This article is reprinted with permission from Crisis, Stress, and Human Resilience: An International Journal, published by the International Critical Incident Stress Foundation, Inc.
By John D. Hunt, MA, CCISM
On average, in the United States, there are approximately 240 million annual calls to 9-1-1 (NENA, 2022). When those calls are made, heroes respond. These dedicated first responders – police officers, firefighters, emergency medical technicians, dispatchers and paramedics – are individuals who devote their lives to the service of others in their communities. They do so selflessly, knowing the potential risks and, all too often, the devastating consequences inherent in their profession.
In their roles, these first responders encounter multiple stressors daily. Contributing factors include shift work, long hours, the unpredictability of the calls, continual occupational contact with high-risk and stressful situations, and frequent exposure to traumatic events. As a result, approximately 30% of first responders develop behavioral health conditions (SAMHSA, 2018). These chronic and significant job-related stressors and exposures often manifest in increased risk for mental health morbidities, including depression, substance abuse, suicidal thoughts and behaviors, and hastened mortality (e.g., death by suicide) (Stanley et al., 2016). First responders often relate how seemingly ordinary images, sounds, or smells bring horrific events crashing back into their consciousness, often with crippling results (Ebersole, 2019).
First responders are often viewed in the context of a “hero culture” where they are commended for enduring physical injury but, within the culture, are shamed for displaying mental weakness in handling the things they see (Ebersole, 2019). This can exacerbate the issues associated with their occupational stress and create resistance to seeking support. Unfortunately, these heroes face a scarcity of tailored mental health support and specialized resources for effectively coping with cumulative stress or following traumatic events (Lanza et al., 2018).
Veteran first responders can appreciate that a unique bond, a camaraderie, exists among professionals in their fields. This bond, and the trust that comes with it, can serve as a foundation to successfully introduce Critical Incident Stress Management (CISM). In turn, CISM can be combined with Animal Assisted Crisis Response (AACR) interventions to bring a therapeutic, compassionate, and healing presence that instills resilience in those affected by traumatic events. This article will present the lessons learned from firsthand experiences in combining CISM/AARC, explore evidence to support these therapeutic interventions, and share how first responders can access these resources to gain their extraordinary benefits.
Critical incidents, as related to first responders, are defined as “any event that has a stressful impact sufficient enough to overwhelm the usually effective coping skills of an individual” (Kulbarsh, 2007). CISM protocol allows first responders who have been involved in a critical incident to share their experiences, vent their emotions, learn about stress reactions and symptoms, and obtain a referral for further help if required.
CISM is a comprehensive, integrative, multicomponent crisis intervention system with a longstanding history of effective interactions with individuals and groups in the aftermath of a critical incident. These interventions range from the pre-crisis phase, through acute crisis, and into the post-crisis phase. Interventions may be applied to individuals, small functional groups, large groups, families, organizations, and even communities (Everly & Mitchell, 1997). The positive impact of CISM programs on building resilience and promotion of healing has been empirically validated (Everly & Boyle, 1997).
There are six core factors to CISM: pre-event strategic planning/preparation; surveillance assessment; triage; individual crisis intervention, including psychological first aid; informational crisis intervention groups; interactive crisis intervention groups; and fostering resilience in individuals, groups, organizations, and communities (Everly & Mitchell,1999). Studies on the effectiveness of CISM conclude that post-disaster crisis interventions yielded positive outcomes for up to two years in the form of reduced depression, reduced alcohol dependence, reduced PTSD severity, and reduced anxiety (Boscarino, et al., 2006).
Animal Assisted Crisis Response (AACR) is “the utilization of certified canine-and-handler teams assisting in crisis interventions to support the psychological and physiological needs of individuals affected by, and responding to, crises and disasters in complex, unpredictable environments. These interventions provide needed respite during periods of unimaginable turmoil” (Tedeschi & Jenkins, 2019). Following traumatic events, there is a natural defense mechanism to withdraw and isolate, but there is ample evidence to support the strategy of implementing AARC interactions.
