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Apr 27 / cism.perspectives

CISM Perspectives working with Knoxville Police on LODD responses

April 27, 2011, Rochester, New York

Daniel McGuire, President of CISM Perspectives, announced today that the firm will be working extensively with the Knoxville Police Department, Knoxville, TN, to plan for and respond to incidents when a police officer is killed in the line of duty.

“We are very pleased to be working with such a large and progressive police department as Knoxville,” stated McGuire. “Although we have worked with many local and regional fire and EMS agencies on this difficult topic, the Knoxville project represents our biggest challenge to date, as we provide information and guidance to a police department with hundreds of officers and civil employees.”

“Our nationally recognized training and consulting program Tradition, Honor, Respect™, which focuses on how any emergency services agency needs to pre-plan and respond appropriately when one of their own is killed in the line of duty, will now be used by our largest customer in CISM Perspectives,12 years of professional services,” McGuire added.  McGuire is also a board certified grief counselor who specializes in educating and supporting all types of emergency responders.

CISM Perspectives is a Rochester, NY, based consulting and training company that works comprehensively with police, fire, and EMS agencies on a topic that is often overlooked. The grim reality persists that, in the United States, we lose more than one police officer, firefighter, or EMT every day due to line of duty deaths.

“One of the key deliverables with a project like this is to enable any emergency responder agency’s leadership to avoid the two most haunting questions that emerge once the funerals and memorials are over.  Those two questions are: ‘Did we do it right?” and ‘Did we do enough?’ The answers to those questions will have repercussions for the surviving family as well as the surviving department.”

McGuire emphasized, “The regrettable common denominator in the emergency services is that most departments do not have any type of pre-plan or manual to help them though what we refer to as a ‘high-definition event,’ one that will remain with those left behind, for years to come. Having carefully planned and tradition-guided steps, logistics, and proper death notification tools can greatly lessen the traumatic impact and resulting grief difficulties. Departments that prepare for the worst will be equipped to affirm that yes, we did it right and we did do enough.” The Knoxville project begins on May 3, 2011, and will continue throughout the next several months until completion.

Feb 28 / cism.perspectives

Emergency contact information: How ‘fresh’ is your members and staff’s information?

Regardless of the size of the emergency services agency, there is an inherent risk of one of your members or employees becoming injured or ill while at work.  Probably the risk that tops the list would be a death while on duty, or what is referred to as a line of duty death (LODD).

The exact moment when any of the above incidents occur, we refer to that as the Zero Hour.  Much like the “Golden Hour” in EMS, the Zero Hour has many critical steps that need to be addressed immediately and done with the utmost of care and attention.

Part of the overall well designed program Zero Hour response program in your agency ought to include up to date Emergency Contact Forms (ECF’s) for the leadership or supervision to have quick access to.  These forms require some key information about each employee or member in case of an emergency involving them.  A sample of the top 10 key points would include:

  • Date of last revision
  • Employee/Members full name
  • Current address
  • Home number
  • Name of emergency contact person
  • Emergency contact person address
  • Their phone numbers (cell, work, home)
  • Any children present at home
  • Parents contact information
  • List of any employee/member to help with any notification

Often it is found the above information is either missing or so out of date it must be considered incorrect.  As a supervisor or leader within an agency, you have the primary responsibility to get an ECF completed for everyone in your agency, initiate a plan on receiving annual updates to the ECF’s and a solid plan on securing this confidential information, but, allowing for a restricted access to them in the event of an injury, illness or LODD.

A recommended ECF access plan is essential to accomplish these main issues.  First, maintain controlled access to them will assist in guaranteeing their confidential information will remain secure and only be accessed in the event in an emergency involving the individual.  Second, one caution must be noted.  While the access to the ECF’s has to remain secure, often the plan is so ‘tight’ that an agency may not have enough redundancy or flexibility in the plan to prepare for unforeseen circumstances.

An example of this would be an agency’s ECF plan only allows the Chief and one assistant access to the forms.  If the event requiring notification involves one or both of these leaders, then there is no back-up plan to cover this particular scenario.  Ideally, only 2-3 individuals ought to have direct access to the forms and perhaps no more than 2 alternates to be identified who would be able to access the forms under very special circumstances

It is also recommended that when each member or employee submits their completed ECF, they do so in a sealed envelope with their signature across the seal.  This is one more component that will insure the information was filed confidentially and will remain so unless there is an emergency requiring access to it.

