New Report Addresses the Need for Critical Incident Stress Management

With the continued threat of terrorism, emergency responders are finding they must not only face physical danger, but emotional trauma as well.

The Oklahoma City Fire Department (OCFD) has released a special report on the psychological lessons learned from the 1995 Oklahoma City bombing. The report focuses on the impact of post-traumatic stress disorder (PTSD) in the lives of firefighters and their families. "On Scene Stress" can help other emergency responders and emergency response agencies prepare for future catastrophic incidents.

PTSD is defined by three sets of symptoms, says Prof. Carol S. North, M.D., M.P.E., Psychiatry Department, Washington University School of Medicine: intrusive memories, such as nightmares of the event and flashbacks; avoidance and numbing, such as inability to face reminders of the event and feeling isolated, distant and numb; and hyperalertness, which includes sleeplessness and feeling keyed up, jumpy and easily startled. PTSD is diagnosed when enough symptoms in all three groups persist for a month or longer, says North.

Researchers from Washington University in St. Louis and the University of Oklahoma studied the effects of Oklahoma City bombing rescue and recovery work on rescuers' mental health. Of the nearly 1,000 members of the Oklahoma City and Tinker Air Force Base fire departments who participated in the rescue and recovery effort, 175 men and five women chose to take part in the study, the results of which are published in the June issue of Fire Chief magazine.

The report makes the following suggestions to help rescuers cope emotionally with disasters like the Oklahoma City bombing and the terrorist attacks on the Pentagon and the World Trade Center.

Create a critical incident stress management (CISM) team. The Oklahoma city Fire Department (OCFD) CISM team was created in 1990 and is part of the standard operating procedures at the Murrah Building.

Be aware not only of physical injuries to rescuers, but emotional trauma as well. Fourteen percent of the OCFD firefighters were diagnosed with post-traumatic stress disorder (PTSD) after the bombing, and distress was more widespread. Don't forget that all workers deserve attention to their mental health needs after disasters. Also, disasters have a tendency to bring depression and alcoholism to light and acceptable programs to address misuse should be an ongoing priority for fire departments.

Be ready to provide in-house counseling: Many OCFD firefighters who used mental health counselors or debriefing valued this support. Such support and counseling opportunities should be made available for those who wish to use services as an ongoing part of the normal organizational structure of public safety agencies. First-responders are a unique culture that requires trained counselors.

Offer spousal support and counseling: OCFD firefighters reported changes in relationships with their spouses in the year following the bombing and suggested that public safety agencies consider providing educational programs for rescue workers and their spouses as a part of continuing education within departments.

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