Routine Operating Policies and Procedures

ROUTINE OPERATING POLICIES AND PROCEDURES San Jose Fire Department

Chapter Title: Section No:

Section Title: Critical Incident Stress Management Effective Date:

6.0 CRITICAL INCIDENT STRESS MANAGEMENT (CISM)

6.1 PURPOSE The purpose of this policy is to identify the application of "Critical Incident Stress Management (CISM).” Situations and incidents that our personnel respond to that meet the criteria of a Critical Incident should be treated as an emergency for those involved. Every effort should be made by Company Officers, Battalion Chiefs, and Deputy Chiefs to ensure our firefighters are responded to in a timely fashion.

6.2 SCOPE OF APPLICATION

The CISM policy applies to all San Jose Fire Department employees.

6.3 BACKGROUND Case studies of major incidents where numerous injuries or fatalities occurred have revealed that significant numbers of emergency personnel experienced some form of stress-related symptoms following the incident. Some of these symptoms were transitory and had no long-term detrimental effects. These studies however, have also revealed that a percentage of personnel do experience some form of long-term detrimental effects after a period of no apparent symptoms. Without intervention, some personnel may experience declining work performance and deterioration of family relationships, as well as increased health problems. The objective of this procedure is to provide CISM intervention immediately after critical incidents to minimize stress-related injury to Fire Department personnel.

6.4 THE CISM TEAM

The San Jose Fire Department’s CISM Team consists of SJFD peers of all ranks, including Fire Dispatchers, who are trained in critical incident stress and trauma/death notification. The team also has access to mental health professionals experienced in stress-related counseling.

The CISM Team operates under the Office of the Fire Chief. The team coordinator shall report directly to the Fire Chief or his designee (Assistant Fire Chief). The CISM Team coordinator shall meet with the Fire Chief on an annual basis to discuss the upcoming year’s budget including approved expenses and any current issues impacting the department or the CISM Team.

6.5 EDUCATION AND TRAINING OF THE TEAM / CISM TEAM MEETINGS / CALL OUTS

The CISM Team conducts ongoing training throughout the year. The training may include Basic and Advanced CISM Training, Suicide Prevention Training, Crisis Management, Death Notification, and Managing Grief and Loss. Overtime will be provided for attending ongoing training in accordance with City of San Jose policies. If a team member is on duty, time off to -1- ROUTINE OPERATING POLICIES AND PROCEDURES San Jose Fire Department

attend training shall be granted through approval of the team member’s supervisor. The CISM Peers position may be backfilled with overtime or relief. Prior approval for back-fill with overtime will be authorized by the Fire Chief or his designee. Training sessions can occur in the City of San Jose, outside of the City and County, and out of state. All training shall be approved by the Fire Chief or his designee (Assistant Fire Chief). Before any training can occur the appropriate documentation must be submitted for approval. All training that occurs out of state must be authorized through the Office of the City Manger through the Fire Chief. The CISM team also conducts quarterly CISM Team meetings. Overtime is provided to team members attending off duty. CISM Team members will also be compensated with overtime in the event they are called in for a defusing and they are off duty.

6.6 THE CRITICAL INCIDENT Fire Department response to incidents that expose personnel to unusually strong emotional involvement may qualify for "Critical Incident Stress Management.” The following are examples of incidents that may be selected for intervention:

1. Serious injuries or death of a Fire Department member or other emergency personnel. 2. Mass Casualty incidents. 3. Suicide of a Fire Department member. 4. Serious injuries or death of a civilian resulting from Fire Department operations (i.e., auto accident, etc.) 5. Death of a child, or violence to a child. 6. Loss of life of a patient following extraordinary and prolonged expenditure of physical and emotional energy during rescue efforts by Fire Department personnel. 7. Incidents that attract extremely unusual or critical news media coverage. 8. Any incident that is charged with profound emotion. 9. An incident, in which the circumstances were so unusual, or the sights and sound so distressing, as to produce a high level of immediate or delayed emotional reaction.

6.7 CRITICAL INCIDENT STRESS MANAGEMENT INTERACTIONS

Critical incident stress management interactions are not a critique of fire department operations at the incident. Performance issues will not be discussed during these interventions. No documentation of the interaction will be made except for the San Jose Fire Department Contact Form. This form is used for numerical data collection purposes and has no record of the details of discussion. CISM provides a format in which personnel can discuss their experiences and reactions and thus reduce the stress resulting from exposure to critical incidents. All CISM interactions will be strictly confidential.

