Healthy Commanders Make Healthy Agencies

On a sunny spring morning, medics were alerted to a crash at the north end of the city. As dispatchers provided more information to the ambulance en route, it became evident this was not an ordinary crash.

Upon arrival the paramedic in charge sized up the scene for dispatch and other responding units. “We have two cars and seven patients,” he reported. “Four trapped in a minivan, two trapped in a convertible with one ejection. Declaring an MCI alarm. Notify the chief to respond to the scene, emergency!”

One of those trapped in the minivan was an agency paramedic who’d just gotten off shift 45 minutes before. He was going to church with his family after work. He did not survive.

After several days of dealing with the media, investigators, attorneys, and city officials, the EMS chief was mentally and physically exhausted. He made all the proper notifications and completed the paperwork, but the scenario kept running through his head. Were his department’s policies and procedures adequate? Had he done everything he could to prevent this tragedy?

He felt responsible for the trauma his paramedics and EMTs experienced and worried about their families. He worried about the victim’s family. He worried about his own family. He began to have trouble sleeping, and his sense of guilt made him spend more and more time at work, where he isolated himself with paperwork.

As a leader he did a commendable job of supporting his employees, but he had nowhere to turn for support for himself. His small department did not have access to a formal support program. He didn’t want anyone on his staff to know he was wrestling with these issues, and he wouldn’t even consider seeking help from a therapist in the community—in the first responder culture, that’s often seen as a sign of weakness.

Luckily there is now another solution for this chief and others like him: a new peer-support program specifically tailored for command staff.

Improved Resiliency

In July 2018 the Mid-America Regional Council—a council of governments and the metropolitan planning organization for the Kansas City region—launched a command-level peer-support pilot program. As the association of city and county governments for the Kansas City region, MARC has supported EMS agency coordination since 1973, managed the region’s 9-1-1 system since the early 1980s, and coordinated regional homeland security efforts since 2003. That meant it had the necessary relationships, collaborative spirit, and sense of trust the program would need to succeed already in place.

With guidance and support from MARC’s Regional Homeland Security Coordinating Committee, emergency services agencies across the region are working together to advance the region’s ability to respond to and recover from intentional attacks that result in casualties and fatalities among either civilians or responders. One goal of this work is to strengthen our capacity to help those affected by these incidents, including survivors, families, responding agency personnel, and the community as a whole.

From recent line-of-duty deaths and injuries experienced by local agencies to lessons learned from attacks in other parts of the country, there is a heightened awareness of the toll these types of incidents take on all involved, including command staff. The idea of building a regional capability around command staff peer-support training resonated with leaders in fire, law enforcement, and emergency medical services.

“We know the responsibilities a commander faces during a large-scale event can be excruciating,” says Erin Lynch, MARC’s emergency services program director. “If we can provide training and tools to help commanders in events such as officer-involved shootings and line-of-duty deaths, they will be in a much stronger position to respond to large-scale, complex incidents.”

The pilot, believed to be the first of its kind in the nation, is testing the feasibility and functionality of a command-level peer-support program. A 12-person group consisting of senior-level police, fire, and EMS staff, along with their union and Fraternal Order of Police presidents, worked with local psychologist Jennifer Prohaska, PhD, to customize training that addresses the unique challenges and stressors faced by command-level first responders. Her work has involved both the design of the training and guidance on its effectiveness.

“The feedback from participants in this initial training cadre has been powerful,” says Lynch. “Having a systematic way to provide command-level peer support to one another upon request increases the collective resiliency of our emergency services community.”

Prohaska has years of experience helping individuals and response professionals cope with trauma. “It’s a common misperception that once men and women take on more administrative roles and leave the field, they become immune to major traumatic stress. That simply isn’t true,” she says. “By the time commanders reach that point in their careers, they could have 20-plus years of accumulated stress and trauma from working on the front lines, plus the added burden of chronic stress that comes with command responsibilities.”

Training modules in the pilot program cover tools for dealing with command stress, PTSD in first responders, suicide risk and assessment, resilience among command-level first responders, practical applications of knowledge, and critical-incident stress debriefing scenarios. International Association of Chiefs of Police (IACP) guidelines and state-level peer-support legislation are also incorporated.