The examples shown on what an ECF should have only covers the very basics and what the minimal amounts of information you need to have readily available.  We recommend that the ECF be expanded into two parts to include information such as:

  1. Organ donor information
  2. Primary doctor information
  3. Location of any health care proxy
  4. Location of any will
  5. Location of a Power of Attorney document
  6. Insurance information on vehicle, home
  7. Life insurance policy
  8. Funeral service wishes/requests
  9. Burial information

The above information ought to be completed with the spouse, parents or significant other of each member or employee.  It will be important that these family members know well in advance of these very private but important information so there is no questions or other situations that may only add to the grief and pain of the serious injury or death of your loved one in the emergency services.

We do recommend that the above information not be kept at the workplace, but in a safe but easily accessed location at the home of the responder.  This is very sensitive information and needs to be respected as such.

In summary, having updated emergency contact information is vital to managing any traumatic event involving the people you manage and work with.  If you do not have an ECF plan in place now, you need to move towards the top of your priority list.  If you would like a sample of our ECF form, please contact us and we will be happy to forward a sample ECF to you.  Just contact us at www.cismperspectives.com or cism79@frontiernet.net and we’ll be glad to send one to you promptly.

As an ending note, there are three key words we teach in our LODD Pre-Planning workshop.  We refer to them as the “3 Guiding Principals” when you respond to a LODD.  Those 3 words are Tradition, Honor and Respect. Take good care of your own and that begins by taking care of ourselves first.  Be well and let me know how we can help.

Feb 15 / cism.perspectives

The High Cost of Workplace Trauma

by Bob VandePol, President of Crisis Care Network

When tragedy strikes the workplace, employers face not only the obvious human loss but also increased exposure to significant financial loss. Stemming from the psychological damage to the organization’s human resource, cost drivers include:

  • Increased exposure to Workers Compensation claims
  • Workforce attrition and recruiting challenges
  • Increased absenteeism
  • Diminished concentration and accuracy
  • Increased conflict between employees and with customers
  • Increased use of alcohol and drugs to self-medicate

In retrospect, business leaders often pinpoint a workplace tragedy (violence, catastrophic accident, robbery, employee fatality, terrorism) as pivotal to the ongoing productivity of their work teams. Some identify how the incident launched a new sense of loyalty, commitment to excellence. Others bemoan the event as triggering a collective negative image, increased conflict, and distrust of leadership.

Trust of leadership and a desirable corporate culture are at risk. A dynamic common to work groups following a traumatic incident is increased “we/they” thinking and blaming of “administration” for problems related and unrelated to the incident. People impacted by trauma predictably tend to:

  1. Regress to more basic, primitive impulses and defenses
  2. Immediately attempt to make sense of the incident in effort to gain a feeling of control over it
  3. Isolate from others

When the crisis counselors arrive on-site they immediately establish communication with a designated on-site contact, typically from Human Resources or other management position. Prior to meeting with employees, it is clinically important to draw circles of impact and arrange groups of similarly impacted individuals. For example, people who experienced risk to their safety or witnessed horrific scenes will typically inhibit verbalization if co-workers are present who were not first-hand witnesses and, conversely, exposing non-witnesses to gruesome images can secondarily traumatize them. Another rule of thumb generally advises against mixing employees and those who supervise them in the same group.

Counselors can coach business leaders in utilization of The ACT model, a structured process to promote recovery. Managers need to respond immediately, visibly, and effectively because how they handle a tragedy offers both tremendous opportunity and serious risk for their management relationships and outcomes. If ignored, the employees feel as though insult was just added to injury and feelings of betrayal further fuel the likelihood of blame.

Acknowledge the trauma

  • Have an accurate understanding of the facts
  • Acknowledge that the incident has an impact on team members and individuals will be impacted differently
  • Communicate compassion and competence
  • These characteristics are not mutually exclusive and must both be present to productively lead a traumatized group.
  • Leaders may benefit from the support of a colleague, EAP consultant, or trauma expert to help script a response
  • Have a crisis response plan that includes use of trauma-trained mental health professionals. Inherently, exercising this plan communicates compassion and competence.

