9-1-1 leaders’ post tragedy care checklist€¦ · 2 | 9-1-1 leaders’ post tragedy care...

The9-1-1Leaders’PostTragedyCareChecklist:Step-by-StepGuidancetoLeadYourTeamthrough

theAftermathofHighImpactEvents1

VERSION4.1.23.20J.Marshall

INTRODUCTION

AttentionPSAPleader:thisLeader’sCareChecklistiswrittendirectlytoyouoryourdesigneewhowilloverseeprovidingstaffsupportwhenHighImpactEvents(HIE)happeninyouragency.Ifyouarefacingatragedyrightnow,proceednowtotheCARECHECKLISTonpage2.

Optimalpreparationforpost-tragedycareofpersonnelrequiresfore-knowledgeofthisresourcetoolandpre-planningtoreadyyourteamforimplementation.Soasable,forbestresults,pleasereadthisdocumentthoroughlyincludingthefootnoteexplanations,andBackgroundandAppendicesinformationbeforeusingthesematerials.

Thisplanwillhelpyourespondtoavariety“HighImpactEvents”(HIEamongyouremployees.Foradditional,morespecificguidanceforresponsetoanemployeesuicide,seeAppendixA(backgroundinformationbeginningonpage10).911TrainingInstitutedefinesHighImpactEventsas…

…thoseeventswhichinvolveactualorperceivedriskofseriousinjuryordeathtoselforothers,andwhichmaythereforeactivatefeelingsofintensefear,helplessnessorhorrorintheinvolvedpersonnel.ThoseexposedtoHIE’smaybeatvaryinglevelsofriskfordevelopmentofPTSDandstress-relatedhealthimpacts.Accordingly,strategicsupportassuringHIEriskeducation,assessmentandmanagementshouldbeprovidedtoemployeesbyemergencyresponseagencies.

Examplesofhighimpacteventsinclude(butaren’tlimitedto)thefollowing:

• ActsofTerrorism• EventsinvolvingMultipleFatalities• NaturalDisasters• OfficersKilled• HouseFireswithlossoflife• ChildDeaths• Homicide• Suicide2

1 © Copyright, 2019. Jim Marshall and 911 Training Institute. All rights reserved. The author grants leaders of Public Safety Answer Points (PSAP) permission to use this document locally. The Institute also authorizes the National Emergency Number Association (NENA) permission to post this document on their official website to support this local use. NENA and PSAP leaders are encouraged to collaborate with the Institute in its ongoing revision, to support continuous improvement optimizing its value to PSAP personnel. Please email [email protected]. Other parties interested in collaboration on or use or of the document should email the Institute. The author wishes to thank NENA President Monica Million for her extensive contributions to the development of this resource.

2 Marshall, Jim. The Resilient 9-1-1 Professional: A Comprehensive Guide to Surviving and Thriving Together in the 9-1-1 Center (pp. 338-339). Kindle Edition.

2 | 9-1-1 Leaders’ Post Tragedy Care Checklist

THE9-1-1LEADER’SPOSTTRAGEDYCARECHECKLIST

DocumentPurpose:thistoolisdesignedtoassistthe9-1-1directorinoverseeingallaspectsofsupporttoyourpersonalintheaftermathofaHighImpactEvent(HIE).ItrecognizesthatyourtwoobjectivesasaleaderduringandafterHIEare1)tosustainoperationsofthePSAP,and2)supportthewellbeingofallpersonnel.

NoteaboutSupportingrespondersduringtheHigh-ImpactEventRespondersmaynotbeabletostopworkingduringaline-of-dutyorpersonaltragedyasitunfoldsinreal-time.Insuchcases,theirimmediateemotionalsupportwilloccur“organically”asthey,theirpeers,andsupervisorsworkingtheincidentpursuetheirtaskstogether.PSAPleadersandallotherpersonnelcanalsoprovideasupportivepresencethatfortifiestheabilityoftheseteammemberstoretaintheircomposureandfocusontheirwork,byprovidingthefollowing:

1. Simplerecognitionofthechallengeandaffirmationofthegoodjobtheyaredoing2. Invitationtoprovidebackup,breaks,orfullrelieffromthetasksasneeded33. Offeringacceptanceandcomfortwhenstrongemotionsareexpressed44. Remainingpresentnear-byforventing,encouragementduring“in-between”moments5. Providingnourishmentandplentyofwater6. Assurancethatsupportisavailableduring,andwillbeofferedafter,theevent

*COPY,CLIP,ANDSHAREWITHSUPPORTTEAM/PEERSUPPORTTEAM

ChecklistInstructions:Followorrevisestepsbelowasfitsyouragencyandtheincident;check-offtasksascompletedandrecordkeynotesashelpful.Forexplanationsrelatedtorecommendedsteps,seefootnoteswhenprovided.Guidanceiswrittento“you”asifspeakingdirectlytoPSAPleader.

PHASE1:First48-HoursPost-Event

� Step1:GatherinfoaboutHIE(4Ws:WhathappenedtoWhom,WhenandWhere)

3 IntheeventofanongoingHIE,membersofthepeersupportteammaybeneededtoprovidereal-timeoperationalsupporthelpattheconsole.Insuchcases,itshouldbecleartoallparties,andspecifiedtoon-dutypersonnelthatthesepeersupportteammembersarenot,inthosemoments,operatingaspeersupportersbutasco-workers.(911TrainingInstitutedoesnotconsidersuchoperationalassistanceaspeersupportinitself.) 4 Refrainfrominquiringaboutaskingaboutaworker’sfeelingswhentheyarestillworkinganincident,sincethiscanbedestabilizingandimpairtheirabilitytoretaincomposure.Thosefeelingemotionallycompelledtoimmediatelyprocesstheirdistressshouldbeprovidedrelieffromtheirpostssothiscanoccurwithasupportpersoninaprivatesetting.

