Central Oregonian

First responders could be at risk for CIS

Critical Incident Stress awareness and training has increased considerably in the past 10--20 years

Ramona McCallister

June 29, 2010

They are on the front lines and are there when we need them.

First responders are up close and in the front of emergency situations, putting their safety and lives at risk, so the public can be safe. They are often the first on the scene when there is an accident, a fire, or any number of critical incidents. They are our paramedics, firemen, police officers, and they are our soldiers on the front lines.

In addition to serving in such important capacities, these brave men and women also have the best training and skills possible. But when the day is through, they are still inherently human, and must cope with what they see and deal with in the field.

Looking from the outside-in, the general public does not see the bigger picture of the low-level stress that these public safety workers cope with every day. Most will not suffer long-term effects, but for a few, there will be emotional or psychological stress associated with a critical incident.

According to the Journal of Emergency Medical Services, Critical Incident Stress is a normal response to an event where you see and experience things that the average person doesn’t see. Unusual situations, such as violent crime, the unexpected death of a child or co-worker, disasters, or any life-changing event falls into this category. It is life trauma, and the way that people react to critical incidents is always different.

“Stress affects everyone differently, and you can’t put two people in the same situation and expect the same result-ever,” said Prineville Police Chief Eric Bush. He also emphasized that anyone can be affected by a critical incident, not just public safety personnel.

Bush said that one of the challenges for these workers, especially police, is that over time, they are exposed to a great deal of low-level stress in general.

“You are always looking, and concerned about officer safety, and your training is to never treat a traffic stop or a contact as something routine. You never know what you may be walking into. The reason for that is because officers have been killed by treating a situation as if it were routine. Spending years and years of always keeping your guard up all day long has an effect on people psychologically, overall.”

“In the last 20 years or so, we have done a very good job in law enforcement in recognizing the effects of long-term low-level stress,”

Jim Soules, retired Police Chief of Prineville Police Department, reflected on the fact that nothing growing up prepares you for some of the things you see in police work. Soules has been in police work since 1971, and also agreed that as a profession, they have done a better job in providing tools and resources in debriefing critical incidents.

Bush said that there are also the dramatic, high-stress incidents like you see on TV, the ones that police officers relive on occasion. Once again, he stressed that every officer deals with these situations differently.

Matt Smith has been a paramedic for the Crook County Fire Department for 10 years.

Smith also said that he has seen an increasing awareness of CIS stress in his field of work. He said that when new paramedics are hired, they are required to take a crisis intervention class, which educates personnel on the response to critical incident stress, what it is, and what a CIS debriefing would entail.

“In my opinion, educating people that we are all human, and it is very normal to have a response to a critical incident is important,” said Smith. “As human beings, we are going to be affected.”

Smith said that in their department, their staff gets an hour of exercise each day when they are on duty. Exercise is one of the best ways to cope with the stress in a healthy way. They also encourage their staff to eat right and get lots of sleep, as well.

Tobie Reynolds, Communications Director for the Prineville Police Department, said that the stress from 911 dispatching is different from the first responders.

“We can’t see or touch what is happening on the scene, but we don’t always get closure on the incident, either,” said Reynolds. She said that you don’t always know what the outcome may have been of an earlier incident, such as giving CPR on the phone, or going through some other life-saving process.

Reynolds also said that dispatchers go from dealing with the person on the 911 call, to dealing with responders and getting them on the scene. Sometimes, they are doing both at the same time. Dispatching is a difficult job, and requires extremely good multi-tasking skills.

Reynolds also agreed that like police and first responders, the day-to-day low-level stress was the biggest issue for them, as well.

Although their capacity for service is different from a first responder, veterans of combat have similar issues with critical incidents.

Angela Gilley, Veteran’s Service Officer for Crook County, said that as many as one third of her clients show signs of post-traumatic stress disorder in one degree or another. PTSD is a clinical diagnosis of a more serious outcome from a critical incident. Veterans who have been in war and combat are especially vulnerable to this disorder if it is unrecognized or untreated.

“In war and combat, it usually doesn’t hit until you have been home for awhile, back in the real world,” said Gilley. “For many, it is ‘how do you put those feelings aside, when you re-integrate into society, without feeling like you have to be on guard?’”

Gilley reinforced that awareness for PTSD is better than it used to be. She said that there is still a stigma, but it isn’t as much as it used to be. Gilley conveyed that the issue with the lack of help for the Vietnam veterans has played a big part in the level of service to the current military veterans. Before Vietnam, the disorder was called “shell shock.” Since that time, the definition has become more accurate, Gilley said, and it is still a huge issue.

“PTSD can be hard to deal with,” said Gilley. “You can only push it aside for so long.” Gilley said that there is a Central Oregon Veterans’ center in Bend, where they offer free services for veterans and dependents, as well as the Veteran’s Office in Bend. Gilley is also there to help with awareness of services, and assist with paperwork to get veterans into the system when needed.

Chief Bush added that “You have to understand it for what it is. There is a stigma surrounding the counseling, whether you are a police officer or an officer in the military, and getting the help and seeking out to get the tools that you need individually to deal with that stress.” Bush indicated that the stigma is starting to go away, although it used to be pretty significant.

“Really, though, what probably affects you most is the low-level stress year after year,” Bush concluded.

Smith said that as a general rule in the EMS department, having a critical incident become an issue for more than one to two weeks is reason for personnel to get additional help or counseling.

Soules said “I started in 1971 in police work, and at that time, no one recognized it (critical incidents) as an issue for police. No tools were given.”