Posted by: njrigg | February 23, 2010

Aquatic Accidents: Crisis Intervention on Scene

Aquatic Accidents:  Crisis Intervention on Scene

By Nancy J. Rigg

Critical Incident Stress Management (CISM) specialists understand that all drowning deaths and other serious or fatal accidents in the aquatic environment automatically qualify as “critical incidents.”  Sudden, powerful emotional trauma can have an immediate and long-term impact on surviving family members and other witnesses who are on scene, as well as water rescue and recovery personnel responding to these emergencies.

Research has shown that the sooner survivors are educated about the impact of trauma the better their chances are of making a healthy recovery, even from the most tragic loss.  Water rescue personnel who are well educated in CISM also have a better chance of maintaining a long and healthy career in an environment that is not only dangerous physically, but taxing emotionally.

CISM peer support resources are being made available at an increasing rate to emergency responders nationwide.  Unfortunately, for those who are most seriously affected by any given tragedy – surviving family members – crisis intervention information is scarce, if available at all.  And at a time when families most need sensible, accurate information and guidance, they may have no idea where or how to find it.

CISM trained chaplains and crisis counselors, including volunteers, need to be woven into the structural matrix of all swiftwater rescue and dive recovery protocols, including the pre-planning process.  Skilled counselors can be deployed through pre-set, automatic call-out protocols to avoid confusion and ensure that appropriate resources respond quickly.

Crisis counselors can serve as liaisons with the families and others on scene, freeing dive rescue personnel to attend to other issues.  They can also work with public information officers (PIOs) to protect families from media intrusion, especially during prolonged recovery missions.  This is something that is frequently overlooked in the pre-planning process, which can result in added stress and trauma for family members who are waiting at the edge of the water for news about their missing loved one.

By integrating CISM trained volunteers into your response matrix, water rescue and recovery team members can also be buffered from the emotionally draining job of working with the families and others who are invested in the outcome of the mission.  Trained crisis counselors can aid families, watch for signs and symptoms of shock and other physical ailments that may need medical attention, and also keep an eye on the emotional well being of rescue personnel on scene.

Information: Too Much… Too Little

One of the more difficult judgment calls to make is how much information to share with families, the media, and other interested parties, and in what manner the information is relayed.  It is rarely helpful to sugar coat the truth, but it can also add unnecessary layers of trauma when “too much” graphic information is presented to families who are aching for news, or when they are visually exposed to their deceased loved ones who may be maimed or disfigured or covered in silt and grime.  If possible, remains should be secured in a closed body bag before being brought to the surface where both the media and anxious relatives of the victim are watching closely.

The media does not have an automatic right to cover every phase of the recovery process.  Having both a PIO and crisis counselor on scene can help control interaction with members of the media who feel entitled to every aspect of “the story.”  PIOs can aid the media in “getting the story,” in a way that is professional, but not intrusive either to the surviving family members, or the deceased victim, who also deserves protection and to be treated with dignity.

CISM trained counselors, who also need to be educated in water rescue and recovery, can evaluate how best to interact with the survivors and what details to share with them.  It is important to have a collaborative effort.  Although it is not wise to withhold information, neither do you need to batter someone with gruesome details that can add to the post-traumatic stress cauldron already brewing.

If a family member feels compelled to view their loved one’s remains, then this needs to be aided, not impeded, but the request should be filtered through the issue of trauma exposure.  An on-scene crisis counselor can assist in making this process the least vividly traumatic possible.

Death and dying pioneer, Dr. Elisabeth Kubler-Ross, always stressed that while viewing remains must be a choice open to the family, rescuers can make it less traumatic by making the remains as clean and presentable as possible.  If the face is disfigured, Kubler-Ross recommends having the family view an arm or article of clothing.  If there is severe decomposition, Kubler-Ross recommends against viewing the remains on scene, but rather viewing them later at the Corocner’s Office, using photos or other appropriate filters.  If family members can be accompanied by the on-scene CISM trained counselor when they go to the morgue, this can help maintain continuity of care and ease the shock and trauma of this experience as well.

Building Resources

In today’s world, rescuers should not be expected to serve in the capacity of on-scene crisis intervention specialist, which is a discipline that requires specialized training that meets current disaster mental health standards.

Some cities, including Los Angeles, have developed highly trained volunteer community crisis support teams that respond to homicides, fires, major traffic accidents, mass casualty incidents and other accidents and emergencies, and assist local agencies with death notifications.  LA Crisis Response Team volunteers receive specialized training necessary to provide immediate on-scene crisis intervention, emotional support, and referrals.  Many volunteers are multi-lingual and sensitive to diverse cultures.

The American Red Cross is another invaluable resource through their Disaster Mental Health program.  Tragedies do not necessarily need to be on the scale of a major disaster to involve skilled Red Cross specialists.

For rescue personnel, the International Critical Incident Stress Foundation in an invaluable resource, with information about CISM programs and peer support teams nationwide.

The United States Coast Guard Search and Rescue Manual includes very well defined protocols for working with families, especially when a rescue or recovery operation is prolonged.

At the very least, water rescue and recovery teams could offer survivors a tremendous service by giving them a simple printed hand-out, like the one developed by the Drowning Support Network, with additional crisis counseling resources listed in the local community.  Flashbacks, nightmares, and other symptoms of post-traumatic stress are normal in the aftermath of a sudden and traumatic drowning or other aquatic accident, but this is not well understood in the general community.  Education is vital.

First responders are the first stop for surviving family members on the road to recovery.  Your interaction, pre-planning, and coordination with crisis support resources can lay the foundation for families to begin a healthy recovery process even in the aftermath of the most devastating of personal tragedies.

Support is essential to healing

ADDITIONAL INFORMATION:

Drowning Support Network

http://health.groups.yahoo.com/group/DrowningSupportNetwork

Sudden Death – Grief and Trauma Brochures

http://higginsandlangley.org/death_grief_information.shtml

Los Angeles Crisis Response Team

http://lafd.org/crt.htm

International Critical Incident Stress Foundation

http://www.icisf.org

American Red Cross Disaster Mental Health Services

http://www.ifrc.org/docs/pubs/health/bestpractices_04.pdf

United States Coast Guard – Search and Rescue

Next of Kin Notification Guidelines – an excellent model program for all SAR groups

http://www.uscg.mil/hq/cg5/cg534

© Nancy J. Rigg

February 2010

Please do not reproduce without permission from the author.

Advertisements

Responses

  1. Good luck! Check out

    http://www.paloaltomrc.org Medical Reserve Corps specializing in alternatives to CISM (what’s the statistic? found 25% of the time for people to have no intervention than that.)

    http://calesar.org CA state explorer team

    and myself at facebook http://groups.to/communitysafetyprograms

    SAR and Psychological First Aid instructor


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Categories

%d bloggers like this: