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20 Years Later: Remembering Oklahoma City - The Communications Center Impact: CISM
Copyright: 9-1-1 Magazine, Feature Content
Part 5: Critical Incident Stress Management
Originally published in our Sep-Oct 1995 issue
Images of the massive, brutal devastation in Oklahoma City touched the nation. But for the emergency services personnel who responded, the impact was a powerful echo of tragedy and loss which reverberated long after the Murrah Federal Building itself was demolished.
In the aftermath, members of the Los Angeles County Fire Department Urban Search and Rescue (USAR) Task Force, including county firefighters and civilian physicians, canine search specialists and structural engineers who served for ten days in Oklahoma, found that participating in their department’s well-orchestrated Critical Incident Stress Management (CISM) program provided them with a clear awareness of the impact of traumatic exposure, strengthening their ability to heal the heartache.
Even as the Task Force was mobilized, Health Programs Coordinator Marguarite Jordan recognized that the potential impact on those serving in Oklahoma City could be "very significant.” But she also knew from experience gained during previous disasters that with "appropriate intervention," the welfare of team members could be maintained during deployment, and a healthy recovery process could be supported upon their return home.
"CISM is not psychotherapy", explained Jordan. "It is psycho-education. Our goal is to help people understand that their reaction to a critical incident is normal, and to help them understand what that reaction may involve. Using the Critical Incident Stress Debriefing (CISD) process, we try to prevent more serious problems from developing."
Los Angeles County Fire has had a CISM program for over a decade. As Jordan explained, "Our overall objective is to keep firefighters on the job and to insure that once they retire, they will do well." For any incident which is defined as a "critical incident,” including line-of-duty deaths, "CISD is mandatory. It is done on-duty. Like a drill, personnel are taken out of service and put through debriefing. We take the pressure off by helping participants understand that while they may not feel that they personally 'need it,' by participating, they may help someone who does."
"Some injuries are obvious, like burns and broken bones," explained Psychologist Robert Scott, a mental health consultant who works with Jordan. "But there is an almost inherent resistance to admit the presence of 'invisible' psychological injuries, which can result from traumatic exposure." If left unattended, according to Scott, such injuries can damage the careers and personal lives of valuable, highly skilled emergency services personnel.
In addition to the six mental health professionals who participate in L.A. County Fire's CISM program, one hundred peer counselors from within the department serve on a volunteer basis. "Since we know that a critical incident will affect more than our sworn personnel," Jordan explained, "we have peer counselors in several areas. Spouses and significant others work with spouses and significant others, dispatchers work with dispatchers, and so forth. We've found that sharing a common background works best."
Both Scott and Jordan credit Fire Chief P. Michael Freeman, and other L.A. County Fire Department managers with being "visionary," fully supporting the CISM program. The Federal Emergency Management Agency (FEMA) also receives high marks for making CISD mandatory for Task Force team members responding to federally declared disasters.
FEMA Task Force Mobilization
Having the CISM program well established prior to the Oklahoma City incident was an advantage, according to members of the Task Force. Assistant Fire Chief Mike Idol, who served as Task Force Team leader, is a 26-year veteran of the fire service, who previously served in the Army. "I haven't seen anything this bad since Vietnam,” he said. “In combat there was a similar destruction and impact on people. This will be a vivid memory for all of us for quite some time."
Idol thoughtfully elaborated on the numerous problems confronting crews working at the site. "It was hard to conceive what the blast must have been like. The impact was different than what usually goes on in a collapse from an earthquake. There was an absence of void spaces where you might find victims who survived. The place just pancaked down. The surrounding area was also heavily damaged."
According to Dr. Scott, "In a lot of disasters, the USAR team responds immediately, helps save victims, and finishes the job in a fairly short period of time. In Oklahoma City, team members really expected to save lives, but the reality was that for days and days they only recovered bodies."
Even the search dogs were frustrated by the lack of positive reinforcement which comes from finding live victims. According to Wilma Melville, who served with her two-and-a-half year old black lab, Murphy, "The dogs get a lot of praise when they find a live person. But in Oklahoma, we didn't go through the positive praise routine." To maintain a balance, volunteers would hide in other damaged buildings in the area so that the dogs could be sent in to find them. "When the dogs would alert, we would praise them. This helped keep them cheerful."
Initially, the pressure to quickly recover victims conflicted with the need to secure a safe rescue environment. This was in part due to the fact that the usual boundary lines between "personal" and "professional" involvement had been violated by the blast itself, which killed and injured loved ones, colleagues and friends from many of the same law enforcement and emergency services agencies which were involved in rescue operations.
Structural engineer Keith Martin was acutely aware of the fragile, potentially deadly condition of the building itself. "At the point where the building broke away in the blast, desks, filing cabinets, loose concrete - everything from 30-pound slabs to slabs weighing 15-tons - was just hanging there. We didn't know what mechanism was holding it up there, let alone what might trigger it and send it cascading down on us."
According to Capt. Al Fortune, who coordinated heavy equipment operations, "The image of a 225-pound federal agent who had just identified his partner by his boots and blue jeans intensified the emotional atmosphere. There he was, trying to dig his partner out with no tools. It was very frustrating for him, and frustrating for us, because those at the site who were 'shell-shocked' and overwhelmed developed tunnel vision. Eventually, we were able to balance out safety issues with the need to recover victims, but it took a few days to work out a system."
