International Critical Incident Stress Foundation, Inc.
International Critical Incident Stress Foundation, Inc.
By Marilyn J. Wooley, PhD
In the mid-1980s, when CISM was still fairly new, I took the Mitchell Model Basic course. I was one of two mental health professionals (MHP) in a class of about 40 first responders—firefighters, medics, and police. They shared graphic stories of traumatic events that gave me a punch to the chest.
At the end of the first day I approached the instructor. “Your class is fascinating,” I said, “but I’m not sure I’m in the right place. I treat what goes on inside peoples’ heads. I don’t see the trauma first responders see daily. I don’t think I could deal with that stuff in my head.”
The instructor asked, “Do you think you could listen to their reactions to what they see?”
“That’s no problem,” I said. “I listen to all kinds of horrible things and manage to help people.”
“Then you’re in the right place,” she said. “They really need someone to hear them.”
The other MHP didn’t come back, but I’m glad I did. Being part of CISM has been among the most rewarding parts of my career.
LESSON LEARNED: Don’t underestimate your ability to contribute to the team.
I live and work in the Far Northern Sacramento Valley or UpState California, which is characterized by picturesque river valleys and rugged mountain peaks. Although it makes up 20% of California’s landmass, it is sparsely populated. The largest town, Redding in Shasta County is home to 90,000 individuals and is the shopping, cultural, and educational hub for eight counties. Big city dwellers have likened it to an outpost on Mars. Politics tend toward conservative–it is culturally separate from the blue coastal cities. Even in the 21st century a wild west attitude is prominent and talk of seceding from California arises. The yellow double XX flag representing the rebel State of Jefferson decorates many a bumper sticker.
I continued with my training and took Advanced Group from Jeff Mitchell. Soon after, I was invited to work with CalFire with their nascent Shasta-Trinity CISM team. The peers seemed to look at me like I actually knew something. As the newbie and only psychologist, I looked at them wondering if I would ever comprehend the firefighter culture. Mercifully, I had patient mentors who were willing to teach me.
The CalFire team invited me along on a CISD–my first. We gathered to discuss the critical incident—a volunteer department chief had died from a heart attack while responding to a shed fire. A Line of Duty Death. We prepared handouts, assigned roles, and discussed tactics.
We drove for two hours over increasingly narrow, winding mountain roads, into evermore dark forests far away from civilization until we arrived at a small, battered fire house jam-packed with about 18 people. I soon realized this was not the fire department, but the entire town. Firefighters, spouses, girlfriends, dogs, the postmaster. And they all were drinking beer.
Jeff Mitchell’s voice echoed in my head, “I can’t emphasize enough the importance of pre-incident education.” Unfortunately, it was a little late for that.
While the peers covered my back, I addressed the townspeople. “I am truly sorry for your loss and I appreciate you all coming but the CISD is designed to help those who responded to the chief’s death.”
A weathered woman raised her beer bottle. “That’s nice, but we were all there when our chief died. We all debrief together.”
I looked at my team as if to ask, “Is this really the right time to do this?”
At that point, an inebriated man jumped up and threw his chair. He began screaming that if we couldn’t honor his chief, we could get the hell out.
Options flew through my head. We could leave these grieving people who would undoubtedly never trust us again or try to reason with them about putting down their beers and asking their spouses to leave, or….
The chair-throwing man got my dander up. I faced him, looked him in the eye, and said, “Sir, I need to talk to you alone.” I led him outside. “Sir, I can’t do my job if you throw chairs. I understand you are upset, but you need to sit down and set a good example. Understand?” He looked at the ground, went back in, sat down, and nodded to his friends. We continued.
What followed was essentially a 5-phase CISD but served more as a wake. The community mourned and praised their chief. They thanked our team for staying. The chair-thrower tearfully apologized. On the drive back I said, “I hope all CISDs aren’t like that.” We later learned that the volunteers had appointed a new chief and were grateful to us for helping them.
LESSON LEARNED: The compassion and confidence our team showed under adverse circumstances were more valuable than rigidly following the rules.
Years later the CalFire CISM team responded to another isolated volunteer fire department. One of the peers was able to give us intel about several stressors the department had experienced. The chief recently suffered a heart attack and was retiring. The new chief had only a few years of experience. Of eight firefighters in the department, half had served for less than two years; the newbie, still a teenager, had never been on an incident before.
The firefighters responded to a housefire in a secluded area. Tragically, after confusion about the location, they arrived after the house was fully engulfed. An elderly woman lived in the home and had not made it out. Angry members of the community arrived before the firefighters and physically assaulted them while they tried to extinguish the fire. The department was so stressed that they asked for our team to respond less than 24 hours later. We would meet at their active station because no one else could be found to cover for them.
By this time, I had the confidence that comes with an ICISF instructor’s certificate. Still, when the peer told me the circumstances, I thought, “This one could be brutal.” I considered doing a defusing, but the firefighters needed more.
The firefighters greeted us eagerly. I informed them that we’d stay as long as we needed. The major theme of the CISD was the attack of citizens and the firefighter’s resultant fear and feelings of betrayal. We moved through the facts, thoughts, reactions and symptoms slowly and thoroughly. The firefighters were emotional. I could tell our entire team was moved by their stories and getting fatigued.
When we were halfway through the teaching phase, the newbie spoke. “I’ve never been on a fire before and I didn’t know if what happened to me was important, so I didn’t say anything before,” he said.
One of the peers nodded for him to continue.
“I don’t want to upset anyone but after the fire was out, I went in and stepped on something and it went crunch.” His eyes stared blankly. “It was the old lady’s skull.”
My team seemed to have a collective visceral reaction. We went back to the facts and moved through the phases again until we finished. We later debriefed ourselves at length.
LESSON LEARNED: Prepare, prepare, and prepare to be surprised.
More recently I was asked to help a community in the most secluded corner of California after a well-loved deputy sheriff was ambushed and murdered. While pursuing the suspect, the Sheriff fought for his own life in a protracted “OK Corral” gun battle. The department was so small that law enforcement, dispatchers, business managers, and clerical staff operated out of an expanded sheriff’s department trailer. They heard every detail as the incident unfolded and feared that the Sheriff would be killed, too. Psychologically, they were all responders.
The folks up there are naturally wary of outsiders. I was fortunate to work with a law enforcement officer and his wife, both experienced in CISM, who lived in the area. Throughout the days I spent in their community, they gave me an “in” and helped me negotiate the self-reliant small-town culture. We devised a plan to provide a Crisis Management Briefing, CISDs for employees who actively heard or were involved in the incident, 1:1s for the sheriff and deputies, groups for spouses who’d listened in terror at home on scanners, and outside support for their children. We offered 1:1s to townspeople at large. We attended the funeral. We adapted to make CISM work in that town.
LESSONS LEARNED: First responders not only have their own culture, but police, fire, medical, military, and communications have cultures within that culture. There are also microcultures in each department. Finally, regions, such as UpState California have cultures that the CISM team must understand to be accepted and effective.
To summarize, the more I’m involved with CISM, the more I’m prepared to think on my feet and adapt to the specific culture before implementing a plan.
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