In the second edition of her book on animal-assisted therapy, Dr. Chandler details a unique phenomenon that occurs during a crisis response. Dogs and handlers can establish a collective rapport that helps individuals in the immediate aftermath of an event, creating a sense of safety and support through their presence. They also promote security, comfort, and stability, thus re-grounding individuals back to reality and fostering resiliency in individuals who have experienced a critical incident (Chandler, 2012).
Extensive research has been conducted on the psychological and physiological impact canines have on first responders who have experienced traumatic events. The interaction between humans and canines prompts neurochemical releases, such as oxytocin, in the circulatory system and brain (Bau, 2013). Oxytocin buffers the stress response and cortisol secretion (stress hormone) and is also involved in emotion, trust, and bonding (Gee et al., 2021). This neurochemical effect enhances the positive interaction between the canine intervention team and the first responders with whom they interact.
Lessons drawn from previous experience reveal that for those on the frontlines of healthcare, traditional crisis response resources offered only passively (such as handing out a list of options) have not achieved the desired results, as those most in need of them are often unable or unwilling to seek help when needed (Hunt & Law, 2021). A similar pattern is seen within the first responder community. Coupling CISM and AACR interventions can support the well-being of not only frontline healthcare workers but first responders as well.
Filomenia Bau from LaTrobe University studied the impact of therapeutic interventions on people in crisis and found they “believed that AACR dogs have an innate ability to find the people in crisis who appear to need the most support.” Those with proper advanced skills, training, and certifications can implement AACR work safely and effectively (Bau, 2013).
Taken individually, the distinct programs of CISM and AARC each demonstrate positive impacts. Combining these interventions harnesses the powerful synergy of both, thereby providing an innovative approach that has been broadly accepted when put into practice. When these resources are actively brought together, they are much more likely to be and have been, accepted by the first responder community.
During a deployment to Surfside, Florida, in the aftermath of the June 2021 condominium collapse that claimed 98 lives, members of the Israeli search and rescue team would meet with the New Jersey-based Crisis Response Canines (CRC) team and find moments of respite and relief. One rescuer shared- “The interaction with your dog is exactly what I needed to be able to return to work on the pile.” The team also met daily with families at the reunification site as loved ones awaited word on the status of the missing.
Research in the field of CISM and AARC interventions is a testament to the ability of animals, particularly dogs, to serve as catalysts or facilitators in creating “affiliation[s] and relations in social interactions” (Guéguen & Ciccotti, 2008). With the sense of safety a canine presence provides, the AARC team can advocate for CISM interventions- to call those first responders needing help out of the shadows and dispel any stigma of being seen as weak. Canines genuinely serve as the bridge between post-critical incident isolation and the connection to trained interventionists and the help that CISM can provide.
On June 12, 2016, forty-nine people lost their lives, and fifty-three were wounded following a shooting at the Pulse Nightclub in Orlando, Florida. The first responder community was deeply affected. The CRC team provided therapeutic interventions to police, fire, and EMS personnel who responded to this event.
Additionally, authorities on site requested that CRC members meet directly with healthcare workers and others who aided those directly impacted by the shooting event. It was first responders themselves who directed CRC members to meet with family and friends at an established memorial. It was at this memorial that CRC members truly comprehended the significance of Animal Assisted Therapy and vowed to redouble their efforts to bring these opportunities to others affected by tragedies.
The presence of canines serves as reassurance that there is a non-judgmental companion who doesn’t ask questions, has no expectations, but rather is just there to provide a moment of respite and comfort. Often, affected individuals feel safe to lower their defenses and allow handlers to introduce CISM interventions and provide psychological first aid.