Transition

  • Communicate an expectation of recovery. Those impacted must gain a vision of “survivor” rather than “victim.”
  • Communicate flexible and reasonable accommodations as people progress back to “return to work” and “return to life” normalcy.
  • Lead visibly for several days and be accessible to employees for support and information.
  • Destigmatize and encourage use of trauma counselors

The counselor also engages in immediate assessment for suicide or violence indicators. Following intervention completion, the counselor provides the company’s management with recommendations for next steps.

You can do well at doing good! When business leaders manage the risk of a traumatic event via this process they speed individual and organizational recovery and gain greater likelihood employees will positively view their involvement.

Bob VandePol is President of Crisis Care Network. CCN You can contact him at bob.vandepol@crisiscare.com or 888-736-0911.  www.crisicare.com

Feb 15 / cism.perspectives

Upcoming Training Programs

Please join us at our upcoming training programs! Complete details can be found at the URL’s below…

All training is presented in a multimedia format including video, lecture and significant practical skill sessions

CISM Perspectives is a member of the ICISF and the American Academy of Experts in Traumatic Stress

CISM Perspectives brings to all instruction 25+ years in EMS, Fire, Law Enforcement CISM programs, training and consulting

Jan 31 / cism.perspectives

Death Notification – it’s never easy

Regardless of your position within the emergency services, you will eventfully be tasked with some extraordinarily difficult responsibilities.  It not difficult to imagine that in a Chief’s, Administrator’s or other leadership position you will be asked to and perhaps looked upon as the right choice for these challenging tasks.

Without a doubt, as a past Chief myself, the mere thought of having to deliver a death notification to the family of one of our staff would keep anyone up at night.  Too often these exact skills are not taught or mentioned in the many leadership training courses one takes as you come up through the ranks of any agency.

We have to fully realize that in the emergency services we loose either a firefighter, EMT/Paramedic, police officer each and every day.  The work they do has its inherent risks that simply come with the job.  By choosing one of these types of careers we must appreciate and acknowledge those risks and be the very best prepared for them as we can on an individual level and an agency-wide level.

With a line of duty death (LODD) occurring every day, we then have to look inside of our agency and begin with the following statement “It’s not a matter of if, but a matter of when a LODD will strike my agency.”  In 2006 alone, we lost 106 firefighters, 9 EMS responders and 124 police officers.

There are a few basic skills that anyone delivering a death notification should be fully aware of and confident in these skills:

  • Realize this will be the most difficult task of your emergency services career
  • The words you choose will be the words the family receiving this information will remember the most and for the longest
  • The ability of you delivering a death notification properly will directly impact that family’s ability to survive the event and the eventual moving forward

Other issues to remember are:

When you arrive at the home, identify yourself and as to go inside.  Under no circumstances should you break this tragic news at the door step.  Determine if the people you first meet are the family members of the injured or deceased.  Ask to go inside and for everyone to sit down.

Make and keep good eye contact with each of the family members present.  This will show to the family that you have their attention and that you are being honest and genuine with them

Begin with a simple statement such as “I’m sorry to tell you….” or “I have some tragic news to share with you….”.

Be direct and use the words ‘died’, ‘dead’, etc. and be sure to avoid phrases such as ‘Passed away” or “Is with God now. Or the one that raises my anger the most “You got to be strong!”

Remember, those first words you say will stay with that family forever!  Use the injured or deceased’s name at all times.  As hard as this may be, the family will need to hear this. Avoid at all costs any emergency services ‘jargon’.  This will only confuse the family and this is not the time to have to ‘translate’ your words.

Allow for the families grief and anger but be sure to protect your personal safety at all times. (I have always taught that you should keep 2 arms length between you and those you are delivering this information to.)

Expect many, many questions.  If you don’t know the answers to all of them it’s perfectly correct to say “I don’t know but I will try to get you an answer.”  It’s imperative that you DO NOT speculate to any answers whatsoever.

Offer simple gestures to the family such as making any needed phone calls, transportation to the hospital, helping to arrange any immediate child care, etc.  Be aware of differing grief expression due to the many different cultures that makes up our communities.

