In the line of fire

275 Pages·2005·1.896 MB·English

by  Cheryl Regehr, Ted Bober

IN THE LINE
OF FIRE
TRAUMA IN THE
EMERGENCY SERVICES
cheryl regehr
ted bober
1
2005
1
Oxford New York
Auckland Bangkok Buenos Aires Cape Town Chennai
Dar es Salaam Delhi Hong Kong Istanbul Karachi Kolkata
Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi
São Paulo Shanghai Taipei Tokyo Toronto
Copyright © 2005 by Oxford University Press, Inc.
Published by Oxford University Press, Inc.
198 Madison Avenue, New York, New York 10016
www.oup.com
Oxford is a registered trademark of Oxford University Press
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of Oxford University Press.
Library of Congress Cataloging-in-Publication Data
Regehr, Cheryl.
In the line of fire : trauma in the emergency services / Cheryl Regehr, Ted Bober.
p. cm.
Includes bibliographical references.
ISBN 0-19-516502-0
1.Emergency medical personnel—Job stress. 2. Fire fighters—Job stress. 3. Police—Job stress.
4. Emergency medical personnel—Mental health. 5. Fire fighters—Mental health. 6. Police—Mental
health. 7. Psychic trauma. 8. Post-traumatic stress disorder. I. Bober, Ted. II. Title.
RC451.4.E44R44 2005
616.02'5'019—dc22 2004006827
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
throughout the processof preparing this book, we have
experienced the fullness of life, including stresses and
challenges of clinical and research work, the SARS epi-
demic, concerns of West Nile virus, technological prob-
lems such as a blackout that left one-quarter of North
America in the dark, and, most importantly, the serious ill-
ness and death of family members. At the same time, ba-
bies were welcomed into lives of our extended family and
friends, one child left for university, and others entered
new and exciting stages of life. All the while, colleagues
and friends were supportive, brought tea and humor.
this book is about resilienceand strength in the face of
adversity. It is dedicated to those important individuals in
our lives who have taught us about resilience, grace, and
gratitude. These are experiences that will continue to en-
rich our lives forever. To our families who have always pro-
vided the love and support and been our secure base—
thank you—always.
Foreword
This book provides an objective, original, enlightening, and thought-pro-
voking analysis of the full range of emergency and trauma recovery services
practiced by social workers and emergency services personnel throughout
North America. Cheryl Regehr and Ted Bober have made a major and sig-
nificant contribution to the mental health and human services literature.
This is the most thoughtful, compassionate, inspiring, readable, insightful,
and original book I have ever read on emergency services, crisis manage-
ment, and trauma recovery. This book is so engaging and well-written that
I could not put it down until I read every page at one sitting.
Dr. Cheryl Regehr and Ted Bober have been on the front lines of com-
munity disaster intervention as co-directors of the Critical Incident Stress
Team at Toronto Pearson International Airport for over 15 years. In addition,
the authors’two decades of clinical work, training workshops and seminars,
and research on trauma and emergency services are evidenced throughout
this timely book. I was also delighted to see an emphasis on evidence-based
individual and group interventions.
This gem of a book is a rare combination of outstanding writing, stimu-
lating case illustrations, and an integration of qualitative and quantitative
research. In sharp contrast to other academic trade books, the valuable in-
formation in this original volume is both superbly researched and emi-
nently readable. Catastrophic events, trauma and coping case exemplars,
emergency services and the continuum of early interventions and long-term
follow-up, and the everyday lifesaving and recovery work of police, para-
medics, firefighters, and emergency mental health practitioners are high-
lighted throughout this book. The figures, models, and graphs add an im-
portant conceptual and practical dimension to the book.
In summary, this book is essential reading for almost every mental health
practitioner because of the continued threat of community disasters, emer-
gencies, terrorist attacks, and trauma-precipitating events. Every informed
citizen, student, and practitioner interested in mental health and emer-
gency services should purchase this book. It is a pathfinding and seminal
viii foreword
contribution to the most challenging societal problems of the twenty-first
century.
Albert R. Roberts, Ph.D.
Professor of Social Work and Criminal Justice, Director of Faculty and Cur-
riculum Development, Faculty of Arts and Sciences, Livingston College
Campus, Rutgers, the State University of New Jersey, Piscataway, and edi-
tor in chief, Brief Treatment and Crisis Intervention journal (www.crisis
interventionnetwork.com).
Preface
In the wake of disaster, emergency service workers including police officers,
firefighters, and paramedics are first on the scene and last to leave. They
are repeatedly exposed to violence and its aftermath and are expected to
