BY CRAIG A. HAIGH AND REVEREND JENNIE SWANSON
The fire service is good at many things. When people dial 911, we respond rapidly, employ expert tactics that extinguish fires, rescue trapped occupants, and salvage personal belongings. We provide emergency medical care and, in some cases, ambulance transport for victims who are critically ill and injured. We assess and mitigate spilled and leaking hazardous materials and perform carefully planned and executed rescues of those requiring technical expertise.
We are not good, though, at providing emotional and spiritual care to the family and friends of those affected. Consider this scenario: A couple, married 60-plus years, begins the morning routine. He sits in his normal spot at the kitchen table, scanning the newspaper and sipping his morning coffee. She glides around the kitchen, lovingly preparing their breakfast and looking forward to spending time working the crossword puzzle while listening to him muse about the headlines and the status of his favorite baseball team.
Suddenly, the love of her life and the family’s patriarch, grabs his chest and falls out of the chair and onto the floor. He is unconscious and not responsive; he appears not to be breathing, and she is unsure if he has a pulse. Horrified, she quickly dials 911 and answers the telecommunicator’s questions. The prearrival instructions from the EMD-trained dispatcher seem strange, and she is having difficulty focusing on what needs to be done. She repeatedly asks that the ambulance “please hurry” and wonders if “this is it.”
The engine and ambulance arrive, and her normally quiet kitchen becomes a flurry of activity focused on saving her husband’s life. Fire-EMS personnel begin CPR; they carefully and quickly move the kitchen table out of the way so they can attach electrodes to his chest and prepare to defibrillate. They skillfully intubate, initiate two IVs, and push their first round of cardiac medications. Other crew members ask her detailed medical-history questions and for a list of medications. They lift her husband from the floor, wires and tubes hanging from his lifeless body, and place him on an ambulance gurney for transport. They resume CPR and whisk him out the door to the waiting ambulance. The lieutenant explains where they will be transporting, and then they are gone, leaving her wondering if this was the last morning she will have spent with her faithful friend and to contemplate the future.
We are good at providing patient care. We are experts at bringing the emergency room procedures to the streets and living rooms of our communities. We are about serving those who are in need. The question is, did we really serve all the patients involved with this situation? Did we treat the wife’s emotional and spiritual needs?
Emergency responders are not equipped to, and probably cannot, provide the holistic care called for in such a situation. Rendering care to the patient and the family most likely exceeds our capabilities. Most of us have become hardened to what we see. Veteran responders realize that if they allow themselves to become emotionally involved, they leave themselves open, vulnerable, and most likely unable to handle the next incident that waits just around the corner. Who we are or how strong our souls may be does not matter. If we do not disengage from the emotional events of an incident, we will be unable to continue serving as required.
Yet, if we truly want to meet the needs of our customers, we need to provide holistic care that addresses the emotional and spiritual needs of the victim/patient’s family and friends. We are not talking about long-term counseling; the priority is meeting the immediate needs and then handing the family and friends off to other caregivers, hospital chaplains, family pastors, and mental health experts to help facilitate the long-term healing process. The fire service chaplain is uniquely qualified to fill this role.
THE CHANGING FACE OF THE CHAPLAIN
Fire department chaplains can trace their beginning back to the early fire service. Departments have used local clergy or members who have special skills or church affiliations to give the invocations at special meetings, christen new fire apparatus, and conduct funeral services for fallen firefighters. Few chaplains routinely respond to incidents; fewer are actually rostered members of their departments. However, if the fire service wants to provide all-inclusive service, the argument can easily be made that chaplains should be part of the operational team.
Today’s trained chaplain provides an effective solution to the intentional and purposeful provision of holistic care to department members, their families, and command as well as on-scene support for community residents during and after an incident. Beginning with a calling to serve those within the fire service and their local community, fire chaplains should be trained in fire department culture and operations, pastoral care, crisis intervention, comprehensive critical incident stress management (CISM), and grief support, making them uniquely suited to meet additional needs beyond the general scope of what first responders are able to provide.