After the first 72-hours, hope for uncovering live victims diminished, and teams started to make a transition from the "rescue" mode to the "recovery" mode. Capt. Bill Masten reported that the team "knew from our experience with earthquakes that there might have been survivors, and at first, this is what kept us going. We'd find a void, and we'd send the dogs and tunnel rats in." Anxiety would rise when team members would uncover stuffed animals and toys, knowing that this was where the children were. "Once we realized there probably weren't any more survivors," Masten said, "the constant body recovery was hard."
Firefighter-paramedic Gregory Lopez, who served as a Rescue Specialist with the Task Force, agreed, adding that it was "very frustrating not to make any saves." The presence of hundreds of people assembled near the building, holding up photos of family members or clutching Teddy bears, deeply affected him. "We were all motivated by the need of the families to have closure and say good-bye."
Back at the "BOO"
For Chief Idol, the Base of Operations (BOO) offered a "safe haven" which none of the team members could have anticipated. "It was amazing to see that in all of their obvious misery, the people of Oklahoma had the fortitude to reach out and do something for us. To this day I can still see the faces of the volunteers."
Medical Team Manager, Dr. Bruce Cummings, explained that the team "expected to be in tents, sleeping on the ground near the building," but found themselves welcomed by a sea of loving volunteers who catered all their needs. While at times Cummings and other team members found the attention "overwhelming, it absolutely kept us going."
Rescue Squad Officer Tod Mitcham explained that going from the site of the bomb blast to the convention center was both a jolt and an experience to be treasured. "Physically, mentally and emotionally it was a time of extremes. You weren't just 'up' or 'down', you were 'way up' or 'way down'."
"I couldn't believe the commitment of the local volunteers," added Al Fortune. "When the Dallas Cowboys showed up and were doing autographs, I went out and had all the volunteers sign my hat. It wasn't the Cowboys who gave us the care and ability to carry on, it was the incredible local volunteers."
When the rescue team received numerous letters from school children, it made Tod Mitcham stop and examine how heroism is defined. "We do this kind of stuff, picking up twisted bodies, every day," he said. "But in Oklahoma, suddenly we were being called heroes, even though we were just doing our job."
Mitcham took time to write to the children. "To me," he said, "a hero is not someone who is worshipped. A hero is not someone who has done something dramatic or dangerous. A hero is someone who thinks about others before thinking about himself."
The sometimes confusing and embarrassing spotlight of heroism affected several team members, including Wilma Melville, who said, "Going to a disaster doesn't make you a hero. The heroism is in the dedication to the work. Day after day, year after year, we train and work with the dogs, not knowing if we'll ever get called to an incident. The local people who called us heroes didn't seem to realize that it was our privilege to be there."
For the demobilization, Marguarite Jordan recognized that because returning rescuers would be tired and eager to be reunited with their families, the last thing they would want to focus on was the psychological impact of trauma. For this reason, when CISD team members greeted the Task Force at March Air Force Base, they spent "no more than ten minutes with them, welcoming them back, telling them how proud we were of them, and giving them written information on possible stress symptoms and how to take care of themselves."
As family members gathered to welcome the team home, they were also briefed by CISD team members. According to Jordan, "We planned entertainment for the children while peer counselors provided information to the spouses and significant others about what to look for and be aware of." Involving family members was one of the most positive aspects of the CISM process, according to several team members.
Careful pre-planning extended to the formal, follow-up debriefing sessions. "It was our desire that no one be overlooked," explained Jordan, "including the medical doctors, dog handlers and engineers, who were not all fire department personnel." All County Fire Department personnel were debriefed, but logistical, personal and career conflicts prevented some of the civilians from participating.
"Because of a family commitment," said Wilma Melville, "I was released early and didn't go through debriefing with the other members of the team. I wouldn't want to do it this way again, because I didn't have the same kind of closure."
The Road to Recovery
Mental health professionals and peer counselors guided the formal debriefing sessions. "Overall," observed Dr. Scott, "this incident had a deeper impact than previous local disasters." But by sharing their pain and getting feedback and support from the group, team members were able to explore the impact and honor their unique, intense experience.
Certain images resonated among team members. "We've been put to the test here in Los Angeles many times," said Dr. Cummings, "with the riots and the Malibu fire, the floods and earthquakes. Even so, there were some hard times in Oklahoma, like when we recovered the Marine. We all stopped working while the Honor Guard saluted him as he was carried out in a body bag. Tears were going down our faces during this time."
Al Fortune was struck by this moment as well, although for a different reason. "I'd close my eyes and there it was, this big old concrete guillotine hanging over the area where the Marine was buried..." Fortune found it reassuring that he wasn't the only one "taking concrete off that building every night for a week and a half after we got home."
"Because we were so focused on the rescue effort," said Bill Masten, "and it was all we were doing for days and days, it was hard when we stopped doing it. After we got back, there was a lot of emotional numbness, irritability and short tempers. Everything in the 'normal', daily routine suddenly seemed kind of trivial."
After each debriefing, additional follow-up care was offered. Marguarite Jordan wanted team members to know that the debriefings were not necessarily the end. "Thus far," she reported, "everybody's doing really well. We initially thought that we were going to get a monumental emotional response, but I'm happy to say that we got normal reactions to an intense experience on extended duty."
Dr. Scott sums it up this way: "I've learned that CISD works. It's very rewarding to be able to provide intervention that's so immediately effective that within a few hours, you can actually see the transformation of the human spirit."
Nancy J. Rigg is a freelance writer and filmmaker with an extensive background in Search And Rescue and disaster preparedness. Since this story in our Sep./Oct 1995 issue she has been a regular contributor to 9-1-1 Magazine and a nationally-recognized expert in swiftwater rescue training for public safety professionals.