Responding to Incidents

We practice aerial rescue, but are we prepared for a real one? All photos courtesy of the author.

A positive trend in the tree care industry is the awareness that we can be a key link in the chain of survival for trauma incidents, especially the aerial ones. But those responding to and assisting with such incidents can often end up with wounds of their own.

There are increasing efforts on the part of tree companies to seek out their local fire-and-rescue services for joint training exercises to better prepare for an arboricultural incident. Tree workers want to have a better understanding of their potential roles – and that of the professional rescuers – for if and when an incident occurs within their company. Many climbers have gone a step further and have volunteered to assist fire and rescue in any local tree-related aerial incident if the situation arises.

While arborists’ efforts to cooperate with local fire and rescue are not always met with enthusiasm, many rescue professionals are willing to work with them to train for rescues in the unique environment of a tree canopy. They recognize that climbers have a skill set that complements their rescue capabilities. Climbers who have worked with their local fire-and-rescue crews are now finding themselves called upon to assist in the professionals’ rescue services. This is what we all want to see, and there has been good success in developing these cooperative arrangements.

But there is a dark side to this success. What if the climber does respond to a trauma incident, one that involves more than assisting an injured climber down? Instead, perhaps it’s a trapped-and-pinned incident where there are dismemberment or other gruesome injuries that will be seen close up. And what if the aerial rescue becomes a body recovery?

One climber who worked with his local fire-and-rescue service and volunteered to assist found his first response was to retrieve the body of a climber who had severed his neck with a chain saw and bled out before anyone reached him. Another climber performed a rescue with his fire-and-rescue service that was successful – the injured climber survived – but the wounds were horrific.

These climbers commented afterward that while they were glad they could offer their services, they were on their own afterward in coping with the stress of the incident. As one commented later, fire and rescue took control once the injured climber was lowered; he was placed in the ambulance and everyone left. The climber felt abandoned and has had trouble dealing with the event.

This feeling is not unique to climbers assisting in a rescue. It also can occur to any crew member who responds to help an injured ground worker. Since they are first on the scene, the first aid they provide can be critical to a successful outcome. However, an injured worker may die or suffer life-long disabilities regardless of the efforts of the crew.

One part of first-aid training, a prerequisite for any responder, is knowing its limitations – knowing what can be done on site with minimal medical supplies and what cannot be done. A crew with no first-aid training that witnessed a co-worker dismembered by a chipper felt guilty that they could not bring themselves to do cardiopulmonary resuscitation (CPR) – the wounds were that shocking. If they understood CPR and knew how to perform it, they would have known it would have had no impact on the outcome. Sometimes there is little that can be done on site.

Managing the stress of responding to a severe nonfatal or fatal incident is not a topic frequently addressed in the tree care industry. We focus on incident prevention, clearly a priority, and the first-aid response if an incident does occur, but we do not discuss the needs of the aerial rescuers and ground workers who respond to the incident.

This is a topic that is discussed as part of the training with emergency medical technicians (EMT), fire/rescue and law enforcement. Critical Incident Stress Management (CISM) was integrated into EMT curricula during the 1980s, and, while it has detractors for some of its practices, stress management is an important subject for these professions.

What happens after EMS leaves?

Once, the prevailing attitude in emergency medical services was just “suck it up.” Do your job, don’t complain, forget what happened and just move on to the next call. You were not expected or encouraged to talk about it. Just block it out. And some did and can. But others who seemed to be fine began suffering days or weeks later; the horrors of the event were bottled up in their brains and just kept playing over and over in their minds.

Some compensated by drawing inward, becoming more isolated; others became workaholics, maintaining heavy and constant work schedules to keep from dwelling on the event. We also had some who became angry, lashing out at others for the smallest provocation. And some found refuge in drugs.

All these were reasons for the development of a stress-management system for the professionals for whom exposure to traumatic events can be part of their job. The genesis to this process was called critical-incident stress debriefing, and its objective was to provide an opportunity shortly after the incident for responders and a facilitator to talk out the responder’s reaction to the event. This was expanded to become CISM as the objectives expanded to include prevention of long-term disorders such as post-traumatic stress disorder (PTSD).

Aerial rescues can involve the rescuer having to deal with trauma related to the event afterward.

We, as an industry, need to respond better for those who step up and assist an injured worker, whether a co-worker on the ground or one aloft. The responders, having witnessed firsthand severe injuries and death – referred to as critical incidents – may not be able to cope with the emotional stresses that, left unaddressed, can lead to longer-term disorders. Unfortunately, many companies do not have a formal plan to address this critical need of responders.

The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) does not have standards for employers to assist employees dealing with critical-incident stress. However, it does have recommendations for helping reduce the risks associated with it.

OSHA recommends following CISM, and this includes a critical-incident stress debriefing (CISD) within 24 to 72 hours after the event. These are facilitator-led group exercises usually limited to those who actually experienced the event. As mentioned earlier, there are some elements of CISM, including the group debriefing, that are not universally accepted among professionals. Regardless, these are not something to be run by someone in the company, but should be run by a professional facilitator who has the training and certification to help begin the recovery process and also to screen to identify responders who may benefit from additional support or care.

Formal debriefing may not benefit all nor always be necessary, but many responders may seek an opportunity to work out their emotions. There are many approaches to supporting someone who witnesses and assists in the event, one being to give the person an opportunity to talk it out. This should not be forced, nor mandatory; not all will welcome the opportunity, and some may be more traumatized by having to recollect the event.

Often, the only person or persons they want to talk with are others who were on the crew at the time. Talking with a manager or boss who was not present may seem more like a review of the incident to determine right or wrong. Professional counseling may be preferred for some.

Companies also should be alert to a responder who is having difficulty coping with the event. Everyone responds differently and some will hide any difficulties, worrying that expressing emotions are a sign of weakness. However, there are some common signs and signals of a stress reaction that companies should watch for and anticipate in workers who have responded to a traumatic event. Some may become distracted or disorientated. They may have poor concentration and have trouble remembering simple day-to-day tasks. Depression, anger, outbursts and feeling overwhelmed are also possible emotional reactions to the event.

Crew members who have been through one of these events should be monitored. They may still be working through the stress and be distracted. Arboricultural operations require continual situational awareness. A momentary lapse of attention, i.e., forgetting to clip in when repositioning or switching climbing systems, can have lethal consequences. Incident rates go up with distracted workers; incidents can build on other incidents.

Every tree company should have a plan for how to assist crew members who respond to a critical incident. The plan should be in place and executed immediately following the incident. As OSHA notes in their Critical Incident Stress Guide, shortly after the incident, do not rush the responders to return to work, and provide a blend of support. Give them time to rest and settle down after the adrenaline rush of responding to the event. Reduce exposure to distracting sensory inputs such as noise, harsh lights and even smells, and provide non-caffeinated (and non-alcoholic) drinks. Give them an opportunity to talk out their feelings, either with co-workers who also responded or at home with family and friends.

Not every critical incident or responder will require the same interventions. However, the company should have a pre-incident process in place to proactively address, rather than wait for a worker to exhibit symptoms of, critical-incident stress. Recovery from the stress, building resiliency and a return to health is in the best interest of the workers and the company.

John Ball, Ph.D., BCMA, CTSP, A-NREMT (National Registry of Emergency Medical Technicians), is professor of forestry at South Dakota State University and a Board Certified Master Arborist.

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