NOTES


� Step2:Informyoursuperiorsofeventandstepsyou’lltake(below)/noteinput:

� Step3.EngageHRDepartment,reporteventandseekinputtoassistinplanning5

� Step4:CallABriefingofYourPSAPLeadershipTeam(includePeerSupportTeam,andmembersofCriticalIncidentStressManagementTeam(CISM),ifexist6)� Informthemofevent7(ifnotalreadycommonknowledge)� Prefacethatthiswillbedifficulttohear� SharetheBrief4Wsabouttheevent� Acknowledgeandnormalizeemotionaldistressamongthosepresent� Assurethemyou(ordesignee)willleadincreatingaPSAPCarePlanASAP� Appoint,recruit,seekvolunteerstohelpyoubuildtheCarePlan� AdviseteamtonotifyyouifanyupdatesabouttheHIE,orifcomplicationsarise� Requesttheymaintainconfidentialitytoassurecarefuldisclosureofeventtostaff� Inviteinputfromteamre:theirgreatestconcernsforpersonnel/ideasforplanning

5 Thisstepispertheleader’sdiscretionaccordingagencyrequirementsandtheperceivedvalueofsupportexperiencedbyyouragency’sHRpersonnel. 6 YourcentermayhavepersonnelwhoserveasmembersofanareaCriticalIncidentStressManagement(CISM),oremployeesmaybeinvitedtoparticipateinCISMserviceswhenofferedafterHIEs.Insuchcases,youasleadercanseekinvolvementofCISMpersonnelinyourPSAPcareplanningmeetingsandincludeCISMgroupdefusinganddebriefingsessionsinyourchecklistplanning.ResearchoneffectsofparticipationindebriefingsessionsshowsvaluewhenqualifiedfacilitatorsfollowtrainingandpracticeguidanceoftheInternationalCriticalIncidentStressFoundation.NotethatperICISF,groupdebriefingshouldneverbemandatoryforpersonnel.Bycontrast,debriefingsessionsimproperlyconductedmaydomoreharmthangood.Therefore,itcanbevaluabletoincludeyourlocalCISMteamincareplanningifyoutrusttheircredentialsandcompetenceindeliveryofsupport. 7 Dependingonthenatureoftheevent,itispossiblethatonlyoneorafewpeoplewillknowithasoccurred(e.g.,suicideofapeer).Othereventssuchasmasscasualtiesmaybecomecommonknowledgeimmediatelytoallpersonnelonand,oftenthoseoffduty.Theprincipleatstakehereistocarefullymanagedisseminationofinformationabouttheeventforbestmanagementofemotionalandperformanceimpacts.

NOTES

NOTES

NOTES


� Step5:InformandseekguidancefromyourEAPincareplanningandimplementingplan(orothertrustedmentalhealthprofessionalsifnotEAP).81. DefineyourintenttobuildaCarePlanforinitial,intermediate,long-termsupport2. DefineEAP’sRole:if,whenandhowEAPcounselorswillbeavailableonsite@PSAP:

� Floatingforinformalsupport:allshiftsbeginningimmediately,wk.1,thentapering� Offeringpersonnelbriefconfidentialon-site1:1check-insinsubsequentweeks� Immediatelyandthereafterofferingin-office1:1counseling� Definehowyourteamcanmakeimmediateurgentandemergentreferralsasneed

uponinformingpersonnel(nameofclinicians,fail-proofphonenumberstocall)NOTE1:theintensityandlengthofEAPcareplannedwilldependonthemagnitudeoftheHIE/numberofpersonnelimpacted.DiscussthiswithyourEAPrepresentative.NOTE2:ifyourEAPdoesnotrespondandisnotabletoprovide24/7clinicalsupporttoyourpersonnelandorisnottrainedandexperiencedtodelivertraumatherapy,assignateammembertoseekthenamesoflocalcliniciansspecializingintraumaticstress;contactthem;determineiftheycanpartnerwithyourPSAPinfulfillingStep5.

� Step6:ReconveneyourPSAPLeadershipTeamtosetCarePlanperSteps1-5.

1. Acknowledgeemotionaldistressamongthosepresent,sharesupportasneeded2. Gainagreementthatleadershipteammemberswillseektheirownsupportasneeded3. Identifyneedforbackfilltosupporton-dutypersonnelwhenreliefneeded4. Shareoverviewofstepstakenthusfar,inputfromHR,PlansforEAP/clinicalsupport

8 Preferably,you(oryourdesignee)willhavealreadyworkedtobuildarelationshipwiththeEAP,determinedcapableofprovidingurgentandcrisissupporttoyourcommcenter.Itisalsopreferabletohaveidentifiedatleastashortlistofmentalhealthcliniciansintheareawhoarequalifiedandknowntobehelpfultofirstresponders.SuchpreparationmakesthecoordinationwithEAPandcliniciansmucheasierwhenHighImpactEventsoccur.ForspecificPSAPguidanceinpursuitofoptimalEAPservices,seeTheResilient9-1-1Professional,Chapter17:TheVitalRoleofYourEAP:HowEmployeeAssistanceProgramsCanHelp9-1-1Pros.Marshall,Jim.TheResilient9-1-1Professional:AComprehensiveGuidetoSurvivingandThrivingTogetherinthe9-1-1Center(p.257).KindleEdition.

NOTES


5. Definehownewsmediarequestswillbehandled(e.g.,byyouordesigneeonly)I.D.mostdeeplyimpactedpersonnel;I.D./assignwhobesttoinformthem(ifnotleader)9

� Step7.Designeesinformmostaffectedsurvivors10(identifiedabove):

� Informsurvivorsin-personifpossible;ifnot,byphonewithpersonalfollow-upASAP� (Ifbyphone,verifytheyareat,orencouragethemtoseek,agoodplacetotalk)� Prefacethatthiswillbedifficulttohear…� SharetheBrief4Wsoftheevent� Allowtimeforsurvivortoreact/vent� Empathizewithdistress,withouturgingemotion;don’ttrytofix,justbepresent� Helpsurvivorplantoconnectwithsupportiveothers(PSs,friends,family,Pros).� Assurestabilityandsafetyofsurvivorbeforeendingmeeting� Ifimmediateneed,bridgetoEAPorotherdesignatedmentalhealthclinicians