Be sensitive to the diverse family structures that you can expect.  Regardless of that family structure (domestic partner, common-law spouse, etc.) they all need to be treated the same with dignity and respect.

Regardless of your training and background, death notifications are never easy nor are they something that ‘gets easier the more you do them.’  With the proper training and large amounts of solemnity and consideration, death notifications can be done properly.

As an ending note, there are three key words we teach in our LODD Pre-Planning workshop.  We refer to them as the “3 Guiding Principals” when you respond to a LODD.  Those 3 words are Tradition, Honor and Respect.

Jan 17 / cism.perspectives

Crisis Response Readiness for Colleges & Universities!

NEW! From CISM Perspectives, Inc.

University Crisis Response, developed by the American Academy of Experts in Traumatic Stress, provides a structure and process for effectively managing the wide spectrum of university-based crises—from the smallest to the most tragic.  It is an invaluable resource in preparation for and during actual crisis situations and serves as a meaningful standard for our nation’s colleges and universities. This program recognizes that crisis response cannot be delegated solely to administrators and members of the Crisis Response Team. Effective crisis management is the responsibility of all university personnel.

This program introduces and incorporates a practical and effective strategic curriculum, Acute Traumatic Stress Management (ATSM) for addressing the emergent emotional needs of people during traumatic events. ATSM does not require caregivers to be mental health practitioners. Rather, ATSM can empower all university personnel by providing a “road map” to keep people functioning and mitigate long-term emotional suffering.

Call us at (585) 739-9011 about bringing this powerful and unique training to your area college and university emergency responders, staff and faculty!

Jan 17 / cism.perspectives

Line of Duty Death Pre-Plans

Recently I finished a year-long project with a large and very active fire department in Western New York State. This project was to design, build, and initiate a full line of duty death (LODD) pre-plan strategy and procedure manual and Emergency Contact Form (ECF). This was the culmination of years of knowing that they needed something to use as a guide and from recognition that, once every 24-hours, we lose an emergency responder in the line of duty.

What this project, one of many I have been directly involved in, has taught me is:

  1. All too often, people mistakenly believe that “We are too small a department to worry about a LODD.”
  2. Or, “We’ll use our state’s funeral protocol to guide us.”
  3. Lately, “budget” has become a four-letter word, effectively precluding too many agencies from even beginning allocating funds and time for the design of an LODD pre-plan—or even updating an existing plan.
  4. Or I hear this frightening statement: “We will depend on our state, regional, or local officials to take care of LODD issues.”

Let me go on record by stating that, yes, many good resources exist for EMS, Fire or Police agencies to tap into should a serious injury or LODD strike your agency. However, and this caution comes directly from many of these fine resources, you still must have something in place within your own department to use as a guide for those critical 12-24 hours immediately after the tragic event.

By now it should be well known that there is genuine resistance to working on a pre-plan that deals directly with a LODD. We, as Americans, are generally uncomfortable even talking about death, end of life issues, and planning for the inevitable. But that reality should not be used as an excuse to avoid this topic.

I will share with you some of the comments that I have received from the Chief Officers, family of departmental members, commissioners and others now that they have a plan in place. Overwhelmingly, there is a great sense of relief that, finally, they have something to lean on—a complete list of outside resources, local resources, and a mutual understanding of what will be done should a tragedy strike their department. There will be a response to it, in concert with the other resources available.

I often teach in our LODD training program “Tradition, Honor, Respect” that it is CISM Perspectives’ goal to be able to help you avoid asking these two haunting questions after any LODD:

“Did we do enough?”
“Did we do it right?”

These two questions will frequently be in the minds of those who find themselves in charge of the overall response and coordination of the surviving family support, surviving department support, and the logistics and financial matters that envelop any department that experiences a LODD, or even the unexpected death of a member or employee from other causes.

Let me be clear on this fact. It takes time (months), finances, and a great amount of passion and determination to take on this intimidating topic. And it takes courage to begin planning for what will be perhaps the most tragic event in your personal and departmental history.

If I can suggest three main ideas on just how to tackle this mission, they would be:

  1. Fully realize this will happen to your department, one day sooner or later. Remember this statement from CISM Perspectives, “It’s no longer a matter of if, but when.”
  2. To help address the resistance to implementing a LODD SOP, approach it and speak about it as simply another protocol. Protocols have become everyday necessities in the emergency services and using the word “protocol” can ease some of the discomfort in approaching this topic.
  3. And finally, John F. Kennedy gave us a quote more than 40 years ago that is quite appropriate for this topic: “The time to fix the roof is not when it’s raining.”