One example of this can be seen after the August 2019 El Paso Walmart shooting. Some of the families of victims were undocumented individuals from Mexico. Because of their fear of stepping forward, they were reluctant to approach teams for the comfort and healing moments they so deserved and needed. The presence of the Crisis Response Canines soon dissolved that fear as they realized they were safe and secure with these compassionate canines and handlers. Investigators of the event asked CRC members to join them at the Victim Advocacy Center to continue to allay the fears of individuals whose family and friends were victims of the shooting. One of the agents in charge spoke to the CRC team at the event and noted how the strong bond between animals and humans was able to overcome barriers and increase therapeutic interactions.
Listen to John Hunt discuss the work of Crisis Response Canines on Police1’s Policing Matters podcast
The significance of Canine Assisted Therapy was evident in the wake of Hurricane Katrina in 2005. Members of Operation L.E.A.D. (Louisiana Emergency Assistance Deployment) from New Jersey were collaborating with members of the Red Cross during several operations in New Orleans and surrounding parishes. Those in the area were devastated by the destruction from the hurricane, and many were reluctant to interact with emergency personnel. The L.E.A.D. team observed therapy dogs at one location engaging with survivors from the storm, and these encounters were extremely positive. As noted by others who were witnesses to these encounters, it was only then that those impacted by Katrina began to open up to responders. Additionally, team members observed firsthand the canine’s positive effects on first responders. If but for a moment, the canine-human encounters provided the decompression so desperately needed by the emergency services.
An example of two organizations that have successfully partnered to introduce their combined model of CISM and AARC is the aforementioned Crisis Response Canines (CRC) and the Mercury Critical Incident Response Teams (Mercury CIRT).
Mercury CIRT was established to provide a form of crisis intervention specifically designed to help emergency workers, correctional officers, and healthcare professionals cope with the psychological stresses inherent in their professions. Operational since 1984, the Mercury CIRT Team provides critical incident stress management intervention for particularly stressful events such as multiple casualty incidents, the death of a child, the death of a co-worker, traumatic incidents involving critical media coverage, failure of rescue efforts following a prolonged intervention, and other events that are unusually emotionally stressful. On-duty team coordinators receive and screen requests for services. When the need for a CISM intervention is determined, the team coordinator contacts one or more team members as needed for the requested intervention. The request is reviewed, the appropriate complement of a team dispatched, and interventions targeted to the need at hand.
CRC is a non-profit organization whose members provide CISM interventions and AARC to frontline responders and the victims (and families) they are helping. CRC’s mission is to provide strength, comfort, and emotional support to individuals, families, communities, and first responders experiencing traumatic emotions in the aftermath of critical incidents. CRC has two team levels: CRC Comfort and CRC Operational Deployment. CRC Comfort Teams serve as the foundation for our visits to hospitals, schools, businesses, speaking events, and other similar opportunities. The CRC Operational Deployment teams have the capability to respond to National Crisis Events.
CRC canines and handlers are highly trained with extensive experience interacting successfully with first responders on deployments. The canines’ certifications include Alliance of Therapy Dogs, AKC Canine Good Citizen, AKC Canine Good Citizen Advanced, Canine Good Citizen Urban, Crisis Working Dog Certification, Law Enforcement Defensive Systems Crisis Working Dog Certification. Handlers train continually, including FEMA’s National Incident Command Structure training, and learn the principles of Critical Incident Stress Management (CISM). In addition, several members have achieved CISM certification through the International Critical Incident Stress Foundation (ICISF) program with the University of Maryland, Baltimore County.
Members of the Mercury CIRT and CRC teams have a wide range of backgrounds, including law enforcement, military, health care, and education. This highly experienced cohort of team members affords for a broad range of peer-to-peer support in virtually any situation. Their collective experience with helping first responders, healthcare, and other professionals cope with the psychological stresses so prevalent in their professions make them uniquely qualified, and relatable.
