Chronicle link here.

August 16, 2004
The first response

by Deon Lackey, Chronicle Staff Writer

The legend goes that the first firefighters on the scene heard the screams of victims trapped in a burning car.

Some physicians at Bozeman's hospital arranged for on‑site counseling for the firefighters, law enforcement, and paramedics who worked the Norris Road accident in spring of 1991. But the horrific things the responders witnessed led emergency workers around the county to ask the question: how are we helping our front-liners deal with what they have to see?

"The responders just had to suck it up," said Les Anderson, Belgrade fire chaplain.

The "suck it up" philosophy meant people didn’t stay long in emergency services. In Belgrade, with a mostly volunteer fire department, the average firefighter stayed less than three years.  "What was consistently brought up (at exit interviews) was it's just not worth it," Anderson said, "because of what they see and go through."

Anderson pointed out that eighty‑five percent of responders struggle with stress‑related affects, health  problems like high blood pressure to troubled marriages or substance abuse, as the aftermath of what they see at work. Something needed done.

So emergency personnel around Gallatin County formed a Critical Incident Stress Management Team as a means for 9‑1‑1 dispatch, EMS, firefighters, law enforcement, ski patrol, search and rescue, and emergency room personnel to cope.

Critical incidents can be line‑of‑duty injuries or deaths, extensive physical injuries like burns, knowing the victim, or any event that involves children – anything out of the ordinary that “kicks it up a notch,” as Anderson said.

CISM is a system of dealing with on-the-job trauma with a three pronged approach: preparation, debriefing and defusing.

"It's only for the worst of the absolute worst," stated Carol Burroughs, clinical director for CISM and a local therapist. "(Double fatality accidents) tend not to be critical. It's not that big a deal,"she explained.  "It's the five to 10 percent of things you never see, you can't expect, can't prepare for that can overwhelm the stress mechanism."

According to Burroughs, coping mechanisms, or a  "trauma barrier," build up within the first six months to year on the job, allowing responders that detachment or callousness to tragedy that helps them function through routine events. For critical events, though, that trauma barrier may not be enough  for responders to cope with what they see.

The team focuses on preparing responders for the affects of stress, things like sleeplessness, flashbacks, irritability, crying and losing track of time. Anderson said many responders were stressing themselves out over completely normal stress reactions.

"It helps people to know (they) are not going crazy," said Lynnora Jetter, an emergency room nurse at Bozeman Deaconess and peer counselor. "Whatever is happening is a normal reaction to an abnormal event."

Critical incident stress debriefing is a structured, in‑depth, interagency review of a traumatic event. Between three and 10 days after a major event, everyone involved in the incident  meets to review the event from the first call to dispatch through the end. According to Jetter, a lot of stress comes from "misunderstanding," missing pieces in the story.

"What happens is, we don't get closure," said Ben Hess, Gallatin County's 9‑1‑1 director.  "A bad event happens, they handle it, and go on to the next."

Paramedics may not understand why a person who was stable at the scene of an accident died in surgery, or police may not know the outcome of an attempted suicide. Dispatchers only hear what goes on at the other end of a phone line.

"We send people; they go," said Connie Mathison, one of the county dispatchers.  "We don't know what happens after that. You don't get closure."

Closure is necessary to move on from an event.  "What our brains try to do is finish (an event), like a jigsaw puzzle," Burroughs explained. Talking it all the way through can complete that picture and help responders come to terms with what happened.

"Part of it's acceptance," Burroughs added,  "(knowing) 'I did the best I could. We made the best decisions we could have right there.'"

But it can be difficult to deal with the emotional aspect of a tragedy, so debriefing actually focuses on facts: what part each person played in the event, the physical descriptions of what they saw or heard.

"In describing (the facts), they are telling us how they feel," Anderson said.  "Emotions are so abstract.; words are very concrete. When we talk about something, it helps us to process the feelings themselves because they give us something we can hold on to and file away."

"We all tend to overestimate our ability to cope," Burroughs said.  "You're not going to forget. The idea is to accept it....(Debriefing) is going to mitigate it so you can start processing the symptoms."

Defusing is a shorter, one‑on‑one, in‑house session that lets a responder vent to a peer.

"(Peers) can provide that means of solace," said Hess. It is common in the dispatch after a difficult call for someone to step out for a few minutes or for another dispatcher to check on how they’re doing. In September, the shift supervisors are going to go for training in CISM techniques so they can be there when someone needs them.

"You need an outlet, you need a listener," echoed Jetter,  "and we don't all have a listener. Typically, whoever you would normally talk to isn't able to help with this. There's a camaraderie that develops when you work closely with somebody."

After 18 years as a dispatcher, Mathison has seen her share of tragic events and is looking forward to the training next month and more involvement in the CISM team. "It's a necessary thing," Mathison said.  "We deal with some pretty horrendous things sometimes, and you're not able to have a meltdown. We need to look out for our people that are on the other end of this, from the people who take the call to the responders. It's all a trauma in some way."