Even the toughest senior folks in the firehouse have a breaking point. Sometimes it is also the slow trickle of continuous stress, not the flood of acute trauma that does the most damage.

I talked about the need in part one for some type of emotional rehab following a run with high psychological involvement. Jeff Mitchell, Ph.D., who developed the Critical Incident Stress Management (CISM) concept, describes ten types of critical incidents for emergency services personnel:

1) Line-of-Duty Death
2) Suicide of an emergency worker
3) Multi-casualty incident/disaster
4) Significant event involving children
5) Personally knowing the victim in the event
6) Serious Line-of-Duty Injury
7) Police shooting
8) Excessive media attention
9) Prolonged incident with loss
10) Any significant event

All of these 10 listed critical incident categories tend to overwhelm first responders' natural abilities to cope. These are the exceptional calls in someone's career. The problem is that this horrible call may be in the first year, month or even first day on the job.

Have you ever heard a song or smelled something that threw you back to a previous time? These flashbacks can trigger a negative response. We also can carry around personal baggage; the load might not even be work related. The bottom line on all of this is for everyone to be on the lookout for those in trouble. Your department may have the services of an employee assistance program, local psychologist, or chaplain. Any of these arrangements are viable sources of help when a department member may need it the most.

Examples of the CISM approach include:

• Pre-incident education
• On-scene defusings
• Debriefings
• Demobilizations
• Individual interventions
• Spouse and family programs
• Follow-up referrals

Defusings, usually held within 12 hours of the event, focus on symptom mitigation. Keys to a successful debriefing include holding them 48-72 hours after the event. Having trained peers is vital to the success of the program, and this care is offered as psychological first aid, not long term therapy.

If improvement is not seen, it is always recommended that those affected seek out referrals in the mental health profession. Needless to say, strict confidentiality is enforced, and the ethos is, "What is said in this room, stays in this room."  The education stage of the debriefing helps participants to identify other resources to utilize when signs and symptoms warrant such an intervention.

Suggestions for taking care of yourself:
1) Vigorous exercise
2) Plenty of rest
3) Structure your time; stay busy
4) Proper diet including Vitamins B and C.
5) Spend time with others
6) Share your feelings with trusted friends and family
7) Relaxation and meditation
8) Deep breathing exercises
9) Do things that feel good to you
10) Reach out, avoid isolation
11) Avoid major life-altering decisions
12) Keep a journal, write your way through sleepless nights
13) Avoid or reduce caffeine, drugs and alcohol
14) Keep a watchful eye over coworkers
15) It's OK to laugh and smile

Firefighters and rescue personnel are willing to literally give their life to save another. So, chief officers and department leaders must be willing to look after the emotional wellbeing of their members. My personal involvement on the Southwest Ohio Critical Incident Stress Management team began in 2000. I have been fortunate enough to witness some highly dedicated people make a positive impact on fellow rescue personnel.

If you are not aware of how to contact your local CISM team, the International Critical Incident Stress Foundation may be found at www.icisf.org or by calling (410) 313-2473.

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