I could not have said it any better. In closing, let me make this offer. If you have any questions on how or where to begin, please contact us. We want to help as many departments and agencies as possible, regardless of budget constraints, leadership apprehension, or any other difficulty you may face. I have been there personally and professionally and I hope I can show how you too can not only survive this type of tragic event, but also grow from it.

Jan 7 / cism.perspectives

Not Always As It Appears

By Guest Author Jeffrey T. Mitchell, Ph.D., CTS

There has recently been a series of negative studies and media attack articles on CISD and CISM.  A glance at the studies and articles suggests that the CISM field is in real trouble.  But, the question must be asked, are those studies really measuring the effects of CISD or something else entirely?

The negative studies are of single session “debriefings” provided to individuals.  Those studies demonstrate clear violations of the acceptable standards of CISM practice.  Single session “debriefings” are a collection of interventions that are, in fact, a form of psychotherapy provided to primary victims such as rape victims or medical patients in a hospital. The providers of these therapies are nurses and emergency department staff members.  Provider performance does not indicate any formal CISM training.

Some studies loosely apply the steps of a CISD, but to individuals not groups.  (Group interventions are inherently different than individual interventions.)  There are no follow-up interventions.  Single session debriefings have never been approved or endorsed by the International Critical Incident Stress Foundation, the Red Cross, the National Organization of Victim’s Assistance, The Association of Traumatic Stress Specialists or the American Academy of Experts in Traumatic Stress.  None of these organizations has a training program which teaches “single session debriefings” because they do not comply with essential crisis intervention standards.

Some researchers erroneously call their non-standard debriefings “CISD.”   Some have made quantum leaps from poorly designed and badly executed studies to a condemnation of the entire field of CISM.  The opponents failed to study debriefing within the proper context of a comprehensive, systematic and multi-tactic package of crisis interventions.  In summary, inadequately trained personnel are providing a hodgepodge of non-standardized, stand- alone interventions to individuals for whom the CISD process was never intended and in inappropriate circumstances.

Furthermore, the opposition insists that randomized controlled trials are the gold standard in research to the exclusion of all other forms of inquiry.  Yet, in several studies claiming to be randomized controlled trials, the individuals who were given “debriefings” were quite different from those who did not receive the “debriefing.” Randomization efforts did not achieve equality of groups.

CISM opponents consistently mistake crisis intervention services for psychotherapy.  In fact, debriefings are being substituted for psychotherapy and then criticized when they cannot achieve results which even psychotherapies would be hard pressed to achieve.  That is a core misunderstanding of the very nature of CISM.

The primary goals of the crisis intervention program entitled CISM are to mitigate the impact of a critical incident and to accelerate recovery processes of normal people with normal reactions to abnormal events.

CISM services perform well as screening mechanisms that may be utilized to identify people who need additional services.  CISM also enhances group cohesion and unit performance.  It does not eliminate all stress symptoms, depression or anxiety disorders nor does CISM claim to be a cure for PTSD.  Many positive outcome research studies demonstrate that CISM does, in fact, achieve its primary goals.

From my point of view, every study presents a small window through which we can view the field of CISM.  Each one tells us more about what works and what does not work.  Even the negative studies tell us at least what we should not be doing if we wish to engage in helpful crisis intervention.  We can learn from all forms of study.  CISM services based in well founded theoretical frameworks and supported by a broad range of studies can be properly applied by well trained professional and paraprofessional crisis interventionists.

For twenty eight years I have studied the theories, the studies, and the reports concerning CISM.  In all that time I have not found any relevant documented evidence that has dissuaded me from the careful application of appropriate crisis intervention procedures for individuals and groups.  Crisis intervention tactics, particularly the group tactics, are not simple.  To be effective, crisis intervention must be applied by well trained and skillful interventionists.  Various tactics must also be applied at the right time and under the right circumstances.

