International Critical Incident Stress Foundation, Inc.
International Critical Incident Stress Foundation, Inc.
By: Ken Harbert, PhD, MCHESâ, PA-C Emeritus, DFAAPA
ICISF Member & Approved Instructor Since 2014
We all create paths in our life. Often, we never know the direction they will take us. My path led to over thirty years of providing critical incident stress management. I left the service as a young Navy corpsman and Vietnam Veteran. I became an emergency medical technician in one of the first emergency medical systems in the United States in Pittsburgh, Pennsylvania. As an EMT instructor at the Community College of Allegheny County I saw the effect that trauma had on new EMTs and Paramedics, many of whom like myself were still coping with Vietnam. Many lessons were learned in those thirty years.
After nursing school, I became a Physician Assistant. Initially working in Psychiatry and volunteering in a free clinic as a provider and on a hotline for rape counseling. Again, I was seeing, feeling the pain and suffering of traumatic stress. In the seventies most leaders in emergency medical care expected EMT providers to stick it out and move on. The consequences of this attitude affected all healthcare providers. I wondered if there was a better solution for crisis intervention. Lesson learned – Follow your gut if it seems wrong find a better way.
Hired as a clinician in 1979 at Greater Southeast Community Hospital in Washington DC I later became the Director of Medical Education for medical staff and students. During this time, as vice chair of the disaster committee I was responsible for disaster events. On January 13, 1982 while in the hospital addressing weather-related issues the hospital operator notified me of Florida 90 hitting the 14th street bridge. With eight inches of snow in the district, huge traffic jams, a Metro subway train derailment in downtown we were all overwhelmed. After the event I made the mistake of seeing the body recovery under the bridge. Lesson learned-You don’t have to visit the critical incident scene to care for those involved.
Again, my life took a surprising path. I met Jeffrey Mitchell, PhD whom I had heard was counseled families after the same events. He intrigued me and I believed he had the answer I had been searching for both personally and professionally. This motivated my continued research about his theories. Also, the group therapy sessions for PTSD I co-directed with a clinical psychologist, gave me the insight into how the sequelae of trauma could last lifetimes for veterans and their families. Lesson Learned – Traumatic stress requires lifelong learning there will always be changes in CISM learn from the best.
That event led to ongoing training in CISM. I became active providing CISM in community and professional settings in the civilian world and the military. I worked with teams in Pennsylvania, Idaho, New Mexico, Tennessee and Alabama. My role evolved into being a trainer and eventually a team leader. I found truth in that “helping others helps yourself”. These teams provided valuable lessons about life and caregiving more than anything in my clinical training. Lesson learned – Learning the culture of CISM as a peer based, integrative multicomponent form of crisis intervention was truly an “aha” moment for me.
My first team became a chosen family for me. The Susquehanna Valley CISM Team was a rare group of individuals. This team taught me to value the planning process and selection of the team. It called for serious thought into what a team would be, what it would do and what its limits were. This happened due to Ralph Cope EMT and Cheryl Walter RN who helped develop the policy and procedure manual. They got our team with the Susquehanna Emergency Health Council. Our team covered eight counties in a large area of central Pennsylvania. Lesson learned – Teams often end up working together day and night, making a lifelong impact on those they help and allowing them to help themselves, but teams must also learn to care for themselves
Susquehanna Valley CISM Team Founding Members: Left to Right: John Staje, Ken Harbert, Dave Gehrum, Cheryl Walter, Susan Swan-Caschera, Ralph Cope, Skip Moran, Rich Longenberger (missing Marie Hunsinger)
Many years later, our team lead by Susan Swank-Caschera PA-C would provide on sight support for families that lost students on Flight 800. The team also spent long months at the 911 site in New York City doing one-on-one crisis interventions. Lesson Learned – One-on-One interventions are vital especially during long events (think COVID-19)
I learned about team dedication after Rich Boland asked our team offer support for the Allegheny County CISM Team in Pittsburg as they dealt with the Flight 427 accident. Imagine waiting on the tarmac during a foggy, violent rainstorm waiting for a USAIR corporate jet to take us to the plane accident. No one said a word. We all just got on that plane. Lesson learned: Teams need to help teams, no one can do it all, you just have to be there for teach other.
During that event we learned a vital lesson. The media searched for how crisis intervention support was given. We were given a restaurant, providing warm food and hot fresh coffee 24/7 during the clean-up of the accident. Buses with emergency workers came thru the alley far away from the media. Lesson learned – Come in quietly and leave quietly no media and no cell pictures.
Our early members of the team stepped up to become “train the trainers”. We had a diverse team such as Captain John Staje and Captain Rick Lonenberger who worked with law enforcement. Chery Walter, RN and Marie Hunsinger, RN who worked with emergency room nursing and life flight personnel. Susan Swank-Caschera PA-C and I focused on Physician Assistants and Nurse Practitioners. We developed a CISM course for physicians, medical students, and other medical professionals at the Philadelphia College of Osteopathic Medicine. Lessons learned – Utilize core components of CISM to offer educational programs to traditional academic programs such as medicine and nursing. Do lectures in the morning and simulated team activities with trainers acting as “flies on the wall” evaluating the learning curve.
Marie Hunsinger, RN, BSHS, and I talked about the need for a team at the medical center where we both worked in the emergency room. Our vision was to start a multispecialty CISM team at Geisinger Medical Center, one of the largest tertiary rural health systems in the United States. This became possible with support we had from the Chief Medical Officer, Dr. Thomas Royer, and the CEO Kenneth Ackerman. They supported our ability to assist with critical incidents at the medical center. The Geisinger team included a diverse team of medical staff, nursing, social workers, chaplains, emergency personnel. We provided continuous coordination and access for critical incident events and staff training. This multispecialty group of individuals offered a great resource to the medical center by coordinating and collaborating the provision of crisis management. Lesson learned- follow your vision from the top down.
After this experience I moved to Idaho and was involved in the CISM team there. I learned from this experience that culture is vital in understanding CISM. We dealt with different events than I had in the east. Many were wildfires involving children and having fire teams sacrificing their own safety at times. In these sessions self-disclosure was rough. Adding a medical examiner involved in the event proved to offer the right answers to what was done to save the children. Lesson learned: Culture is important, having the right people at the right time for the right reason is crucial to the outcome.
I next went to New Mexico. Asked to develop a Medical Reserve Corp offered an opportunity to do something from the beginning and get it right which is rare for anyone. Little did I know that it would become more than a full-time job during Katrina. We had thousands of survivors housed in our large convention center for over three months. Working with the mayor’s office we started to care for over 3,000 patients every day. During this time, we had a number of medical issues to deal within the center. So, we developed a mobile team of three to four infectious disease nurses, mental health workers, EMTs with CISM training rotating daily rounds of all occupants 24/7 dealing with acute stress reactions, missing medications and anxiety regarding the families left behind in New Orleans. Lesson learned – In times of chaos think out of the box, CISM can be integrated with essential medical care for those in need, but you need to identify what will be essential for the care and support of the participants.
Dr. Mitchell created the concept and I just followed its path along with Dr. Everly challenging me to learn more as no other has in my life. Today more than any time in our history CISM is vital to the health of the caregivers in our community. Health care teams are overwhelmed, engaged in deadly encounters. They worry about their own health and their families. Our teams will continue to provide crisis intervention now when it is most needed. Together we will get through this era.
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