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IPSA's Public Safety Column
The IPSA's Public Safety Column is an opportunity for our members and corporate sponsors to provide thought leadership articles about all topics facing public safety.
The articles we publish are not necessarily the views of the IPSA, rather they are opinions shared by each contributor.
By Gerald Steckmeister, IPSA Fitness and Wellness Committee Member
First responders and public safety officers have a higher rate of suicide than the average population, and it is time we started to talk about it. In 2017, a reported 103 firefighters and 140 law enforcement officers died by suicide, higher that the line of duty deaths for both disciplines, and according to another study, the rate of suicide attempts among EMS workers is 10 times the national average. In 2018, there was a similar trend in law enforcement.
High stress work environment
First responders make life and death decisions every day. They have a front row seat to horrific accidents and, even worse, an individual’s inhumanity toward another. Some first responders are required to use force on a fellow human being. In an average month, first responders are exposed to more trauma than some people see in a lifetime. No one calls for a first responder’s help when things are going ok. They call when because their lives are in chaos, which sometimes causes first responders to experience second-hand trauma. This vicarious trauma takes a toll. One study noted that the types of stressors identified in this line of work “may lead to a temporary reduction in the biological ability to respond to further stressful events.” And these constant encounters can result in cumulative PTSD.
Most first responders choose a career in public safety to help others. As such, first responders do not generally think about asking others to help them when help is needed. Unfortunately, when a first responder realizes he or she needs help, it is often too late and there is also a fear of being stigmatized by their peers and colleagues. They are often the last to seek assistance when they really need it.
Make an actionable difference
There are several actionable differences that departments can make today. Some of the suggestions are simple to implement and others require substantive conversations and planning. The below items will make a difference and may save a life. Below are some ideas to get a conversation started.
Cultural shift. A paradigm shift is needed in the public safety profession in which behavioral health is viewed in the same regard as medical health. A behavioral health checkup should not be feared by the public safety profession. Self-care needs to be practiced, just like preventative maintenance on our equipment, firearms training or any other regularly scheduled activity. Make sure to perform a regular self-assessment.
Identify risk factors. It is important to recognize the risk factors and warning signs of depression, PTSD and suicide. If you recognize these symptoms in one of your friends or co-workers, reach out and talk to them. Try to convince them to seek help. The IPSA created three free downloadable infographics on depression, PTSD and suicide. Everyone is encouraged to print and post them in their departments.
Implement a resiliency program. All departments need to develop a resiliency program. The IPSA recently did a webinar that is available for 24/7 viewing about how to start a resiliency program. It is titled: Mental Readiness: Stigma Reduction & Resiliency Program.
Use peer-support programs. Another solution that has worked well is an inter-agency peer support program. Some first responders may be reluctant to speak to someone on their own job, but they may speak to a peer with a different agency, allowing for a certain amount of anonymity.
Suicide in public safety is prevalent and it is rarely discussed. This needs to change. Discussion can lead to solutions and save lives. First responders advocate to the public “if you see something, say something” and they need do the same. When a co-worker needs help, the department needs to be there. Self-reflection is equally important. If first responders don’t look after themselves, they will not be able to help others.
About the Author
Gerald Steckmeister is a Police Lieutenant, with 19 years of law enforcement experience, and a Major in the NY Army National Guard. In addition, he serves on the Board of Directors of the Westchester B.L.U.E. Foundation and serves as member of the IPSA Fitness and Wellness Committee.
Infographics: Depression, PTSD and Suicide
Why public safety professionals need to prevent, identify stress (and apply coping strategies)
How self-care can reduce police officer stress
Webinar: Mental Readiness: Stigma Reduction & Resiliency Program.
Suicide Prevention Lifeline: 1-800-273-TALK (8255)
National Association of Mental Illness: 800-950-6264
Safe Call Now: 206-459-3020
By Jim Dundas, Ret. Battalion Chief, IPSA Board Member and IPSA Memorial Committee Chair
The United States observes Fire Prevention Week beginning Sunday, October 7 - Saturday, October 13, 2018. This national week is a time to reflect on the firefighters who put their lives on the line to protect our communities.
A week in October in which the 9th calendar day occurs commemorating the Great Chicago Fire of 1922. The purpose of FPW is to champion fire prevention and control practices. The theme for this year’s FPW, as dedicated by the National Fire Protection Association is “Look, Listen, Learn, Be aware. Fire can happen anywhere.™”
FPW is kicked off by the National Fallen Firefighters Memorial service at the National Fire Academy in Emmetsburg, Maryland – the site of the National Emergency Training Center and the National Fallen Firefighters Memorial. Each year, a remembrance service is held in which the names of fallen firefighters and fire-based emergency medical personnel are added to the memorial wall. Family members, agencies and friends also sponsor bricks engraved with the names of the fallen all along the courtyard walkways.
When I was on the job, firefighting was neck and neck with mining as the most hazardous of occupations in the U.S. The fire profession has accomplished a lot in decreasing the number of
line of duty deaths in the operational environmen, partly due to enhanced safety procedures and improved protective equipment, the incidence of death by cancer and cardiovascular disease is increasing exponentially. Firefighters suffer cardiovascular and cancer deaths at a far greater rate than the general population. It is estimated that firefighter cancer deaths exceed the general population by 14 percent.
