Experienced EMTs, paramedics, firefighters, officers and chiefs have all been on difficult calls and should appreciate the need for critical incident stress debriefing (CISD) immediately following such an event. But as we discuss behavioral health issues in fire and EMS, we also need to understand that the trauma experienced by a firefighter or paramedic can be both immediate and cumulative. Equally as important, what triggers that trauma can be response-related or even driven by a seemingly unrelated personal event.
Here’s a personal example. When I was starting out as a much younger firefighter/EMT, our department on weekends began using the services of a National Guard Huey med-evac helicopter as a means of managing the “Golden Hour” for severe trauma injuries. The rotors on a Huey have a characteristic “chop” sound, familiar to all of us who served in the military, especially those who served during the Vietnam Era.
For years, every time I heard that distinguished rotor sound, for a brief instance, I had to remember where I was, what I was doing, and most of all that I was “home” and not back in Vietnam. Over the years, that reaction faded, but I share that example when I talk to other brother or sister firefighters who are managing their own trauma.
Now, add to all of this the effects of COVID-19 responses where isolation doesn’t allow us our normal “bedside manner” with our patients, and responders can seem more robotic than human. (Read next: ‘Please, may I see your face?’: Connecting with patients during COVID-19.) The result is a building stress that can mirror cumulative trauma.
The chief’s role in managing trauma
What can we do, first as chiefs, to help in these instances when our crews have faced a difficult or even disturbing response?
If the department has access to a CISD team, a team counselor should meet as soon as possible with the affected crew, even if it means taking that crew out of service or holding them over at the end of shift.
Ahead of that response, a chief also has to convince their elected officials, whether yours is a career, combination or volunteer department, that access to an Employee Assistance Program (EAP) is essential, not only for your firefighter/paramedics/EMTs but also for your local police agency. This gives a member the ability to privately discuss the incident and the related trauma and its effects at a time and place that is private for them.
In addition to setting up the availability of both CISD and EAP, providers/firefighters need to know that you, as their chief, and the department as a whole, do not and will not attach a negative stigma to an individual who seeks this assistance.
Field officer roles
What about field and company officers? I’ve written recently about how company officers are perhaps the most vital link in this or any process in a well-run fire and EMS department. A good company officer takes care of the needs of their people, while a great company officer anticipates those potential needs as they observe any subtle changes in the attitude or behavior of their people on a day to day basis, with or without them having experienced a traumatic incident.
Firefighters and EMS providers, too, can play an important part in this equation as peer-to-peer discussions and examples can help a newer member through one of these difficult responses.
Offering your help
Recently, a neighboring department had an exceptionally traumatic day. In the course of eight hours, they had a non-breather call for a 1-year-old, a “stand-by” at an extended SWAT stand-off and, lastly, an adult patient who died almost instantly from the trauma of being hit by a fireworks explosion.
Their chief, who also responded to these incidents, called for a CISD representative to talk and debrief his crew. But what of the chief?
I called him a few days later just to chat and find out how he was doing. I’ve done that on occasion because several years ago, I had two of my firefighters fall approximately 30 feet from a roof ladder and both were taken to a trauma center in critical condition, with one not expected to live.
A fellow chief called me almost immediately and not only offered his help to me, but also suggested that I take that station out of service for 36 hours and he would supply both apparatus and personnel to staff our station. The chief of another department where my son was on duty sent him to be my aide-de-camp for the rest of his shift.
I was overwhelmed and quickly accepted both offers, which gave those of our officers and firefighters closest to the injured a chance to be at the hospital to support each other and the firefighters’ families.
It also gave me a chance to plan how we would proceed as a department after that incident, including deciding early on to have an in-depth study and report of the incident that included research into metal roof ladders on metal roofs. The resultant study of that extensive research was published in the February 2005 issue of Fire Chief Magazine under the title “Metal on Metal.”
Fortunately, both firefighters survived, and one is still an active career firefighter at another department, while the second remained many years as a paramedic on our department before retiring.
I will never forget the caring shown by those chiefs who more than stood by me. Since then, I’ve tried to pass on such favors to other departments in need or if by nothing else, by making a phone call to another chief who may need to talk and occasionally vent their own feelings.
Fit for duty – in every sense
While we are now emphasizing both physical and behavioral health in the fire and EMS service to overcome some long-term effects, including heart attacks and suicides, both issues have been with us for as long as there have been firefighters, EMTs and paramedics.
What we really need to do is shed our stoic façade and begin to create a culture where both physical and behavioral health needs are embraced by the chief down to the newest recruit, and to have chief officers who aren’t afraid to set the example by being physically and emotionally fit for duty.
Stay safe!
