International Critical Incident Stress Foundation, Inc.
International Critical Incident Stress Foundation, Inc.
By: Cameron Brown, ICISF Member & Approved Instructor
In the early 80’s, I worked on the Northside of Fort Worth at Fire Stations 12, 15, and 25.During this time there were many gang shootings and stabbings involving adolescents and young adults. As firefighters we used gallows humor to help us cope with the flow of blood that greeted us or the metallic smell that penetrated our nostrils. We rationalized that, after all, these were the negative consequences of the poor choices these individuals had made.
During the holiday season there were a number of structure fires where children were dying from smoke inhalation, denying us the opportunity to rescue them and possibly save their lives. We finished salvage and overhaul, then waited hours for the medical examiner to give us permission to place their small, fragile bodies in body bags to be taken to the morgue. We would use tank water from the truck to try and wash the smell off our hands and bunker gear, then drive back to the fire station in silence. We would never talk about these pediatric deaths again. There were no Critical Incident Stress Debriefings nor peer support to provide a safe venue for us to share our experiences. As customary, we stuffed our powerless thoughts and feelings deep inside vowing to never open that coffin again.
Approximately three months after these fires, I was driving with my windows down past a Burger King restaurant. As the pungent smell of charbroiled meat invaded my olfactory system my mind became an old-fashioned slide projector rapidly firing images of these pediatric fire fatalities.
My solution to avoid this trigger was to avoid driving past any BBQ or hamburger restaurants. Of course that is no small feat in Texas. At the fire station, I never talked with my peers about this because I did not want them to think that since I am a female that I am weak and can’t handle the job. My mantra was “You have to have feelings to have hurt feelings!” In reality, I am empathic and very compassionate. It became my mission to help my fellow first responders and healthcare workers have a safe place to talk about the horrific things they see, touch, hear, and smell.
I worked for the Fort Worth Fire Department for 34 years and am honored and blessed to have worked with Chaplain Ed Stauffer. I will forever be thankful for his mentorship and leadership in the field of Critical Incident Stress Management. I have facilitated over 1000 debriefings, including major events such as Hurricanes Andrew and Katrina, 9-11, Branch Davidians Waco, Wedgewood Baptist Church Shootings, Fire and Police Line-of-Duty deaths, Oklahoma City Bombing, and many others.
When teaching, I ask first responders and health care workers for an example of a critical incident they have encountered in their professional roles. I am never surprised when they state “Pediatric calls” because those incidents warrant the most requests for debriefings.
In late 2008, I was recruited to join the Cook Children’s Health Care System Pastoral Care Team as the first Staff Care Chaplain. This was a new position with a new job description and I was honored to be a caregiver to the caregivers. As a member of the Stress Hardiness Work Group I was tasked with helping develop and implement a comprehensive stress hardiness program for physicians and staff that includes resources and tools for coping with both occupational stress and work-life balance. My skill set and experience in Critical Incident Stress Management (CISM) became a natural pathway to help improve patient satisfaction by decreasing staff stress.
In January 2009, Cook Children’s Emergency Department (ED) was the first department to request pre-incident stress education classes and to use CISM on a regular basis. The director Dana Toudouse, and medical director Dr. Kimberly Aaron, required all physicians and staff to attend a two hour in person session that included recognizing critical incidents in the ED, and differentiating between Crisis Management Briefings, Defusings, and Debriefings. One key factor in classifying best practices for early response was empowerment and employee participation. It was established early on that anyone in the Cook Children’s Health Care System can request a critical incident stress intervention.
The first debriefing was requested after the horrendous mauling of a three year old. The parents were in the trauma room watching resuscitation efforts, and when told that their child had died, there was a primal scream that reverberated throughout the hallways. Many of the first responders and medical team had children that age. First responders were invited to the debriefing and that established a standard practice that anyone who participated in the care of the patient or patient’s family is invited. The debriefings are multi-organizational and multi-disciplinary yet homogenous. First responders and ED healthcare professionals respect each other, work well together, and further connect during debriefings. I receive many calls from the ED staff requesting me to reach out to firefighters, medics, and police officers after a traumatic event. There is always concern for the first responders who are tearful. One word I never use is the F….word—that is feeling. I never ask someone how they are feeling I phrase it “What were your thoughts when you were doing compressions on that baby” and “It has been three days since the full arrest, what have been some of your lingering thoughts?” Thoughts lead to feelings, and the cognitive phase has a way of dipping into the affective domain without being invasive.
One of the many benefits of working out in the EMS field has been the opportunity to interact with many organizations. Traumatic events bring people together for a common cause but Critical Incident Stress Management connects communities by strengthening bonds through affirmation and enhancing working relationships through better communication.
The Cook Children’s Critical Incident Response teams are comprised of child life specialists, nurses, paramedics, social workers, and chaplains who are exceptionally skilled subject matter experts.
Examples of pediatric traumas where debriefings have been requested are co-sleeping deaths, dog mauling’s, fatal snakebites, fires, non-accidental traumas and neglect, motor vehicle crashes, shootings, stabbings, Sudden Unexplained Infant Deaths (SUID), and suicides.
News about the pre-incident education and CISM services soon spread to other departments. The next department to request pre-incident training was Pediatric Intensive Care Unit (PICU). Following the guidelines established in ED, the PICU also required physicians and staff to attend a two hour class. Currently, CISM is an integral part of the culture and is used extensively throughout the Cook Children’s system especially in the Cardiac Intensive Care Unit (CICU), Hematology/Oncology (H/O), Neonatal Intensive Care Unit (NICU), Surgery, and Transport. Ongoing pre-incident classes, Assisting Individuals in Crisis, and Group Crisis Intervention are taught throughout the year.
Brene’ Brown says “Vulnerability sounds like truth and feels like courage. Truth and courage aren’t always comfortable but they’re never weakness.” My mission continues to promote resiliency by fostering a safe environment where people feel comfortable, not weak sharing their ghastly experiences. When we have the courage to be open we don’t have to lock our emotions in a lonely vault because we fear being perceived as weak.
Over the years, I have learned many things about CISM and I still continue to learn. When it comes to facilitation, debriefers have their own unique style. Here are some lessons learned and this style may not fit everyone. CISM is effective and I have witnessed healing unfold in the midst of a tragic situation.
The following are some of the lessons learned from facilitating debriefings with first responders and healthcare workers after a pediatric traumatic event:
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