Blog - The Raven Speaks

Managing Critical Stress: A First Responder’s Story

Thanks to Raven Rescue Instructor Jim Douglas for this piece addressing Critical Incident Stress Management.  Jim's background in critical care has led him to his current dedication to Critical Incident Stress Management.

When I ask myself, "how did I become involved in Critical Incident Stress Debriefing?” I realize that it was a culmination of my personal journey as a Paramedic over the last 30 years.

At a certain point, I realized that I had seen too many similar events along the journey of my career.  Too many co-workers had taken their own lives, were divorced or in dysfunctional relationships because of “the job", or had left the service because they felt they couldn’t continue in their chosen calling.

And at the height of all these premature deaths, broken marriages, and career-ending decisions, they continued to be seen as isolated circumstances.  They were not well-understood or, in some cases, even acknowledged.

I reached a watershed moment when I came to realize that this life I'd chosen had “changed me”. In many ways, I'd changed for the better - I had achieved a valuable skillset, and I had helped an immeasurable amount of people. But I'd changed in other ways too, ways that were not so good. 

You see, I’m an old Paramedic… or at least I was feeling very old a little while back. I’ve been involved in the prehospital and rescue profession for the last 30 years.  I started my career during a period of time when we didn’t have any support.  Seeking help resulted in ostracism.  It's not that way any more - I have witnessed first-hand how we in the rescue industry have finally learned to take care of ourselves and each other when it comes to Cumulative and Critical Incident Stress. 

I wanted to be part of that learning and that change.

Current Critical Incident Stress Management (CISM) science is well understood as an adaptive, short-term psychological helping process that focuses solely on an immediate and identifiable problem. It can ranges from pre-incident preparedness and acute crisis management to post-crisis follow-up.

Critical Incident Stress Debriefing is a specific technique designed to assist others in dealing with the physical or psychological symptoms that are generally associated with trauma, under the guidance of trained practitioners. Debriefing allows those involved with the incident to process the event and reflect on its impact. Ideally, debriefing can be conducted on or near the site of the event.

Defusing, a component of CISD, allows for the ventilation of emotions and thoughts associated with the crisis event. Debriefing and defusing should be provided as soon as possible, but typically no longer than the first 24 to 72 hours after the initial impact of the critical event. As the length of time between exposure to the event and CISD increases, the less effective CISD becomes. (Davis, 1993; Mitchell, 1988).

Research on the effectiveness of applied critical incident debriefing techniques in the workplace has demonstrated that individuals who are provided CISD within a 24 to 72 hour period after the initial critical incident experience have less short-term and long-term crisis reactions or psychological trauma (Mitchell, 1988; Young, 1994). Subsequently, emergency service workers, rescue workers, police and fire personnel, as well as the trauma survivors themselves, who do not receive CISD are at greater risk of developing many clinical symptoms. (Davis, 1992; Mitchell, 1988).

Critical Incident Stress Debrieifing and Defusing should not to be confused with the operational debriefs we often see among teams after a major event.  Exploring the operational side of the incident to obtain better knowledge on how to respond to future events is useful, to be sure... but not at all the same as a Critical Incident Stress Debrief.

First Responders have always understood the benefits of taking care of our physical fitness, but until recently we still didn't understand or have the tools to take care of our mental fitness to the same degree.

Thankfully, many organizations have taken steps to develop programs that support their frontline First Responders. CISM Programs have proven to assist responders to normalize their reactions to the abnormal events we are exposed to. The stigma associated with seeking help has decreased since my early days as a Paramedic, and my belief is that we will come to accept that regular mental check-ups will be nothing more out of the ordinary as regular dentist or doctor visits.

With education and help, we can continue in our professions, maintain healthy personal lives, and educate ourselves with techniques to bounce back from a stressful event.

Some of the major strategies used to help us return to “normal” equilibrium are:

  • maintain pre-event nutrition
  • maintain pre-event social activities
  • maintain pre-event physical activities

Maintaining good social contacts has been shown to also be a benefit. We may not feel like eating, talking to family or friends, or going for a paddle as we would usually. But the process of trying to maintain “normal” has shown to help reduce the time it would take to return to our personal balance.

My advice? Don’t be afraid to talk. Take advantage of any CISM program you can.  Get educated. Take care of yourself, climb and paddle on!

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