*** Critical Incident Stress Tips *** Date: Thu, 7 Mar 1996 09:59:33 +0000 From: "Robert H. McCool" To: sar-l@IslandNet.com CC: heamccoo@acs.eku.edu Subject: Re: What Causes CIS >these two men were reported missing many people from the local SAR groups >as well as the University came out to search and the story made a real >impact on everyone involved. The families were here and really touched >the lives of many of the searchers. For them, our SAR group would like to >put an end to this and solve the mystery of what happened to them on that >trip. I would guess the problem I forsee is that we now know the subjects >too well for our own mental health. I was not involved in the original > >Kiera -- > >I would think that you are correct about the "known quantity" making a big >difference (plus the long wait for resolution). I have been on several >water searches, and I believe that having the limited knowledge that we are >there for a finite amount of time to help the authorities pinpoint the >location of a drowning victim makes it easier to do the job and move on. >Also, especially here where the water is warmer, even if the body isn't >found right away, it doesn't take long for the resolution to occur. (I've >not yet been present when a body was found during a water search -- I don't >know how often this happens.) > >I think it's the "getting inside" the potentially live lost subject that we >have to do to search more effectively (or that we get bombarded with via >the media in a highly publicized incident) that makes it more difficult to >deal with an untimate body recovery. > >Sky Hoenig (and 14 mo Basenji trailing partner, Bubba) Although I sent this to Kiera earlier as a direct E-mail message, I also want to share some observations about CIS with the list, in hopes of providing information to others and gaining new insights myself. Although I (and our entire team) am a relative new-comer to SAR, I have served as a member of a general rescue squad for eight years. In addition to SAR, our agency does car crash rescue, water rescue, structure collapse, cave rescue, technical rope rescue, farm rescue, etc. We also handle all transports of cadavers for our county coroner's office. I have served as squad chaplain for almost seven years. My role is primarily counseling, rather than religious, and I deal with squad members from all faiths (or none at all). I am _not_ a mental health professional, and I have no formal counseling training beyond some college courses in sociology. It has been my (very limited) experience that SAR folks tend to become more emotionally involved in the health and well-being of the search subject(s) than general rescue personnel do in general. I think this relates directly to two facts: (a) SAR personnel often have good outcomes from their work. In many cases, search subjects are found alive and relatively unharmed. This leads SAR personnel to believe that their personal efforts may make the difference in whether someone lives or dies, so they become very involved in their work emotionally. (b) A primary search tactic is to learn as much as possible about the search subject, his/her life, habits, goals, hobbies, mental state, friends and family, etc. In our society, we seldom know this much information about our closest neighbors. The possession of so much information about a person almost automatically causes us to begin identifying with them, and seeing them as a human being rather than as a "case". By talking with family and friends of the subject, we come to identify with them as well, and we hate to let them down and dash their hopes. This increases the emotional stake we have in getting a "good" outcome. I think that general rescue personnel do not become quite so emotionally involved with their patients because: (a) Most general rescues are responses to traumatic injuries. (Our squad's #1 call, by any measure, is auto crash extrication.) If you are responding to an injury crash, you know in advance that the outcome is not going to be "good". At best, your patient will be in pain, suffering from trauma (and probably shock), and probably bleeding all over the place. He/she may be intoxicated, combative or emotionally disturbed... not a pretty sight. In many cases, he/she will simply be dead. Because you never know what to expect, EXCEPT THAT IT WILL NOT BE GOOD, you do not have the expectation that you are going to be able to save a life. You hope so... but it isn't necessarily the "expected" outcome. Because of that, when you can't, it is a little easier to accept. (b) In general rescue calls (except in small communities), you seldom know anything about the person(s) involved until you arrive on the scene. Because of this, and the fact that most of your knowledge after you arrive will be a catalog of vital signs and injuries, you don't get the same opportunity to identify with the patient. Sure, losing a small child is still traumatic, but you never had to learn about her favorite teddy bear that she always carried, her fear of the dark, what shoes she liked to wear and other things that you are forced to know about an SAR subject. "Bodies" are much easier to deal with than "people". By keeping patients categorized as "cases" rather than as human beings, it is much easier to deal with if you have a bad outcome. As for water searches (see above), the actual recovery of a body is generally _very_ much "not pretty". Since our agency does both water rescue/recovery _and_ coroner transports, we have no option but to see the entire operation from beginning to end. We have found that some people just cannot handle it... that's OK. They serve in support functions where such things don't occur. We have also found some things that help in dealing with death (and especially gory or decayed bodies). These are particularly important for new members: 1) Take it easy at first. As others have mentioned already, try to find a position during your first few body recoveries where you don't have to handle the worst chores. 2) Always work with an experienced crew. The more older (and thus, usually, more hardened) personnel on the crew, the easier it is to find a shoulder to cry on when you need it (you will). If the crew is mostly new people, it is harder, since everyone is so busy hurting that it's hard to help others. 3) Deliberately harden your emotions by experiences under controlled conditions. This is where the gory training slides and videos come in... they help you prepare yourself mentally for what you will face in the field. (One word of warning... I know of no training which can prepare you for the smell, whether it is a decaying body or the odor of blood at a trauma scene. You will react to it, but you can learn to handle it.) This is a controversial position, I admit, but I believe that a certain amount of emotional armor is essential in rescue. 4) DO NOT identify with your subject/patient more than you have to in order to provide effective care. I am _not_ saying to treat your patients without care; emotional/psychological "first aid" is essential to good patient care. Just don't let yourself feel too much... that way lies early burn-out. 5) Come to terms with your own mortality. Most of us see (at some level) ourselves and our loved ones in the faces of our patients. Until we can say subconsciously "that might be me... and that's OK", it's hard to deal with death. This is maybe the hardest thing to do, and many of us never are able to do it, but it helps a lot if you can. 6) Develop (and use) your own constructive method for releasing stress. Some of us tell morbid jokes, others just talk, some cry, and a few just sit together in unspoken support. What matters is that no team member feel left to deal with pain all alone, and that destructive outlets for emotion (violence, alcohol, etc.) not be allowed to creep in. This is just my personal contribution to the CIS discussion, not a research report or an expert opinion. I hope it helps. ***Robert McCool*** Robert H. McCool, MS, EMT E-mail: rmccool@pop.uky.edu Univ. of Kentucky Medical Center --------------------------- KY Injury Prevention & Research Center Training Officer 333 Waller Avenue, Suite 202 Madison County Rescue Squad Lexington, Kentucky 40504-2915 P.O. Box 249 (606) 257-6741 Fax: (606) 257-3909 Richmond, Kentucky 40476 ---------------------------------------