cope with it. They put concern for the lives of others over concern for their
own lives, working tirelessly to recover the bodies of the missing. Their
heroic actions save lives, provide comfort to and care for the wounded, and
inspire onlookers, but at what cost to themselves? We now know that res-
cue workers who are exposed to mutilated bodies, mass destruction, mul-
tiple casualties, and life-threatening situations may become the hidden vic-
tims of disaster. The sequelae in terms of traumatic stress symptoms and
depressive symptoms have the potential to be highly disruptive and long-
standing both for the individual worker and their families and for the or-
ganizations in which they work.
Additionally, emergency workers are exposed to events involving human
pain and suffering on a daily basis. These events often do not make the
news or capture public attention. They do not result in an outpouring of
public support for emergency services. While for the most part emergency
workers are equipped to deal with these events, on occasion one particu-
lar event will have a lasting impact. Indeed, this one event may have a more
lasting effect than other more dramatic events involving the loss of many
lives. How do we understand such a process? How do we intervene to en-
sure that we do not lose these valuable resources for society?
This book is based on the authors’combined experience of over 40 years
of clinical work in emergency departments and with emergency service or-
ganizations. This experience has included managing crisis intervention
teams in both health care and emergency service settings, interventions fol-
lowing critical events in the workplace and response to disasters. In addi-
tion, the book is based on research conducted with more than 350 police,
fire, and ambulance workers in two continents, 300 emergency mental
health practitioners, and qualitative research interviews with more than 50
emergency service workers.
This book provides an overview of the issue of trauma in the emergency
x preface
services. It is intended to serve as reference for social workers, psychologists,
and other mental health professionals who provide services to emergency
service organizations. It is also intended as a guideline for administrators
and peer support team members within emergency service organizations. Is-
sues addressed include the event-related, individual, organizational, and so-
cietal factors that influence trauma response. Various theoretical models for
understanding trauma response are reviewed. In addition, practical advice
is provided regarding planning intervention programs, developing trauma re-
sponse teams, training both emergency service professionals and mental
health professionals regarding providing mental health trauma response in
the emergency services, and evaluating the effectiveness of services provided.
Finally, the stories of emergency responders and the strategies for both self-
care and care of significant others will resound and make the book of inter-
est to both emergency services workers themselves and their families.
IN THE LINE
OF FIRE
1
SETTING THE STAGE
Following the crash of two subway trains during rush hour, ambulance, fire,
and police crews worked tirelessly in cramped and difficult conditions to
move ambulatory victims safely from the tunnel, to carry out the injured, and
to extricate those trapped in the debris. The response was time-consuming
and hot. Paramedics held the hands of trapped victims and reassured them.
In the end, however, three passengers died during the rescue attempts. As
indicated by the advertisement in figure 1.1, which ran in newspapers one
week later, the public response was overwhelmingly supportive towards
emergency responders. People brought food and drink and offered their
thanks. Emergency responders were called heroes. At the public inquiry
that followed, however, it was suggested that altered fire and ambulance
procedures during the course of extrications could have saved at least one
life. It seems that heroism isn’t necessarily forever.
On a hot August night, the crew on Engine 11 arrived at a blazing home.
A woman on the lawn screamed that her children were still in the building.
Firefighters immediately set about dousing the flames. Two firefighters en-
tered the building and managed to rescue the children. A newspaper pho-
tographer managed to get a picture of Joe Driscol (not his real name)
emerging from the flaming building with a three-year-old child in his arms.
The picture ran on the cover of every local newspaper declaring that
Driscol was a hero. Television and radio stations sought interviews and de-
scribed his brave actions. But Driscol did not want to be heralded as a hero.
3
in the line of fire
4
Figure 1.1.Toronto Transit Commission
He repeatedly stated that there is no one hero in such a situation; rather,
everyone works as a team to manage risk, preserve life, and protect prop-
erty. Other firefighters in the hall who also worked on that fire shared
Driscol’s sentiments, but expressed them by putting hero signs on Joe’s
locker and bunk and playing Tina Turner’s “We Need a Hero” over the loud
speaker.