Several types of interventions may be conducted depending upon the circumstances of a particular incident. They may be conducted on an individual, one-on-one basis, or more -2- ROUTINE OPERATING POLICIES AND PROCEDURES San Jose Fire Department

typically, in small groups of not more than 25 members. The following five types of interventions singularly or in combination, are most commonly utilized:

• On-Scene or Near-Scene: Conducted during ongoing operations, moderated by either a peer counselor or mental health professional. Most commonly used on large-scale incidents with extended operational periods. Peers will be present on scene to touch bases with crews and access the need for further interventions. (See 6.8 "On-Site Management")

• Initial Defusing: Conducted shortly after the incident and moderated by a trained peer counselor (CISM peer) and assisted by at least one other peer counselor. (The number of peers is determined by the size of the incident and number of individuals involved) The goal is to conduct the defusing before those involved in the incident go off of shift. It is usually impossible to bring the same group of people together again the following shift due to shift trades, overtime and relief personnel. If the defusing cannot occur the same day, every effort should be made to conduct the defusing the next shift. Captains, Battalion Chiefs, and Deputy Chiefs should make every effort to ensure the defusing takes place. Defusings are primarily informational; discussion centers on a chronological recounting of events, observations, experiences and responses to the incident. A verbal update and status report on the incident, outcomes, and related injuries may also be reported. A trained peer counselor will provide a brief review of stress-related symptoms. A more intense debriefing may be provided on an individual basis as requested by a crew member, or as the need is observed by the CISM team during the defusing meeting.

• Formal Debriefing Meetings: Every effort should be made to conduct the Debriefing within 72 hours of the incident. Debriefings should be moderated by a mental health professional. The mental health professional can be contacted by Fire Communications to obtain the contact information for the contracted services. The mental health professional will also be assisted by trained CISM peer counselors. Defusings are often incorrectly called debriefings however by definition a debriefing is differentiated from a defusing by the presence of a mental health professional. A Debriefing is a confidential, non-judgmental discussion of involvement, thoughts, and reactions resulting from the incident. Also included is a discussion of possible stress-related symptoms.

• Follow-Up Debriefing: Conducted weeks or months after the incident by either a mental health professional or peer counselor. Discussion is related to concerns with delayed, ongoing or prolonged stress symptoms. May be done formally, informally, face to face, or by phone.

• Individual Consults: Available at any time, as needed. One-on-one counseling for any concerns related to the incident. Company Officers, Battalion Chiefs, and Deputy Chiefs should make every effort to allow a CISM Peer respond to individuals who have requested an individual consult.

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6.8 ON-SITE MANAGEMENT

Minimizing personnel exposure to these stressful incidents results in fewer stress-related problems. Incident Commanders should attempt to reduce this exposure by rotating personnel and by removing initial personnel from the scene as soon as possible.

Any personnel directly involved in high-stress incidents (particularly examples 1 through 4 in previous section) should be considered as a high priority for removal from the scene. Relief from duty for these personnel may also be a consideration and should provided in accordance with applicable policy.

On-site evaluation and counseling by a CISM Team member should also be considered for some critical incidents when time and circumstances permit. In such situations, CISM Team members can observe, watch for acute reactions, provide support, offer encouragement, give consultation, and be available to help personnel deal with stress reactions. Team members should be considered a resource available to Incident Commanders including possible assignment to Rehab or other divisions as needed.

6.9 ACTIVATION OF THE DEFUSING/DEBRIEFING PROCESS

The process and events that lead up to identifying an incident as a critical incident can be different for every situation. There is no textbook description of how the events will unfold. Every type of situation is different and we must be flexible so that we ensure our ultimate goal of taking care of our firefighters is met.

Company Officers, Command Officers, CISM Team members, and Dispatch bear the responsibility for identifying/recognizing significant incidents that may qualify for CISM. When an incident is identified as a "Critical Incident" (as described), a request for debriefing or defusing consideration should be made as soon as possible. Critical Incidents shall be identified as a true emergency for our Firefighters and responded to in a timely manner.

