Treating the Mind: CISD
BY TROY DYCUS
The Oklahoma City Fire Department Critical Incident Stress Debriefing Team, in cooperation with the State Critical Incident Stress Management Team, set up and performed prebriefings, demobilizations, and defusings from April 19 through May 5, 1995. Both teams worked as one CISM system throughout the incident.
Because of the involvement of OCFD personnel in the rescue effort, a majority of the CISD team members could not be used because they had become an integral part of the incident. During the first eight hours of the rescue operations, some of the CISD team performed one-on-one crisis intervention (assessments) on the scene. After these team members moved from area to area, a permanent site was established later the first day in the Southwestern Bell Building. We used the second and third floors. Defusings took place on the second floor. An office was set up on the third floor to verify credentials of incoming CISD teams from across the country and to communicate with the incident commander and other organizations on site.
DEFUSINGS
Dr. Tom Jones, our volunteer on-board psychologist, developed a “point system” for those team members involved in the initial rescue operations. After visiting with him, if the team member scored more than five points, he recommended that the member not participate in any defusings.
OCFD personnel were broken up into teams of three members working 12-hour shifts, with teams throughout the state and country working with us. Any OCFD rescue personnel coming through would have at least one OCFD team member in the defusing, if possible. This was done to give our firefighters a familiar face and to help us recognize, if possible, any problems our personnel were having. All personnel were being seen (defused) regardless of with which organization they were involved.
Our objectives for defusings during the incident were the following:
to reduce or eliminate as much as possible the effects of the incident on all personnel involved;
to inform and educate rescuers on critical incident stress and its effects as well as ways to deal with it;
to reduce cognitive, emotional, and physiological symptoms;
to accelerate the “recovery process”; and
to assess the need for postincident debriefings and other services.
Within hours of setting up in the Southwestern Bell Building, we were doing defusings on rescue companies leaving the scene. The first night these were performed by a few OCFD team members and other CISM volunteers from around the state. Defusings took 20 to 30 minutes per group on average. Operational changes for us began to take place on a daily basis for the next several days. Feedback given to use by rescue personnel was taken to Command with the permission of the personnel and while maintaining confidentiality. This was done in an attempt to reduce stress levels by adjusting hours worked and changing work conditions as much as possible.
After all shifts had been defused twice, the defusings were decreased, and we did more of a demobilization to cut down on repetition. The firefighters were getting frustrated with going through this process over and over. We began to see two types of groups coming through the defusing process: rock movers and body recoveries. For rock movers, we began to do just follow-ups, making sure they were doing okay and advising them to eat, rest, and call home to let their families know how they were doing. It was a refresher on stress reactions and what to look for as well. The personnel involved in body recoveries went through the same defusings as previously done, to monitor their condition and any stress reaction evident. It served as a reinforcement for them.
Defusings were done on all personnel who came to the CISD floor–military, mutual-aid fire companies, federal and local law enforcement agencies, and volunteers from all walks of life (welders, electricians, construction workers, and so on).
The stress management was given to all agencies that requested it if personnel were on hand to comply. In some cases, we traveled to sites where help was needed. Sometimes we could not help because of lack of personnel. CISM personnel from the FEMA USAR Task Forces assisted as well.
Also available to all personnel going through our area were massage therapists, chiropractors, change of clothes, and free phone service for calling home.
PREBRIEFINGS
Prebriefings originally were set up to deal with safety issues and to make rescuers aware of equipment available to them (such as gloves, masks, shoes, knee pads, etc.). At prebriefings we also told personnel of conditions on-site for that day, any changes, and what to expect on and near the site.
As the firefighters checked in to the Command Post, the command center would notify the CISD floor that a prebriefing was needed for personnel entering the scene. After several defusings, and with permission from defused personnel, we relayed information to other personnel during prebriefing about the conditions they would be facing at the bomb site (for example, procedures for body recovery and how to deal with the sights and smells they would encounter). On or around Day Four, we used company officers leaving the scene to assist in prebriefing companies entering, to give firsthand accounts of what they would face.
