Author: Nick Arnett (page 1 of 5)

15 Days on the North Bay fires

I’m still decompressing from the North Bay fires, but here are some thoughts on the experience.

  • I’m grateful for CAL FIRE’s trust. It is a privilege to work with its Employee Support Services team and CISM leads. They are devoted, compassionate, hard-working people, without exception.
  • If there was a big story coming out of our deployment, it was the dogs. Two years ago, chaplains brought their personal PTSD service dogs to the Rocky and Valley fires (also in the North Bay). We saw what a great comfort and ice-breaker they can be. So this time, we invited just about every trained service, therapy or comfort dog we knew about. The result
    Hope AACR dogs outside breakfast in fire camp.

    Hope AACR dogs outside breakfast in fire camp.

    was that we had dogs present in base camp (which peaked at about 6,000 people) every day. We even took the most highly trained dogs, from Hope AACR, whose handlers were former first responders, out to public safety agencies and neighborhoods that burned. We also had a great response from PALS and others whose names I don’t have. The dogs helped people relax and sometimes seemed to be the key to lowering anxiety about telling their painful stories. As a result, all of us are thinking about how to integrate dogs – and their handlers, of course – into our responses (large or small).

  • Hearing “thank you” from people who lost their homes and entire neighborhoods, was often difficult. For a few days, a crowd of up to 200 people with signs and
    Tree snapped off in Coffey Park.

    Coffey Park – tree snapped off.

    noisemakers stood on the corner by the fire camp at the county fairgrounds, cheering and waving at every fire vehicle that came or left. It was so overwhelming sometimes that I could not even look at them. I think the gratitude is hard because people in public safety tend to be perfectionists – it makes us good at the work – so we focus on what we did not accomplish.  I found myself repeatedly urging firefighters, EMTs and others to “let it be both” – sadness at the tremendous losses, but pride in what was accomplished. My most difficult thank-you came from a little girl in Coffey Park, perhaps six years old. I gave her a CAL FIRE badge sticker and she looked me in the eye, saying, “Thank you for saving our houses and lives.” I had to turn around, take about 15 steps breathing deeply, before I could turn back, smile and say, “You’re welcome.” I really just wanted to go somewhere and cry. They deserve our tears.

    Coffey Park – note aluminum from a structure caught high in tree.

  • I communicated back and forth with Angela Leath, who heads peer support for the Las Vegas Fire Department. She is dealing with the aftermath of their horrendous shooting incident, so we traded ideas – what’s working, what’s not – about responding to a large incident. Our conversation helped me remember that we can expect many people too struggle with feelings of guilt – that they didn’t do enough, that they made wrong decisions, that they were not there. We know we can’t save every house and every life, but part of us – a good part – will always whisper that we should have.
  • Exercise really helps, even when you are worn out. Eight or nine days into our deployment, I decided that the best thing I could do for myself would be the kind of hiking I ordinarily do every two or three days – three miles, with at least 25 lbs in my pack, at a fast pace (this keeps me in shape for firefighting and has done wonders for my health). Afterwards, I felt almost normal again. It was as if I’d punched a “reset” button in my body and brain.
  • It was an incredible privilege to help distribute cash gift cards from the California Professional Firefighters’ foundation. We could give them to anyone who lost at least 25 percent of their home. Although a  few people accepted them matter-of-factly, most seemed stunned when I explained what was in the envelope. Many big hugs resulted. Thousands of them have been given to fire victims in the North Bay.
  • It seemed as though nearly everybody wanted to tell us their stories. That’s unprecedented, in my experience. Almost everybody – firefighters on the line, doing damage inspection, mopping up, in overhead management – stopped for a while to talk about how they were doing (especially when we had dogs!). That speaks both to the magnitude of the fires and the changing public safety culture. It is becoming okay to acknowledge how difficult this work can be.
  • After doing and teaching this kind of work – crisis intervention and peer support – for more than a dozen years, I usually have some kind and gentle words for any situation. But three times in Coffey Park, I met firefighters who lost their own or family homes. For them, I had no words, just a lot of eye contact and big hugs. And that’s okay – if there is any time no words are needed, that’s it.
  • We will be talking about, and healing from these fires for a long time. Until last month, the “career fire” for most people was the Valley fire in 2015. More than once, our team and others mentioned that we are still dealing with it. This year’s fires killed many more people and destroyed more than three times as many homes. And more than once, I heard someone ask the rhetorical – and scary – question, “Is this the new normal?”
  • Something to be grateful for – because the fire happened at night, when people are home, most of their pets survived. That’s really good.

Peer support act is dead (for now) in California Assembly

AB 1116, which would have created privilege (legal confidentiality) for CISM and peer support, is dead for this session of the California legislature. However, it is expected to come back in the 2018 session.

