Editor’s Note: The NFFF recently introduced a new Behavioral Health Model that changes the way the fire service assists firefighters and others on the path to healing. It is based on the concept that no two firefighters will necessarily have the same reaction to the same call. Considering the importance of this topic, FireRescue will cover what firefighters need to know about maintaining strong mental health amid a stressful job environment. In this first article, Bill Carey addresses the after-action report (aka curbside critique) and how this well-known element of the job–coupled with a new concept called Curbside Manner–can be employed to help firefighters handle potentially distressing calls.
A little after 0200 HRS, and a once-dark street is alive with the flashes of red and white lights and the drone of diesel engines. The front windows of a two-story row-home are blackened, the result of a fire that tore through the structure just moments earlier. The sidewalk is a clutter of hoselines, burnt window frames, a section of security bars now removed from a window, a PPV fan blowing fresh air, and electric cords running inside to light the darkened shell of the house.
It was a quick and nasty fire, with one person hanging out of a second-floor window when the fire department arrived. As he watches his crew talking about the fire, the lieutenant of the first-due truck thinks to himself, “The new guy with the irons–it took him a while to get that door, but he kept his calm and didn’t let it beat him.” He then decides to make the most of this moment, while the fire is still fresh in their minds, and walks over to discuss the incident with his crew.
Understanding the After-Action Report
A concept adopted from the military, the after-action report (AAR) is basically the informal curbside critique or kitchen table discussion that’s common in nearly every firehouse after a significant fire or other alarm. It usually focuses on what actions were taken, what might have been missed, any corrections and any additional details that should be added to the accounts, which are retold by those who were intimately involved in the action. AARs don’t need to be led by an officer; any firefighter can initiate the AAR so long as the objective is focused on learning, solving problems and improving performance.
Many firefighters will be surprised to know what an AAR is not. It is not a lecture or a gripe session, nor is it a time to gather and hand out blame, and to ridicule others. Instead, the AAR is informal, flexible and focused on learning.
The AAR asks five simple questions:
1. What was our mission?
2. What went well?
3. What could have gone better?
4. What might we have done differently?
5. Who needs to know?
The simplicity of the AAR allows it to remain focused on what is called “local learning.” Every aspect of the operation or incident is up for discussion.
Sharing the Information
One key element that sets the AAR apart from other curbside critiques or backstep discussions is the AAR’s final point–sharing the information. “Who needs to know?” is key to the discussion because it shares what was just learned (or relearned) with other members of the company, station and even department. How each company and department delivers that information is up to them. It may be something as formal as a company, battalion or greater-level meeting. In other departments, it could be shared as an e-mail to other members and responding companies, or it could be as simple as a note on the riding assignments board in the dayroom. The key is to share what was learned in the AAR with others so that everyone benefits from the experience.
Most traditional views hold that such a review is best when fire and EMS personnel have faced “the big one” or some other significant traumatic event; however, the AAR is low-key, flexible and geared toward every incident. That said, you don’t have to conduct an AAR after every call, but if you start the practice now and don’t wait until that once-in-a-lifetime event, crews will be better prepared to recognize the good job they did, identify the areas they can improve on, and share the information with other companies. Further, having an AAR after every incident makes the process habit-forming, thereby reinforcing the importance of this act.
New Use for the AAR
Among the 16 Life Safety Initiatives (LSIs) produced by the National Fallen Firefighters Foundation (NFFF), LSI #13 focuses on firefighter behavioral health; specifically, it states, “Provide firefighters and their families access to counseling and psychological support.” How does this relate to AARs? An important first step in absorbing the lessons learned from an incident, an AAR is also useful in identifying when a firefighter is having trouble managing the emotional or psychological aspects of the call. A simple, informal discussion about how members performed at an incident and what improvements could be done gives each person involved a chance to see how they are doing personally and if they are having trouble dealing with any part of the call.
Curbside Manner
Customer service is an old term to the fire service and one that has been abused and misused over time. Although useful in stressing the need to assist citizens in a wide variety of ways, the idea of firefighters as customer service providers has sometimes led to a “business model” approach that has twisted the image of true public service.