There has also been recent speculation that firefighters’ protective clothing contains carcinogenic materials. In ongoing research, Notre Dame University in their experimental nuclear physics laboratory, tested swatches of turnout clothing that had not yet been used. They found a significance presence of fluorine in the material, a known carcinogenic. "The results were phenomenal—off the scale in parts per million of fluorine in all but one of the samples,’ Peaslee said. ‘Everything was just loaded with fluorine.’ Following the initial tests, Peaslee is leading a study of new and used turnout and personal protective gear issued throughout the 2000s, including jackets, pants and undershirts—all of which are either new or have been in service for more than a decade.”
Many fire departments are adopting practices in which they supply firefighters with two sets of protective clothing, require that exposed personnel be decontaminated prior to leaving the scene, that the protective ensemble by washed after every fire, be professionally cleaned periodically or if specific contamination occurs, and that personnel shower prior to returning to service. These are positive practices to protect fire personnel from unnecessary exposure.
Review of 2017 LODDs
In calendar year 2017, 113 firefighters and fire medics died in the line of duty according to the USFA and another 103 firefighters died by suicide according to a report in USA Today.
Cancer and CVD: The U.S. government has approved and created the firefighter cancer registry and many states have adopted presumptive legislation that considers cancer and cardiorespiratory diseases to be job related. As reported by the U.S. Fire Administration, 68 of those LODDs were the result of occupational related diseases, namely cancer and CVD/respiratory disease. This is a staggering 60 percent of all firefighter and fire medic line of duty deaths in 2017 were from job related illnesses.
“Over the last decade, our understanding of CVD among firefighters has significantly improved and provides insight into potential preventive strategies. The physiology of cardiovascular arousal and other changes that occur in association with acute firefighting activities have been well-characterized. However, despite the strenuous nature of emergency duty, firefighters' prevalence of low fitness, obesity, and other CVD risk factors are high.”
Seatbelts: Another 28 firefighters and fire medics (25 percent) died in vehicle crashes, either in response mode or in normal driving conditions. Without researching each individual crash report, there is no way to determine if the vehicle occupant(s) were wearing seatbelts. Modern fire apparatus is equipped with passive restraint systems that are integrated with the SCBA harness. The cabs of fire apparatus are designed to locate controls and mounted equipment out of the path of deploying airbags.
We need to reinforce the notion that a first responder is no good to anyone if they don’t arrive safely on scene.
Other causes: The remaining LODDs succumbed to a variety of injury modalities such as burns, smoke inhalation, falls from heights, falling trees and drowning. The fire services of North America have substantially improved incident scene safety by employing the Incident Command System that includes the Safety functions and Rapid Intervention Teams.
Suicide: An April 11, 2018 article in USA Today cited that more police officers and firefighters die by suicide than in the line of duty. They reported that in 2017, 129 police officers and 93 firefighters died in the line of duty, while 140 law enforcement officers and 103 firefighters died by suicide.
There are numerous resources available to first responders who feel overwhelmed by PSTD and other circumstances. The National Suicide Prevention Hotline is a 24 hour, seven days a week “national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress.” In addition, the American Foundation for Suicide Prevention is the USA’s largest “non-profit dedicated to saving lives and bringing hope to those affected by suicide. Local chapters of the AFSP host annual “Out of the Darkness” walks bringing together friends, families, and colleagues of those who have experienced suicide in their own lives. I just participated in one in Fairfax, Virginia.
The loss of any public safety practitioner is tragic, whether by job related injury, occupational borne illnesses or suicide. While eliminating deaths within our ranks is not possible, we must – as a community of practice – never cease in our pursuit of survival. Sometimes we need to remind ourselves that health and safety should be our ever present top priority.
As you travel this week after dark, you may encounter a firehouse or a landmark with all its lights on. This is part of the “Light the Night” campaign by the National Fallen Firefighters Foundation in honor of fallen firefighters.
During FPW 2018, take note of your fire safety profile: in your home, in your places of work, in your school and in your community. Once you have done so, then thank a first responder for their service to the community – and even though this is FPW, thank them regardless of the uniform they wear, and tell them to be safe.
Jim Dundas is a retired Fire Battalion Chief and Paramedic from the Fairfax County Fire and Rescue Department. In his 25-year career, he held both administrative and operational roles. Following his retirement, he has worked in private industry as a business developer, consultant, and communications and IT specialist. He is a Board member of the IPSA and he chairs its Memorial Committee. He currently resides in Ashburn, Virginia.
Editor's note: This article is from the International Public Safety Association’s Acts of Mass Violence: Public Safety Response and Recovery Initiative
By Amy Morgan, MSC, Executive Training Director at Academy Hour and IPSA Mental Health Committee Member
If you were attacked and bitten violently by a dog when you were a kid, you would most likely have an adverse reaction throughout adulthood every time you see a similar dog. At a minimum, you would feel a heightened sense of caution and awareness. Any disturbing, traumatic or high-risk event that we are a part of becomes a factor in how we see the world around us. An act of mass casualty violence is this type of event, but on a much larger scale, and with the added component of the attack being with a person’s purposeful intention to frighten, hurt and kill other people.