NOTE:Steps7and8mayoccuralmostsimultaneouslydependingoncircumstances

� Step8.DesigneesinformremainderofOn-DutyPersonnelofEvent:� Informthemin-person,ifpossible� Striveforasupporter-to-workerratioof1to2or3,foradequatesupport11� Prefacethatthiswillbedifficulttohear� SharetheBrief4Wsoftheevent� Assurethatthoseclosestto[thevictim(s)]havebeennotified� Acknowledginghowdistressingthismaybe� Urgingemployeestoseekrelieffromconsoleifhavingdifficultyoperating� AdviseEmployeesnottonotifytheiroff-dutypeersuntilleadershipteamindicates

theyhaveinformedallpersonnel,toassurecarefulhandling.� Encouragingthemtofollow-upwithsupportersasneededandstandbyforupdate

onformalsupportplanned

� Step9.DesigneesinformRemainderofOff-DutyPersonnel: 9 Inmanycases,newsofthetragedywilloriginatefrompersonnelandreachthoseworkingthefloorpriorleaders’awareness.Insuchunavoidablecases,leaderswilladopttheircareplanningdefinedherethebesttheycanto“comealongside”theiremployeeswithsupportfittingtheircurrentstatus.10 Akeyconceptinpost-tragedysupport:thosesurvivorsmostpersonallyrelatedtothevictimsshouldbeinformedbythemostpersonalmeanspossibletoassuremostcarefulmanagementofpotentialpsychologicalfallout.11Thisratiomaynotberealistictoachieveinmanycases.Itisencouragedperthekeyconceptsinfootnote10aboveandassumesaHIEofpotentiallydevastatingmagnitudeforallpersonnel(e.g.,masscasualtyevent).Thisratioofsupporters-to-employeesmakesitmorefeasibletomanagetheindividualandgroupemotionalfallout,posinggreaterrisktosustainingoperations.WhethertherecommendedratiocanorcannotbeachievedPSAPleaderareurgedtorecruitmutualaidfromneighboringagenciessincesupportersfromyourPSAParealsoimpactedbytheevent.

Personnel to Inform First On/Off Duty? Designee to inform:

1. 2. 3. 4.

Others:

Special Considerations:


� Informoff-dutypersonnelbyphone;includethefollowing:1. TheBrief4Wsoftheevent2. Assuringthatthoseclosestto[thevictim(s)]havebeennotified3. Acknowledginghowdistressingthismaybe4. WelcomingthemtocometoPSAPifpreferred,togiveandreceivesupport5. Requesting,asyoudeemnecessary,forthemtoreturntowork6. Encouragingthemtoidentifyandusetheirnaturalsupportsystem

(family/friends)whilestilloffwork7. Assuringthemyouwillbesendingemailupdatestoallpersonnelasableand

deemedhelpful

� Step10(Day2):ConsidersendingE-mailand“SignstoLookFor”resourcetoallStaff(uponassurancethateffortsmadetopersonallynotifyallpersonnel).Objective:assuringallareaccuratelyinformed,encouragedtoseekhelp,andequipped.� ConstructLetterwiththefollowingkeyelements(usingtheSampleLetterin

AppendixD,asdesired)Note:sendcopiestoyoursuperiors,HR,EAPProgram.� Acknowledgetheeventandhowdifficultthishasbeenforall� Affirmeffortsmadebyallpersonneltosupporteachotherandoperations� ExplainthataLeadershipSupportTeam(joinedbythePeerSupportTeam,ifexists)

isworkingtoassureongoingsupportnowandintheweeksandmonthstocome� Providenames,emailsandphonenumbersofthoseonyourPeerSupportTeam(if

exists,andifnot,yourLeadershipSupportTeam)� Urgeacceptanceofpersonalresponsibilityforseekingouthelpavailablefromthe

Team,fromtheEAPProgram,andtherapistsspecializingintraumaticstress(includenamesandcontactinformation)

� RemindandwelcomeuseofyourOpenDoorPolicyastheirleader(s),includingdeputydirector

� Attachthe“SignstoLookFor”resourceinAppendixCorcomparableinformationsheet.

PHASE2:LeadershipSteps:Day3throughEndofWeek1

Note:youractualtimelineforimplementationoftheseactivitiesmayvarysignificantlyfromthetimelinesuggestedhere,dependingonnatureoftheHIE,readinessofpersonneltoengageinsupportefforts,staffing,availableresourcesandothervariables.

OptionalStep1:Identifyandengageyourcommunity“LOSSTeam”(ifeventwasasuicidewithintheemergencyresponsefamily).12SeemapandlistingofLossTeamshere.

� Step1:ReconveneSupportTeam1. SharepeersupportwithyourSupportTeam:inviteventing;remindmembersoftheir

agreementtoseekpersonalsupportasneeded2. RemindteamofyourOpenDoorPolicy(DirectorandDirector’sDesignee)fortheirpersonal

use;andencouragethemtoremindallPSAPpersonneltouseasneeded3. PursuepersonnelparticipationinaCISMDebriefingi

12LOSSTeamsarehighlytrainedsurvivorsofsuicidewhohavebeenequippedtodeployafterasuicideandprovidespecializedsupporttobringinsight,comfortandsupporttoyourteammembers.ThemodelwasdevelopedbysuicidologistFrankCampbell.existinmanylocationsintheUnitedStates,soagenciesandtheircommunitiesmaybeabletoliaisonwithexistingteamsforsupportwhiledevelopinginternalsupportsystems.


4. InformthemofroleofLOSSTeam(ifapplicable)anddefineanycoordinationneededwithteammemberstoassurefollowthroughhowyouasafullteamwillprovidesupportintheremainderofWeek1andbeyond(refertoallinformationbelowinStep2andbeyond):

5. IntroducethePEPCP(PostEventPersonalCarePlanner,AppendixB)ifadopted.13� Provideprintedcopiesofthistoolanddescribeitspurpose� WalkthroughstepstocompleteanexamplePEPCP� Identifythosewhowillassistemployeesinadministeringthistool(beingyourPeer

SupportTeamifexists,ordesigneesoneachsquad)� ProvidethelinktotherecordedwebinarPEPCPOrientationandTraining

� Step2:DeployyourPeerSupportTeam(ifexists,orotherdesignatedsupportteam

members)tomeetandpartnerwitheachemployeetocreatetheirPEPCPs� Day2and3forinitialmeetingsandbegincompletingPEPCPswiththosemostaffected(as

definedearlierinPhase1,Step6)andactivatereferralsasneededforprofessionalassistance

� Days4-7CompletePEPCPsforremainingpersonnelandactivatereferralsasneededforprofessionalassistance

