International Critical Incident Stress Foundation, Inc.
International Critical Incident Stress Foundation, Inc.
By: Melissa A. Taylor, RN, BSN, CLNC, CHEP
Imagine a sixteen-year-old girl in 1982 who had already decided that her career path would be in the medical field. She had several family members who were nurses or worked serving others. This girl was focused on her goals and was very excited to be given the opportunity to take an Emergency Medical Technician (EMT) class at her local volunteer Life Saving Crew. The Life Saving Crew, at that time, did not accept female volunteers and that was quite frustrating. But, while taking this class, she met some members of a neighboring Volunteer Fire Department who were seeking to gain a license to allow them to run a basic life support ambulance out of their station. They asked the girl to join the department and become a volunteer first responder.
Imagine a sixteen-year-old girl who was a brand new EMT working her very first shift as a volunteer first responder when the phone rings and it is a call for help. A ten-year-old boy was playing in the snow with his brother and walked out onto a frozen pond. The ice gave way and the boy fell into the freezing water. A response was mounted, a search ensued and finally after approximately an hour the boy was retrieved from the bottom of the pond. The resuscitation efforts began, the girl and her partners did everything in the book to revive the boy because she had just been taught that there is always hope of revival from a cold-water drowning. The phrase from EMT class “they are not dead until they are warm and dead” echoed in her brain as she worked to warm the boy and restart his circulation. She and her partners remained at the hospital assisting the Emergency Department staff for the next three hours. It was to no avail; the boy did not survive.
Now imagine a sixteen-year-old girl hit with the reality that a ten-year-old boy, a boy the same age as her little brother, was just pronounced dead in front of her eyes. There should have been some form of Critical Incident Stress Management activated and offered for that girl and her crew. There was not. This first call was a devastating blow. EMT class taught her how to respond and how to preform but in no way prepared her for the mental and emotional impact that many calls would bring. This was a pivotal moment in that girl’s life. Would she give up all hopes of succeeding in a medical profession and walk away? The thought was very real. Fortunately, she had a very strong family support system and was able, with their guidance, to process and recover from the immediate trauma of the call and make the decision to remain on as a volunteer. But, as time will tell, this was the first link in the chain that would years later manifest as post-traumatic stress.
That girl was me and I firmly believe that had some form of CISM been offered at the time of that first call, I would have been able to begin the process of building the coping skills needed to deal with the traumas and losses that I endured over the next thirty eight years as a first responder paramedic, registered nurse and everyday person.
Several years after that first call, I was given the opportunity to join a brand-new team that was being formed in my area. It was called a Critical Incident Stress Debriefing (CISD) Team. I would have to take several days of additional training to be a part of this team. It was a miracle; this was the type of help that I firmly believed all first responders needed! After joining the team I quickly realized that this CISD concept would be only sparsely utilized by first responders because the over-arching mentality related to mental health was expressed as “suck it up and move on” and “if you can’t handle it you need to get out of the profession.” The team finally disbanded due to lack of leadership and lack of utilization. Over the years that followed, I saw many good people come and go from the profession, most from burnout, some from suicide. I continued to advocate for first responder mental health awareness but was mostly met with obstinance and refusals.
Move forward to 2011 when I became the Nurse Consultant for Emergency Preparedness for the Tennessee State Department of Health in the Northeast Region. The position gave me the opportunity to utilize my nursing and first responder skills, along with my many years of experience, to begin to assist all responding agencies in multiple ways including; emergency preparedness, disaster planning to include mitigation, response and recovery and provide an array of training opportunities on multiple topics. CISM, as it is now called, was still vastly underutilized in my region by first responders but I was beginning to see a shift in the thought processes around responder mental health care. Some doors were slowly beginning to open for opportunities to educate responders on mental health care. I seized the opportunity to become a Mental Health First Aid Instructor and began teaching the class and concept to first responders in my region. This also gave me the opportunity to educate about and promote CISM.
As responder mental health, and mental health in general, continued to become the ‘hot topic’ across the state, I was able to assist in formulating a proposal to the State Department of Health which proposed the formation of a brand new, never seen before, mental health response team to not only serve first responders but hospital staff, schools and school staff, industry employees and the general population as needed and requested. We did not need to reinvent the wheel the resources and evidence-based concepts were out there. It was time for us to harness these approaches and create a well-trained, professional and ever ready team.
Now it is 2020 and the State of Tennessee has the incredible asset of The Tennessee Crisis Response Network Disaster Mental Health Strike Team. CISM plays a leading role in this team. Through a contract with the Tennessee Federation of Fire Chaplains and the state of Tennessee, we were able to create a team that is currently over 100 strong in membership and training. This team is highly trained in multiple modalities of CISM response, Mental Health First Aid, Triage and Suicide Intervention. Our members come from a myriad of professional backgrounds to include; EMS, Fire Service, Law Enforcement, Dispatch, Public Health and Mental Health. The CISM response model is utilized in all responses. The team can respond to incidents and disasters, large and small, across the state and into other states as requested. Since the inception of this team over a year ago, they have responded to almost 100 requests for assistance and have provided services to include critical incident stress debriefings, diffusing’s, one on one services and have been able to successfully refer multiple individuals to more advanced mental health services as needed. The team has responded to calls from first responders, industry and schools.
As we navigated the ongoing response to the COVID-19 pandemic, I realized the toll this response is taking on the mental health of our dedicated Public Health employees. I started seeing the signs of stress and anxiety and hearing stories of the difficulties and traumas that many of our staff were enduring. This prompted me to request the activation of our response team and we are currently offering debriefings to all public health staff across the state. This offering has been met with an overwhelmingly positive response and some are now receiving more advanced mental health services as facilitated by team members. I am proud to be an Executive Director and responding member of this incredible team. From the time I found out about the concept of Critical Incident Stress Management I have utilized it’s concepts and teachings to not only navigate through and survive, but also thrive, in the medical profession – my goal from the age of sixteen.
The Crisis Response Disaster Mental Health Strike Team can be requested 24/7 by calling the statewide dispatch center at 1-800-792-1033. This is a free service.
Respectfully Submitted,
Melissa Taylor
Melissa Taylor, RN, BSN, CLNC, CHEP
Nurse Consultant – Emergency Preparedness
Northeast TN Regional Health Office
185 Treasure Lane
Johnson City, TN 37604
423-979-4663
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International Critical Incident Stress Foundation, Inc is a 501(c)3 Non Profit