The fire is out. The engines are hosed down, equipment is cleaned and put away, and the firefighters are sitting around the table relaxing after a particularly difficult incident. What happens next? Typically, there is a technical debriefing that focuses on what occurred, how it happened, and what could have been done differently to improve the end result. Feelings are checked at the door of this debriefing, and the tone is businesslike and focused.
Once that is completed, there is the informal, off-the-record discussion of the firefighters as they wind down and rest up for the next call. Often these discussions consist of cynical sarcasm or dark humor. Feelings are either ignored or squashed down. Jokes fill the air. Is this a good thing? Is there another way?
Firefighters are respected for being tough, keeping their cool under crisis, and mobilizing effective responses in split-second decisions of life and death. Sometimes, however, things do not turn out as expected. Lives are lost and people are severely injured, creating what we call potentially traumatizing events (PTE) or critical incidents.
In part 1 of this article, I focused on how firefighters can take care of themselves day in and day out and keep themselves in peak condition not only physically but also mentally. Part 2 focuses on what to do immediately after a critical incident or PTE. A critical incident relates to an event that carries with it exposure to loss of life, physical injury, and threat to one’s own life. While for many people the events that firefighters deal with are all critical incidents, there is no doubt that you can identify for yourself a fire that was a “critical incident” for you.
Coping in the Aftermath
Studies that document what leads to the best outcome for firefighters after critical incidents are hard to find. The research that has been done on debriefing, particularly critical incident stress debriefing (CISD), calls into question the effectiveness of sitting together as a group and having each person talk about his thoughts and feelings after a critical incident. While the motivation for these groups has been to help firefighters cope better with difficult and potentially traumatizing events and reduce the amount of post-traumatic stress disorder (PTSD), the outcomes have been mixed at best. As a result, many companies have modified their debriefing protocols or disbanded them entirely.
So the questions remains, what would be helpful? Do firefighters need to talk after a PTE? With whom? Is there something else that should be happening in the station house after a difficult event? What might that be?
Critical incidents can affect us on many levels. First, there is the physical level. After the huge output of adrenaline during the event, it usually takes some time to wind down before the fatigue sets in. Some firefighters have trouble letting go and may feel wired for hours or days. Others may find it difficult to concentrate or to fall asleep, and some may feel on edge or short tempered. There is a wide range of individual responses. What can you do to help yourself in the physical process of winding down? Self-medicating with alcohol or drugs, while easy, can be dangerous. Having one beer or a glass of wine can be okay, but the problem with using alcohol is that too often it is hard to stop at one drink.
Finding a Physical Outlet
Acknowledging that you have this excess energy is of course the first step to finding a solution. So, what can you do aside from drinking? What about a run or a workout at the gym? Discharging extra energy in this way will not only help you on the short term but will keep you in shape for the long term. Is there something else that suits you better? Perhaps going out dancing, on a hike in the woods, taking a long soak in the tub, or some other physical activity is more to your liking. Whatever it is, identify the activity for yourself now, and have it ready and available to you when you need to wind down after a particularly tough incident.
Finding Support at Home
In addition to the physical impact, a critical incident affects your thoughts and feelings as well. Sharing your day with loved ones who are able to hear what you have to say, show that they care, and support you can be most helpful. Firefighters often like to keep their professional and personal lives separate and may try to build walls around what they have experienced at work. I have heard from firefighters who say that they are afraid of sharing their experiences with their spouses. This can easily lead to a sense of isolation and loneliness and effectively cuts off an important resource and source of support for the firefighter. So how about turning to your spouse and sharing a bit of your day? Try it before you reach a critical incident so that when you do have that tough day you are both ready. You may be surprised at the response.
Finding Support at Work
An alternative source of support that has been effectively used in several first responder agencies is a peer support network. Peers who have volunteered and undergone in-depth training can provide a wonderful first tier of support and help for units or individuals who have experienced critical incidents or PTEs. There is nobody like a fellow firefighter to understand exactly what you have experienced and how you are feeling now. It may be difficult to talk about thoughts and feelings in the larger group, but one on one is a good place to start. If your agency does not have a peer support service, you might look into starting one.
Critical incidents that involve children often hit us hardest and make us feel particularly vulnerable. “Why” questions can frequently prey on our minds. There are no easy answers to these questions. How can we find meaning in the tragedy that we have seen unfolding in front of us? How can we maintain a sense of optimistic hopefulness after seeing such destruction, loss, and pain? These are difficult questions, and there is no one right answer. Each one of you will need to find a personal response that suits you. Developing a spiritual life, whether it is church centered or involves volunteering in the community, meditating, tai chi, or working in a homeless shelter, can often help with existential questions that have no easy answers. For some, this is an active reaffirmation of life. For others, it is the connection to a Supreme Being. Each person is unique, and thus each person’s response will be different.
Taking Care of Yourself
In the hours and days after a critical incident, check in with yourself and see how you are doing. Ask yourself how you are on all levels: physically, emotionally, cognitively, and spiritually. If you find that you are having trouble winding down, or you feel particularly unsupported or unhappy, this is the time to make some active changes in how you are taking care of yourself.
Remember: There are many things you can do to make your situation better. You cannot undo the past, nor can you change the outcome of whatever happened at work. The only thing you have control over now is you. Make the most of it!