CRITICAL INCIDENT STRESS: WHO TAKES CARE OF THE RESCUER?
Douglas, Eric. “Critical Incident Stress: Who Takes Care of the Rescuer?” Alert Diver Asia-Pacific Edition. May-August 2010. 12-15. Print.
There are many different resources for learning to deal with critical incident stress. This article is based on the process used by the American Red Cross to debrief emergency workers and survivors following natural disasters. – Eds.
Dive accidents and dive fatalities are rare events, but they do happen. And when they do, dive buddies, friends and boat crews often switch their roles from divers to rescuers. Dive professionals – as well as many divers – are trained to carry out a rescue and perform basic life support. Later, when the situation becomes calmer, after professionals have intervened and removed the injured diver, those same rescuers must then deal with the aftermath. Often they do not have the training, support system or experience to cope with the natural emotions they are experiencing. Professional rescuers such as firefighters, emergency medical services personnel and police come to expect that they will deal with difficult situations. Not every rescue goes as planned, and not all have successful outcomes. But when a rescue involves someone they know, multiple victims with major trauma, a co-worker or a child, rescuers may struggle to deal with their emotions. It’s a natural reaction, but it’s one to deal with directly rather than ignore.
Divers as rescuers
In the diving world, instructors, divemasters or buddies are sometimes pressed into service as first responders in a dive accident. In such instances, rescuers cannot mentally insulate themselves from the event. Additionally, the situation most certainly involves someone they know. This makes dealing with the consequences much more difficult. In some instances, when the injured diver is evacuated off a dive boat, the rescuers may not even know whether the diver survived. This unknown and intimate knowledge of the injured diver can cause rescuers to internalize stress; they may find themselves struggling with it for years afterward. In fact, divers have been known to quit diving altogether after witnessing a dive accident.
Critical incident stress debriefing (CISD)
Professional rescuers learn to take care of themselves first in any situation. It is literally one of the first discussions new first responders or medics have in their training: They do not enter situations that aren’t secure or safe, and they take every precaution to protect themselves from illness. Following particularly disturbing rescue situations, many professional rescuers also participate in critical incident stress debriefings to help them come to grips with their natural emotions.
This debriefing affords a chance for rescuers to discuss their reactions and realise they aren’t alone in a given situation. This process usually begins within hours of a rescue, although it certainly can happen later.
Step 1 – Facts: Typically, a CISD begins with a chance to discuss what everyone remembers about the rescue, what role each rescuer played and how each remembers events unfolding. Often participants will remember these details differently from each other since they may have experienced the situation from a different vantage point or reacted individually. In this phase of establishing facts, rescuers go into detail about where they were and what they did.
Step 2 – Feelings: The second step is the feeling phase. This is when rescuers discuss how they felt during the rescue, make note of their feelings now that things are over and note any unusual feelings that persist. Ultimately, there are no wrong answers or inappropriate feelings. It’s important, however, to try to recognise these emotions. Denying an emotion only makes it harder to face; the rescuer has a more difficult time of moving on.
Step 3 – Symptoms: In the symptom phase, participants discuss any physical reactions they are experiencing in regard to the situation. For an extreme example, imagine a person who was an avid diver suddenly fearing the water after he witnesses an accident. Anything is possible, and nothing is wrong in this situation. These are challenges rescuers will have to deal with and try to understand.
Step 4 – Teaching: In the final phase, rescuers need help understanding that any abnormal reactions they may feel are actually normal responses to abnormal – and stressful – situations. Some physical manifestations can include headaches, insomnia, flash- backs, anxiety, inability to concentrate, crying spells, lack of appetite, irritability, intense anger and depression.
Dealing with it
To deal with critical incident stress, follow these guidelines:
1. Do not use alcohol or drugs to cope.
2. Do not isolate yourself from friends, family or co-workers.
3. Expect the incident to bother you, but work to prevent yourself from becoming obsessed with it.
4. Eat well, and exercise.
5. Assess your work situation: Do you need time off?
6. Don’t become obsessed with finding reasons for the tragedy; simply allow time to pass.
7. Allow yourself time to heal; don’t have unrealistic expectations for recovery.
8. Learn about the emotions you are going through.
9. Seek professional help if you feel you need it.
Know that each individual has an equally unique process of coping. Some people take longer than others, and some situations may be harder to shake. Stay connected with your support system – your family, friends, co- workers, doctor – and keep in touch with your feelings.
In the final analysis, don’t bury your troubles; if you need someone to talk to, don’t be afraid to ask. There is no stigma attached to grieving; getting over it takes time, but it will happen.
About the Author
Eric Douglas, Director of DAN America Training, has nearly 20 years’ diving experience and has been with DAN for more than seven years. Eric feels he has one of the best jobs in diving because he helps to develop programs that can be used by all divers to make diving safer for all of us.