Over the years, I have written several literature reviews in peer reviewed journals.  Yet the same flawed arguments pointing to the same flawed studies against CISD arise again and again.  I hope that there will soon be an end to the persistent rehashing of worn-out criticisms of the field based on faulty studies.  If not, then I can only agree with Dr. Atle Dyregrov of Bergen, Norway who stated in 1998, “In my opinion the debate on debriefing is not only a scientific but also a political debate.  It entails power and positions in the therapeutic world.”

Dec 26 / cism.perspectives

Help With Grief and Grieving

The loss of someone who is special to you can be a very difficult experience.  When we lose someone close to us (personal family or work family) we can experience many emotions, feelings and reactions.

Some of these responses can include shock, disbelief, denial, sadness, anger, hopelessness, personal pain, fear and, at the right time, acceptance.  These reactions can often become intense, especially if the loss is unexpected or tragic in nature.

These feelings and emotions are to be expected, should be seen as individualized to each person, and not be viewed as wrong if another person is not feeling or reacting the same way. As individuals, each of us will experience a loss differently from our peers, our family members and those we work with.  We as individuals will each mourn and grieve differently too, since we are just that— individuals.

Simply stated, “Normal people, with normal reactions to a traumatic event.

A sudden loss can be a particular source of increased pain, sadness and the other emotions listed above.  We tend to feel guilty or partly responsible for the loss since we feel that we ‘didn’t do enough’ to help, we didn’t tell the person how we felt about them, and we regret not having more time with them.

Steps to help you move through this experience include:

  • Recognize the loss and understand that it has occurred.
  • Allow for your own feelings and emotions.  This is not the time to allow others to dictate how to feel, react or what to say.
  • Recall the times you did have with the person and find comfort in the positive experiences you have gained from knowing them.
  • Begin to realize and accept that your life will be different without them
  • Find time to yourself to begin the acceptance of the loss, realize that you feel sad, angry or are in disbelief that they are now gone.
  • Also realize that you will have to re-adjust to the loss and that this takes TIME!  We will all process and proceed through the loss at our own pace and others may ‘bounce back’ sooner or may take longer.  Individual reactions to a shared experience!
  • Peer support at a time like this can be invaluable!
  • Put yourself first by eating sensibly, getting adequate rest, reduce caffeine, sugars and fats, increase the amounts of water you drink and get some moderate exercise to help relieve a portion of the stresses you may be experiencing.
  • Try journalizing your thoughts to help you organize them and better understand them.  With grief and stress, our thought processes can become diffuse and we can find ourselves overwhelmed with fleeting thoughts.
  • Asking for this level of help does not in any way mean that you are crazy, weak or that there is something wrong.  It means that you cared about the person who died, and that you may need some help in moving on.

In summary, the death of someone close to us is a very sad and painful encounter.  Realizing that our close friend, loved one or spouse is no longer with us can be frightening and traumatic.

However, using this basic advice can assist you through this difficult time.  It is completely normal to miss that special person and think about them often.  As the days ahead turn into weeks and months, you will be able to work through this sense of loss and grief.  We ask that if you know of someone who is experiencing grief and may be having difficulty, please share this informative article with them.

Dec 16 / cism.perspectives

Holiday Greetings

I send this holiday wish to each of you.  We so often become overwhelmed by all of the expectations and traditions we each seek out and partake in.  There are so many things we like to do for the holidays, be with family, shop, prepare traditional foods for those important meals and then enjoy the meals too.

It’s no secret that those of us in the emergency services, hospitals and CISM sometimes find ourselves on duty during these special days.  The needs for our services and talents won’t ever go away, but we do think to ourselves that we desire a quiet shift.  I know from past years, it’s tough being at the station or base on the big day, and not being with our families and loved ones. While we do have our second families at these work locations, it somehow just doesn’t fit the bill when we are not with our family and part of all of the joy they bring.

In closing, I’d like to quote from the book Merry Christmas: Celebrating America’s Greatest Holiday: “If the Fourth of July, with its fireworks and parades and Uncle Sams-on-stilts, is the most patriotic of the holidays in its red-white-and-blue symbolism, then Christmas is the most American in its red-and-green essence.  Christmas speaks to dreams that come true, to comfort, generosity, and the sheltering warmth of home—to the elusive American dream.”

May your holidays be blessed and bursting with joy, peace, but most of all, hope.