Health and wellness
Refresh your department’s CISM training
By David Moseley
By David Moseley
The neigbouring fire department calls you about a multi-casualty collision to which it responded. Among the dead are well-known community members, some related to responders.
Three years ago, you took a critical incident stress management (CISM) course and you are asked to come and deliver a debriefing.
Are you ready?
One of the best ways to ensure firefighters certified to deliver CISM maintain their skills is through refresher training. In the interest of time and various other department priorities, firefighters in volunteer or smaller career departments who completed CISM training rarely have the opportunity to participate in formal refresher courses. Similar to practising NFPA 1001 skills on training nights, CISM-certified firefighters can arrange to do their own informal refresher training in-house with their CISM teams.
CISM peer support workers are often trusted, caring members of the department. Being a CISM peer support worker has nothing to do with rank, rather those who choose to take the training do so based on qualifications and suitable demeanor. Having CISM peer support workers in the department is extremely important because firefighters are generally more comfortable opening up to peers than to someone outside the profession.
The format for CISM refresher training is simple: review the defusing and debriefing components, then practise, using role-playing exercises. There are typically four to seven steps involved in CISM defusing or debriefing; however, a simplified, three-step process works well: introduction; exploration; and information. As is the case with much firefighter training, there is room for variation, as long as the refresher program stays within the guidelines based on the Mitchel method of CISM taught by the International Critical Incident Stress Foundation.
The defusing or debriefing introduction reminds everyone of the steps involved. Participants review the objective, the process, and some boundaries or ground rules. The process goes something like this:
- Introduce yourself. Briefly describe your CISM qualifications – I like the mental-health first-aid analogy.
- Let everyone know why they are there (because they responded to a traumatic incident). Describe critical incident stress: a normal reaction by a normal person to an abnormal situation.
- Explain that the objective is not to fix or treat, but to provide the opportunity to talk openly in a safe space and provide some basic information about coping strategies .
- Describe the three steps: introduction; exploration; and information.
- Stress voluntary attendance – never guilt firefighters to attend.
- Ensure confidentiality; the only exception is a threat of harm to self or others.
- Ensure that no one is pressured to speak who does not feel comfortable doing so.
- Let everyone know the defusing or debriefing typically will take between 45 and 90 minutes.
- Minimize disruptions such as cell phones.
A good introduction will put everyone at ease and establish trust, which sets the stage for the exploration phase.
In a sense, the exploration stage is easy because, generally, firefighters want to talk after responding to a traumatic incident. Because a CISM defusing or debriefing is a safe space, firefighters usually don’t hold back.
To facilitate the exploration stage of the debriefing or defusing, use escalating questions. Start by asking participants to describe the stressful situation that happened, then ask more probing questions such as:
- What was your initial reaction?
- What did you think / feel?
- What was the worst part for you?
The key to active listening is sincerity and empathy. Simple responses such as, “that’s a perfectly normal response,” or even a nod and a “hmm” often suffice to validate the affected member’s experiences. Paraphrasing is a powerful tool to ensure the CISM peer supporter understands and show members that they are understood.
Members will normally express anger, fear, sadness or guilt after a traumatic incident; they feel disoriented, as their sense of normal has been destroyed. Peer support workers should acknowledge and accept these responses and reassure members that these emotions are common reactions to stress and trauma.
It’s important not to rush the exploration stage; allow some pause or silence. Ensure the participants talk more than the peer supporter. If an important issue has been raised and bypassed or overtaken by another topic, try to redirecting the group: “Earlier you said xyz, can you tell us more about that?”
Having more than one CISM responder facilitate the defusing or debriefing is beneficial as one person may pick up on something the other misses.
When the peer supporter(s) think it’s time to move on from the exploration stage, let participants know. Ask if anyone else wants to speak before continuing. Remind members that the group can come back to the exploration stage if they want to do so.
It’s not uncommon for one person to dominate the conversation while others absorb information before coming up with questions or comments.
The purpose of the information stage is to describe common signs and symptoms of critical incident stress, and outline common coping methods. A handout can be useful at this stage; it’s worth putting some effort into finding or developing a good handout.
Responders have different reactions to stressful situations; members should not expect to experience every symptom, nor should they worry if they experience none. There’s no need to rattle off the whole list of symptoms during a defusing or debriefing; the point of the exercise is to recognize that these feelings and behaviours may be a result of the incident.
As a peer supporter, providing examples for your own experience during a defusing or debriefing may encourage others to open up, but be cautious not to overuse self-disclosure. Remember, the key to CISM is to listen.
In direct response to symptoms, provide useful coping strategies – again, sharing your experiences may be useful but be sure to ask your members how they dealt with previous critical incidents and have them provide suggestions. Exercising, spending time with family or outdoors are common ways to cope and recover. I always encourage participants to cut themselves some slack immediately after an incident – remind them it’s OK to not be OK – and to keep in mind that others may be experiencing similar emotions.
Family members can play important roles in a support system. Suggest that firefighters share CISM information with family members, friends or others in their networks. Be sure to focus on firefighters’ emotional responses and what might help them, rather than the details of the incident. If firefighters want to discuss details, encourage them to do so with a willing fire peer or a mental health professional.
To close the session, remember to thank firefighters for participating. Acknowledge that fire fighting is a difficult job and indicate your gratitude for their work. Invite anyone who wants to talk further to stay behind, but also limit your personal involvement – additional support should come from a mental-health professional whose contact information you provide.
Be sure to have a prepared list of resources including employee and family assistance program information, mental-health helpline details, and other local and regional support agencies.
■ Follow up
It is normal after a defusing or debriefing for senior officers or managers to ask if anyone requires additional support.
CISM peer supporters must consider confidentiality – it’s enough to say that either nobody stood out or some members took the incident harder than others, and that officers should keep an eye on everyone.
Another follow up item to remember is self-care. Providing CISM is emotionally demanding, so those to deliver it also need to recover afterwards.
■ Role play
CISM training involves role-play practice; after reviewing the components, the balance of the refresher training time can focus that aspect of the program. Everyone should have a chance to lead and provide feedback. Most adults learn best by doing, so take the time to go through several scenarios and have fun.
CISM refresher training is vital to maintain and develop peer supporter skills and competencies. With some support, your original training material and the information above, you should be able to provide that training for your qualified CISM peer supporters.
Firefighters like to help people in distress, so it’s only natural that we want to help our own. A robust CISM program that includes refresher training will allow your organization to do just that.
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Parts 1 and 2 of David Moseley’s series on critical incident stress management appear in the February and March issues of Fire Fighting in Canada. Visit www.firefightingincanada.com and click on Hot topics, and then Health and wellness.
David Moseley is a forest officer with Alberta Agriculture and Forestry, and lead training officer with Lac La Biche County Fire Rescue in Alberta, focused on operations; other areas of interest include instructing, CISM, and wildfire investigation. Contact him at firstname.lastname@example.org