One chaplain, however, cannot be available 24 hours a day, 365 days a year. To address this issue, a meeting was held between the chaplains and chiefs of 16 western Chicago suburbs last November. Participants focused on ways to ensure coverage. Discussions included mutual-aid/auto-aid response of chaplains and establishing a system to mobilize multiple chaplains for multivictim incidents. It was determined that to accomplish these goals, all chaplains should receive similar training and operate off similar operational response policies.
THE ROLE OF MABAS
Since visionary leaders of some of the same departments represented at this meeting were present at the Mutual Aid Box Alarm System (MABAS) meeting in 1968 when the chaplaincy issue had been previously discussed, it became evident that MABAS would be the appropriate vehicle for beginning to build a high-quality chaplain component.
With the blessing of the MABAS Corporate Executive Board, MABAS Division XII, representing 24 fire agencies including the DuPage County (IL) Office of Emergency Management, quickly added a Chaplain Committee to its working organization and appointed a chief liaison to the chaplains, a chaplain coordinator, and a chaplain training officer. The chiefs developed and adopted response policies and initiated the concept of joint training.1
From its inception, the program has crossed MABAS divisional lines and currently includes 140 chaplains from 33 MABAS divisions. The Illinois Corps of Fire Chaplains (ICFC) was developed as a professional fire and emergency management chaplain’s organization and works in partnership with the Federation of Fire Chaplains. The ICFC’s purpose is to serve fire service chaplains, to support the ministry of fire and emergency response chaplains, and to assist fire service agencies in developing their own chaplaincy programs. We are working to develop standards of practice in cooperation with emergency agencies and to develop a network designed to assist victims of fires, disasters, and terrorism.
The ICFC has established rigorous training recommendations not as a replacement for existing department policies or training chaplains as firefighters but as a tool for structuring an effective introduction to fire department and emergency response chaplaincy. The training includes a 12-week mentoring relationship for new chaplains with an experienced chaplain, basic fire scene policy and operations, proper use of personal protective equipment, and completion of NationaI Incident Management System (NIMS) 100, 200, 700, and 800. The chaplain should be trained in CPR and first aid and have a comprehensive understanding of CISM and emotional and spiritual care in disaster response. Training in line-of-duty deaths and other death notifications is also necessary.2 In Illinois, a partnership has been formed with the Salvation Army Emergency Disaster Response, and fire chaplains are attending training several times per year with other crisis and disaster workers, working toward certification by the International Critical Incident Stress Foundation. Each division chaplain committee conducts and records training and assesses future training needs at local, state, and federal levels.
FIVE POINTS OF SERVICE
The MABAS Chaplain Program Leadership Team has identified five critical points of chaplaincy service for a successful program.
1 First Responders and Staff. In addition to the role the chaplain plays for those we serve is the equally important role to our departmental membership. The primary role of the chaplain is to take care of the troops. As an internal support within the department, the chaplain maintains a presence during downtime as well as on-scene during a response. Sometimes incidents are so overwhelming that immediate defusing is necessary to assist the firefighter in processing the events of the tragedy. In these cases, the chaplain is able to facilitate one-on-one crisis intervention or is trained to be a member of a CISM team to assist other departments.
Firefighters normally seal off their emotions associated with the day-to-day events, pushing them to the back of their memory warehouses and moving forward as if nothing significant has happened. But as is typical for many who have seen more than their share of tragedies, when it is least expected, something will trigger a reminder, and the emotions that should have been experienced and dealt with months or years ago will forcibly reveal themselves by means of physical, psychological, or spiritual distress. Because many firefighters feel that recognizing these feelings is a sign of weakness, the feelings are again forcefully suppressed, and the firefighters move forward or find comfort through self-destructive options. This suppression builds, producing harmful behaviors such as domestic violence, not wearing seat belts, extreme risk taking, increased accidents, alcohol and drug use, and suicide.3
(1) A chaplain documents information gathered from the victims of a structure fire prior to briefing the incident commander. (Photo by Kenneth D. Zaccard.)
The chaplain who frequently visits the fire stations for nothing more than conversation and coffee will begin becoming a part of the department’s trusted inner circle. Firefighters must learn that the chaplain is one of them and is available for confidential assistance. Sometimes firefighters see chaplains as spies for the chief or administration; chaplains must constantly guard against this impression. Firefighters are concerned that what they share might get back to the bosses and negatively impact their career.