� Step3(byDay4):VerifythatEAPisfulfillingallagreedstepsofsupport:1. Hasinitiatedvisitsonsiteasagreed2. HasprovidedprintedinformationontheEAPProgram3. AlsorequestthatEAPtoconductfollow-upemailwithPSAPpersonnel(throughyou)

encouraginguseoftheEAPProgram

� Step4(Day6):VerifyPEPCPshavebeencompletedperabovegoalsandreferralshavebeenachievedwhenprofessionalassistancewasrequired

� Step5:ProvideHIEWeek1ReporttoSuperiors(topmanagement,governingbody)informingofallstepsabovetakenthusfar,andplansforongoingfollow-upbelow

PHASE3:Weeks2through8(actualnumberweekswillvaryperspecificevent14):

� ReconveneLeadershipTeamonWeeks3,4,6&8(ormoreasneeded)(includingPeerSupportTeam,ifexists):� Sharepeersupportwithmembersofteam;encourageventingtosupportwellbeing� Seekreportsonoverallstatus/well-beingofpersonnelforallsquads� Assesssupporteffortsthusfar(Phases1&2);strategizetooptimizeongoingefforts

13 UseofthePEPCPinyourPSAPrequiresthatPSAPleadersandthosewhowilldirectlyadministerthetoolhaveparticipatedintheweb-basedPEPCPOrientationandTraining,providedatnochargebythe911TrainingInstitute.Contactinfo@911Training.netformoreinformation.IfyouragencyhasnotyetadoptedthePEPCP,strivenonethelesstoassureeachemployeehasbeenpersonallymadeawareofallavailableresourcesandisencouragedtousethemasneeded.

14 Beflexibleinyoureffortsoutlinedheretofithowyourteamisreactingtoyourinterventionsteps.Theymayfeelyouhave“doneenough”,soyoumayapproachthemmoreinformallyandlessfrequentlyforcheckins.However,alsoremember,youremployees’“pushback”tocheck-insdoesn’tautomaticallymeanyoushouldceaseofferingthem.Mostrespondersarestillquiteawkwardwithacknowledgingtheirstruggles,perthetraditional“SuckitUp”EmotionalCode(TheResilient9-1-1Professional,Chapter5).Theobjectiveasaleaderandsupporteristodoyourbesttoassure“nooneisleftbehind”whilealsorespectingpersonalprivacyandindividualdifferencesinhowfolkscopewithtraumaandloss.


� Identifyandmakeplans/identifyadditionalresourcesneededtosucceedatongoingsupporttopersonnelandtoaddressanyseriousfallout(e.g.,increasedsickleave/staffing,morale,performance)

� PeerSupporters(orDirector’sdesignees)continueweeklycheck-inswithpersonnel� FormalCheck-inswiththosemostaffectedpersonnel(followingPEPCP)toofferreal-

timesupportandassuretheirfollow-throughwithothersupportsandpursuitofprofessionalmentalhealthassistancetoassessandtreattraumaticimpacts

� InformalCheck-inswithallotherpersonnel

� VerifyhowEAPwillcontinuesupportandweeklyon-sitevisits:determine(withEAPrep.)numberofconsecutiveweeklyvisitspriortotaperingoffin-housesupport;requestEAPtoprovideprinted/emailcorrespondenceremindingandencouraginguseofservices

� ContinueWeeklyLeader’sEmailtopersonnelremindingofsupportsavailablefrompeersupportteam,EAP,clinicians,andyourownOpenDoorpolicy

� ContinueweeklyLeader’sPost-TragedyUpdatetosuperiors

Phase4:Month3throughYear1AnniversaryofEvent15:Continueoversight:

� LeadmonthlymeetingsofyourLeadershipSupportTeam(includingPeerSupportTeam,ifexists)� Sharepeersupportamongmemberstoassurewell-beingandencourageseekingof

professionalcare(sinceleadersoftendefercareuntilafteremployeesarecovered)� VerifythatPEPCPsarebeingimplementedwiththoseidentifiedasmost-affectedbythe

HIE(whilemaintainingconfidentiality)toassureneededsupportsaredelivered� Verify(bycontactifneeded)thattheEAPProgramcontinuestoprovideservices

requiredtosupportPSAPrecoveryfromHIE:1. Monthlyvisitsonsite(atminimum)2. In-servicesontopicssupportingrecoveryofyourpersonnel,163. Printed/emailcorrespondenceremindingandencouraginguseofEAPservices4. Otherservicesasdeemednecessary5. Iftheaboveservicesarenotforthcoming,seekalternativeclinicalsourceforsame

� AssureFunctioningofPeerSupportTeam(ifexists;or,ifnot,LeadershipSupportTeam)

� MeetingregularlyasdefinedinPEPCPswiththoseidentifiedasmostimpactedbyHIEtofosterfollowthroughparticipationwithallneededsupports(allconfidentialityupheld)

� Regularlyre-invitingemployeestoparticipateinPS(vianewsletter,emailblastsandpersonalinvitationsduringworktotheirsquads)

� Referringthoseinneedofprofessionalhelpasneeded

� ContinuesendingmonthlyLeader’sEmailtoallpersonnel:

15 Eachemployeemayhavedifferent“triggers”ortouchpointstotheoriginalevent.Someeventsarepredictable,e.g.,(e.g.,birthdaysofthedeceased.Considerbrainstormingsuchpossibledates,eventsthatmightbetriggers.Also,astimepassesthroughthefirstseveralmonthsconsiderwaysinwhichyourteammightbenefitfrommemorializingthedeceased.Suchsharedexperiencesoftenareapowerfulpartofthehealingprocess. 16 TheroleofaneffectiveEAPincludesdeliveryofin-servicepresentationstoagencypersonnelontopicssuchas:griefrecoveryaftercatastrophiclosses;copingaftermass-casualtyevents;recoveryfromexposuretotraumaticevents,etc.IfyourEAPproviderdoesnotoffersuchin-services,seekassistanceforsuchservicesfromthelocalcliniciansidentifiedasqualifiedtotreattraumaticstress.


1. AcknowledgethathealingaftersuchaHIEcantakemonthsorlonger2. Affirmyourbeliefastheirleaderthatprofessionalismmeansseekingneededhelp3. Encouragepersonneltouseallavailablesupports(inaccordwithPEPCPswhen

used)4. RemindthemoftheavailabilityandkeyroleofthePeerSupportTeam(ifexists)5. RemindthemofyourOpenDoorpolicy,andencourageuse

� 1-2WeeksPriorto1stAnniversaryoftheHIE17a. Writealettertoallpersonnelacknowledgingtheanniversaryoftheevent

recognizingthatfolksmaystrugglemoreduringtheperiodofthisanniversaryandreiteratingthepointsintheabovemonthlyLeader’semail.