ALL RECEIVED CISD
Our quality-assurance system was set up to ensure that every one of our firefighters came through some sort of CISM after completing their shift at the bomb site. Their ID tags were left at the Command Post when they checked in. To check out and receive their ID tags, they had to present a signed form showing they had been through CISD. Our team workers filled out these forms after defusings.
On May 4, when rescue operations were concluded, all personnel assembled in front of the building. Chief Gary Marrs and Assistant Chief Jon Hansen let them know it was the end of the rescue operation. OCFD Fire Chaplain Teddy Wilson closed with prayer. Then the CISD teams and Dr. Jones gathered the OKC fire personnel for a 20- to 25-minute session. This was a very exhausting and emotional time. It allowed rapid ventilation of the stressful experience, provided information, affirmed the value of personnel, and developed expectations for the future.
On May 5, a memorial service was held for rescue personnel and their families. The CISD teams began to plan and develop the postincident formal debriefing process.
Formal debriefings for OCFD were conducted May 6 through 15 in Oklahoma City by the State of Texas CISM Network. Paul Tabor, state coordinator, was assisted by Mike Pitts, clinical coordinator. A total of 16 teams of three were sent, which included 15 mental health professionals and 29 peers (firefighters). Debriefings were mandatory for all personnel on the OCFD, bringing the total number of debriefings to 59, with six makeups for personnel who were off-duty during that time. We currently are in the process of doing follow-ups and assessing our personnel. The Oklahoma State CISM Team used teams from across the country to assist them in postincident formal debriefings for all Oklahoma mutual-aid fire and police departments. They are in the follow-up phase as well.
Since this terrible tragedy, we have tried to emphasize to our firefighters that we are “normal people experiencing normal reactions to an abnormal event.” We also are in the process of educating our department even more on stress and how to manage it. The spouses of our personnel are currently establishing a Family Foundation to support the families of our firefighters. n
JERRY FLOWERS, sergeant, Oklahoma City Police Gang Unit: A few minutes later, Don came back to the front opening where I was. He was carrying a small baby wrapped in a blanket. We laid the baby on the front sidewalk just outside the building. A nurse put a piece of tape around the ankle of the child. Don opened the blanket to wrap it better. That is when I saw that the child was decapitated. I wondered why and how in God`s name this could happen. Cradling the baby in his arms, Don carried it to emergency-services workers and then rejoined me in the building to continue the search. In a small area cluttered with rocks and steel, I saw the tiny pink foot of a child. Altogether, five children were carried from this area of the second floor.
From the book In Their Name, edited by Clive Irving, Project Recovery OKC. Copyright © 1995. Reprinted with the permission of Random House, Inc.
BRENDA McDANIEL, worked in a canteen for the Salvation Army: Early in the evening, an Oklahoma City third grade class had left a large box of paper sacks filled with candy and a decorated letter of thanks to the rescue workers. During the night, an exhausted fireman came up, shaking, and asked for a cup of hot coffee. He had helped recover a victim and said he was having a hard time emotionally. I noticed he had one of the paper sacks in his hand. He said, “I`ll be okay in a minute. I`m having flashbacks to Vietnam. You see, I was wounded in Nam, and while I lay waiting for someone to find me, a plane flew overhead and dropped little paper sacks and I had one close to me from a little girl in Pennsylvania. She was in the third grade, I still have it. Much later, I wrote to tell her how her letter had kept me alive. I can`t believe it, here I am tonight with another letter from a third grader–just when I needed it.” I poured him a cup of coffee, and he slipped away and asked for a chaplain.
From the book In Their Name, edited by Clive Irving, Project Recovery OKC. Copyright © 1995. Reprinted with the permission of Random House, Inc.
TROY DYCUS is the field training officer for the Oklahoma City (OK) Fire Department. He is a member of the department`s Critical Incident Stress Debriefing Team and EMS Advisory Committee and of the state`s CISD Team. Dycus has an associate`s degree in emergency medical technology and is completing a degree in fire protection at Oklahoma State University, where he is a faculty-adjunct. During the Oklahoma City Bombing, he was involved in the initial phases of critical incident stress management and helped organize the CISD branch of the system. He was assigned as a supervisor in the defusing area.