The trust factor is crucial in the development of a successful program; new chaplains must realize that this trust will be built over time as the firefighters come to view the instances of their interaction with the chaplain as successful. This trust will manifest itself in unscheduled conversations, where firefighters pull aside and seek the professional mental health assistance of a trained fire service chaplain. Encourage and foster this vital role of fire service chaplaincy at all levels within the organization.
The chaplain is not primarily a religious advisor, even though many may be a member of the clergy. In addition to regular visits to the stations, responses to incidents, and special events, the chaplain can make hospital visits and home visits and also perform religious services on request. Meeting emotional and spiritual needs does not simply mean providing religious advice or ritual. Chaplains help people according to their own system of beliefs and values, offering healing and hope to those in need. In some cases, this may be prayer or counsel; but, more often, it is simply presence. The chaplain’s position should not be used to preach, recruit members, or impose beliefs on others. A properly trained chaplain does not direct care in a faith-specific manner but with compassionate integrity and always serving the particular needs of the individual.
The chaplain is available for a tailboard conversation about some family stress, to keep a watchful eye out for signs of addiction and substance abuse, or to be an empathetic listening ear for the everyday frustrations associated with a 24/48 work schedule. After a particularly rough run, a chaplain may just happen to be around and provide a trained ear to listen and then to provide advice. This alone can save a career.
2 Families.Support needs to be extended to families of staff as well. Those at home often cannot understand the stress of the job, and the schedule and extra hours can cause a drain on home life. The firefighter needs a place where it’s not about the job, and many firefighters’ spouses would rather not hear all the details anyway. But that doesn’t mean spouses want to be left completely in the dark.
Additionally, concerns over transmission of disease from exposure to patients, long-term health concerns because of exposure to the products of combustion, the stresses of shift work, and the emotional impact of dealing with the situations firefighters face all multiply to produce disastrous consequences within family relationships. U.S. Census data show that one of every five adults has been divorced at some time.4 A survey of your department may show even higher numbers.
Support often can be best provided by a continued presence. In some departments, families are invited to a special time of education during rookie school to learn the basics about the department, shift schedules, equipment, and safety. Family members, children especially, try on some turnout gear, drag an uncharged hose, and see the apparatus close up. A bridge is built during this time to provide for support in the future. If needs arise in the years to come, a familiar face is available for support.5
A chaplain can also be trained to explain insurance benefits to rookies and families and approach difficult subjects such as beneficiary designation from an unbiased perspective. Providing information to new staff and families prevents misunderstandings and fosters positive communication. These conversations are best initiated at the beginning of a career and should not be left until the information is needed.
3 Command.The only one who knows what it is like to be the fire chief is the one who wears the badge. The old adage that it’s lonely at the top is true. Isolation in any leadership position is not effective for the long term and can be destructive to the person, the family, and the department.
In addition to the chief’s own increasingly hectic schedule, administrative paperwork, existing family stress, and complicated personnel issues, the chief also needs to be a surrogate parent, a big brother, and sometimes a marriage counselor to each firefighter and officer. There has to be a place for the chief to let some of that go. The chaplain who has invested time and effort in the fire service and in building communication and trust is the one who listens, encourages, and supports leadership. Through a shared dedication and commitment to serve and a mutual calling to give one’s life for others, a trusted relationship between a chief and the chaplain can make the difference between burnout and long-term success.
4 Victims of Emergencies and Disasters. Crises take many forms and generate a wide spectrum of traumatic stress reactions in those affected. When experiencing physical or psychological trauma, individuals struggle with strong and disruptive emotions, intense fears, and insecurities. A critical incident overwhelms a person’s normal coping mechanisms. When an emergency or a disaster strikes, many people find themselves unable to comprehend what has happened, to make necessary decisions, or to control their emotions.
As medics roll up on a full arrest and work the patient while preparing to transport, the responding chaplain serves the needs of the family, explaining procedures and offering comfort and support. By lessening the traumatic response, the chaplain helps make the scene safer for those involved in the response and can help produce a better outcome for those left behind. This is an opportunity to raise the level of care beyond traditional medical intervention.
