It often has been said that the fire service is one of those organizations that tries to be all things to all people. Fire-rescue services for years have been on the front lines, responding to community needs. These services grow and expand as community needs require more public safety support.

One common element that crosses all the services we provide is people: those who serve, those standing beside us day in and day out, co-workers and family and friends. We live in a constant state of readiness, and with that comes some very trying times.

Our families often catch the brunt of what happens to us at work. We see things that the public hopefully never will see, except for maybe in a Hollywood movie. We often have to cope with multiple events, staggering losses and the like while maintaining our professional demeanor and striving to help the public. Sometimes we just become silent after the “big one” and revert to our gallows or station house humor. Unfortunately, we may sometimes reach the breaking point.

Critical incident stress is cumulative. Part of our job is to protect our co-workers from that point.

Critical stress defined

That is where critical incident stress debriefing and management come into play. We must take the time to educate response team members, dispatchers and auxiliary support staff that what they may get involved in requires a full team effort. When we break an arm, we don't give a second thought to seeing a trained professional to help us. Well, we may very well have something similar going on that requires some level of trained support and intervention. We owe it to ourselves and to those around us to be cognizant of those things that may be out of our control.

According to the International Critical Incident Stress Foundation, a critical incident is any event that has sufficient emotional power to overwhelm a person's usually very effective abilities to cope. It also could be understood as any situation faced by emergency services personnel that causes them to experience unusually strong emotional reactions that have the potential to interfere with their ability to function either at the scene or later. The stress triggered by such an incident is called critical incident stress.

The foundation reports that following a serious incident without CISM intervention:

• 3% of rescue personnel will have no appreciable symptoms.
• 86% will have some symptoms within 24 hours of an incident.
• 42% will still have some symptoms continuing three to four weeks post incident.
• 22% will still have some symptoms lingering six to seven weeks post incident.

Personnel having symptoms after three weeks should seriously consider enlisting the professional help of a clinician/therapist who has demonstrated an ongoing sensitivity for working with these issues. Individuals continuing to have symptoms after six to seven weeks definitely need supportive help.

Debriefing

We are a family in the fire service, albeit a dysfunctional one at times. Over the last 10 years, I've had the honor of serving as a volunteer on our state's critical incident stress debriefing team and was able to provide education, debriefings and defusing to hundreds of public safety responders and allied personnel. At the Oklahoma City bombing in 1995, we provided critical incident stress defusing on site. We also provided pre-briefings on what responders might smell, feel, hear and do on scene.

When I came back from Oklahoma City, I attended several defusing and debriefings, but none took hold. At the urging of some fellow Murrah Building responders, several of us attended a weeklong debrief in Stilllwater, Okla., three years later.

During that debriefing, the tragedy at Columbine High School occurred. We all should have gone for intervention and support sooner, but we were trained, we were tough, we were firefighters. We did not need that stuff we were talking about in debriefings. How wrong we were on that count. I needed it more than many because it did affect me, and it affected others — people who were trained and able to cope on a daily basis.

While deployed at the World Trade Center in 2001, I also saw the need for interventions. But that was not the correct place and time, while the scene was still hot. I was on site for 100 days, and worked safety and health issues for the incident command at FDNY. To this day when I hear bagpipes, I revert to those days.

My advice to you is simple. Don't build a wall around you just because you wear a fire, paramedic or even chief's uniform. You are not immune from feelings.

Take the first steps now to incorporate CISM training into your academy and in all continuing-education units and in-service sessions. Don't be afraid if someone comes to you and asks for a minute to talk. Better yet, stop and ask “How are you doing?” and mean it.

Critical incident stress does not discriminate. Take time to reach out and help someone. They may be feeling just like you.

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Michael J. Fagel, Ph.D., CEM, served in the fire service for more than three decades before retiring. He currently is a member of the IAFC's Safety, Health & Survival Section and Homeland Security Committee. He served FEMA as a safety reservist for 10 years and now works WMD support for the U.S. Army and DHS. He is a member of the Northern Illinois Critical Incident Stress Team, as well as the Illinois Terrorism Task Force. He serves as the president of Region V, International Association of Emergency Managers, and is the liaison to IAFC from IAEM. He may be reached at mjfagel@aurorasafety.com.