Because most people do not think like the individuals who commit acts of mass violence, it is difficult for us to understand the why behind their action. It is common for events like these to make us question things and people around us. The unknown and questioning often leads to the development of fear and anxiety. We start to question the safety of our workplace or school, or even regular outings like a trip to a mall, grocery store, movie theater or an evening at a concert. With this insecurity and fear, we wrap ourselves in negative emotion and thought. We begin to discuss the darker sides of people in general, the world as we see it changing for the worst and the possibilities of more violent and unpredictable events happening around us or to us.
Negative thinking after experiencing trauma
For emergency responders, trauma from an act of mass violence can create a cyclical pattern of negative thinking. An up-close view of mass violence, with its injuries and fatalities, and all the accompanying sounds, sights and smells, may create a new trauma. There is the direct impact of the trauma and the incident itself – being right in the middle of it, participating in the response action, interacting with injured survivors, imagining all that happened prior to responder arrival. An act of mass violence is traumatic, and it will create predictable post-trauma responses and reactions.
A new incident may trigger memories and reactions from a previous incident. If an emergency responder had previous trauma, a post-traumatic response could reappear. In this scenario, the emergency responder is not only dealing with the disturbing images of this new event, but he or she is also mentally and emotionally reliving a previous event.
Understanding your personal triggers
Triggers could be things like similar weather, sounds of sirens or of voices crying or yelling or the smell of fire. Anything that either consciously or subconsciously reminds the responder of a previous traumatic incident can make him or her feel as if they are right back there again. As with any difficult event in life, getting immediate help like counseling, education and building a strong, positive support network, will make the difference in speed and effectiveness of recovery. Strength and resilience comes in many forms – mental, physical, emotional and spiritual – and a responder who uses available resources to rebuild that strength, and get back to a healthy state of being, will be better equipped and prepared to manage the next critical incident.
After a traumatic event – like an act of mass violence, it is critically important talk. Talk to a loved one, to friends, to peers and coworkers who are going through the same thing. Do not isolate yourself and keep everything inside. And make sure those you are talking to also use their own resources – it is difficult to be the spouse of a responder, and hear all the danger and risk stories, and not take that in and begin to worry and feel anxiety. Both members of this team need to use resources to keep that strength and resilience at its best.
Acknowledge the trauma
Admit that the incident was disturbing, difficult and even painful. Trying to act like something was not bothersome to you may make you feel like you are protecting yourself from criticism, but the honesty and openness to find resources will protect you far more and for much longer.
Do not over-react, but instead be purposeful and strategic, with a well-researched plan. After something goes wrong, we often find ourselves jumping in to implement changes to prevent something from happening again. Emergency responders need to keep in mind that there are people who are unstable and are intent on doing harm to other people. You need to acknowledge that you cannot resolve the world’s problems all by yourself – but do your part, get involved and know that little by little you can make a difference. Awareness is excellent. Problem-solving is needed.
Be compassionate. Do not let the negativity and cynicism bring you down, but instead use this type of incident to remind yourself that the world needs more good, more positive and more compassion. If anything positive can come from an act of mass violence, it should be that it serves as a reminder to us all that we are all one, that we need each other and that by building each other up we will go much further than by tearing each other down.
Violence is never easy to watch or to clearly understand, and it is traumatic to experience it from many perspectives. Use resources to keep yourself healthy and resilient. Do not let evil bring down your own outlook on the world. Focus on the good that is done every day in the world, by many people. Look out for others, be good to yourself, practice compassion and empathy, and go out there and keep making a difference.
Ms. Morgan is the founder and Executive Training Director of Academy Hour (www.academyhour.com), a training provider offering mental health & leadership courses to emergency response personnel. She holds a Master's degree in Counseling, and a Bachelor's of Science degree in Behavioral Sciences. She serves as a member of the International Public Safety Association's Mental Health Committee, and as a subject matter expert and presenter of leadership & mental health training sessions for the International Public Safety Association, IADLEST (First Forward) and the Council on Law Enforcement Education and Training in Oklahoma.
International Public Safety Association’s Acts of Mass Violence: Public Safety Response and Recovery Initiative
Calm before chaos: 5 tips for 911 telecommunicators during an act of mass violence
Acts of Mass Violence: Preparing immediate responders (the public) with education and training
The AAR: An effective tool for first responders
5 concepts for building a resilient community before an act of mass violence
How to recover mentally and emotionally after an act of mass violence
By Michael Lugo, Lieutenant, Fort Worth (TX) Fire Department, IPSA Rescue Task Force Committee Member
Imagine you have an important test to take, one that has final, forever reaching consequences. Would you want to know the answers before the test was even given? Indeed, anyone serious about such a scenario would.
Law enforcement, fire and EMS and allied emergency responders have specific training, backgrounds and mission sets that make them suitable to prepare the public and build resilient communities. Public safety is not just about actions at the time of, or in response to, a disaster. The level of preparedness of the targeted population will have a direct effect on the impact of the disaster. At best, a well-prepared, aware and empowered community is capable of (and has before) prevented mass violence and other human-caused disasters.