Although the bill passed the Assembly and several Senate committees, no agreement had been reached on how to define the training standards required for CISM or peer support team members to be protected. The current version specifies that the state Office of Emergency Services (OES) would create a new class – and nobody in state emergency services (apparently including OES) thought that was a good idea. But there was not enough time in this legislative session to work out the definition, so the bill went to the inactive file.

Hopefully the relevant state agencies (corrections, CHP, CAL FIRE, OES) will work out a training requirements strategy before the bill comes around again, so that it can pass next year.

Passed CA Assembly – Peer Support and Crisis Referral Services Act

California Assembly Bill 1116, formerly called the Critical incident Stress Management Services Act, has passed the state assembly and is on its way to the Senate. If it becomes law, the act would protect the confidentiality of public safety peer support team interactions except in the case of criminal proceedings. To be covered, team members would have to have completed a peer support training course to be developed by the Office of Emergency Services, the California Firefighter Joint Apprenticeship Committee or the Commission on Correctional Peace Officer Standards and Training.

This legislation would not give the level of protection that a therapist or ordained clergy has, but it will raise the bar considerably – unlike states that have passed similar laws, peer support and CISM teams in California currently have no protection against being subpoenaed. However, in the context of non-criminal proceedings, the legal “privilege” would be the same as between a psychotherapist and patient. The only exception would be “gross negligence or intentional misconduct.”

All of the components of a CISM program along with grief support and substance abuse are named as topics the law would cover.

The bill includes the phrase “toxic stress,” which I believe we should strike from our vocabulary. Stress can be toxic, but it doesn’t have to be, and the phrase “toxic stress” carries a strong connotation that all stress is toxic. That can be a self-fulfilling expectation – if you think stress is toxic, it probably will be.

This is a great step forward for California. I would have preferred that the state also recognize ICISF-approved training, rather than only requiring new courses, but “peer support” covers more than ICISF encompasses, so it is understandable.

If you’re in California, urge your senator to vote in favor. Let’s get the law in place, develop the classes and take the training.

From Quora: Is there a way to make yourself immune to PTSD?

I wrote the following in response to a question on Quora.

Although all of the reasons PTSD develops are not understood, the first thing to keep in mind is that it is a spectrum. For many people it is usually mild and manageable, although it can become quite uncomfortable (or just tiresome) when it is triggered. Realize that hundreds of thousands of public safety workers, who don’t fit any of your categories, live and work with PTSD. Many go though most of their days without giving it a thought.

One of the strong correlations to PTSD risk is how much REM sleep you get. A person who isn’t getting good REM sleep, due to sleep apnea, alcohol or drug use, or anything else that prevents them from dropping into that deeper sleep, is at higher risk. The theory is that our brains consolidate memories during REM sleep, so that we we essentially forget the emotions along with the event. (PTSD is sort of like “remembering” – or re-living – the emotions separately from the event.) There is a good argument that energy drinks and other substances that improve memory also can increase your risk, simply because they improve your memories of the bad event.

It is a mistake to decide if you “should” have a post-traumatic stress injury, based on what happened. “Should” is a word to get rid of in this context. What matters is how you reacted. I meet with people who witnessed or experienced terrible things, but they don’t have a strong reaction – they didn’t feel particularly helpless or out of control. They may not need any intervention at all, even though the incident would have been traumatic for many other people. But the converse is true – a person can experience extreme feelings of helplessness and out-of-control from a seemingly “minor” event and have a significant post-traumatic stress injury. Although those events usually involve loss of life or the threat of it, serious injury, etc. , the common factor is the reaction, not what happened.

There is absolutely nothing in the news article that would indicate whether or not someone involved might be at risk for PTSD. Again, the facts of what happened are not very important; your perception of what happened, along with physiological factors and what else you may have experienced previously (prior trauma can set you up for a more serious injury) all contribute.

I often invite people in your position to say this to themselves: “My stress is the worst stress because it is MY stress.” Comparing yourself to others – especially based only on the facts – is always a mistake (“No comparison stress shopping.”)

Be gentle with yourself. Be as gentle with yourself as you would be with a friend who had the same reactions.

I doubt there is any guaranteed way to become immune to PTSD, but if you aren’t getting good REM sleep and can make changes to do so, that almost certainly will help. Social support has also been shown to correlate to reducing the impact of traumatic events. Connecting with your body and nature – things like meditation, yoga, hiking – also help to activate the part of your nervous system that tells your “fight or flight” response that it is safe to de-activate. Spirituality, in the sense of having bigger-than-self values, also seems to help.