During a structure fire in a rural area where relief organizations are hours away, the chaplain can set into motion a predeveloped plan for providing housing and immediate assistance. The chaplain, who is also trained in dealing with the traumatic reactions disasters create in the victims, families, and communities, can ease the tension and solve some problems before they start.
Victims of emergencies often are not able to see beyond the present problem. Chaplains provide guidance and support and meet basic physical needs such as giving a blanket to someone who is cold and providing immediate shelter for those made homeless by the emergency. It is helpful to have chaplains collect contact information, keep victims in a safe area, and start the insurance process, thereby getting the homeowners on the road to recovery. This gives us all the satisfaction of knowing that we have truly done all that we could.
5 Fellow Chaplains. Significantly different from everyday pastoral work, crisis intervention is physically, emotionally, and intellectually demanding. Addressing the emotional and spiritual needs of others during a traumatic incident is psychologically and physically draining. All those responding to an incident, including the chaplain, are exposed to the very events to which they are called to help others. The language, structure, and skill set needed for this work are not learned in the seminary. Only specialized training prepares chaplains for what they will be asked to do and develops the skills they need to think quickly when things change.
Having a support network of other chaplains to talk to and train with lessens the impact of the experience and is essential to preventing compassion fatigue and burnout. After most incidents, chaplains don’t return to the station; they may remain on-scene long after the ambulances and engines pull away. Even though responders try to stay somewhat emotionally detached from the situation, caring for people and empathizing with their experience can muddy the waters and create potentially unhealthy reactions in us. Having someone to talk to can help the chaplain reflect on the incident, providing insight to what went right and what could have gone better. It’s important that chaplains have a network that facilitates opportunities to listen, learn, and let go.
By providing holistic care, we are addressing the physical, emotional, mental, social, and spiritual needs of those we serve and protect. Using chaplains as an integral part of the response team provides a necessary and effective tool for stabilizing a crisis, supporting and educating our personnel, and ensuring that we meet the community’s needs.
For more information on the Illinois MABAS Chaplain Program, go to http://www.ilfirechaplains.org/.
1. MABAS Division XII, “Chaplain Committee Standard Operating Guidelines,” May 2008, 4-5, http://www.ilfirechaplains.org/sample-policy-listings.html.
2. Illinois Corp of Fire Chaplains, “MABAS Program Policy Manual,” April 2008, 2-3, http://www.ilfirechaplains.org/icfc-mabas-program-policy.html.
3. International Association of Fire Chiefs Foundation, “Stress Management: A Model Program for Maintaining Firefighter Well-Being,” FEMA FA 100, February 1991, 37.
4. US Census Bureau, “Number, Timing, and Duration of Marriages and Divorces: 2001,” February 2005, 70-97, http://www.census.gov/prod/2005pubs/p70-97.pdf.
5. Brown, Cameron, personal interview, April 11, 2008.
CRAIG A. HAIGH is a 25-year veteran of the fire service, chief of the Hanover Park (IL) Fire Department, and a field staff instructor with the University of Illinois Fire Service Institute. He has managed volunteer, combination, and career departments; implemented intermediate and paramedic services; and developed a variety of courses for the fire service. He has presented at numerous local, state, and national conferences and is an FDIC H.O.T. instructor. He has a B.S. in fire and safety engineering and is completing an M.S. in executive fire service leadership. He is a graduate of the National Fire Academy Executive Fire Officer Program, a nationally registered paramedic, an accredited chief fire officer, and a member of the Institute of Fire Engineers.
REVEREND JENNIE SWANSON is senior chaplain of the Hanover Park (IL) Fire Department, lead chaplain for the Illinois MABAS Chaplain Program Leadership Team, and president of the Illinois Corps of Fire Chaplains Inc. She has served as an ordained pastor in the Evangelical Lutheran Church in America since 1996 and has done extensive training in CISM, disaster response, and NIMS. She has a B.A. in psychology and a master of divinity from the Lutheran School of Theology at Chicago; is a certified fire chaplain; and is the Illinois state director and Great Lakes regional director with the Federation of Fire Chaplains.