When dealing with traumatic and sudden life-changing events, instead of viewing citizens as “customers” and firefighters as “employees,” we need to have a bedside manner similar to doctors and nurses; this will allow us a much more personal and positive impact on everyone we interact with.
At the NFFF Behavioral Health Conference in March, Dr. Richard Gist of the Kansas City Fire Department and Captain Bob Martin of the Chicago Fire Department presented the concept of “Curbside Manner,” explaining to attendees how, when combined with the AAR, the fire service has a simple yet highly valuable tool that benefits both civilians in their time of crisis and the firefighters in the aftermath. Based on the military’s development and use of Combat and Operational Stress First Aid (COSFA), Curbside Manner offers an extra level of service and care that does not interfere with a fire department’s primary duties.
Think about this from the standpoint of helping a citizen: During a traumatic event, what you do will be remembered by the person or people experiencing that event. Putting forth the best of what you do as a firefighter, EMT or paramedic involves solving problems through your fire and rescue tactics, while also acting in a support role to the people in need. Instead of blindly tossing out a “feel good” approach to helping victims, Curbside Manner explains how to help distressed and disoriented individuals.
The objectives of Curbside Manner:
– Establish a positive relationship
– Create a sense of safety
– Calm and orient distressed individuals
– Connect individuals to support services
– Improve ability to address critical needs
These objectives guide firefighters to see the victims in a more personalized way, almost as family members and not as some unattached entity. Once this connection is realized, the interaction between firefighters and citizens becomes more emotional and sympathetic. At the NFFF Behavioral Health Conference, Captain Martin stressed the need for empathy with victims: “The brutality witnessed by the fire service is staggering; it can eat you up.”
How It Helps Firefighters
Being empathetic with victims translates easily to being empathetic with fellow firefighters. If you are more aware of how a tragedy is affecting the stranger whose emergency to which you just responded, you will likely be more aware of how it’s affecting the firefighter you’ve been working with for years.
As revealed at the NFFF conference, years of research, reviews and testing have found the niche that works best for fire and EMS personnel to deal with potentially distressing calls: the informal, peer-supported, casual discussion of what happened. This is in contrast to the older, traditional model of stress debriefing and counseling, which focused on the firefighters involved in a traumatic event immediately meeting with counselors to talk about their feelings. While useful with civilians, this method was not popular with firefighters. The notion of having to discuss your feelings with a stranger who has only the basic knowledge of what firefighters do was a stumbling block for many programs.
Taking a new approach, the AAR and Curbside Manner concepts were combined to help firefighters first become more in tune with each other and those signs of possible trouble. A simple 10-question Trauma Screening Questionnaire (TSQ) has been developed to help identify whether a firefighter should seek help. The questions are meant to be offered three to four weeks after the event to allow time for the natural coping process to happen–a “hot wash” or time out. It is not meant to be the “first step” after a traumatic event, but rather a tool once the AAR has been completed, and time allows for everyone to digest what has happened.
Once this time out has passed, if a firefighter is showing signs of trouble, then the TSQ can be used. Easy to deliver, the 10 questions can be presented at any time, in any location, and can even be self-administered. If the respondent answers yes to six or more questions, then a referral to a behavioral health practitioner is suggested.
In Sum
Adding Curbside Manner to the AAR helps develop a greater awareness of the wellbeing of firefighters without the stigma of rigid critiques and heavy stress-debriefing sessions. As noted, the informal, casual discussion of what happened is really the best approach for handling difficult situations in the fire service. Combining this approach with an effort to be more professional and empathetic to the citizens you serve gives firefighters a better tool to care for one another. Doing the AAR daily and adding the Curbside Manner translates into taking better care of the firefighter next to you.
In my next article on this topic, I will address how using AAR and Curbside Manner can help identify stress among the ranks without the stigma of “needing help,” as well as the ease of administering the 10-question TSQ.
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