Communities do not have to prepare in a vacuum or from scratch. Most public safety agencies provide community outreach to help prepare for community-wide threats and hazards, including fire safety, commercial inspections, drowning prevention, bike safety, stranger danger and drunk driving prevention. When it comes to preparation for incidents of mass violence, here are five concepts that will yield more prepared, capable and resilient communities.
Concept 1. Suspicious Activity Reporting: This is a force multiplier. Establishing a centralized, functional, investigative and easily accessible conduit to report suspicious activity is imperative to preventing mass violence. Having an untold number of potential human intelligence agents, with eyes and ears all over the community, capable of reporting suspicious circumstances and environments helps prevent the unthinkable from occurring.
While that may sound conspiratory, there is no doubt that the best time to stop an act of mass violence is before it even happens – during preparatory and planning phases. While schools, hospitals, public transportation and areas of assembly commonly come to mind, don’t forget to include public safety personnel in this training. The broader See Something, Say Something concept and the specific iWatch program are examples of asking our communities to contribute to the larger public safety mission.
Concept 2. Bomb-Making Materials Awareness Program (BMAP): Learn about the BMAP program. This program intends to put knowledgeable ambassadors in contact with identified commercial businesses to educate these providers of commerce about the precursors and materials related to homemade explosives, as well as potential behaviors of bomb makers that may gather their materials from publicly available sources. The BMAP program should be implemented by a collaboration of neighborhood law enforcement officers, fire inspectors and related public safety personnel with regular access to areas of public commerce.
Concept 3. Civilian Active Threat Training: There may be no greater return on an investment than a class to prepare civilians about the immediate actions they need to take if they find themselves in a situation of mass violence. Civilian training for mass violence is not just for schools. Places of commerce and assembly are traditional targets, making the entire community a target population and necessary audience.
Civilian Response to Active Shooter Events (CRASE) using Avoid, Deny, Defend, or Run Hide Fight, are two examples of programs already created to educate the public in this area. While law enforcement agencies train continuously to quickly end an act of mass violence, and fire and EMS resources join that preparation to quickly access and treat victims, there are still those ominous and deadly minutes before any public safety resources arrive. The actions the target population takes in those moments can be the difference between life and death.
Concept 4. Medical Training: Injuries from mass violence incidents undoubtedly run the spectrum from minor to the most severe and unrevivable. When injuries occur that are survivable if rapid and proper aid is administered, it is easy to see how a populace trained and maybe even equipped for basic trauma care can make the difference in the survivability of that particular segment of victims.
Not only would mass violence victims benefit from this preparedness, but trauma and medical victims from other disasters and emergencies will as well. Some communities have even taken the proactive step of requiring a Stop the Bleed Kit, along with an Automatic External Defibrillator, in certain occupancies. Examples of community medical training include Stop the Bleed and Hands Only CPR.
Concept 5. Proactive Collaboration: The aforementioned programs have stand-alone benefits, but pulling them together, advertising or promoting them and creating opportunities for the public to receive the necessary tools and training will make an incredible impact in disaster preparedness. Several public and private partnerships have joined forces to sponsor half-day and one-day workshops, providing a venue to showcase and teach these programs.
Meetings with community groups, schools and businesses have provided opportunities to discuss these programs, educate and schedule focused program deliveries. These are not fire-and-forget platforms to prepare the public. To be effective, this training and awareness needs continual tending, direction and reinforcement. Identified points-of-contact for these programs as well as ensuring all members of a department or agency is aware of these programs and POCs are important to the longevity and impact of these services.
Public safety is not just about actions at the time of, or in response to, a disaster. The level of preparedness of the targeted population will have a direct effect on the impact of the disaster. At best, a well-prepared, aware and empowered community is capable of (and has before) prevented mass violence and other human-caused disasters. While tragedies happen daily, jurisdictions are experiencing a lull before a storm we are unable to schedule on our terms. Making sure our communities are prepared, resilient and ready to partner together to deal with mass violence is a smart investment of public safety resources. Empowered communities become prepared, and prepared communities become resilient.
Michael Lugo is a Lieutenant and 22-year veteran of the Fort Worth (TX) Fire Department, currently serving in the department’s Homeland Security/Intelligence section and Bomb Squad. A combat veteran and 14-year law enforcement officer, Michael also coordinates the department’s Active Threat program and is a member of the IPSA’s Rescue Task Force Committee.
By Dan Murphy, Lieutenant in the Special Operations Section, Arlington County (VA) Police Department and Vice-Chair of IPSA’s Rescue Task Force Committee
Today, in public safety, most organizations struggle to procure funding for their training budgets. One underutilized tool available to everyone is the After-Action Review. This process, originating in the US military, is an extremely effective method of conducting a professional review of what occurred and how to improve performance in the future, based on the AAR. I’ve seen it work in groups as small as four individuals and as large as 160. This article focuses on the informal AAR, conducted as soon after the event as possible. This process differs from a formal AAR or Report which is much more resource and time intensive.