The process may be initiated in one of the following ways:

1. Fire Communications may identify an incident as a critical incident. Fire Communications is trained in regards to identifying incidents that qualify as critical incidents.  Once identified as a critical incident they will contact the appropriate BC to notify them of the potential need for follow-up by a CISM Peer.  Communications will use the CISM Peer call-out list in communications to call a CISM Peer.  The CISM Peer will make contact with the Battalion Chief and the crew to determine the need for the appropriate intervention.

 If the Battalion Chief cannot be contacted by Communications, Fire Communications should continue to make the call to the CISM Peer so the process is underway.  Both Communications and the CISM Peer will still make every effort to contact the Battalion Chief. Example: attempt to contact via radio and cellular telephone.

2. The Company Officer or any member of a crew may identify the incident as a critical incident. It is the Company Officer’s responsibility to contact their Battalion Chief and Fire Communications to initiate the process of contacting a CISM Peer.

3. A Battalion Chief may identify an incident as a critical incident and initiate the process by calling Fire Communications.  Fire Communications will contact a Peer.  The responding Peer will then contact the Battalion Chief to gather more information regarding the incident.  The Battalion Chief is responsible to notify the Duty Chief regarding any activation.

4. If the incident is still in the early phases when it is identified as a critical incident the process should be coordinated through the IC or their designee. The IC or designee should contact communications to initiate the process.

5. A CISM Peer may initiate the process after they hear of a call that has occurred that may qualify as a critical incident. The CISM Peer may call Fire Communications to verify the potential for a critical incident and follow the appropriate steps to follow-up.

The bullet points below address information that is needed in order to facilitate the call-out. The Battalion Chief should ensure that all items are addressed. The information below should also be given to Fire Communications and the CISM Peer who is contacted as the lead peer for the incident.

• Incident number, date and time. • Brief description of incident. • Affected or involved companies. • Number of affected or involved personnel. • Move-up or relief personnel needed for coverage during defusing/debriefing. • Recommended date, time, and location for defusing/debriefing. • Name of the Duty Chief authorizing the defusing/debriefing.

When a CISM Peer is contacted the incident will be evaluated by the peer for the level of intervention required. The specific services utilized will depend upon how early the team is activated and the nature of the incident. Battalion Chiefs will work with the CISM Peer(s) to help facilitate a timely response to the needs of the Firefighter(s) involved.

Any member who feels a need for an individual, confidential debriefing, may contact a CISM Peer directly (call communications for a list of peers) or may contact the contracted professional counseling staff directly.

To ensure the welfare of all employees, remember that anyone may request either an individual or Company CISM intervention.

6.10 CISM RESPONSE:

Fire Communications maintains a current CISM Peer Counselor contact list and contact information for the contracted mental health professional. The list rotates through the peers for each shift so that the same peer is not contacted for multiple incidents. Fire Communications will call on-duty CISM Peer Counselors first. Every attempt shall be made by the CISM Peer’s supervisor to allow the Peer to leave their station in order to facilitate and conduct defusings/debriefings. This may include moving up companies or reassigning personnel to accommodate the Peer leaving the station to meet with the individual or crew(s) affected. Each critical incident defusing/debriefing is different and may dictate a greater use of resources and Peer Counselors depending on the size and scope of the incident.

In the event that no on-duty Peer Counselor(s) is/are available or able to conduct the debriefing/defusing, off-duty Peer Counselors will be contacted. Compensation for coming in off duty will be compensated at the appropriate overtime rate.

San Jose Fire’s Peers will facilitate Defusings. Debriefings will be facilitated by mental health care professionals, accompanied by SJFD Peer Counselors. The Fire Department team members' role in the debriefing process will be to assist and support the professional counselors as necessary. Contracted mental health professionals may administer follow-up care.

In the event of a Line of Duty Death, CISM Peers from other Fire Department Agencies may be contacted to assist with Debriefings. The San Jose Fire Department CISM Team Coordinator will be in charge of overall coordination of any Debriefings. San Jose Fire Department is part of a larger “Bay Area CISM Team.” The Bay Area CISM Team works together in the event of large incidents or when no San Jose Fire Department CISM Peers are available. San Jose Fire Department Peers are also available to assist other agencies when they lack resources. All requests to assist agencies outside of San Jose must be approved by the Duty Chief, Assistant Chief, Fire Chief, or his designee.

