Safety and the hometown MCI

A well-trained firefighter is a safe one, but when a large-scale incident hits home factors like mental health support play a key role

Rick Markley, FR1 Editor-in-chief

If you've been in this business long enough, you've likely responded to an emergency involving someone you know.

Fire chiefs and officers know those are high-stress events for that particular firefighter. When everyone on scene knows the victim, in the case of an off-duty or former firefighter, the stress goes off the charts. And when firefighters are that emotionally taxed, firefighter safety is a real concern.

So what happens when it's not a single event, but entire neighborhoods — firefighters' neighborhoods — that require emergency response?

Last month's one-year anniversary of the massive landslide in Oso, Wash., a small town north of Seattle, is a stark reminder of what can go wrong in the blink of an eye. That event was the deadliest landslide in U.S. history; 18 million tons of earth wiped out dozens of homes and buried 43 people.

Travis Hots became the face of the rescue and recovery efforts in the slide's aftermath. Hots is fire chief of the Arlington (Wash.) Rural Fire and Rescue Department, a 30-member volunteer fire department that serves Oso.

Hots declined many interview requests and only talked of the event. In fact, he did not respond to requests to be interviewed for this and other Fire Chief stories. However, Merlin Halverson, chairman of the Snohomish County (Wash.) Fire Chiefs Association, spoke to the Associated Press about what Hots was facing.

"The thing that people don't realize about those of us who are fire chiefs in these rural areas is that we live here. You're talking about people that Chief Hots may know," he said. "It's a huge emotional burden. It's a huge emotional burden when you don't know the people, and when you do, it just adds to it."

Jeff Dill says most firefighters are suffering from some form of stress. And the big safety issue becomes whether or not responding to a large-scale incident in their community will be the trigger point for debilitating stress.

Dill organized and runs the Firefighter Behavioral Health Alliance, a nonprofit group that assists firefighters with mental health issues and focuses on suicide prevention. Dill is a retired fire captain and licensed counselor who belongs to several behavioral health and firefighter associations.

Compounding effect
While firefighters face high-stress incidents often, a large-scale incident has a compounding effect.

Firefighters who handle a call such as a child who drowned in a pool can go back and process those emotions after the call. When it is a tornado, Dill says, they may recover a child and be sent immediately to another tragic call.

"That long-term care comes into play as a chief," Dill says. "It might be weeks (on scene). The adrenaline for those firefighters might still be there and they won't be able to process the stress. There is a difference.

"The dynamics of human beings is why does it bother someone right away and another may never be affected," Dill said. "If both firefighters are on the same call, why does one become debilitated while the other is able to process it and move forward?"

Among the best-remembered large-scale incidents was the tornado that cut a 7-mile-wide path of destruction through Joplin, Mo. on May 22, 2011, killing 161 people and injuring hundreds more. It was the deadliest tornado in the United States in 60 years. The fire department lost two fire stations and five apparatus.

Job to be done
Joplin Fire Chief James Furgerson was a battalion chief when the tornado hit in 2011 and was on the ground overseeing rescue efforts. Chief Furgerson said the tornado hit the former fire chief's and a firefighter's houses, injuring the firefighter's wife.

"The guys did a heck of a job," Chief Furgerson says. "There was a job to be done and they went and did it. The one firefighter knew where the tornado was and that his house was likely hit. But they didn't miss a beat."

When there was a break, the firefighter left the scene to be with his wife. Then-Fire Chief Mitch Randles stayed in command despite his personal loss, Chief Furgerson said.

This, says Dill, is common. Dill was on the ground in New Orleans after Hurricane Katrina and tells of other agencies abandoning their positions so that they could take care of their families. That's human nature, he said.

"But in the fire service, that dynamic is so much different," Dill says. "We have a job to do and we perform under some God-awful situations.

"It is afterward when we start to digest what we just did; that's where it becomes an issue. And if you are there long term, that's why you need to have those special units to debrief people and talk to them if they want to talk."

It took a little while to have them in place, but as the days wore on Joplin Fire had chaplains on duty around the clock, Chief Furgerson said. They have their own chaplains on staff and had a team of critical-incident counselors brought in.

"Sometimes the best help is each other," Chief Furgerson says. "You sit around and talk and you work through those issues."

Dill agrees, saying it is common for firefighters to lean on company officers during such tragedies and urges fire chiefs to make sure their officers are on secure ground with mental health issues and training.

Planning for tragedy
Dill stresses the importance of getting trained counselors on scene as fast as possible. And that, he says, requires a great deal of planning.

"Fire chiefs have to be very proactive very early on," Dill says. That means working with local counselors to set up for those types of scenarios. "That's different from what we are usually taught."

Chiefs, he says, need to walk through what local counselors will be available to be on scene and what other resources are available if the closest at hand cannot be there. It almost has to be like a MABAS or other mutual-aid agreement, he said.

One problem is that when these disasters hit, you get counselors who want to help and show up at the scene. But, Dill says, "if they're not specifically trained and specifically assigned, that's chaos."

Likewise, Chief Furgerson advised against self-dispatching, which created a logistical and safety problem for emergency leaders in Joplin. The city was flooded with well-intentioned responders who began freelancing, creating efficiency and safety concerns.

There were many efforts that were duplicated because there wasn't communication between incoming responders and Joplin leaders. And more importantly, if one of those responders became injured no one would have known where they were, Chief Furgerson said.

Like tactical planning, the level of planning for mental health resources can take at least one year, Dill says. It involves building agreements, locating qualified counselors, training those counselors and running through exercises. And because we never know when that Joplin-style tornado will hit, the training and relationship maintenance must be ongoing.

Beyond the logistical coordination is planning for how firefighters will emotionally handle such a large-scale incident. Make sure firefighters understand that it is OK to talk about how such an event would affect them, not physically, but mentally, Dill says.

The barriers
One of the barriers to preparing for such an event is cultural brainwashing, Dill says.

"You put this uniform on and you do what is expected of you and that is to be brave, don't ask for help," Dill says. "History dictates that we act this way because everyone tells us, 'You're so brave.'"

Firefighters have to be strong, but they also have to buy into mental health training.

When it comes to behavioral health, everyone from the chief to the union to each firefighter has a responsibility for their own mental health. They need to work together to create a strong program.

Another barrier is available resources. And that can hit volunteer departments especially hard.

"I spent six years as a paid-on call and 20 years as a career, and it is absolutely more difficult for paid-on call," Dill says. The stress levels are the same, but the challenges of being in rural areas make it more difficult for volunteer or combination departments.

In the end, it is nearly impossible to fully plan for a "once in a lifetime" event. But preparation does bring you closer to that goal.

"There are two incidents in my career that you can do all the training in the world, but you can't train for," Chief Furgerson said. "You just do the job. Since we've had that incident, I know how most of my guys will react. It is hard to train for emotional type things."

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