The value of the AAR process cannot be argued. By sharing the experience of everyone involved in the incident, with personnel who were not there or did not see or hear exactly what other personnel experienced, everyone gains a better understanding of what transpired during the incident. The AAR provides immediate feedback so everyone has a better understanding of what actions were taken and why. Results of the AAR should be used to resolve questions pertaining to policy application, process clarification and/or updates can be addressed. During the process, leaders can collect teaching points and trends. Training gaps and deficiencies can be discussed and identified. Future training plans can be modified to improve future performance.
Conducting an AAR
Ideally, the optimal time to conduct an AAR is immediately following the incident, when details and questions are fresh on everyone’s mind. This is especially true because you want to include just those who were directly involved. If you wish to include the entire squad (group), it is best to wait until the end of your shift. When possible, ask the oncoming supervisor to relieve your squad early, to ensure employees do not stay over their scheduled time to conduct the AAR. If leaders do not accommodate personnel schedules, poor participation is often the result because people want to leave on time. At shift change there is usually an overlap of time to help facilitate the early relief. When supervisors embrace a spirit of reciprocity between all shifts, this is usually not a problem.
Leaders should take brief notes to facilitate upcoming training adjustments or policy review. It is important to highlight that significant events may require an administrative or criminal investigation making an informal AAR inadvisable or against policy. Depending upon the incident, there may be value in delaying the AAR until after the investigation. In the event of a delayed AAR, the detailed notes of the leaders are very important. The AAR will likely take on the format of a peer support, rather than training performance, based on the length of the delay.
If you are not conducting AAR’s on a routine basis, begin by conducting small AAR’s following lower profile incidents. As your personnel and leaders become more comfortable, they will be familiar with the format and able to facilitate AAR’s with larger groups. This familiarization with the process prepares everyone for the larger scale, higher profile event AAR’s. Everyone benefits from a well-executed AAR.
Less experienced personnel can gain experience faster by learning how to correctly respond to an incident before they are faced with a similar call. Note, leaders must demonstrate that actions, mistakes and thoughts of participants will not be used in professional evaluations. Allow the rank and file to respectfully discuss what occurred and what they were thinking as the scene unfolded. When they observe a senior officer admit to a mistake or that he could have done it better they gain respect for their senior officers for being authentic, a common area needing improvement among first responders.
The AAR is an optimal time for supervisors to listen. The goal is to create a respectful environment where people can admit mistakes and improve future performance. The focus must remain on the action (improving performance), not the person. Depending on the incident, it may be beneficial to utilize a moderator who was not there. He or she may be able to ask difficult questions without offending the participants. Senior personnel benefit by gaining a keen insight to the preparedness and professionalism of the squad. Just by listening and observing how the squad interacts can provide valuable information about employees.
Rules of engagement
The U.S. Army has a standard format, but the process can be modified. Try the below standard format. Trusting the process usually leads to positive results. The below format (on the next page) is readily available through open source of the internet in Army Publication, TC 25-20, A Leader’s Guide to After-Action Reviews.
When most agencies are faced with reduced staffing and reduced budgets, it is difficult to deny the inherent value of the informal AAR. The AAR can be done anywhere at any time. First responders work in a time-compressed environment. By slowing things down and allowing them to self-analyze their own response everyone benefits by increasing the perspective of their peers and leaders alike. Leaders better understand their personnel/unit capabilities and shortcomings. Training assessments drive the specific training needed to improve overall performance and safety.
Introduction to AAR and ground rules.
Start with a short background on what was known at the beginning of the incident.
What was supposed to have happened?
What was done well? How can we sustain that level?
What was not done well? How can we improve?
Discussion of key issues.
Dan Murphy has been involved in public safety for over 35 years, working in a wide variety of positions in the law enforcement field, military and civilian. He served as an operator on a law enforcement tactical team for over 18 years, serving eight years as a SWAT Team Leader. He was instrumental in the early development and fielding of Rescue Task Force Operations and Critical Emergency Tactical Training for law enforcement. Dan privately consults in the corporate environment and serves as a subject matter expert in Active Shooter Response for the US federal government. He is a retired Senior NCO from the US Army Reserves. Dan is currently a Lieutenant in the Special Operations Section, Arlington County (VA) Police Department. He is also Vice-Chair of the IPSA's Rescue Task Force Committee.
By Mark Warren, Vice President, Strategos International and IPSA Member
The term first responder has been used for decades to describe the heroic women and men in uniform that make up our law enforcement, EMS and fire services. Due to several significant and recent acts of mass violence, there is now a new, different way of thinking about the term first responder. What we have learned from these tragedies is that the group of people who have a significant impact on survivability are the individuals on scene – the immediate responders. What immediate responders do, or don’t do, will make a difference. Any individual who is on-scene during a violent event is effectively considered as an immediate responder.
Unlike the professional first responder who has ample training, equipment and knowledge to respond to crisis, the probability of immediate responders having similar training, resources and knowledge readily available to aid in a response is low. The likelihood that immediate responders have received training and education about how to respond may be greatly limited. There are several response options that immediate responders can take. Each option impacts the outcomes of the individual and the victims.
