Health & Wellness: Critical Incident Stress Defusing & Debriefing

The accumulation of stress from fires, EMS calls, motor vehicle accidents and other emergencies often leads to chronic anxiety among firefighters. Certain emergency calls— for example, a firefighter fatality, a mass casualty incident and the death of a child—can be particularly impactful on a firefighter’s psychological well-being. Such incidents can lead to irritability, flashbacks, disturbed sleep and/or post-traumatic stress disorder, among others.

Identifying critical incidents when they occur is vital to building resilience, activating peer support networks and preventing more severe behavioral health problems. Defusing and debriefing sessions are the first steps to healing.

Triggering events

Firefighters grow accustomed to stress. Each time that they hear the emergency tones, their body feels a spike in adrenaline. They jump up from the kitchen table, don their turnout gear, and rush across town with lights and sirens. Furthermore, as the saying goes, firefighters often see people on the worst day of those folks’ life: automobile extrications, fires, heart attacks, etc. Nevertheless, members remind themselves to focus on the emergency and rely on their training. There’s no time for distractions, because every second counts. They do their job and move on to the next emergency, again and again.

Over time, stress accumulates subconsciously. Some firefighters grow irritable, unable to relax and unable to sleep. Compassion fatigue—the burnout and secondary trauma that results from witnessing the suffering of others—often takes hold. Stress tends to weaken firefighters’ psychological resilience, which leaves them vulnerable to a potential triggering event.

Triggering events are emergency calls that can cause a distressing emotional response that can overwhelm resilience and typical coping mechanisms. These calls aren’t routine fires or small gas leaks. These calls are shocking and painful. They can be emotionally debilitating. They can derail a firefighter’s emotional stability and cause immediate grief and suffering. Triggering events also are known as triggers or critical incidents.

Work-related triggering events include:

• An unsuccessful rescue attempt
• A civilian injury or death that results from an emergency vehicle collision or other firefighter action
• A child’s traumatic death, sudden death or violent injury
• A police emergency that involves firefighters (i.e., a shooting at a fire/EMS call, a hostage situation, etc.)
• A mass casualty incident
• A victim who is known to emergency personnel
• A first responder injury, death or suicide

Defuse and debrief

When a triggering event occurs, fire officers immediately must acknowledge the same. It’s important to avoid pretending that a triggering event is just another emergency call.

Fire officers should notify superiors to request a Critical Incident Stress Defusing as soon as possible. Chiefs should consider placing the affected firefighters out of service for a short period of time, because those members might be distracted and unable to perform as otherwise expected.

A Critical Incident Stress Defusing is an immediate intervention to minimize the psychological trauma of a triggering event. The focus is on talking. Group discussions are important to communicate each person’s experiences. This is an opportunity to activate a peer support team or psychological first-aid team, if available. The session also should assess the emotional effect that the triggering event has on each firefighter as an individual. This discussion demonstrates that firefighters aren’t alone in experiencing stress and grief.

Confidentiality is essential and should be broken only when there’s threat of violence or threat of a member self-inflicting an injury. Peer support teams should serve as a bridge to licensed professionals, the Employee Assistance Plan, and even the department chaplain.

Follow-up meetings are vital. A Critical Incident Stress Debriefing should occur within days of a triggering event. This is a more structured group discussion than a Critical Incident Stress Defusing. It’s designed to facilitate psychological closure. Ideally, a therapist or other trained professional serves as moderator.

Mitigating the swagger

Group discussions help to mitigate ongoing stress and to rebuild resilience and to reestablish coping mechanisms. It’s crucial to remember that recovery takes time and often involves multiple steps.

The greatest potential obstacle in stress management is an unwillingness to participate. Firefighters might embrace stereotypes of swagger and strength. They might think of grief and anxiety as weakness rather than as natural human responses to a crisis. This skepticism diminishes teamwork and undermines the supportive environment that’s indispensable to recovery. Although there’s no one-size-fits-all treatment for stress, firefighters must remember that peer support is important. The participation of chief officers and union leaders can help to improve participation.

A discussion of behavioral health statistics also can help to mitigate the tendency to think of grief and anxiety as weakness. Various studies show that: psychological stress causes depression in 21.7 percent of firefighters; more than 32 percent of firefighters report significant levels of post-traumatic stress symptoms; binge drinking alcohol is prevalent among career (56 percent) and volunteer (45 percent) firefighters; and 46.8 percent of firefighters reported suicidal ideation (thoughts/ideas), 19 percent made suicidal plans and 16 percent attempted suicide. Clearly, untreated stress and anxiety are prevalent in the fire service, and it’s very important to build ongoing resilience.

Finally, defusings and debriefings are an opportunity to reinforce the importance of diet, exercise and sleep as essential components of holistic health and wellness and positive psychological health. Harvard University’s “Feeding America’s Bravest” program encourages firefighters to eat a Mediterranean diet that values high-fiber foods over meats and sugars. Harvard also recommends 150 minutes per week of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity. No fewer than seven hours and as much as eight hours of high-quality sleep are recommended for firefighters.

Onus on leadership

The effect of stress on emergency responders is grave. Establishing a supportive environment of peers, minimizing the symptoms of grief, facilitating recovery and rebuilding resilience require buy-in from a department’s leadership and a discussion about untreated emotional stress (post-traumatic stress disorder, depression, etc.) and holistic wellness.