LAS VEGAS FIRE & RESCUE
STANDARD OPERATING PROCEDURES
EMERGENCY MEDICAL SERVICES / CRITICAL INCIDENT STRESS MANAGEMENT – CALL OUT PROCEDURESEffective Date: / 01/31/03
Supersedes: / 540.05 / M.P. / 530.04 / Page 1 of 5
I. INTRODUCTION
A. Purposes: To provide an organized approach to the management of stress responses for firefighters having been exposed to, or showing signs of traumatic stress experienced in the line of duty.
To provide continuous stress management education for all department staff to address on-going, non-critical, job-related stress; encourage proactive response to stress management.
B. Background: The Las Vegas Fire and Rescue personnel regularly confront circumstances which subject them to unusual levels of stress, both from excessive physical exertion and from the psychological and emotional impact of the situations encountered. The effects of stress are best countered through debriefing the personnel within a short period following exposure to extraordinary duty. Fire Service agencies have found this practice most successful when conducted internally from peers and professionals specifically trained for this purposes.
Firefighting has long been regarded as one of the most stressful occupations. The demands of the profession can be extreme, and the emotional costs to firefighters and their families can be immense. Fire fighting is also a profession that can provide phenomenal rewards. “The fire service must structure work and support mechanisms to enable fire personnel to minimize the toll of career stress on themselves and their families while maximizing the personal rewards of the professions.” {Developing Fire Service CISM Programs, IAFF 1999}
C. Scope: All department personnel are responsible for identifying and recognizing significant incidents, which may qualify for CISM response. It is recommended that the term “mandatory” be changed to “automatic.” By using the term “automatic” CISM become standard operating procedures. By doing so, a method to protect the psychological welfare of emergency personnel becomes as automatic as putting on safety protection equipment. {International Journal of Emergency Mental Health, 2000, 2 (4), 259-257}.
D. Author: Deputy chief of Operations in accordance with the Crisis Intervention Administrator (CIA).
E. Objectives:
1. To reduce and control the harmful effects of critical incident stress on LVF/R personnel.
2. To reduce the impact of a traumatic event.
3. To accelerate the normal recovery process from a traumatic event.
4. To normalize the stress response in traumatic events.
5. To provide for education in stress management and coping techniques.
F. Definitions:
1. Critical Events: Any event that has the sufficient emotional power to overcome the usual coping abilities of emergency personnel.
2. On-Scene Support Services: Brief assistance to obviously distressed firefighters, advice to the command staff as the situation warrants, and brief assistance to victims and their family members to reduce interference with operations. The CIA will respond upon request of the on-duty Battalion Chief, Captain, EMS Field Coordinator or any fire personnel.
3. Defusing: A three-stage intervention implemented immediately or within 8 hours of a traumatic event; used to either eliminate the need for a formal CISD, or enhance a subsequent CISD. The CIA will respond to designated station, and meet with personnel involved in the incident.
a) Introduction – States purpose of defusing, motivate the participants to accept and cooperate with the process.
b) Exploration – Description and clarification of what happened.
c) Information – Normalizes experiences and/or reactions, teach multiple stress skills.
4. Individual Crisis Intervention: One-on-one confidential assistance with any issue.
5. Critical Incident Stress Debriefing: The CISD process is a seven-stage intervention for group discussions about a traumatic event or series of traumatic events. A CISD is schedule within 48 hours after the incident. It is designed to mitigate the psychological impact of a traumatic event, prevent the subsequent development of post-traumatic syndrome, and serves as an early identification mechanism for individuals who might require professional mental health follow-up subsequent to a traumatic event.
a) Introduction – Introduce team members, explain process and set expectations.
b) Fact – To describe traumatic event from each participant’s perspective on a cognitive level.
c) Thought – To allow participants to describe cognitive reactions and to transition to emotional reactions.
d) Reaction – Identifies the most traumatic aspect of the event for the participants and to identify emotional reactions.
e) Symptom – Identifies personal symptoms of distress and transitions back to cognitive level.
f) Teaching – to educate as to normal reactions and adaptive coping mechanisms, i.e., stress management.
g) Re-entry – Opportunity to clarify issues, answer questions, make summary statements and return group to normal functions.
6. CIA: Crisis Intervention Administrator – to provide and administer crisis intervention services for the City of Las Vegas Fire Services Department.
7. CISM: Critical Incident Stress Management – A comprehensive, integrated multi-component crisis intervention system.
8. EAP: Employee’s Assistant Program – A cost effective, humanitarian job based strategy for helping employees whose personal problems are affecting their work performance.
II. RESPONSIBILITY
Battalion Chief, Captain, EMS Field Coordinator, fire alarm dispatcher, firefighter or any fire department personnel can contact the CIA. The CIA will make a determination of the scope of intervention needed.
A. Functional Position: The Crisis Intervention Administrator will be responsible for the activities and functions regarding Crisis Intervention.
1. Evaluates need for type of CISM.
2. Answers request for CISM information.
3. Seeks guidance from EAP on unusual situations.
4. Activates Peer Support Team.
III. POLICY
The CIA should be contacted for critical events that have sufficient emotional power to overcome the usual coping abilities of emergency personnel. The typical critical incidents capable of causing distress for emergency personnel are, but not limited to:
1. Line of duty death.
2. Suicide of an emergency worker.
3. Multiple-casualty incident/disaster.
4. Significant event involving children.
5. Knowing the victim of the event.
6. Serious line of duty injury.
7. Involvement in several stressful events in a short time frame.
8. Excessive media interest.
9. Prolonged incident with loss.
10. Any event that has an unusually powerful impact on fire personnel.
All I can say to any Chief, Captain or Fire Alarm personnel is that if you say to yourself, I wonder if I should call…..Just do it!
(Dr. Jeff Mitchell, Train the Trainer, April 2002)
IV. PROCEDURE
Any fire personnel may activate the CIA for a critical event or for any confidential reason. Contact the CIA by phone or pager system. The CIA is available 24/7.
SAFETY is a departmental concern, and notification of call-outs for destinations other than Fire Station will be made to the Deputy Chief of Operations or Assistant Chief of EMS. Confidentiality will be maintained by the C.I.A.