PHASE5:Year2andBeyond18

� ReconveneyourLeadershipTeam(includingPeerSupportTeam,ifexists)1. Invitememberstosharetheirimpressionsofthestatusofpersonnel(overall)relating

totheHIE2. TogetherreviewPhase4Activitiesanddeterminewhich,ifany,shouldbesustainedto

assurefullsupportneededtofosterongoinghealing3. EncouragePeerSupportTeam(ifexists)andLeadershipSupportTeamtocontinue

monitoringwell-beingofsquadsandurginguseofsupportsandservicesasneeded

17 Traditionally,military,paramilitaryandemergencyresponseagencieshavesoughtto“getpast”tragediessufferedbytheirpersonnelbyavoidingrecalloftheevent,staying“strong”andpressingonwithbusinessasusual.However,expertsinrecoveryfromtraumaticstressandgriefconcurthathealingisfosteredbyopenlysharingrecollectionofamajorlossortraumaticeventamongthoseimpacted.Itisespeciallypowerfulwhenleadersoftheseagenciessetthe“standardofcare”bydeclaringtheirbeliefin,andcommitmenttoremembering,feeling,andhealingtogether.Accordingly,leadersshouldstrivetoofficially,andbytheirownconduct,communicatethismessagetotheirpersonnel. 18 ThepsychologicalfalloutofaHighImpactEventmayextendforyearsbeyondtheincident,makingitvitallyimportanttoreviewandconsiderre-implementationoftheactivitiesrecommendedinPhase5.Messagingtostaffcanbeabbreviatedovertime,butalwaysincludingassurancethatPSAPleaderswillprovidesupportwhenneedednomatterhowmanyyearshavepassedsincetheHIE.

10 | 9-1-1 Leaders’ Post Tragedy Care Checklist BackgroundandRationaleofthisDocument

This9-1-1Leader’sCareChecklistisadraftdocumentpreparedby911TrainingInstitute(911TI)withinputandinspirationfromMonicaMillion,2019-202OPresidentoftheNationalEmergencyNumberAssociation,andother9-1-1leaders.Theyareamongmanywhohaveexpressedtheurgentneedforsucharesourceamongournation’s9-1-1directors.NENAiswelcomedtofreelydisseminatetheCareChecklisttoitsmemberagencieswiththeprovisothatitisrecognizedasadraftdocumentaboutwhich911TIwelcomescommentsandsuggestionsforimprovement.PleasecontactJimMarshallbyemail:[email protected]

9-1-1directorshaveincreasinglyfoundthemselvesfacingHighImpactEvents(HIE)asdefinedwithexamplesgivenonpageone,includingthesuicideof9-1-1Professionalsandfieldresponders,andman-mademasscasualtyeventstowhichourPSAPshaveresponded.9-1-1leadersreportsharingastrongconcernforattendingtothepsychologicalfalloutamongtheirpersonnelassociatedwiththeseHIEs;yetalsoasenseofhelplessnessandlackofconfidenceinhowtoproceed.Theydescribefeelingquiteunpreparedtoprovideoptimalguidancethroughtheaftermathofsuchtragediesamidstconcernabouttheimmediate,andlonger-termimpactsonthepersonalwell-beingoftheirsurvivingpersonnel,theirfamilies,andthestabilityoftheworkforcetosustainperformanceamidstunrelentingdemandforservice.ThisleadershipstruggleisexpressedwellbystatementsandquestionsIrecallandwillparaphrasehere:

• “Wecheckedonthosemostinvolvedbutnotmuchelsefortherest…notsurewhatthatwouldbe…”

• “Wejustjumpedintoaction,checkedonpeople,butdidn’treallyknowwhatweshouldbedoing.”

• “Whatdowedonext?Howlongdowecheck…whendowereferthemtoprofessionalhelp?”

• “It’sbeenafewweeksnow.Hardtoreallyknowhowpeoplearedoing…notsurehowtoaskorhowoftentoask.”

Reliableanswerstosuchquestionscanbegainedfrommentalhealthexperts,suchasSuicidologistFrankCampbell.Dr.Campbellemphasizestheimportanceofproviding“postvention”,amodelhepioneeredandwhichhedefineshumblyas“…thosekindactsthatareextendedafterasuicide…tothosebereavedbysuicide…”20

Suchpostventionactsofkindnessneedtobewell-organizedandguided.Most9-1-1centershave(throughtheirgoverningagencies)EmployeeAssistancePrograms(EAP)whicharecontractedtoprovidementalhealthassistancetoallemployees.Ifwellprepared,suchEAPscanbeofgreathelpinpostventionandsupportafterotherHIEs.Yet,toooftentheEAPorganizationsuponwhich9-1-1centersdependarenotavailable24/7/365,arenotknowledgeableaboutthespecificpsychologicaldemandsoffirstresponderworkandhavenotdevelopedongoingrelationshipswithPSAPpersonneltoearntheirtrustandconfidence.MostEAPsarealsonoteequippedspecificallytoprovidepostvention.Inlieuofsuchsupport,9-1-1leadersthroughtheyearshavesoughthelpfromthe911TrainingInstitute(911TI).ButdependenceonanorganizationexternaltothecommunityliketheInstituteisnotanoptimalorsustainablesolution.911TIrecognizesthat9-1-1leadersmustbelocallyempoweredwithahands-onresourcetooltheycanusetoguidetheirstepsaftertragedyandassistedbycapablelocalclinicianswhereverpossible.Forthispurpose,the911TrainingInstitutehasprepared

19 IfNENAneedsinclusionofadisclaimerstatement,wecanaddit.Forexample:“NeithertheNationalNumberAssociationnorthe911TrainingInstituteareresponsibleforuseorimpactsofuseofthisdocument.Theinformationhereindoesnotconstituteclinicalmentalhealthserviceoradvice.Thoseatriskofsuicideorstrugglingwithotheracutementalhealthcrisesshouldseektheguidanceofalicensedmentalhealthprofessional.”20Campbell,F.PostventionisPrevention:Overviewofthecircularmodelofsuicidereduction.http://www.lossteam.com/postventionisprevention.php.Lastaccessed7.31.19.


the9-1-1Director’sPost-TragedyCarePlanner,toguideyoustep-by-stepasyouleadyourpersonnelinthemoments,days,weeks,andmonthsaftersuchadeath.ItwasdesignedonthepremisethatadequatesupporttopersonnelafterHIEsisnotaweek-longendeavorafterwhichweproceedwith“businessasusual”;itisacalculated,coordinatedlong-termeffortencompassingpreventiveeducation,intervention,andongoingsupport.

