First responders often refer to it as “the knock.” Most, if not all, of those first responders consider “the knock” one of the most difficult tasks they are called on to perform in their work.
The job involves knocking on a door to tell a parent, wife or husband that their son, daughter or spouse is dead.
Scott Roach, of Wentzville, a traffic sergeant with the St. Louis County Police Department, knows all about “the knock.” The fact that his toolbox for doing the job wasn’t loaded with easy solutions, including advice on how first responders could deal with their own reactions to traumatic events, led him to a police-sponsored program a number of years ago.
The speaker was a Connecticut state police officer. The topic was the then-recent fatal shooting rampage at Sandy Hook Elementary in Newtown.
After the shooter committed suicide, first responders faced the grim and daunting task of dealing with what he had left in the wake of his violence: 20 young children and six staff members dead.
In addition to Sandy Hook, the Connecticut officer also described work done by a Critical Incident Stress Management [CISM] organization that helped the first responders cope with the horrors they witnessed.
A similar group – the Greater St. Louis Region CISM Association – operated locally, but Roach didn’t know much about it or the fact that the county had used its services in the past. Still, he was drawn to the group’s mission and soon became involved in its work.
“I realized police officers need to take care of themselves if they are going to be able to do their jobs and have things going OK in their personal lives,” Roach said.
Addressing a local need
The St. Louis CISM was organized in 1991 to provide education and crisis intervention specifically designed to help emergency responders cope with the stresses inherent in their work. Its top priorities are supporting and respecting the individuals using its services and maintaining confidentiality.
The group’s services are available at no cost to first responders throughout the metropolitan area, including law enforcement, firefighters and emergency medical personnel. Also included are those in dispatch centers who receive 911 calls, gain needed information from the caller and send the appropriate responders to the scene.
One of those involved in the local CISM group’s early days and still active today is Judith Landvatter, a West County resident and former paramedic, emergency dispatcher and nurse.
The local CISM was based on a well-researched model developed by Jeffrey Mitchell, a clinical professor of emergency health services at the University of Maryland in Baltimore and a co-founder and former head of the International Critical Incident Stress Foundation, Landvatter said.
“We are not here for psychological therapy. All of those involved in the organization are volunteers trained in ways to help those trying to cope with what they have experienced,” she said. “What we remind people who are having problems after they’ve been through a traumatic experience is that they are having normal reactions to abnormal situations.”
Those reactions range from flashbacks of the event, nightmares and difficulty sleeping to family and marital problems, depression, anger, decline in job performance, substance and alcohol abuse, memory loss and confusion.
Steve Spiegel, now a captain with the Pattonville Fire Protection District, also played a role in founding the local CISM organization.
“Our first step was addressing the attitude that if it’s not bleeding, it doesn’t hurt,” he recalled. “Right along with that was a big outreach to educate first responders in general.”
Fire service personnel were the first to embrace the concept but other first responder organizations also got on board as word of the association’s efforts spread, he said.
Needed now more than ever
In the wake of civil unrest in Ferguson two years ago, the CISM group’s activities ramped up considerably.
“The association is well used by all the services today,” Spiegel said. Those enrolled in local police and fire academies learn about CISM during their initial training.
“Older generations, which include many of those in supervisory positions today, often have a disconnect with the millennials [those born between 1980 and the mid-2000s] now coming into the workforce. Most millennials aren’t chest pounders who think there’s a stigma attached to getting help,” Roach observed. “The [previous] challenge with law enforcement has been overcoming suspicion and distrust and building trust in the confidential nature of what CISM does.”
Roach believes law enforcement personnel aren’t alone in overcoming a reluctance to seek help during difficult periods in their lives. Employee assistance programs offered by many businesses are probably the most underutilized of all employee benefits, he observed.
Mike Laws, a 40-year law enforcement veteran, chief of the Overland Police Department for eight years and a past president of the local CISM board, described law enforcement’s initial reluctance in similar terms.
“It used to be everyone thought they were John Wayne and didn’t need help. The prevailing view was that you just had to buck up, hide your feelings, act like nothing had happened and pull yourself up by your bootstraps. That’s just not healthy. We’re trying to let everyone know it’s ok to express their feelings,” Laws said.
“We don’t force people to use CISM,” he added. “And we’re not trying to fix people because we think they are broken. We’re simply trying to open up communications and make people realize we are here as a support.”
Critical incidents causing powerful emotions among those directly involved can vary according to each person’s background and personality. However, a multi-casualty event and any calamitous happening involving children or young people typically are on a first responder’s list of things that cause stress. Incidents like the 9/11 terrorist attack and the Sandy Hook shootings come readily to mind. A line-of-duty death, the suicide of a co-worker, a serious work-related injury and events with a high level of threat to those involved also are among incidents likely to result in emotional trauma and stress.
CISM’s efforts focus on what it describes as defusing, debriefing and follow-up.
Defusing is limited to individuals directly involved in an incident and is designed to let the person, or persons, know their feelings and emotions are normal, what kind of symptoms could arise and whom to call if there is an immediate need to talk to someone. The process takes place informally, sometimes at the scene or quickly thereafter.
Debriefing usually occurs from two to 10 days after an incident and can include others not directly involved as well as those directly affected. According to Landvatter, the local CISM group has at least one non-involved, trained peer included among those participating, along with a mental health professional who can watch for cases that may require additional intervention.
Roach, for example, has been trained and serves as a peer in debriefings involving police officers. Larger groups could have two or more peers participating. Similarly, Pattonville’s Spiegel would be a peer participant with firefighter/paramedic groups.
Spiegel estimates the number of trained peers and mental health professionals now involved in the local CISM group is between 30 and 40.
The debriefing process calls for a more lengthy discussion of what happened, as viewed from participants’ differing perspectives of the incident. The session encourages a more thorough review of emotions, reactions and any resulting symptoms that have occurred.
“It’s amazing how all the pieces start to fall in place when people start giving their individual perspectives of an incident, based on what they saw or experienced,” Landvatter said. “Others in the group can see they aren’t alone in how they may be reacting to what happened.”
Follow-up occurs within a week or so after the debriefing session and serves as a double-check on how the first responders are doing.
There are no sure-fire remedies for stress and its symptoms but a number of do’s and don’ts have been shown to be effective in dealing with it. The CISM group recommends these strategies:
• Physical exercise alternating with relaxation to alleviate some physical reactions to stress.
• Reminding yourself that it’s OK to experience expected reactions to a stressful incident.
• Keeping your life as routine as possible and avoiding significant life changes.
• Avoiding alcohol and drug use. They won’t help and may hinder recovery.
• Helping co-workers by sharing your feelings and seeing how they are doing.
• Giving yourself permission to react.
• Maintaining regular eating habits while minimizing sugar and caffeine use.As a fundraiser for its activities, the local CISM organization recently held its fourth annual trivia night, silent auction and 50/50 raffle at Temple Israel in Creve Coeur. Although the organization’s board of directors and trained peers work on a volunteer basis and its services are provided without charge, funds are needed to pay for printed materials and training program expenses. Anyone wanting more information or interested in supporting the organization can call (314) 803-8196 or send an email to firstname.lastname@example.org.