CISM and Peer Support: My thoughts

April 29, 2023

Firefighter:

I was an official member of the Fire Service from January, 1990 to August, 2015, working as an Aircraft Rescue Firefighter (ARFF) for two years at the Dayton Airport Fire Department, then, spending the balance of my career at the Dayton Fire Department, as a regular Firefighter, retiring as a Fire Captain. After retirement, I spent portions of the next five years working here and there in Fire-Service related activities so, in essence, my Fire Service spans thirty years.

If there ever was a case of “Divine Intervention”, my entry into the Fire Service fits in all categories.

When I applied for the ARFF position – a Civil Service offering – I was totally ignorant of anything “fire” or “rescue”; I just needed a job. I really needed a job! I had recently been awarded custody of my two preteen children, and I was willing to do virtually anything that was honest and gainful in order to fulfill the role of parent to these two children.

To keep things going, I had been working at a job in a local steel fabrication shop as a prime coat painter for $7.45/hour, and at night I stocked the shelves at a local grocery store for $4.25/hour. I regularly clocked somewhere between sixty and eighty hours a week. The future looked grim. It looked so grim I sometimes believed the only thing keeping me from giving up on life altogether was my stubborn conviction that if I was going to die a failure, I would do so after having genuinely tried to succeed.

One day, while I was spraying primer onto steel beams in the outdoor paint yard, an “Angel of the Lord” visited me. He came in the form of my next-door neighbor, Dave, a captain on the Dayton Fire Department. Dave stopped by in the Ladder Truck he commanded and handed me a notice for the Civil Service position of “Aircraft Rescue Firefighter”.

“You need to apply for this”, he commanded, “Tomorrow is the last day!”

I did exactly that during my lunch hour, and thus began the long, challenging but rewarding journey into the vocation that brought me out of the darkness and into the light. I guess one could say I began my career by being rescued by the Fire Service!

I worked hard during my long tenure on the Department; I believe I did so out of gratitude as much as anything. Although I hadn’t dreamed of being a firefighter in my youth, I found that I was compatible with the work in many ways:

1. I was a born “helper”.

2. I was used to heavy physical labor and rigorous athletics.

3. I had spent years driving heavy dump trucks and tractor-trailers.

4. I was unimpressed by many “dangerous” situations.

CISM:

It seems that the good things have come into my life in spite of me, rather than because of me. Oh, in some inadvertent way, I would make choices that would ultimately benefit me – or teach me one of Life’s lessons – but at the conscious level, there was no intention to do or be the things that I did or became! Such was the case with the Southwest Ohio Critical Incident Stress Management Team, or SWOCISM.

In the year, 2000, I was working for the Dayton Fire Department as a Relief Lieutenant “out in the District”, gradually getting my “sea legs” as a fairly green officer, when I was visited by the District Chief (equal in rank to a “Battalion Chief”) in charge of the section of Dayton where I normally worked. The Fire Department was creating a new position for a Lieutenant: The “Health and Wellness Coordinator”. For some reason, unbeknownst to me, I had been chosen to be the first one. I would start at the beginning of the very next week. Prior to the visit by the Chief, I’d had no idea that such a program might exist. Furthermore, who’s to say whether if I had known it did that I would have applied for it?

Nevertheless, it was mine to do, now; Department’s orders.

Suddenly, my 24/48 schedule evaporated and I went to a 40-hour week like so many folks in business, public or private. I was to research, create a template, and then implement (after approval by the Administration, of course) a wellness and fitness program that was to apply to the members of the Department.

The amount of work that was required far exceeded the forty-hour per week allotment that I had been assigned. Nevertheless, I dove into all aspects of it with appropriate enthusiasm, having found a practical expression for the “fixer, healer, builder” instinct I was discovering within.

The Health and Wellness Program consisted of four basic elements:

1. Physical Fitness

2. Medical Health

3. Mental/emotional health

4. Spiritual Health (Chaplaincy program)

Under mental/emotional health came a thing called Critical Incident Stress Management, or “CISM”.

I had some limited knowledge of CISM because I, like many of my coworkers on the Department, had participated in a “debriefing”, a few years back, after an incident that included a Police Officer line-of-duty death and a bizarre shooting death of a potato chip vendor . We Fire Department members were involved because we provided treatment to those involved: The Police Officer who’d been fatally shot, another seriously injured Police Officer, the deceased vendor, and the shooter. I remember being glad that such a program existed to help those who were seriously disturbed by the events that day; however, I recalled little else – perhaps that’s because I had been struggling with the images and feelings, myself, since I was a responder to the “potato chip guy” scene.

One of the first CISM-related things that my supervisors asked me to do, as the new Health and Wellness Coordinator, was to work with the administrators of the CISM team that served our area, the Southwest Ohio Critical Incident Stress Management Team (SWOCISM), to offer a training session to firefighters in Dayton who might want to become Team members. In the process of doing this I met Jim Edrington and Linda King-Edrington. They were the face of SWOCISM, and they headed up a thriving organization that served a large area of Ohio, Indiana, and Kentucky. In the year 2000, Jim and Linda were the face of CISM in this region. This dedicated couple had pioneered the movement in Southwest Ohio, building the Team from the ground up since the late 1980’s. They readily agreed to host a class for the Dayton Fire Department and its invited guests from other regional departments.

The class was well-attended, although many of the participants walked away with certificates but not applications to join the Team. I was among those who hesitated to commit. As a result of taking the class, I had developed a strong appreciation of the Team and the work that it did, yet I had “way too much on my plate” to begin yet another commitment. I suspect that was the case of many of the others who also trained but didn’t join.