Yet,thereismoretopreventionthanwhatwemaythink.InaccordwithDr.Campbell’smodel,weneedtorecognizethat9-1-1leaders’involvementinpostventionwillalsoserveassuicidepreventioninthe9-1-1industry.Bymoreeffectivelycomingalongsidethoseintheaftermathofsuicide,wecanhelprestorehope,lessenhelplessnesswhilefuelingempowerment,andbegintheindividualcorporatehealingprocess.Thissharedexperienceenablesmembersoftheimpactedcommunitytostopthecascadeofdespairanddecreasetheriskofmoresuicidesamongthosemostprofoundlyimpacted.21

TwoofthemostcommonHIEsimpactingour9-1-1centersinrecentyearsandontheincreasearesuicidesamongemergencyrespondersandman-mademasscasualtyevents.

UnderstandingSuicide

SuicideintheUnitedStates(GeneralPopulation)

ThenumberofsuicidesintheU.S.increasedsignificantlybetween2007(34,598)and2017(47,173)22,anincreaseof30.5%duringthisperiod.Therateamongmenin2007was27,269,andin2017itwas36,782,anincreaseof34.8%,whereastherateamongwomenin2007was7,329andin2017itwas10,391,fora41.7%increaseduringthisperiod.Whiletheseratesarealarmingforbothgenders,itisalsosignificanttonotethatbetween2001and2016,thesuiciderateincreasedmoredramaticallyamongwomen(50%)comparedtomen(21%)between2001and2016,withthegreatestrateofincreaseinthelattertenyearstretch.2324

SuicideAmong9-1-1Professionals

Someofthesuicidesembeddedamongthosestatisticsaredeathsofour9-1-1professionals.Eveninthethreeweeksprecedingwritingofthisintroduction,threemoredispatcherssuicided,leavingawakeofdevastationamongour9-1-1familymembers.Whilethe9-1-1TrainingInstituteisunawareofanyofficialdataspecifyingtherateofsuicideamongemergencytelecommunicators,wecanreasonablyassumethattherateamong9-1-1Professionalsandotherfirstrespondershasatleastbeenonparwiththeincreasescitedaboveforthegeneralpublic.Many9-1-1leadersintheU.S.(includingmembersourInstituteteam)havebeenpersonallyimpactedbyseveraltelecommunicatorsuicidesinthepastthreeyearsalone.Thestatisticsaboveindicatingincreasesinfemalesuicidearecauseforalarmwithinthe9-1-1communitysinceourworkforceisstillpredominantlyfemale.

21Ibid,Campbell,F.22Drapeau,C.W.,&McIntosh,J.L.(fortheAmericanAssociationofSuicidology).(2018).U.S.A.suicide2017:Officialfinaldata.Washington,DC:AmericanAssociationofSuicidology,datedDecember10,2018,downloadedfromhttp://www.suicidology.org23NCHSDataBrief,No.309,June2018.https://www.cdc.gov/nchs/data/databriefs/db309.pdf24Drapeau,C.W.,&McIntosh,J.L.(fortheAmericanAssociationofSuicidology).(2018).U.S.A.suicide2017:Officialfinaldata.Washington,DC:AmericanAssociationofSuicidology,datedDecember10,2018,downloadedfromhttp://www.suicidology.org.SeeAppendixAforadditionaldetails.


Furtherconcernforanticipatedincreasesinsuicideratesamong9-1-1professionalsissupportedbythefindingthatforeachwomanwhocompletessuicide,3.5menwillsuicide.25Moremeneachyeararejoiningthe9-1-1ranks,includingmilitaryveterans--apopulationwithasuicideratehigherthanthegeneralpopulation.

Inthegeneralpopulationwomenattemptsuicide3.5timesmoreoftenthanmen.26Yet,thereissomesupportfromcurrentunderstandinginsuicidologythatwouldsuggestthatahigherpercentageoffemalesin9-1-1andotheremergencyresponserolesmaycompletesuicidecomparedtofemalesinthegeneralpublic.(Thesefactorsincludelessenedfearofdeathandincreased“courageandcompetence”totakeone’sownlife,duetoextensiveexposureonthejobtoviolenceanddeathinmanyforms.27(Seefootnotebelowformorethoroughexplanationaboutthesefactors.28)

Afinalfactordrivingconcernaboutsuicideamong9-1-1ranksisthatsuicideriskisknowntobesignificantlyhigheramongthosewithuntreatedPost-traumaticStressDisorder(PTSD)andclinicaldepression;theratesofPTSDinthe9-1-1industryisbelievedtobefourtofivetimeshigherthanthegeneralpublic29,whiletherateofdepressioninthispopulationisdoubletherateamongthegeneralpublic.30

UnderstandingOtherHighImpactEvents

9-1-1Professionalscanbeexpectedtofacegreaterriskofstress-relatedstrugglesfollowingothertypesofHighImpactsincludingthoselistedbelow.Additionalinformationabouttheseeventsisalsooffered.

• MassCasualtyShootings:2018NationalCrimeVictims’RightsWeekResourceGuide:CrimeandVictimizationFactSheets:https://ovc.ncjrs.gov/ncvrw2018/info_flyers/fact_sheets/2018NCVRW_MassCasualty_508_QC.pdf(TheOfficeforVictimsofCrime,OfficeofJusticePrograms.U.S.DepartmentofJustice.)

25Drapeau,C.W.,&McIntosh,J.L.,ibid.26 Ibid.