Stress doesn’t have to be toxic. Kelly McGonigal (“The Upside of Stress”) gives a good summary of this in her TED Talk. Watch to the very end, where she gives a great bit of advice: “Chasing meaning is better for your health than trying to avoid discomfort.”

CISM Protection Bill Introduced in California

California may join Michigan and other states that have made CISM activities “privileged” communications, meaning they could not be subpoenaed or otherwise demanded by a court. Michigan’s legislature unanimously passed the “First Responder Privileged Communications Act” a year ago.Subpoena protection for California CISM

California will consider AB 1116, the Critical Incident Stress Management Services Act.

Here is the key provision.

Except as otherwise provided in this section, a communication made by an emergency service provider to a CISM team member while the emergency service provider receives CISM services is confidential and shall not be disclosed in a civil, criminal, or administrative proceeding. A record kept by a CISM team member relating to the provision of CISM services to an emergency service provider by the CISM team or a CISM team member is confidential and is not subject to subpoena, discovery, or introduction into evidence in a civil, criminal, or administrative proceeding.

The exceptions are not problematic – they cover referrals, events where most of us are already mandated reporters, imminent threats and waivers.

The bill was introduced last month by Assemblyman Tim Grayson, former mayor of Concord, California, who is also a Concord Police Department “Critical Response Chaplain.” He undoubtedly knows a thing or two about this issue.

In my dozen years in CISM I’ve dealt with this through our team’s policy of never keeping written records and my own lousy memory for what other people say during interventions.

New! Pocket Guide to Stress Management and Crisis Intervention

Until now, nobody has offered a pocket guide covering all of the protocols and methods that we use in stress management and crisis intervention.

Good news! Now there is one.

I have written and published a 60-page pocket guide (spiral-bound with durable, Stress Management and Crisis Responsewaterproof covers), including essential references for self-care, peer support, psychological first aid, critical incident stress management (CISM), suicide, death and trauma notification and more. I’ve included sections on helping children and grieving people, and what to keep in mind when dealing with various faiths and cultures – the essentials to review and remember.

In the back of the book, I’ve included a guide on when and how to make referrals, with contact information for national crisis lines and online resources, plus plenty of space for you to write in your own contact and referral information.

For more information, including the Table of Contents, see the Pocket Guides page, where you’ll also find testimonials from the expert reviewers who helped me ensure that this is  a high-quality reference guide.

You can order the guide on Amazon, where you will also find a Kindle version.

Article: How One Paramedic is Recovering from PTSD

The Journal of Emergency Medical Services has published the PTSD recovery story of Benjamin Vernon, a paramedic/firefighter in San Diego. Vernon and his partner who was knifed by a bystander during an ordinary call. He describes the attack, recovery and the nightmares – a word he says isn’t strong enough – that followed. Unfortunately, the therapist he saw had never treated a firefighter or a victim of workplace violence.

“On the fifth day, I finally understood suicide,” Vernon writes.

The story ends well – he finds a competent therapist (whom he’s still seeing weekly) and receives EMDR (Eye Movement Desensitization and Reprocessing), which he describes as “the coolest Voodoo.” (It’s also sometimes called “FM” for “F%&#ing Magic.”

Registration opening for “The New Science of Stress”

If you are in or near Santa Clara, California, registration opens tomorrow for The New Science of Stressoffered by Santa Clara Adult Education.

Class meets for ten Thursday evenings, 7:30-9:00, starting February 16th. Here’s the description.

Stress management is more than just learning to relax. This class will show how insights from cognitive neuroscience and medical research are revealing how to thrive and perform under pressure. Classes will cover how and why stress — at home or at work — doesn’t have to be toxic to your health. Relaxation methods will be described and practiced, along with coping techniques that use beliefs and social habits to balance your mind, nerves and hormones for greater health and performance. Instructor is experienced in public safety and high-tech business, with more than 10 years in crisis intervention and stress management.

Some of the feedback about a recent class I taught (Psychological and Spiritual Care):

  • Very informative, great Powerpoint, examples and videos.
  • Everything was awesome!
  • Professionalism. Good information/topics.
  • Easily understood and could apply to helping out a friend as well as somebody in a natural disaster.
  • Perfectly balanced with visual aids, group participation and anecdotes. Truly an expert in how to effectively teach on this subject.

Article: You Can Improve Your Default Response to Stress

The Harvard Business Review has published an article by Michelle Gielan (a positive psychology researcher married to Shawn Achor, author of The Happiness Advantage), describing how our response to stress matters more than what happened to cause it.

Our perception of an event – what psychologists call appraisal – makes a big difference in our emotional and physical reactions. If we see a threat, our stress response will be negative. If we see a challenge instead, stress is an ally helping us rise to the occasion. Gielan reports on the results of a study by Plasticity Labs that shows how we can change our response. There are three keys, she says.

