency services. He has a bachelor's of science degree from the University of Maryland and is a graduate of the EFO program. Tobia is the former chair of the IAFC’s Safety, Health and Survival Section and is active with the National Fallen Firefighters Foundation (NFFF) and the Mid Atlantic Burn Camp for Children. He can be reached at matthew.tobia@loudoun.gov.  Read Full Bio



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