After completing their training, the pilot program’s first 12 participants formed the Command Level Peer Support Team, a roving crew that stands ready to both respond to formally scheduled critical incident stress debriefings (CISDs) and provide individual assistance to commanders in times of crisis. Since the group’s inception in July, members have already been asked to deploy seven times to incidents involving suicide, officer-involved shootings, and deaths within their own agencies, as well as others inside and outside the nine-county MARC region.

A Niche Often Missed

The Command Level Peer Support Team is modeled after a successful 9-1-1 Peer Support Team for dispatchers. Dispatching is and always has been a stressful job. But as we implement next-generation 9-1-1, dispatchers won’t just be hearing traumatic events take place through their headsets. They’ll also be seeing these events unfold through photos and video. We expect that may have a much greater impact on their mental well-being. Since its formation in January 2018, the 9-1-1 Peer Support Team has deployed 23 times to support fellow dispatchers by attending CISDs.

The peer-support teams fill a niche often missed by typical employee assistance programs (EAPs) and department psychologists or chaplains. Peer support can be immediate, right after a call or even while still on the scene. Peers perform the same job and often understand each other’s stress in ways someone on the outside cannot.

Peer-support training augments other parts of an overall mental wellness program within an agency but is not intended to replace professional help. MARC’s peer-support program is proactive and preventive, helping identify problems immediately after an incident, before serious trouble develops. Team members are trained to provide accessible, practical, and destigmatized support to personnel during times of work-related and personal crisis.

“Our goal is that commanders will not feel like the EMS chief in the beginning of this story,” says Eric Winebrenner, MARC’s public safety communications program director. “We want them to know they have a team of their own to reach out to in times of need, across jurisdictions and disciplines. Healthy commanders make healthy agencies.”

The Command Level Peer Support Team and 9-1-1 Peer Support Team are both involved in a national research study to gauge the efficacy of peer-support programs, and the data they provide will be used to help shape programs in the future.

“In helicopter EMS we serve a lot of rural communities. Many of the first-responder agencies in those communities are volunteers. The leaders of these agencies often wear multiple hats where they carry plenty of stress when things are going right, let alone when they have a critical event,” says Joe Coons, director of safety and communications with LifeFlight Eagle and one of the first commanders to be trained in the program. “The focus on cumulative stress management during our training really resounded with me. Being able to provide support to an agency leader who may not have access to an employee assistance program or other help is something I’m proud to be a part of.”

“EMS managers and supervisors have a great deal of responsibility beyond EMS operations,” says J. Paul Davis, EMS chief with Johnson County Med-Act. “In addition to ensuring the EMS needs of the community are met, they must also ensure needs of medics and support staff are met. They are held accountable by their community leaders and must be sure they and their department are compliant with regulations and laws. They must also balance their work and family lives so neither is neglected. Add in more than two decades of service as field medics, educators, and mentors and all the experiences that have occurred during that time, and you realize these strong women and men might also benefit from peer support.

“Strength is not only a trait managers and supervisors hold; it’s also expected,” Davis adds. “Our community leaders, our public, and our medics need us to be mentally, physically, and spiritually strong so we can serve in our very best capacity.”

Regional leaders are now reviewing the results of the pilot training and discussing how the peer-support training for command staff might become an ongoing resource. There are currently 23 commanders on a waiting list for the next training.

Command-Level Peer Support Team Founding Members

Missouri

• Lt. Matt Kellogg, Liberty Police Department
• Maj. Darren Ivey, Kansas City Police Department
• Lt. Aly Abdelgawad, Raymore Police Department
• Ret. Chief Carl Tripp, Kansas City Fire Department
• Director of Safety Joe Coons, LifeFlight Eagle
• Capt. Everett Babcock, Kansas City Police Department
• Battalion Chief Arby Todd, Lee’s Summit Fire Department

Kansas

• EMS Chief Paul Davis, Johnson County Med-Act
• Battalion Chief Morris Letcher, Kansas City Kansas Fire Department
• Maj. Wade Lanphear, Olathe Police Department
• Sheriff Andy Dedeke, Leavenworth County Sheriff’s Office
• Sheriff Frank Kelly, Miami County Sheriff’s Office

Pam Opoka, MPA, ENP, has over 23 years of experience in 9-1-1 and is the regional peer-support program planner at Mid-America Regional Council. Contact her at popoka@marc.org. The author thanks J. Paul Davis for writing the introductory scenario.