It started like many hot summer days — a busy public pool, full of families.
“… a mom arrives with her three kids … but then, all of a sudden, she notices that her 3-year-old boy is missing,” said Sheila Roth, a professor of social work at Carlow University.
She warned attendees of last week’s citywide public safety meeting that although the story she about to tell was fictional, it was rooted in reality, so if people were triggered by it, it was OK to leave the room. Roth went on, listing the first responders who answered the call for help and what happened to them three days later.
There’s Sarah, the 17-year-old lifeguard who found the drowned boy and called 911. She can’t sleep and doesn’t know if she wants to go to college like she planned.
Meet Mary, a medic who worked to save the boy in the ambulance. She can’t close her eyes without hearing his mom screaming or seeing the little boy’s Spiderman swim trunks that look like her son’s bathing suit.
David, a longtime firefighter who did CPR on the little boy, said he’s fine, but his wife disagrees. He’s complaining of nausea and headaches. And David insists that his daughter in Ohio come visit for the weekend with his grandchild.
And then there’s John, a new police officer. He can’t stop thinking about the call — his first child fatality — and wondering if can remain on the force. He wants to talk to some one but doesn’t want to look weak.
The crowd at the Teamsters Temple in Lawrenceville stayed hushed as Roth spoke.
“The stuff I’ve given you is the stuff I’ve heard over and over. And the kid calls are the worst.”
Roth has spent three decades working with first responders, even becoming one herself to understand the role more. For nearly as long, she’s also been an active member of the Pittsburgh Critical Incident Stress Management — or CISM —team.
The more than 100 volunteers on the team include those working in dispatch, EMS, fire, law enforcement, nursing and behavioral health. They organize response groups via email and phone to go out and help emergency workers care for themselves following traumatic incidents. It gives first responders tools to continue working after calls like the death of a child or the death or injury of a colleague.
Due to confidentiality, Roth declined to say which local agencies CISM works with, but stressed that they will help anyone who needs it.
While the CISM group and Roth’s work is longstanding, there’s a current and continual push to raise awareness both with the public and first responders themselves. It’s an issue that needs to be understood better, said Roth, who also spoke to the Pa. House Veterans Affairs and Emergency Preparedness Committee in March on this topic.
Roth wants to see a statewide network and meetings of similar teams, as well as state standards, ongoing education and more CISM volunteers across the state.
“Our brains process trauma different than normal thought,” she said Wednesday in Lawrenceville.
An understanding ear
Jeff Kelly, executive director of Cranberry Township Emergency Medical Service, has been a first responder for 25 years and has used CISM teams for a handful of calls.
One of those was in July 2016, when an on-duty crew member shot himself. Kelly called CISM almost immediately to have them at the station and to help the staff “work through everything,” he said. “You can’t understand the why.”
What CISM does is not counseling, Roth stressed. It’s psycho-education and support.
Volunteers listen to people vent and validates their feelings. Since most are emergency workers themselves, there is a sense of shared experience and understanding, which goes a long way, several team members said.
But they’re also careful to not share their experiences, even if they are similar, said Roy Cox, a district chief with Pittsburgh EMS and CISM operations director.
It’s about listening.
People usually feel guilty that they could have done more, he said. “You have to tell them, ‘You did everything you could.'”
Often, a person’s reaction has a lot to do with how they relate to the call — maybe an elderly patient reminded them of a grandparent or a child was the same age as their son or daughter, Roth said. That reaction is often an “acute stress reaction” and the symptoms look a lot like PTSD, she said.
The team helps educate emergency workers on signs of stress, ways to relax and self-care strategies, such as eating healthy, focusing on a hobby and spending time with family, Cox said.
At Cranberry Township EMS, Kelly works to keep CISM and other employee assistance programs at the front of mind for management to use and talk about with employees. Offering those services to staff is all about making sure they are as mentally and physically prepared as possible when they come to work each day, he said.
The approach works, said J.C. Tedorski, Arnold, Pa. fire chief, adding that he’d be more worried about first responders unaffected by calls. He’s been on both sides — as a member of the team and someone who has relied on its services.
“I’ve been there, and it does work,” he said. “You’re talking to someone who can say, ‘I get where you are coming from, I know what it’s like to drop off that kid in the ER.’ … I know where you’ve been, you’re not crazy, it’s going to be OK.'”
Tedorski is also the executive director-secretary of the Western Pa. Firemen’s Association.
Part of that role includes processing the payments for death benefits after a firefighter dies, and about three years years ago, he noticed more suicides.
So as a way to help — and aim to prevent those cases — he started P.S. It’s OK, a program for firefighters and other emergency workers to learn how to have difficult conversations with co-workers if they think they might harm themselves.
In EMS and EMT training, time is spent on how to respond to patient mental health, but nothing is said about personal mental health or the mental health of coworkers, Tedorski said.
In roughly two years, P.S. It’s OK has provided training to 200 to 300 first responders. Tedorski is working to have mental health and self-care education added to training for new firefighters.
Similarly, Roth is also working to help first responder units to create peer groups to support each other with active listening, crisis intervention and suicide prevention. Those teams could help coworkers after a traumatic call or with personal issues like divorce, she said.
It’s all about culture change, they agreed. And it has to start with the newest members of the profession to stick, Tedorski said.
“We’re supposed to be the helpers, and we don’t want to seen as weak … We’ve got to get our people to understand that it’s OK to ask for help.”