Decompression and de-escalation of emotional scenes
Eliminating the distressing sights and sounds of the job is impossible, but we can better prepare first responders for dealing with emotional scenes
While tragedy can befall anyone, what are frequently considered once-in-a-lifetime events for most are routine occurrences for first responders. Repeated exposure forms “thick skin” but insufficiently protects against burnout, emotional exhaustion and post-traumatic stress disorder (PTSD).
First responders have a 10% increased risk of developing behavioral health conditions such as depression compared to the average American. Without proper coping mechanisms and support, many succumb to substance abuse or lose their lives to suicide. Every year fire stations are 3-4 times more likely to experience a suicide than a death in the line of duty. Also, first responders cannot follow the conventional advice of “removing the stressor” from their lives without sacrificing their career, income, and passion for helping others.
Communities cannot afford to lose experienced first responders; their expertise improves outcomes and saves lives. Eliminating the distressing sights, sounds, and smells of the job is impossible, but we can better prepare first responders for dealing with emotional scenes to preserve and protect their well-being.
The following recommendations can help with de-escalation and decompression of emotional scenes.
1. Knowledge is power
Provide first responders with as much information as possible before they arrive on the scene so they can prepare themselves mentally, physically and emotionally. Knowledge reduces unpleasant surprises, increasing confidence in performance. For example, if the victim’s family members, friends, or neighbors are on the scene, first responders can brace themselves for public grieving.
An explanation can be a powerful balm for an anxious or agitated individual. Most people are unaccustomed to emergencies and unfamiliar with the types of personnel involved and protocols in place. Take time to guide them through the process by sharing your knowledge and experience. You may find that it helps them remain calm throughout the emergency.
2. Divide and conquer
Role ambiguity increases burnout. Be specific about the responsibilities involved in each task to limit confusion where duties may overlap. Emotional situations are dry tinder for chaos, but an organized response helps keep the flames contained. When team members understand their assignments, they work effectively together to complete them. The emergency never devolves into disarray because first responders stay on top of the situation as events unfold.
Carefully assign tasks. If a first responder was recently on the scene of a high-stress or emotional emergency, consider giving them a light assignment or letting them sit out the job altogether. Having sufficient recuperation time between tragedies reduces compassion fatigue.
3. The buddy system
Encourage each first responder to have a backup person to take over for them if they become overwhelmed and need to step away from the situation. Having an exit strategy eases anxiety during stressful events and prevents emotional or violent outbursts.
Understand that we can all become overwhelmed from time to time. Emotional scenes can be difficult to navigate. Acknowledging this – as individuals and as agencies – is the first step toward creating a culture where it’s OK to step away if you fear for your own mental or emotional safety.
4. Body language
Aggressive body language unknowingly escalates an already tense situation. First responders should learn to identify nonverbal aggression in themselves and others and practice non-confrontational posturing. When uncomfortable, first responders should maintain physical distance from the potential threat and locate a safe place to escape to, if necessary.
Sometimes there is nothing that will calm down an angry individual. Recognize when that might be the case, and if they present no physical danger, keep your distance and let their emotions run their course. If you determine an aggressive person might harm you or a coworker, remain situationally aware as you work, and watch each other’s backs.
5. Speak up
Ask for help. Verbalize discomfort. Create a culture of open communication by praising those who speak up when they enforce a boundary or vocalize a concern. Remaining silent to save face compromises first responder and patient safety. If a first responder is emotionally compromised and unable to proceed safely, it is better for them to admit that than carry on anyway. If a lifesaving intervention results in a poor outcome because of first responder negligence, the threat of litigation and personal guilt will compound the preexisting trauma.
Talking face-to-face is essential for processing traumatic events. Ideally, each first responder has a co-worker with whom they can share their unfiltered thoughts and feelings. Debriefing, recounting “war stories” and using black humor foster camaraderie and healing. If not, encourage first responders to confide in a family member or close friend. Repressed emotions fester by isolating the individual further and reinforcing feelings of helplessness.
6. Pay attention
Often we let things happen without noticing how they affect us, which leads to feeling overwhelmed by our circumstances. Mindfulness is an empowering meditative practice that builds resilience. Through acknowledgment and acceptance, practitioners of mindfulness increase their coping capacity. Simple ways to become present in a high-stress situation include taking deeper breaths, focusing on the sensory input from one of the five senses, and listening to thoughts without trying to change them. We exacerbate mental stress when we try to fight rather than accept our unpleasant thoughts and feelings.
7. Stay professional
Maintaining professionalism protects first responder mental health. It enables effective service by letting them do their job. Excessive empathy distracts first responders from their work by compromising their emotional stability. Be professional without acting robotically. Some emergency responders view patients as objects to encourage emotional detachment, but this attitude taken to an extreme may further aggravate victims and bystanders. Professionalism tempered by compassion is the ideal balance. Compassion frequently de-escalates hostility by validating the victims’ suffering.
First responders should seek out a small, personal way to make a difference for those they serve. A desire to help others continually motivates many first responders to do what they do each day despite hardships. Even if an emergency doesn’t end with the desired outcome, first responders will be less discouraged if they feel like their presence meaningfully benefited at least one person.
8. Prioritize peace of mind
Pencil in much-needed R&R following your shift. Choose a simple and enjoyable activity that ideally enriches your connection with a loved one.
First responders should avoid using alcohol as part of their relaxation plan or limit themselves to one drink. Substance use is a poor coping strategy that often breeds more problems than solves. One study found recent heavy or binge alcohol drinking in approximately 50% of male firefighters and driving while intoxicated in 9% of male firefighters.
Visualization or repeating a relaxation plan like a mantra may motivate first responders to press through difficult moments by reminding them of eventual respite. Being on the scene of a tragedy is difficult, but it doesn’t have to be detrimental to first responders’ mental health. These recommendations effectively de-escalate and decompress emotional moments to protect first responders, and by extension, benefit on-scene victims to improve outcomes.