27Joiner,T.Whypeoplekillthemselves.Kindleed,.HarvardUniversityPress,2007. 28SuicidologistThomasJoiner(2015)explainsthatlethalityofsuicideincreasesonparwiththedegreetowhichtheindividualexperiencesthreeofthesuicidecomponents,beingsuicideDesire,CapabilityandIntent.DesireisunderstoodinaccordwiththeSuicideStandardestablishedbytheNationalSuicidePreventionLifeLine(NSPL)asthecombinationofoneormoresub-componentsincludingideasofsuicide,hopelessness,helplessness(tochangelifecircumstances),feelinglikeaburdentoothers,feelingintolerablyalone,unresolvedpsychologicalpain,andfeelingpsychologicallytrapped(Joiner,etal.2007);PertheNSPLStandard,SuicideCapabilityincludeshistoryofsuicideattempts,historyofviolence,exposuretosomeoneelse’ssuicide,alcoholintoxication,substanceabuse,suicidemeans,recentdramaticmoodchanges,outoftouchwithreality,andextremeagitation;andSuicideIntentincludes:attemptinprogress,expressedintenttodie,plantokillselfand/orothers,preparatorybehaviors.InaccordwithJoiner’smodel(2015)itmaybethatemergencyresponders(irrespectiveofgender),duetotheirrepeatedexposurestowork-relateddeathsinmanytragicformsincludingsuicideamongco-workers,maybecomemore“competent”tocompletesuicide;i.e.,they“getusedto”deathandthuslosetheirfearofdeathwhileboosting“courage”tocompletetheact.AsPalmerhasfound:“Acquiredcapabilityorthelearnedabilitytoovercomeone’snaturalfearofdeath—makessuicidepossible…”(C.Palmer,C.,MonitoronPsychology,November,2018).Lethalityescalatesfurtherwhensuchcompetenceiscombinedwithangerwhichcandissolveambivalenceaboutsuicide(Joiner,2015).

29 Lilly, M., in The Resilient 9-1-1 Professional, 2019, p. 42.

30 Lilly, M., ibid, p. 44.


• DeadliestShootings:1949to2019(August)(CNN)https://www.cnn.com/2019/08/19/us/mass-shootings-fast-facts/index.html

• FactsandStatistics:Wildfires:https://www.iii.org/fact-statistic/facts-statistics-wildfires(InsuranceInformationInstitute)

• FactsandStatistics:Hurricanes:https://www.iii.org/fact-statistic/facts-statistics-hurricanes(InsuranceInformationInstitute)

• FactsandStatistics:Floods:https://www.iii.org/fact-statistic/facts-statistics-flood-insurance(InsuranceInformationInstitute)


APPENDIXA:PreparingYourPSAPforPostventionSupport

afterEmployeeSuicides

ThefollowinginformationsupplementsthePost-TragedyCareChecklistandisofferedtohelpyouasaleaderassurethatyourpersonnelreceivethebestpossiblesupportintheaftermathofasuicide.SuchcareafterasuicideiscalledPostvention.31� PreparatoryActivitiesfor9-1-1Leaders(pursued,asable,beforedeployingtheCarePlan):

� ParticipateinTrainingtousethePost-TragedyCareChecklist(aspresentedinmaindocumenthere)

� Participate(orappointadelegatetoparticipatein)SuicidePostventionTraining.911TrainingInstituterecommendstheLOSStrainingmodel(LocalOutreachtoSuicideSurvivorsTeam)developedbyFrankCampbell32toachievethefollowingobjectives:

� DefinethePurposeandGoalofPostvention:Reduceimpacts,jointhoseaffectedinthebeginningofahealingprocess

� DescribePostventionwithinthefullcycleofcare(PostventionisalsoPrevention:seehttp://www.lossteam.com/postventionisprevention.php

� Defineandestablishcorecompetencytocomealongsideothersdoingpostvention

Note:ifyouseekoutPostventiontrainingfromsourcesotherthanDr.CampbellstrivetoassurethattheTrainingapproachisconsistentwithhisLOSSTeammodel.

� DefineTheroleofa9-1-1PeerSupportTeaminyouragency(ifinplace)� Purposeoftheteam� Activitiesoftheteamtofulfillthispurpose(includingtheTeam’sroleinactivity“d.”below.

� HowtoproceedasaPSAPwithPostventionifyoudonothaveaPSTeam1. IdentifylimitationsduetolackofsuchateamintheabilityofPSAP

personneltofulfilltheactivitiesabove2. Defineaplantoachievethoseactivitiestogreatestextentpossible

� Identifyandestablishrelationshipwithareamentalhealthproviders� EmployeeAssistancePrograms(EAP,Ifnotalreadyachieved)33

1. Assesstheirabilityandknowledgetoserve9-1-12. I.D.theirclinicallimitations(aretheyexpertsinPTSDanduse

EvidenceBasedTreatmentsforsame;ifnot,definerolewithlimitsclear,andseeA.b.ii.

3. DefinetermsbywhichEAPwillassure24/7availability,includingnamesofdedicatedEAPpersonnel,specificcontactprocedures,and

31 Note that an instructional video on Postvention Care Planning is being prepared to help you and your leadership team prepare in these efforts. Email Jim@911training for more information. 32 Dr.Campbelldefinessurvivorsas“thoseimpactedbyasuicidedeath”.(Seehttp://www.lossteam.com/index.php)

33 For guidance, see Chapter 17, The Resilient 9-1-1 Professional.


meansofcontact/communicatione.g.,dedicatedcellphonenumbersforusebyPSAP.

4. Selectionofclinicianandassignedasdedicatedtocommcenter� BeyondEAP:SelectacommunityclinicianwithexpertiseinPTSDusingEvidenceBasedTreatments(EBT)

1. Definetermsbywhichtheseclinicianswillassure24/7availability,includingcliniciannamescontactprocedures,andspecificmeansofcontact/communicatione.g.,dedicatedcellphonenumbersforusebyPSAP.

� Implementthe9-1-1Director’sPost-TragedyCareChecklistaccordingtotheguidancesetforthinthatdocument.

NOTE:YouarereadingtheWordversionofthisdocument;gotothePDFversionforAppendicesB-D.

i Traditionally,911Professionalshavenotbeeninvitedtogroupdebriefingsevenwhenthedispatcherinvolvedintheevent.Whilegroupdebriefingshouldneverbemandatory,theopportunitytoparticipateshouldbemadeavailablesincetheexperienceofclosure911Proscangainmaybeinvaluable.

