Hurricane Katrina | Dr. Scott responds with LAFD CISM Team to support Gulf States Firefighters

LAFD CISM TEAM DEPLOYMENT TO HURRICANES KATRINA & RITA:

History

The Los Angeles Fire Department maintains an active Critical Incident Stress Management Program. In the past several years, the program has expanded to include a comprehensive Behavioral Health and Wellness component.

Beginning in the late 1980’s, LAFD took a bold step by hiring a part-time psychologist / consultant and a full-time Program Coordinator to develop and maintain a cutting edge Peer Support and CISM program. As a result of the Department’s strong commitment to psychological support services for its members, LAFD’s CISM / Peer Support Program has gained national attention and recognition. At the present time, Dr. Robert Scott is the full-time Clinical Psychologist and Gwen Duyao continues as the part-time volunteer program Coordinator.  The team currently maintains 60 active peer support members.

Because of the team’s vast experience and exposure to numerous local as well as national disasters, the International Association of Firefighters has placed the LAFD CISM Team at the top of a priority list of national teams available for psychological support to firefighters in the event of catastrophic national disasters.

LAFD’s CISM Team was one of the first teams called by the IAFF to be deployed to New York for the World Trade Center bombing. Utilizing an 8-hour shift deployment schedule, the seasoned 23-member LAFD CISM team provided comprehensive psychological support to FDNY members on a 24-hour basis for a period of two weeks. Additionally, the LAFD Team was instrumental in helping to establish the Incident Command System (ICS) that provided the structure, which allowed, 45 IAFF CISM teams from across the country to dispense psychological support services to FDNY members. This two-month, on-scene support effort was a joint multi-agency project, which involved FEMA, the IAFF and it’s local union affiliates as well as the National Fallen Firefighters Foundation.

In the aftermath of 9/11, Dr. Scott and his team have maintained strong cooperative professional relationships with the core members of the IAFF’s health and safety committee, including the IAFF’s Director of Health and Safety, Pat Morrision. Dr. Scott remains a consultant to the IAFF’s Behavioral Health Steering Committee.

As a result of this on-going cooperative relationship, when disaster strikes on a catastrophic level, impacting firefighters and multiple fire agencies, Dr. Scott is often in immediate contact with the IAFF’s Behavioral Health Steering Committee. Through a process of emergency teleconferencing, discussions take place and assessments are made as to what level of behavioral support is required and necessary to provide needed psychological first aid and critical incident stress management to impacted IAFF members.

What Are the Psychological Interventions and Activities a CISM Team will be Expected to Provide?

In the aftermath of 9/11, the traditional CISM model has been significantly modified to include a more flexible and comprehensive package of psycho-emotional activities and interventions. The new modified CISM model can best be understood or described within the context of an emerging model referred to as ‘Psychological First Aid.’

Numerous research studies now suggest that the most efficacious early intervention stress management approach is “Psychological First Aid.” Psychological First Aid is an evidence-informed modular approach to assisting traumatized individuals in the immediate aftermath of disaster and terrorism. Psychological First Aid is designed to reduce the initial distress caused by traumatic events, and to foster short-and long-term adaptive functioning.

For emergency responders who are still working and actively involved in the crisis/rescue phases of a disaster, the structured Mitchell Model of Critical Incident Group Debriefing (CISD) is no longer recommended as a routine practice.

The National Center for PTSD under a grant by the US Department of Health and Human Services (HHS) has produced a Field Operations Guide entitled Psychological First Aid. This manual can be accessed from the Internet at: www.ncptsd.org

Dr. Scott & LAFD’s Critical Incident Stress Management Team Responds to Hurricane Katrina & Rita

In the case of  Hurricanes Katrina & Rita, LAFD’s CISM Team was requested to respond to the IAFF’s Command Center in Baton Rouge, Louisiana after it was confirmed that the local, state and FEMA resources were unable to meet the most basic needs of firefighters in the area of physical and operational support. In a direct request letter faxed from the IAFF’s East Coast Headquarters, Harold Schaitburger requested the support of the Los Angeles Fire Department in response to Hurricane Katrina:

“At this time, the IAFF is asking for the Los Angeles Fire Department’s Critical Incident Stress Management (CISM) team to be deployed to the disaster region for a seven-day tour. During that time, personnel will be tasked to provide CISM assessments for fire fighters involved in rescue and recovery.”

How Were the Above Goals of ‘Psychological First Aid’ Operationalized During the Gulf States Deployment?

Given that CISM deployments to Hurricane Katrina were taking place within the first week to three weeks after the catastrophic disaster, fire personnel were still operating in the rescue / crisis mode. As stated earlier, structured debriefings were not appropriate to this phase. Further traditional ‘one-on-one peer counseling’ sessions were also not appropriate. Traditional ‘one-on-one’ Peer counseling, in the best of circumstances, takes place in a non-emergency mode and the Peer providing the counseling is known and trusted by the individual receiving that form of support. Given that the Peers responding to the Gulf States were from out of state and were unknown to the local departments and their members, this kind of close, personal talking and sharing would not be expected or immediately appropriate.

