Posted by: njrigg | February 23, 2010

Aquatic Tragedies: Crisis Support on Scene

Aquatic Tragedies:  Crisis Support on Scene

By Nancy J. Rigg

Critical Incident Stress Management (CISM) specialists understand that all drowning deaths and other serious or fatal accidents in the aquatic environment automatically qualify as critical, traumatizing events.  Sudden, powerful emotional trauma can have both an immediate and long-term impact on surviving family members and other witnesses who are on scene, as well as water rescue and recovery personnel responding to these emergencies.

Pacific Ocean rocks

Research has shown that the sooner survivors are educated about the impact of severe emotional trauma the better their chances are of making a healthy recovery, even from the most tragic loss.  Water rescue personnel who are well educated in CISM also have a better chance of maintaining a long and healthy career in an environment that is not only dangerous physically, but taxing emotionally.

CISM peer support resources are being made available at an increasing rate to emergency responders nationwide.  Unfortunately, for those who are most seriously affected by any given tragedy – surviving family members – crisis support information and resources are scarce, if available at all.  And at a time when families most need sensible, accurate information and guidance, they may have no idea where or how to find it.

One possible remedy is for CISM trained counselors, including religious leaders and civilian volunteers, to be woven into the structural matrix of all water rescue and recovery protocols, including the pre-planning process.  Skilled counselors can be deployed through predetermined, automatic call-out protocols to avoid confusion and ensure that appropriate resources respond quickly.

Crisis counselors can serve as liaisons with the families and others on scene, freeing water rescue and recovery personnel to focus on finding and recovering missing victims as quickly and safely as possible.  Crisis counselors can also work with public information officers (PIOs) to protect families from media intrusion, especially during prolonged, complex, politically charged, and dangerous recovery missions.  The media does not have an automatic right to cover every phase of the recovery process.  Having both a PIO and crisis counselor on scene can help control interaction with reporters who feel entitled to have access to every detail of “the story.”  PIOs can aid the media in “getting the story” in a way that is professional, but not intrusive either to the surviving family members, or the deceased victims, who also deserve to be treated with respect and dignity.

By integrating CISM trained volunteers into the response matrix, water rescue and recovery team members can be buffered from the emotionally draining job of interacting with families and others who are invested in the outcome of the mission.  Trained crisis counselors can support and guide survivors who are waiting at the edge of the water for news about those who are missing.  They can watch for signs and symptoms of shock, extreme emotional distress, or physical ailments.  And they can also keep an eye on the emotional well being of rescue and recovery personnel on scene.

Beautiful Waves

Information: Too Much… Too Little

One of the more difficult judgment calls is how much information to share with families, the media, and other interested parties, and determining how and when this information is relayed.  It is rarely helpful to sugar coat the truth, but it can also add unnecessary layers of trauma when “too much” graphic information is given to families who are aching for news.  Care must also be taken when families demand to view deceased loved ones who may be maimed, bloated, disfigured, or covered in silt and grime.  If possible, when submerged victims are being brought to the surface, their remains should be secured in closed body bags before being removed from the water.

If family members feel compelled to view their loved ones, this needs to be supported and not impeded, but the request should be filtered through the very real issue of trauma exposure.  An on-scene crisis counselor can choreograph the least traumatizing way to manage this.

Death and dying pioneer, Dr. Elisabeth Kubler-Ross, always stressed that while viewing remains must be a choice open to surviving family members, rescuers can help by making the remains as clean and presentable as possible.  If the face is disfigured, Kubler-Ross recommends having the family view an arm or article of clothing.  If there is severe decomposition, Kubler-Ross recommends against viewing the remains on scene, but rather viewing them later at the Coroner’s Office, under the guidance of forensic specialists, using photos or other appropriate filters when needed.  If family members can be accompanied by crisis counselors when they go to the morgue, this can help maintain continuity of care and ease the shock and trauma of this experience as well.

Crisis counselors, who also need to be educated in water rescue and recovery, can evaluate how best to interact with survivors on scene and what details to share with them.  It is important to collaborate with command staff.  And although it is unwise to withhold information, neither is it sensible to burden family members with gruesome details that can add to the post-traumatic stress cauldron that is already brewing.

Building Resources

CrisisCouseling-sign

It is important to assign a Family Liaison to surviving family members who have missing loved ones in water.

In today’s world, water rescuer and recovery personnel should not be expected to serve in the capacity of on-scene crisis intervention specialist, which is a discipline that requires specialized training that meets current disaster mental health standards.

Some cities, including Los Angeles, have developed highly trained volunteer community crisis support teams that respond to homicides, fires, major traffic accidents, mass casualty incidents, and other accidents and emergencies, and assist local agencies with death notifications.  LA Crisis Response Team volunteers receive specialized training necessary to provide immediate on-scene emotional support, and manage follow-up referrals.  Many volunteers are multi-lingual and sensitive to diverse cultures.

The American Red Cross is another invaluable resource through their Disaster Mental Health program.  Tragedies do not necessarily need to be on the scale of a major disaster to involve skilled Red Cross specialists.

For rescue personnel, the International Critical Incident Stress Foundation in an invaluable resource, with information about CISM programs and peer support teams nationwide.

The United States Coast Guard Search and Rescue Manual includes well defined protocols for working with families, especially when a rescue or recovery operation is complex, prolonged, and extremely dangerous.

At the very least, water rescue and recovery teams should provide survivors with a simple printed hand-out that includes follow-up information and resources.  Flashbacks, nightmares, and other symptoms of post-traumatic stress are normal in the aftermath of a sudden and traumatic drowning or other aquatic accident, but this is not understood in the general populace.  Education is vital.

First responders are the first stop for surviving family members on the road to recovery.  Effective interaction, pre-planning, and coordination with crisis support resources can lay the foundation for survivors to begin a healthy recovery process even in the aftermath of the most devastating of personal tragedies.

ADDITIONAL INFORMATION:

Drowning Support Network

https://www.facebook.com/groups/DrowningSupportNetwork

Sudden Death – Grief and Trauma Brochures

http://higginsandlangley.org/resources-links/sudden-death-grief-and-trauma

Los Angeles Crisis Response Team

http://www.lafd.org/join/volunteer/crt

International Critical Incident Stress Foundation

http://www.icisf.org

American Red Cross Disaster Mental Health Services

http://www.redcross.org/news/article/Red-Cross-Mental-Health-Teams-Help-People-Cope-During-Disaster

United States Coast Guard – Search and Rescue

Next of Kin Notification Guidelines – an excellent model program for all SAR groups

http://www.uscg.mil/hq/cg5/cg534

© Nancy J. Rigg

Updated August 3017

Please Do Not Reprint Any Portion of this Article Without First Securing Permission, Thank You

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Responses

  1. The most important thing is signage in multiple languages in areas of known risk.

  2. Signs can help prevent tragedy, that is true. We are focusing here, with this article, on support and guidance after something bad happens. Thanks!


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