Mental preparedness and readiness
Acts of mass violence occur everywhere. To adopt a when/then mindset, immediate responders need to accept that acts of mass violence happen wherever you work, live or visit. They are not geographic specific. They are not venue specific. By accepting this reality, immediate responders are better prepared to see, understand and proactively look for potential warning signs of concerning behavior. When an act of mass violence happens, then I will do these things.
Unlike if/then (if this happens, then this will be a possible response), the when/then philosophy is about mental preparedness and readiness to respond. It eliminates the theoretical. Skilled first responders inherently use this method when before and during a response to any call for service. Further, paying attention, being knowledgeable and ready to respond prevents normalcy bias. Normalcy bias delays proper response when seconds count. Immediate responders need to adopt the when/then philosophy and accept the situation for what it is and respond.
Medical treatment/casualty care training Immediate responders need to know how to do casualty care. This is a life-skill. Practicing casualty care training every few months will keep the skills current. Once an act of violence stops, or when the individual is removed from harm’s way, he or she needs to be able to transition and stop the bleeding. At a minimum, immediate responders need to be prepared to:
These critical life-saving skills bridge across the spectrum of crisis. Providing aid as soon as possible is one of the greatest steps to saving lives, understand that life could be yours, a family member, friend, coworker or a stranger. Immediate responders can save lives with this knowledge.
Immediate responders are better prepared once they mentally accept the threat and have a plan for proper response. Don’t wait for someone to provide instructions during crisis. The body cannot go where the brain has never been. Learning the knowledge and developing the skills to treat serious trauma will help save lives, including your own.
Mr. Warren is the Vice President and Director of Training for Strategos International and began his 27-year law enforcement career in the U.S. Army Military Police Corps. He has experience as an undercover operative, a tactical team member, and an instructor. He has been involved in the planning, implementation, and execution of hundreds of high-risk arrests, and spent five years with a large multi-agency task force working as an undercover operative and team leader. Mr. Warren was the Firearms/Use-of-Force Program Manager for his department prior to retiring. Mr. Warren is currently a Retired Sergeant for a local agency and was the 2000 Missouri P.O.S.T. Part-time Instructor of the Year.
By Dave Mulholland, Administrator, Arlington County Emergency Communications Center
Each day, 9-1-1 telecommunicators handle stressful calls involving law enforcement, fire and medical incidents. Telecommunicators are trained to calm highly distressed callers and gather the appropriate information within structured protocols and processes. Their training and the protocols they use have been developed and refined over decades. Coupled with strong training and defensible protocols, telecommunicators have become experts in handling high-stress calls through repetitious use of both foundational elements.
However, the 9-1-1 landscape has changed as acts of mass violence and other multi-caller/multi-victim high-threat incidents begin to increase. These acts have restructured in-the-field first response efforts. Police officers now arrive and directly enter the area to engage the threat, no longer securing exterior perimeters and staging until sufficient resources exist for team entry into the incident. Trained fire personnel and medical personnel now enter hot zones rather than waiting for a scene to become secure before they enter to render aid.
Similarly, acts of mass violence impact traditional 9-1-1 response. Telecommunicators, as the first of the first responders, play a critical role in determining the nature and extent of the threat and supplying the in-field responders with information to end the threat. During an act of mass violence, it is likely that the 9-1-1 center will be quickly overcome with calls. Triaging these calls to gather the most pertinent information is paramount. To successfully do this, the telecommunicator may need to deviate from traditional practices such as gathering detailed information about injuries and providing emergency medical dispatch protocols.
Below are five tips to assist the 9-1-1 center in handling mass violence events.
Tip 1: During an on-going act of mass violence, the highest priority is to gather information to stop the threat. Law enforcement first responders must be provided with as much information regarding the type of threat and information to help identify the attackers and their location. High-threat trained fire and rescue personnel need to understand the environment to make informed decisions on when and where to begin their response inside the incident. The dispatcher is informing these decisions. Telecommunicators also help inform the response by identifying any additional information sources at the scene such as video feeds and determining if there are possible secondary threats at the scene.
Tip 2: It is essential that 9-1-1 lines be kept clear so that additional information may be obtained. This often requires truncating calls from victims and witnesses on the scene. It is hard to disengage with someone who is injured or next to someone who is seriously injured or dead. Calls must focus on stopping the threat, and until that happens, telecommunicators should not be triaging medical priorities or providing medical direction through emergency medical dispatch protocols. Jurisdictions could consider creating specially trained crisis personnel from other governmental departments (such as human services) who can be activated to communicate with callers during an active incident and provide direction and comfort to the callers. After the 9-1-1 telecommunicator obtains the necessary information from the initial call, the call be transferred to another phone bank staffed with these specialists.
Tip 3: As soon as it is clear that you have a mass casualty or significant active shooter event, mobilize Critical Incident Stress Management (CISM) or Traumatic Exposure Recovery Program (TERP) team members. When developing these teams, ensure that there are members not actively deployed as an event responder who can respond to on-going event to help begin help with stress management in the 9-1-1 center. Thus, the healing process can begin even as the incident is still ongoing. All 9-1-1 supervisors and managers must constantly communicate with and evaluate telecommunicators during the incident to gauge when they may be reaching breaking points. Be prepared to appropriately relieve an employee who may have reached maximum stress levels during the incident. A broken employee will not effectively contribute to incident resolution.