APPENDIX B: Post-Event Personal Care Planner (PEPCP) Name of Employee: _____________________

G. Plan Care Options

1:1 Peer Support

Clinical Referrals to:a. Initial Trauma Assess. (EAP)

a. Initial 1:1 meeting w/Educ. Info.

c. Refer to Director or D.D. (PRN)d. Seek Peer Supervision e. Continued 1:1 Supportd. Make Clinical Referral

C.I.S.M. Engagementa. Educational Info on acute stressb. Group Defusingc. Group Debriefingd. Individual Debriefinge. Individual Follow-up

Chaplaincya. 1:1 Support meetings

Leader Care Responsea. 911 Director/Designee: 1:1b. 1:1 w/Fl. Spvsr. (after A. thru E.)

2.

1.

3.

5.

6.

4.

(Psychological Proximity)1. Directly Involved AND Family

or close friend of those at risk/believed dead

2. Directly Involved OR family or close friend of those at risk/believed dead

3. On duty with/assisting those directly involved

4. Employed @ agency/Off duty

TIMELINE for Support Delivery (Can be revised over time as best fits needs)

Immediate 1st 72hrs Week 1 4-6Wks. 3 Mos. 6 Mos. 1 Year

EVENT DESCRIPTION:

Note: Peer Supporters operate and are activated for duty in accordance with local PSAP policy or the directive of the director or his designee(s).

Self-Help Activities

b. Review/Practice of Resil. Skills

Note: “Clinic.” indicates that the tool must be scored and interpreted by a clinician.“Self” means that the tool can be self scored and interpreted using instructions.

“Leader” may include supervisors, 911 director or designee(s)

Note: Clinical Referrals may be self activated or initiated by the director or his/herDesignee(s) according to terms established in PSAP SOP.

Note: Cautions apply related to group debriefing process.

Note: All Chaplaincy activity occurs according to terms established in PSAP SOP.

High to Low

“How distressed about this event do you feel right now, on a scale from 0 to 10?”

Date:Planner initiated by:•

*This is a measure of “Subjective Units of Disturbance” (SUD). SUD as a measurement has been shown to be strongly positively correlated with Clinical Global Impression–Change (CGI-C) See K. Daeho, Hwallip, B.Y., Park, C. Validity of the Subjective Units of Disturbance Scale in EMDR. Journal of EMDR Practice and Research, Volume 2, Number 1, 2008 57 DOI: 10.1891/1933-3196.2.1.57

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c. Emergency Psychiatric Eval.

e. Fit-for-Duty Examinationd. Family Physician

b. Initial Trauma Assess (EMDR clin.)

a. Initial Resilience Training

c. Health Incentivizing Program

e. Give SafeCallNow.org #, PRNd. Support Group:________________.

Instructions. Place an X by items to be included in the care plan. Upon completing that care activity, replace the X with the helper’s initials and date it.

A. What role did this employee have related to this event?

Sections A through E: Complete prior to planning care

C. Employee’s Distress: Ask… RecordHere:

D. Invite employee to describe distress:

E. Past HIE exposures. Ask: “Are there other major events you’ve been exposed to in the line of duty that are still disturbing to you?”YES_____ NO ______ (If yes, take note and emphasize benefits of doing PEPCP planning)

Time:

b. Group spiritual support/present.

b. ProQOL (Screen: Comp. Fatigue)

Note: Select A PEPCP coordinator to assure follow-up/documentation through year.

Shared with: ••PEPCP Coordinator:•

Extremely High Possible: Personally devastated Poss. Severe shock, numbness Poss. Serious Difficulty functioningIndicates: ASAP PEPCP & Clinic. Assessment

Very High Likely deeply distressing Functioning may be impactedIndicates: Immediate PEPCP; completion of clinical assessment required/strongly urged within 48 hours

High

B. What intensity level could the event be for this employee, per role?

Significantly distressed: cumulative riskIndicates: PEPCP completion within 1 week

9-1-1 Director's Post-Tragedy Care Checklist Resource

*NOTE: All these signs can be normal responses to abnormal circumstances. But be sure to seek professional help if they endure for over 30 days OR are seriously interfering with your ability to function now, AND OR you are struggling with suicide thoughts. In crisis, text CONNECT to Crisis Text Line: 741741 (https://www.crisistextline.org/textline) or

contact NSPL Hotline @ 800.273.8255 (https://suicidepreventionlifeline.org/). Both are 24/7/365 support for you!

APPENDIX C 9-1-1 Director's Post-Tragedy Care Checklist Resource

9-1-1 Leader’s Post-Tragedy Care Checklist Resource

APPENDIX D

PSAP Leader’s Sample Letter Informing Staff of Tragedy

Note to leader: this is only an example of the type of communication that can be helpful for leaders to initiate after a High Impact Event. It is offered simply as a resource. Be sure to carefully read this sample letter; revise as desired to make it your own as desired; replace bracketed instructions with your actual information; and, place document on your letterhead.

Dear Staff:

When tragedy strikes our comm center, it’s important for us all to be informed so we can join together to give and receive the support we need. As you hopefully know, since our leadership team has worked to inform all personnel in-person, today we face such a situation.

Let me briefly summarize again what we know to be sure we all share the same accurate understanding of what has taken place. On

[…time/date of the event]

[name of involved personnel]

[briefly define the incident and outcome that occurred]

I know this event is very hard to hear, and I want to assure you that we’ve already reached out to most personally affected, including [indicate names). We want to be sure that they, and you too, have all the support needed because each of us will be impacted in some way.

I’m also asking for your help in sharing responsibility for your well-being and your peers’ as we travel through this hardship in the days ahead, so that no one is left behind. Let’s not obey the old “Suck it up” mentality. It IS okay to not be okay as long as we’re in it together. So please carefully read the attached handout called Signs to Look For, and if you recognize you’re having a hard time, please be sure to reach out as needed to a trusted leader, peer, or one of the professional providers available through or recommended by our EAP. A list of all these support folks is attached [build and attach list including those parties, with names, phone and email].

If you notice a peer struggling, please assist them in seeking help, and if you aren’t sure what to do, be sure to let me [or your designee] and or members of your peer support team [if a team is in place]. And please remember, I will keep my office door open to welcome your visit in the days, weeks and months to come.

We can all come through this together! Be assured [I/we] will keep you updated as we learn more along the way.

[Your Name, Title]

9-1-1 leaders’ post tragedy care checklist€¦ · 2 | 9-1-1 leaders’ post tragedy care...

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