Mercury CIRT and CRC have collaborated on several debriefings, and interactions are always strictly confidential. The positive impact of canine inclusion has been observed on multiple occasions involving a broad range of traumatic events. Members observed one such encounter with an emotional individual who a traumatic incident deeply impacted. When the CRC canine sat in front of the person and was simply present with them, they visibly calmed almost immediately and could recount the event to the CISD coordinator while engaging with the dog. Similar encounters have occurred with first responders during deployments (including several with the same department). It is not uncommon for participants to ask for and greet a familiar canine before even acknowledging the CISD coordinator. Handlers are reassured by moments like this and take them as a testament to the value of the partnership developed between Mercury CIRT and CRC members.
CRC Teams have responded to and interacted with countless first responders in the aftermath of tragic events. Additionally, CRC teams have deployed nationally to a myriad of events, including but not limited to shootings at Pulse Nightclub, The Las Vegas Harvest Festival, Sutherland Texas First Baptist Church, Pittsburgh Tree of Life Synagogue, and the El Paso Walmart. The CRC team was most recently deployed to the Surfside Florida Champlain Towers collapse, a post-shooting event at Jefferson Hospital in Philadelphia, the shooting at Oxford High School in Michigan, and Baltimore, Maryland, following the tragic loss of three firefighters. As this article is being written, CRC Teams have just returned from a deployment to Virginia in support of those impacted by the shooting death of two police officers at Bridgewater College.
As positive outcomes associated with team interactions and interventions have become more widely known, calls for CISM and Canine Assisted Therapy sessions continue to increase. As observed by many experienced Mercury CIRT and CRC team members, these can be powerful and effective interventions in support of the community of first responders.
Visit CRC online at https://www.crisiscanines.org/.
Visit Mercury CIRT online at www.mercurycism.org.
References
Boscarino JA, Adams RE, Foa EB, Landrigan P. J. (2006). A propensity score analysis of brief worksite crisis interventions after the World Trade Center disaster: implications for intervention and research. Medical Care, 44(5), 454–462.
Bua F. (2013). A qualitative investigation into dogs serving on animal assisted crisis response (AACR) teams: Advances in crisis counseling. Doctoral dissertation, Latrobe University.
Chandler CK. (2012). Animal-assisted therapy in counseling (2nd ed.). Routledge Taylor & Francis Group.
Ebersole R. (2019). First responders struggle with PTSD caused by the emergencies, deaths, tragedies they face every day. Washington Post.
Everly GS, Boyle S. (1999). Critical incident stress debriefing (CISD): A meta-analysis. International Journal of Emergency Mental Health, 1(3), 165-168.
Everly GS, Jr, Mitchell JT. (1999). Critical incident stress management, (2nd ed.). Chevron.
Gee NR, Rodriguez KE, Fine AH, Trammell JP. (2021). Dogs supporting human health and well-being: A biopsychosocial approach. Frontiers in Veterinary Science.
Guéguen N, Ciccotti S. (2008). Domestic dogs as facilitators in social interaction:An evaluation of helping and courtship behaviors. Anthrozoos A Multidisciplinary Journal of The Interactions of People & Animals.
Hunt J, Law M. (2021) Supporting the frontline heroes; The role of CISM and animal-assisted therapy. International Critical Incident Stress Foundation, Inc.
Kulbarsh P.(2007). Critical Incident Stress. Officer.com.
Lanza A, Roysircar G, Rodgers S. (2018). First responder mental healthcare: Evidence-based prevention, postvention, and treatment. ProfessionalPsychology: Research and Practice.
National Emergency Number Association (NENA). (2022) 9-1-1 statistics.
Stanley IH, Hom MA, Joiner TE. (2016). A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and paramedics. Clinical Psychology Review.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2018). Disaster technical assistance center supplemental research bulletin. First responders: behavioral health concerns, emergency response, and trauma.
Tedeschi P, Jenkins M. (2019). Transforming trauma, resilience and healing through our connection with animals. Purdue University.
About the author
John D. Hunt, MA, CCISM, is the co-founder and chief operations officer for Crisis Response Canines. Contact him at jhuntbgo@comcast.net.