As stated in the PFA guidelines and goals for psychological first aid, it is of primary importance to first establish trust and security by focusing on and attending to the hierarchy of basic needs presented by the impacted members. Trying to move quickly into a ‘therapeutic mode’ when you have not first established trust, credibility, and a compassionate presence is a formula for disaster and could potentially psychologically harm those who you have come to help. Individuals or teams who have attempted to by-pass this basic tenet of trust and sensitivity to basic needs find themselves the recipients of anger, mistrust and most times banishment from interacting with uniformed personnel.

This was a hard lesson learned from our 9/11 deployments. Luckily, we were able to recognize that traditional CISM model was not applicable in a fluid rescue and recovery phase. Within hours, IAFF CISM teams at Ground Zero were able to modify the approach and move the entire direction toward a focus on helping members to meet basic needs utilizing the psychological first aid model.

In the Gulf deployments, our teams under the ICS Command Structure, provided the appropriate Behavioral Health / Psychological First Aid interventions by first building trust among the membership. This was specifically done by participating with other IAFF response personnel (financial, housing, wellness specialists) as well as other agencies including the Red Cross to address the immediate basic physical and health needs of the impac

It is essential that the activities the CISM team members participated in be seen as a means to a particular end. Viewing the activities or “missions,” whether it is delivery of bread and water to a fire station, delivery of financial aid ($500.00 checks), or helping with blood draws, as a static ‘sole purpose’ activity — completely misses the modular, comprehensive nature and design behind Psychological First Aid.

By embedding CISM team members with other IAFF recovery personnel (including other agencies) in the numerous assigned joint missions, the CISM teams were able to accomplish their intended goals. By focusing on providing and assisting with the basic human needs and requirements of impacted personnel, the foundation for trust, credibility, and hope was developed.

When mutual trust is established within an environment of helping individuals to meet their basic needs for food, shelter, and reconnection with family support, the primary initial goals of Psychological First Aid are accomplished. This foundation then becomes the springboard for further Peer Support opportunities, including providing psycho-emotional education about normal and expected reactions, active listening, and assessing and determining future psychological and family needs.

During the two LAFD Team Deployments to Hurricanes Katrina & Rita, the following data reflects the numerous CISM goals and objectives that were accomplished:

 Approximately18 missions were completed by the combined LAFD teams

• A mission typically involved:

o visiting 1 or more Fire Departments within a large geographic area

o bringing to those Departments requested physical supplies including food, water, clothing and materials

o bringing medical assistance (Red Cross Nurses and / or Physicians) to provide for immediate medical attention as well as vacinations and baseline blood draws

• Most importantly embedded within the above activities is the provision of CISM Peer Support

 2 to 4 members of the visiting team include CISM Peer Members. Additionally a team may include a Red Cross nurse, a physican and an IAFF Representative)

 The 18 missions took LAFD Teams from Baton Rouge to Port Arthur and Orange, Texas; Gulfport, Biloxi, and Pascagoula, Mississippi; Sulphur, Lake Charles, Lafayette, New Iberia, Morgan City, Houma, New Orleans, Algiers, the 9th Ward, St. Bernard Parish, Jefferson Parish, Chalmette, Slidell, Bogalusa, Mandeville, and Hammond, Louisiana.

 Peer Support personnel interacted with and provided support to over 750 uniformed members

 22 psycho-educational group sessions were provided during the two deployments

 LAFD Team Clinicians (Team 1 – Dr. Scott & Team 2 – Linda Boyd) provided approximately 25 individual crisis counseling sessions with highly impacted personnel.

Summary and Conclusion:

Hurrican Katrina began her destruction along the Gulf Coast of Louisiana at 6:00 a.m. August 29th. More than 50 IAFF affiliates and their members (approximately 5000) throughout the region felt the brunt of her category four-hurricane force winds and rain. Although many IAFF members evacuted their families in the days before the storm, and suffered total destruction of their personal property during the storm, they did not leave their posts, working before, during and after the hurricanes to protect their communities.

Under the leadership of IAFF 14th District Vice President Danny Todd an Operations Command and Relief Center was established at the Zoar Baptist Church in Baton Rouge, Louisiana. More than 100 IAFF representatives at the Comand Response Headquarters assisted thousands of IAFF fire fighters and their families in the critical days and weeks following Hurricanes Katrina and Rita.

Dr. Scott and The Los Angeles Fire Department’s CISM team played a vital role during the IAFF Relief Operation in providing psychological support and assistance to the thousands of impacted IAFF members.

In what has now been labeled the worst natural disaster in U.S. history, the Los Angeles Fire Department can be proud that they were well represented well in this massive effort to support and care for their IAFF brothers and sisters in the impacted Gulf region. According to recent reports from IAFF Staff who are in touch with the various departments in the region, the conduct, professionalism, and work ethic of our teams has left a lasting positive impresssion on the hundreds of firefighters who we visited and supported.

“Sometimes it’s not what somebody does, it’s just knowing that they care enough to come and talk with you, listen and help…”

Quote by Doug Hague – firefighter Local # 1469, Pasacagoula, Louisiana.

 

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