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Oklahoma City made search and rescue specialist Bill Bertone think hard about Critical Incident Stress Management (CISM). Bertone, a Fairfax County, Va., firefighter and CISM team member who participated in rescue and recovery efforts in Africa as well as Oklahoma City, has begun to find ways to spread his ideas about strengthening CISM for police and firefighters.
As a keynote speaker at the annual meeting of the National Organization of Victim Assistance in August, Bertone outlined lessons learned from Oklahoma City and Nairobi and the need to address new mental health issues in CISM. At the conference he had discussions with staff from the Office of Victims of Crime in the Department of Justice about developing a program that addresses stress and mental health for public safety personnel.
"I'd like to see better recognition of the fact that there is a problem," said Bertone. "We need to have an official task force of people to work out policies to be followed by each team and for creation of support groups for members and families."
Bertone's convictions and concerns about mental health issues developed during his experience in rescue and recovery after the Oklahoma City bombing. Several firefighters left the Office of Foreign Disaster Assistance (OFDA) team, and many have since gone through divorces or become alcoholics, said Bertone. The job the firefighters did there was difficult for many reasons, he added. One of the biggest problems, he said, was that the rescue workers were overwhelmed by the emotion in the community. "I wish I could convey the warmth and love put out to us in Oklahoma," he said, "but there are no words to describe it. We came back feeling like we had a new family."
People in the community cooked for them, washed their clothes, and tried to support them in other ways. One woman who commented on how tired Bertone looked put teddy bears on all of the workers' cots. Bertone said he began to realize that his job was much more than digging through rubble and finding bodies. "Our mission was to help the healing process begin by returning bodies," he realized.
The existence of the intense emotional connections the workers developed with people in Oklahoma made them feel loyal and responsible, said Bertone. The firefighters later felt a lack of closure because of two issues, he noted. One was that the firefighters didn't get a chance to finish the job because local firefighters were the ones who did the last task of blowing up a part of the building to recover the last five bodies. Another was that they left without a chance to say goodbye to the people in the community who had taken care of them. In addition, the close and emotional ties to new friends in Oklahoma caused problems with spouses and significant others when the rescue workers returned home, he said.
Even firefighters who hadn't valued CISM said that they were overwhelmed by the situation and the lack of closure, Bertone said. They thought more needed to be done to help them negotiate through the emotional issues involved. The attention focused on them when they returned home was also difficult for many, he said. Some felt that they were just doing their jobs and that they hadn't even been able to finish the work.
Kenya was a different experience, said Bertone. "There was not the same love. In Africa, we were afraid for our lives." Each rescue experience is different, he noted, and CISM has to take that into account. He hopes that more emphasis will be given to CISM and that mental health and public service personnel will continue to learn from each rescue incident and find ways to better address the stressors that workers experience.
He thinks the Federal Emergency Management Agency and OFDA should create a written policy on the necessity for stress management and that approaches to dealing with critical incident stress should be clearly defined. He believes that debriefings should be mandatory and that needs of firefighters' families should be better addressed. He also thinks employee assistance personnel should be better trained to understand the stresses that rescue workers, firefighters, and police experience in their work
Most important, said Bertone, "whoever is going to be designing CISM has to know the thinking process of people in public service. They need to understand the beast, and then when the beast is in battle, they can understand what he is going through."