  • Cool under pressure.
  • Open communications.
  • Active problem-solving.

People with poor stress management fall into two categories, Gielan suggests, which she calls “Venters” and “Five Alarmers.”  Venters are the people who are quite open about their stress, but they are not cool under pressure and not good problem-solvers. Five Alarmers also share their stress, but they are better able to take action. However, they make no distinction between small and large stresses. They are headed toward burnout, exhaustion and guilt.

Gielan calls people with a healthy, adaptive response to stress “Calm Responders” – they express their stress, but aren’t overwhelmed by it.

The good news is that we really can change how we respond.

The danger of “nobody else can understand”

If you are in public safety or the military, as well as some other fields, you know that some people insist that there it is pointless to talk about work to any “outsider.” Often, big agencies have this attitude toward smaller, less busy, ones –  “We are the only REAL firefighters, police, medics, etc., around here.” So they close themselves off from  support by people who otherwise might be peers.

The walls even go up within agencies – specialized, elite teams form a “tribe” mentality that says if you haven’t been part of a similar unit, there’s no point in talking to you about stresses and challenges, even if do the same kind of job.

No doubt, there is some truth to this. Working at a big, busy, urban agency certainly is different from smaller ones. Combat experience absolutely has unique aspects. Being part of an elite or specialized team really is different. People who haven’t walked the walk truly cannot understand. Experience is the only instructor – words quickly fail if we were to try to fully communicate it, especially the emotions around high-stress events (which can directly impact the brain’s speech center).

For a number of years, I have suspected that organizational isolation – that’s this is about – could be as toxic as individual isolation. We know that social support is the most important factor in resilience under stress or recovery from trauma; isolation aggravates stress. In fact, almost any trauma expert will agree that people will continue to suffer as long as they remain isolated –  connections with others give us strength and healing.

I recently began reading Ellen Kirschman’s book, I Love a Fire Fighter: What the Family Needs to Know, which has been sitting on my nightstand for a while. Dr. Kirschman, a well-regarded therapist in public safety, is also regularly involved in the West Coast Post-Trauma Retreat, where I have volunteered and learned.

Here’s the light bulb that went off as I read Kirshman’s introduction – the “nobody else can understand” attitude cuts us off from our friends and family. If you are certain that even a co-worker who isn’t part of your elite unit can’t support you because “they don’t understand,” then how can your friends and family who are civilians, possibly support you?

Here’s one of Kirschman’s observations about going through a fire academy (emphasis mine).

No one acknowledged how the emotional courage fire fighter families need or the independence that is forced on them contributes to the fire service mission. This is extremely puzzling in light of the many studies that confirm how family and friends are the heart of a fire fighter’s emotional support system.

Her books (she wrote a similar one for law enforcement) are for families, but the message to public safety is just as important. Your social support outside of work is also critical to your strength and resilience in the face of occupational stresses, and recovery from critical incidents and other injuries that aren’t physical.

The following words are why it does not matter that outsiders can’t understand the job.

Empathy does not require understanding.

It’s true – if you are an outsider, you will not understand. If you’ve never been there, I can’t explain what it was like to talk to a patient one minute and then do CPR on him, unsuccessfully, the next. You won’t understand how difficult it was to walk past his wife in the ER waiting room, seeing her comforting another wife, not knowing her own husband was just pronounced dead. If you’ve never done anything like helping a family bury their dogs who couldn’t escape a wildfire, nothing I can say will make you understand. If you haven’t been part of a rescue that went all wrong and killed the victim, I don’t have words for the emotions. If you haven’t done shift work, you don’t know the toll it can take.

Even if you cannot understand, that doesn’t have to stop you from supporting a responder if you are a trusted friend – because empathy does not require understanding. They may spare you details. They probably won’t repeat the sick jokes that helps many get through the day. But if you are willing to simply walk beside them, your presence can be healing.

You don’t need to understand responder experiences to know that they are painful. You don’t have to work shifts to that it is hard to be exhausted and miss family events. Everyone has experienced pain and frustration, he stress of an event or life going out of control. Co-workers can appreciate it more than outsiders, so co-workers are an essential part of any responder’s network of social support. So are spouses, friends with completely different careers, pastors and may others.

Camaraderie is powerful. Every agency – and groups within them – benefits from friendships, mutual support and teamwork. However, the idea that only our co-workers or people like them can support us is a misguided obstacle to wellness. We should not want anyone, from new recruits to  seasoned veterans, to believe that their friends and family have little to contribute. As Ellen Kirschman says, that idea cuts t them off from the heart of their social support system.

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