Flow chart helps fire departments ensure their personnel have access to the appropriate resources after a potentially traumatic event
By Chief Ronald J. Siarnicki

Following is the second in a series of seven articles that describe a new approach to mental and behavioral health in the fire service. Read the first article here.

Early efforts by the fire service to manage the impact of job-related stress have paved the way for much research and information that’s now available regarding occupational exposure to traumatic events. Critical incident stress debriefing (CISD) became a social movement in the fire service and quickly grew footholds in other areas as well. Early articles and workshops promoted the concept of “debriefing” and related interventions as powerful preventative measures for post-traumatic stress disorder (PTSD) and similar negative outcomes.

Critical incident stress management (CISM) seemed an easily doable, logical approach to helping firefighters with occupational stress. It was consistent with other commonly accepted ideas about how to deal with traumatic events. Further, many firefighters reported that it was helpful to have an opportunity to talk about how they felt.

Widespread use of CISM led to rigorous investigation of its effectiveness by independent researchers in psychology, psychiatry and public health. Surprising to many, the results did not reveal an appreciable preventive effect and in fact suggested that some people might actually experience more difficulty resolving their reactions as a result of their participation in these interventions. Authoritative guidelines for early interventions following exposure to traumatic events now recommend against routine debriefing.

Of course, the stress these exposures create for firefighters is very real. These types of experiences happen with unfortunate regularity—they play a significant role in the everyday lives of firefighters. And the larger and more active the department, the more firefighters will experience these types of events. With this in mind, it’s important that firefighters be prepared to deal with these impacts and that fire departments provide access to resources that can make a difference.

Researchers working on early interventions for traumatic stress joined representatives of key fire service organizations to develop a straightforward protocol that fire departments can use to ensure that their personnel have access to needed resources following potentially traumatic events (PTEs). Download the flowchart flowchart.doc. The recommended actions reflect best practices based on current research and should fit easily into the operations and support systems most departments have in place. The key elements include:

1. Determination of a PTE: A trauma for one responder may be a routine event for another. Reaction to a trauma is subjective, driven by an individual’s experience, sensibilities and personal situations. Members should be asked if they require assistance. If so, what type? If not, expression of support may be all that is required.

2. Time out/hot wash: This is a concept borrowed from the military as an element of an after-action review (AAR). It’s a mechanism whereby those affected by an event review what happened, what was successful, what could have gone better and how they might improve. This often helps put the encounter into perspective. After a brief “time out,” providers may elect to return to service.

3. The Traumatic Stress Questionnaire (TSQ): This is a straightforward and easily scored protocol to identify who is progressing well and who may need additional help down the road. Given 3 to 4 weeks after the incident, it consists of 10 simple questions about recent symptoms. More than six positive responses suggest that a more complete screening by a professional may be warranted.

4. Complete assessment: This can typically be accomplished by a referral to a department or jurisdiction’s employee assistance program (EAP) provider or other competent professional. EAP counselors can often help with managing specific symptoms or in dealing with external stressors that might be complicating progress for the member.

5. Treatment by specialty clinician: If more intensive care is needed, it should be provided by a specialist (psychiatrist, doctoral-level psychologist or board-certified clinical social worker) with advanced training and supervised clinical experiences in specific evidenced-based treatment for PTSD, anxiety disorders and depression.

Although this chart may seem overwhelming at first, over the next few months we’re going to walk you through it. Training in the new approach to firefighter behavioral health is now being developed and will be available readily over the next year. For more information about the NFFF Consensus Protocol on Behavioral Health and for information regarding training in its use, visit www.everyonegoeshome.com.

Chief Ronald J. Siarnicki is the executive director of the National Fallen Firefighters Foundation.

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