Tip 4: Train, train, train. As stress levels rise, thinking functionality begins to rely more on how the brain has been trained and conditioned to respond. The adage of you fight as you train is equally true in the 9-1-1 center. Telecommunicators must be trained on response to acts of mass violence, especially through repetitive simulation exercises. This will assist the telecommunicator in developing greater comfort to follow different protocols during a mass violence event. Time spent in continuous roll call and simulation trainings multiple times a year will reap large rewards should a mass violence incident occur.
Tip 5: Great efforts have been made to educate the public on responding to acts of mass violence, such as the “Run, Hide, Fight” educational campaigns. However, little has been done to educate the public on what information is important to relay when calling 9-1-1 during an act of mass violence or what to expect when calling. For example, the public should be prepared for the telecommunicator to quickly gather information regarding the active threat but not remain on the line to determine extent of injury or provide reassurance and medical direction. 9-1-1 centers should work collaboratively with their respective first responder agencies to expand education efforts to include communications with 9-1-1 during a mass violence incident.
The role of the telecommunicator is critical in responding to and resolving acts of mass violence. It is imperative to continually evaluate appropriate response to 9-1-1 calls during acts of mass violence through decomposition of prior events, adoption of best practices and lessons learned and development of new tactics and protocols in the 9-1-1 center. Telecommunicators prove their value in saving lives, providing hope to those in distress, and protecting first responders every day. Efficient handling of acts of mass violence amplify the telecommunicators critical role as part of the first responder team.
Dave Mulholland is currently the Administrator for the Arlington County, Virginia, Emergency Communications (9-1-1) Center. He retired as a Major from the United States Park Police after 27 years of service. He has also served as the Statewide Interoperability Coordinator for the District of Columbia. Mulholland will be presenting at the IPSA’s Mass Casualty Incidents Symposium this Fall in Washington D.C.
By Natasha Lukasiewich, DNP candidate, MSN, HHP, LNC, RN, CCRN-K, CFRN, CEN, EMS-RN and IPSA Mental Health Committee Member, Critical Response Team and Peer Support Unit Member for Washoe County Sheriff’s Office
How many times has one said this to themselves or have heard others say this, I want to help, but I do not know what to say? Sometimes, it is not about saying anything, and it is about the ministry of presence. Active listening and knowing your resources available are key.
When I was seven years old, my dad died by suicide. He died from severe depression, lack of support and not knowing what resources were available for him. From the coroners’ viewpoint, he died of carbon monoxide poisoning, but he also died of shame, guilt and a lack of knowing how to better his situation. Ultimately, he died of reasons unknown to those left behind and, more importantly, he is not here today.
This article presents a tool that allows one to check in with oneself and your colleagues. This tool needs no specifics, but a self-awareness based on color identification.
Health care professionals and first responders
What is happening in our industry of health care professionals and first responders? Think about the calls for service you have been involved with:
These stories are not unique, and everyone could sit here all-day recollecting about how they have all lost some amazing souls in their time. Again, the same responses that occur over and over is often, I just don’t know what to say or do.
Shift workers all have shift changes, pre-brief, debriefs and so on. Why is so much of the health care and first responder industry focused on the hard skills and not the soft skills? Those who serve must be resilient and must improve all skills – hard and soft. Research shows that individuals who health care professionals and first responders serve are only receiving the care and service as good as the providers that are serving them.
Changes to implement today
The challenge for each reader today is to implement what is called the mental health continuum model in your daily shift reports – adapted from the National Defense and the Canadian Armed Forces.
The Red Cross Crisis Response Teams worldwide also use what is called the Stress Continuum Model. This allows for the team leader to check in with those out in the field to see how they are coping with the horrific things they are being exposed to. See below.
Now that the above tools have been shared and we have acknowledged that every health care professional and first responder must begin using them today, what are the next steps? Here’s an example about how to easily apply these tools in practice.
If you serve in an EMS agency, while doing crew change, the team lead can check with the crews and simply ask, “What color level is everyone today?” Without even knowing the details, a crew lead can assess mental readiness to the start of the shift. They have just triaged their team’s mental readiness.
The team lead can also check in after a bad incident – such as after a horrific pediatric call. Teams may have started off their shift in green or yellow, but after the call some of them are likely to be orange or red. If there is a significant shift in color after a bad call or shift, then there needs to be a tactical response to ensure the appropriate resources are dispatched or in contact with the health care professionals or first responders that need it, preferably, sooner than later.
Perhaps if my dad, or my colleagues had some sort of communication tool, they too could have been saved or at least been shown they were not alone.
The health care and public safety industries need to take mental health readiness seriously and regularly assess their personnel. These industries need to stop being reactive and be proactive with mental health readiness.
Try it, challenge yourself, challenge your organization. What color are your today?