Four years later, after doing a second “gig” as Health and Wellness Coordinator – and after taking a second CISM training class – I “caved” and applied to become a member of the Southwest Ohio Critical Incident Stress Management Team. I was accepted into the fold – after the application process, which included an in-depth interview and a presentation of worthy references. Once on board, I was gently but firmly encouraged to participate in interventions, as my schedule and priorities permitted, so that I could grow in experience and effectiveness as a Team member. During this growing process I was always in the company of well-experienced Team members who served as mentors as I gained my own experience – and who “rescued” me if I “went off the rails” and started to take the conversation in a direction that was not helpful.

As I got to know the other folks on the Team, I was impressed by the diversity of the disciplines in which they worked: Police, Fire, EMS, Dispatch, Medicine, Industry, Athletics, and Education, to name a few. There was a wide range of age and experience, and there was some real professional certification as well: Mental Health professionals, Clergy, Medical professionals, Attorneys – all had representation on the team. Most importantly, I found a strong current of dedication and love for the work of Critical Incident Stress management and for the overarching avocation of helping others when they are in serious need.

Among the crew were some real masters of the craft. While there is a lot of science involved in the various steps of an intervention, there is ample “art” as well. You could sense a “presence” in the old “sages” who had been on the team since its inception. With unflappable confidence and quiet wisdom, these folks could transform the mood of an intervention from hopeless and chaotic to hopeful and purposeful. I hoped to exude those qualities, as well.

Even when I was a new member of the Team, my contribution as a firefighter with about thirteen years on was accepted as important in the same way that the highly certified Psychologist was; I was a peer who had “done the deed” and could, therefore, add that degree of legitimacy to the conversations that comprised “defusings”, “debriefings”, and “one-on-one’s” that were the substance of the services that were provided by the Team.

Training was in-depth and relevant. I had already taken the Group Crisis Intervention course and the Individual Crisis Intervention course (one-on-one), but monthly continuing education (first Thursday of each month) presentations added depth and understanding to the Work. Although, some of the presenters were from non-affiliated organizations, many of those who trained us were Team members, themselves, who were able to share their particular perspectives on the subject of Critical Incident Stress, and how they related to the overall goals and operations of the Team.

Serving on the Team has not always been easy; however, it has been undeniably rewarding. I remember coming home from a busy 24-hour shift, one morning, scaring up some breakfast before a planned morning “recovery nap” and a day of personal activity options – and receiving a call from the Team Coordinator who was requesting Team member response to a fire department, over fifty miles away, which had just experienced a double line-of-duty fatality. Full disclosure demands that I say the temptation to “blow it off” and let others respond was strong, since I’d just finished a stressful day at work, but I did not join the Team to let others do the work! These folks were in need. Those of us who have experienced a line-of-duty death in our departments know this! What followed was a full week of supportive activity by the Team. People were helped; friendships at the Team level and at the personal level were made throughout the enfoldment of the response.

We help; we do not “force the issue”

During my twenty-plus years with SWOCISM, I have attended scores of interventions, many of which were on or near the scene, and in the middle of the night. The departments called, and the Team answered. There was no compensation for time spent or miles travelled, the satisfaction came from performing a service according to one’s own “blueprint”. The Team never initiated contact with any department beset with a critical incident; the request had to come from the affected organization. Individuals who had experienced a critical incident were not compelled to come to a defusing or a debriefing; and once they were participants in the intervention, they were encouraged to speak to their own thoughts and feelings, only, but they were not coerced or otherwise “made” to do so.

During an intervention, the Team members serve as peer/guides who follow a protocol that safely takes the attendees through the discussion of the facts of the critical incident; the roles that each person played at the incident; the effects that the incident had on them. The conversation then leads them to the present and the future, explaining that the things they are experiencing are normal for anyone who has been part of a critical incident, and suggesting ways they could enhance recovery. After the formal intervention, Team members remain on site for a short time in order to be available to mix informally with the individuals. This helps those who may not have felt comfortable speaking in front of the group to express any lingering concerns that they may have.

One of the Team members will be assigned to make a follow up phone call with the contact person for the organization in about three days. The purpose of the follow-up is to ensure that the people who experienced the critical incident are moving toward normalization of their lives both at work and at home. Are other interventions needed? Are there concerns about one or more of the individuals and how they are coping with the experience? Would it be helpful for the mental health professional on the Team to evaluate the individual(s) and suggest further professional help? The response by the affected crew or individual is always at their option, and always confidential.

Is CISM “Dangerous”?

You may have come across some recent opinion that CISM is, at best, ineffective and, at worst, dangerous. The idea that CISM can consist of “dredging up” traumatic memories that are better laid to rest, or left alone, has been expressed as a justification for declaring CISM obsolete and unwelcome in public safety organizations. I am not one to challenge peer-reviewed studies regarding this; however, over the course of my association with the Team I cannot recall a time when any individual was compelled to speak, let alone, answer specifics beyond, “What was your role at the scene?”

When we are called, we respond to a need that is either ongoing or very recent. The events with their corresponding reactions and responses are fresh and up front. Often, the affected first responders are so overloaded with emotion they are unable to function. If there is any “dredging” going on it is a pretty shallow ditch.

Our purpose is to help with the unloading process in a safe and confidential atmosphere. Our function is structured, allowing the orderly sharing of information about the incident which helps to stabilize the group’s perception of what went on – and what is going on within each of them. More help is available through the evaluations and guidance of appropriately certified members of the Team.

CISM operations are built around the “Mitchell Model” (see Jeffrey Mitchell), a systematic technique of managing information from a critical incident, whose goal is to expose and address the elements of the incident as they occurred in the field and as they affected the individuals who experienced the incident. The positive outcome is stabilization, normalization, and a return to functionality in the line of work to which the individual is dedicated.