Every year, the Tucson Fire Department responds to an average of 80,000 calls for help.
There are fires and car crashes; medical emergencies and “code arrests,” in which firefighters work to save the life of someone whose heart has stopped.
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Each call carries great responsibility, says Tucson Fire Health and Safety Captain John Gulotta.
“Tucson Fire Department goes and processes a thousand code arrests a year,” he said. “That’s 1,000 families we deal with, 1,000 lives we see ... and that’s not including pediatric or child abuse, that’s not including adult abuse, that’s not including traumatic events we see.”
What first responders see can take an emotional toll, and that’s why many police and fire departments use crisis interventions to help their workers cope.
One of the most common interventions is Critical Incident Stress Management, or CISM. It’s a highly structured system developed to help people recover from emotionally traumatic events. Although it’s sometimes used one on one, it often includes group discussions, called debriefings, to go over the traumatic event.
Tucson Fire paramedic Kevin Chaffee came to know and train in CISM on the job, and says he has seen its benefits firsthand.
“My very first call that I ever went on as a brand-new EMT was a pediatric drowning, and I had the ability to experience the effects of CISM,” Chaffee recalled. “At that point in my career, it was all brand-new to me and I did find it very helpful.”
Over the 13 years that followed that first call, Chaffee saw more than his share of emotional trauma as a firefighter. But one event changed his life—and his ideas about how best to respond to a crisis.
A year ago, Chaffee’s closest friend was killed. His friend was a Nogales firefighter with close ties to his department and to the community.
“It was a huge network of people that needed help,” Chaffee said, “and we utilized CISM initially to help us get through that.”
Chaffee says the CISM team followed the program’s protocol, including a debriefing and some suggestions for self-care—but that the implementation clashed with his and his fellow mourners’ emotional needs.
“When you have a group of firefighters who are used to hanging out together on their days off, barbecuing and having a couple of beers watching a football game on Sunday, and you tell them, ‘Hey, you should avoid those things you normally do to decompress and make things right in your own mind again,’ that didn’t go over well with most of the firefighters from Nogales, or for most of his friends, for that matter,” Chaffee said. “So we had to take things down a different road.”
That different road has led Chaffee, Gulotta and the rest of the Tucson Fire Department to develop their own alternative to CISM.
It’s called the Peer Operational Support Team, or POST, and it has grown from a partnership with University of Arizona researchers, including psychologist Patricia Haynes, director of the UA Stress and Trauma Recovery Clinic.
“It’s a peer system, where fellow firefighters go and talk with their peers who’ve gone through really tough calls, and the whole purpose in the short term is to really promote calming,” Haynes said.
The trained firefighters who make up POST talk to their peers one-on-one and help them find ways to decompress, whether it’s by calling their families or taking a day off.
Haynes says they make themselves available but let the natural recovery process unfold, checking in periodically to catch problems as they arise.
“Where we really emphasize the majority of our intervention is 30 days after the really difficult call,” she said. “That’s when we actually go in and do a formalized risk assessment for PTSD and depression, so that those individuals who haven’t gone through a natural recovery, those individuals who have gotten stuck, can be identified and we can help them.”
POST’s informal, individualized approach differs from CISM’s, and it’s gradually gaining favor in certain circles.
Some studies have suggested that CISM’s group debriefings have the potential to interfere with natural recovery. That has fueled controversy around the practice, and led the National Fallen Firefighters Foundation and some fire departments to move away from CISM.
Tom McSherry is a former firefighter EMT who has implemented CISM all over the country for high-profile disasters including 9/11 and the Yarnell Hill fire. He says he stands by CISM, but understands the impulse to try something different.
“I believe in it, I’ve seen its value, but I must say I’m anxious still every time I do it because I know, if misapplied, you can do harm,” he said. “No different than if you drink too much water, you can end up in the hospital.”
McSherry cautions against abandoning all the tools that CISM offers, because one-on-one interventions—like the ones favored in POST-like models—may not be enough when large-scale disasters strike.
“One tool would not have worked for me at Ground Zero,” he said. “One tool would not have worked for me in two weeks up at Prescott after the 19 were killed. I had individuals, we had small groups, we had large groups, we had families, we had victims, we had survivors, and to be limited to just that one model would not have sufficed.”
Firefighter Kevin Chaffee agrees. As part of the team developing and testing POST, he says he sees himself drawing from CISM to simply offer his fellow firefighters another choice when their burden grows too heavy.
“I feel that by doing what we’re doing with POST—taking some of the best things about CISM and tailoring it to what we individually need in our fire department and for the fire service in general—I think that being part of that is a huge thing that is going to go on for the future of the fire department,” Chaffee said. “That’s why I’m so passionate about being in this program.”