Natasha Lukasiewich started her journey in Health Care back in 2001, when she graduated from Grant MacEwan University, in Edmonton, Alberta, Canada with a diploma in Holistic Health. She later graduated from the same university, and completed her Nursing Diploma, venturing into Emergency Medicine. In 2006, she was recruited central coast California, to continue her ER nurse journey, later becoming a flight nurse for Calstar. She then continued her flight nursing career in Lake Tahoe/Reno, NV areas with Care Flight. In 2017, Lukasiewich completed her MSN and is currently completing her DNP (Doctorate in Nursing Practice). Her focus is primarily peer advocacy and raising mental health wellness in health care and first responders. She has been an invited speaker for many webinars, symposiums and national conferences on the effects of PTSD, depression and suicide for health care and first responders. For the last six years, she has served as a Volunteer Auxiliary Deputy Sheriff on the Washoe County search and rescue team, and also serves on their Critical Response Team and Peer Support Unit. You can connect with Natasha on LinkedIn or connect via her business website at www.legalnurse.solutions. Feel free to email her at firstname.lastname@example.org.
IPSA Infogaphics: Depression, Suicide and PTS
Webinar Recording: Mental Readiness: Stigma Reduction & Resiliency Program
Webinar Recording: Fighting addiction in EMS/Healthcare
Webinar Recording: Heroes are Human Too: PTSD, Depression & Suicide
By Anne Camaro, Assistant Director, Cambridge Emergency Communications, IPSA 911 Telecommunications Committee Member
Training is always needed in public safety, but its methodology, delivery and perceived success of the training is often a subject of controversy. Fiscal resources, staffing and time constraints are often impeding an agency’s ability to form a consistent and well-developed training program.
The private sector recognizes that developing meaningful, impactful and task-focused training will improve business performance, and of course, the bottom line. Private companies seem to have an easier time gauging the impact of talent development. Training effectiveness can be measured by looking at several indicators, including an employee’s cost-effectiveness.
But what is the public safety bottom line? Perhaps the bottom line in a 911 communications center can be defined as the ability of the dispatcher in managing incidents. But how is that quantified or measured? There are myriad possible bottom lines when it comes to public safety call taking and dispatching that the water gets muddied when trying to determine how to measure the effectiveness of training.
Agencies must go back to the basics of risk management and needs assessment, and have a continuous process to identify training needs, desired outcomes and measure whether the training model being used is addressing the needs.
Three training steps
In his book Work Rules, Laszlo Bock talks about the need to create a culture of learning within an organization. He highlights a few steps organizations can take to create this culture of learning.
Step one: Deliberate practice creates improvement. Organizations that focus their training in breaking down job duties into small practicable tasks encouraging employees to perform these tasks repeatedly have more success in improving performance with training. Bock cites the work done by K. Anders Ericsson, a professor of psychology at Florida State University, who studies the acquisition of expert level skills.
Ericsson found that individuals who attain expert level skills in any task, mostly learn by breaking down those tasks into smaller ones, and repeating them over and over after receiving feedback, or observing their results, making small adjustments to their tactics to improve. Ericsson refers to this as "deliberate practice: intentional repetitions of similar, small tasks with immediate feedback, correction, and experimentation.” Public safety agencies can maximize their budgets by utilizing downtime for these practice exercises.
Step two: Identify internal subject matter experts and invite them to teach. Many agencies when faced with training needs go to third parties (e.g. consultants) for classes, but they fail to consider that the consultant has never worked in their agency and do not have a true understanding of the agency’s organizational culture.
While the information received at these classes is often relevant, if not enforced or immediately applicable, it will likely be forgotten within a couple of days. Teaching from within the agency will allow for topics to be relevant to daily tasks, and employees will have easier access to the instructor for follow up questions.
Step three: Identify and measure the intended outcomes from the training. When implementing a new training program in a department, unit or division, agency leadership must be diligent in identifying and measuring the intended outcome from the training. Bock suggests implementing a controlled study in which employees are placed into two groups and only one group is exposed to a training course. Then, after a period time, compare the performance of the two groups. If the group that received the training is performing better, then the agency can reasonably infer that the training was effective.
Bock’s three steps in creating a culture of learning addresses many of the common complaints of public safety agencies. When agencies get creative and leverage internal talent and resources for training, they can address their training needs without having to constantly rely on budget approvals and balancing out staffing and time constraints.
Anne Camaro is the Assistant Director of Administration and Training at the Cambridge Emergency Communications Department in Cambridge, MA. She has a Master’s Degree in Public Administration, and a Post Graduate Certificate in Local Government Management and Leadership. Anne is passionate about the 911 industry and has devoted a lot of her time to developing and implementing training programs.
By Heather R. Cotter, IPSA Executive Director and Founder
First responders experience extreme physical demands, often in hazardous environments. Many tragedies occur suddenly and without warning. Gunshot wounds, building collapses, vehicular accidents, assaults and other causal factors contribute to untimely deaths in our emergency response community. Further, first responders face several threats to occupational related diseases such as cancer and cardiorespiratory related maladies. Law enforcement, firefighting and rescue activities are inherently dangerous occupations.
Since June 2018, we have lost 48 first responders, according to data pulled from the Officer Down Memorial Page and the U.S. Fire Administration. These 48 fatalities include law enforcement officers, firefighters and K9 officers. The cause of death includes vehicle accidents, illnesses, gunfire and duty related injuries.
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