6.11 ATTENDANCE

Attendance at a defusing or debriefing is MANDATORY for all personnel who were directly exposed to the traumatic aspects of an incident or otherwise identified as a person suffering symptoms. While attendance is mandatory for employees who were part of the incident or exposed to the incident, participation is voluntary. Employees are required to be present but they do not have to speak if they choose not to. Only those who were part of the incident may attend the defusing or debriefing. It is the responsibility of the Battalion Chief to make sure all exposed Fire Department members are at the defusing/debriefing. Invitations to other agencies to attend may be considered if deemed appropriate based on their level of involvement with the incident. Examples of agencies that may be included in the defusing or debriefing if they were part of the incident include AMR, SJPD, Park Rangers, Search and Rescue and Cal-Star.

It is also important to remember that Fire Communications is often the first contact with a critical incident. It is important that contact is made with Fire Communications by a CISM Peer to ensure that the call-taker(s) have the opportunity to speak with a peer if they choose. Supervisors should help facilitate the response of a CISM peer to Fire Communications if necessary.

6.12 LOCATION

CISM interactions may be conducted anywhere that provides ample space, privacy, and freedom from distractions. Fire Stations, Fire Station Conference Rooms, Churches, Hospitals, City facilities, or other meeting facilities centrally located to the involved companies are worthy of consideration. Selection of the site may be determined by a CISM Peer, Bureau of Field Operations, the affected BC, or the Company Officer. The affected company/companies will be out of service for both defusings and debriefings.

6.13 RELIEVING PERSONNEL FROM DUTY

Circumstances of a critical incident may result in a recommendation by the CISM Team that individuals or companies be taken out of service, or that individuals should be provided release from duty. It is also possible that employees who were involved in a critical incident may feel that they are unable to complete their shift or return to work. The CISM Team and/or the professional counselor will evaluate the situation and make one of the following recommendations: 1. Return personnel to their station(s) in an out-of-service status and allow the crew(s) to determine for themselves if/when they are mentally and physically prepared to return to service. 2. Recommend that a crew be relieved from duty for the balance of the shift. If this is the case, appropriate steps should be taken to notify the employee’s spouse, roommates, or

family of the member's status, and to provide direction on how they can best assist the member through this difficult time.

Note that approval must be received from the appropriate Deputy Chief or Duty Chief prior to relieving a crew from duty or placing a crew out of service.

A. Personnel Relieved of Duty Related to a Critical Incident / Supervisor’s Responsibility / Employee Responsibility

Personnel taken out of service or relieved of duty after a critical incident are to be viewed as, and are to be treated with the same consideration as an "injured" Firefighter. Under no circumstances is such action to be construed as disciplinary and should not reflect negatively on the member.

If a SJFD Employee is released from duty as a result of stress related to the incident, all appropriate Workers Compensation paperwork must be filled out by their supervisor and routed through the appropriate channels. Employees should be aware that when they miss work due to stress caused by an incident and a workers compensation claim is filed, the claim would be subject to review by Workers Compensation. Employees will have to use their own sick, vacation or compensatory time balances to cover the time pending approval of the claim, or lost time if no personal leave balances are available. If the claim is approved, any balances used will be credited back to the employee. The employee is responsible for following proper policies in order to return back to work. (For example; making an appointment with an EAP counselor or seeing your personal physician). CISM Peers will be available to assist injured firefighters in any way needed throughout this process.

B. Alternatives to Relieving Personnel from Duty

In some circumstances, it may be appropriate to reassign an employee who has experienced a critical incident from their normal duties or assignment for a period of time. The Fire Chief will make this determination based on information and recommendations provided by the CISM Team and the employee’s supervisor. In such cases, the Fire Chief will utilize the right of assignment.

Additionally, it is possible that an employee who has experienced a critical incident may wish to be reassigned from their normal duties or assignment for a period of time. The employee may make this request through a CISM Team member, through their supervisor, or directly to the Fire Chief.

If an employee is reassigned from their normal duties or assignment based on exposure to a critical incident, the supervisor shall ensure that the employee is provided an opportunity to submit or have submitted on his / her behalf on the job injury reports according to departmental policy. BAS may be consulted for guidance on matters related to injury reporting.