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After the Save: Critical Incident Stress

 

 

 

     by Lori Templeman, BA

 

  

 

How prepared are you for an emergency situation?  It can happen at any time.  CPR and AED (Automatic External Defibrillator) training are an employment requirement for most fitness professionals.  As a lifeguard and aquatic fitness instructor for the last two decades, I have kept my skills up to industry standards by recertifying every 2 years.  Recently, I increased my skill level by becoming a Red Cross Lifeguard and CPR Instructor.  During my career, I have made some water rescues and assisted with a variety of medical emergencies.  A recent event required me to summon all my previous training and experience.

Christmas Eve at the Community Center was a slow day.  The gym and pool were open to the public, but many regular patrons were enjoying time with their families.  I was looking forward to a quiet ½ day of work before a 5-day holiday break.

While setting up for a fitness class, I got word there was a medical emergency in the cardio room.  A man had collapsed while using the stationary bike and 9-1-1 had been called.  I responded and immediately summoned two other lifeguards.  The victim was non-responsive and semi-conscious.  After analyzing further, we realized he was not breathing and had no pulse.  Upon saying the words “beginning compressions”, there was a here we go moment when I realized I was about to perform CPR for real. 

The second responding lifeguard and I began CPR while the third lifeguard retrieved and assembled the AED.  In this situation, you have to trust your training and follow the protocol that has been practiced.  The only difference is the realization that this is a real person.  The AED was deployed, and CPR continued.  I have to admit that pushing the shock button was a little scary and made me jump!  Five minutes later, the paramedics arrived and took over care.  Once they felt the man was in stable condition, they transported him to the hospital.

After the event I felt numb, but we still had several tasks to complete.  The area where the incident occurred needed to be cleaned and disinfected.  We gathered witness statements and completed a detailed incident report.  Staff and supervisors on and off-site were notified, and a debriefing took place.  I sat down with the other responding lifeguards to discuss what happened before, during, and after the emergency.  We evaluated the effectiveness of our Emergency Action Plan, as well as a few areas for improvement.  Both lifeguards said they were mentally ok to finish their shift. 

I wasn’t fully prepared for what took place next.  The days that followed were mentally unsettling and difficult.  Flashbacks, dreams, and a constant replay of the scene filled my mind.  I kept visualizing what had taken place.  Bodily fluids, sweat, vomit, agonal breathing (where someone is exhibiting isolated or infrequent gasping but still has no heartbeat), and cracked ribs are all realistic components when giving CPR.  This is not always discussed in training when practicing on a manikin.

These feelings compelled me to seek out information on how other rescuers felt post-event.  The American Red Cross Lifeguard manual describes this experience as Critical Incident Stress.  This can involve a strong emotional reaction – including sleeplessness, anxiety, depression, exhaustion, restlessness, nausea, nightmares, and other problems. Some effects may happen right away, but others may appear days, weeks or months after the incident. 

Besides the flashbacks, I kept evaluating what could I have done better.  I also wondered if the victim was alive and how he was doing.  I went on some scenic drives with my husband, who has experienced similar events and was fully aware of the need for me to talk about it.  Expressing how I felt about the experience was very helpful.  I was able to experience emotional release and discuss my feelings. 

Two days later, my supervisor called to update me on the victim’s status.  I was so relieved to hear the man was in the hospital and likely to recuperate.  Hearing this news helped me mentally.  It was easier to emotionally recover knowing he had survived.  My managers offered time off if needed.  If I hadn’t already had the next few days off work I would have accepted the offer.   Returning to lifeguard duty while still processing thoughts of the event would have potentially caused anxiety and distraction.

According to Joseph A. Davis, Ph.D., “Often times, there are unusually strong emotions attached to the event that has the potential to interfere with that person’s ability to function either at the crisis workplace scene or away from it at home (Davis, 1992; Mitchell, 1983). This is what the author calls “dosage exposure.” The closer the employee or victim is to the critical incident (primary, secondary, tertiary, or quaternary) the stronger or weaker the reaction (biopsychosocial and cultural) they will have to the event (2013. Davis, A).”

After returning to work, I spoke with the other responding lifeguards and they both described similar feelings and responses.  Many people wanted to talk to us about the event, but it was difficult to know how to respond.  We were given accolades by the fire department, co-workers, and those who had witnessed the event.  Our facility received an outpouring of gratitude from the man’s friends and family with phone calls, flowers, and cards.

I was called a hero, but I wasn’t sure how to feel about it. At first, I felt like I had performed my job duty to the best of my ability but nothing extraordinary.  Our team had started the process to help save someone’s life and achieved a positive result. I realized it was best to remain humble and acknowledge their compliments and gratitude.

In lifeguard and CPR training, little is discussed about the mental health or aftermath following an emergency response.  As a community member or first responder, you do the best you can with your level of training until more advanced medical personnel take over.  At the end of the event, you are left behind thinking “what just happened?”  Often the outcome of the event is never known (whether the victim survives or not). Confidentiality laws prevent the discussion of names and details to respect privacy. 

It is important for facility management to offer support and assistance to staff members after a critical incident.  A licensed mental health professional may need to be contacted.  Our city has Employee Assistant Programs which include counseling services.  Some lifeguards decide to resign after an incident, learning they are not comfortable in the role of first responder. 

At our next staff in-service, we discussed incident details along with adjustments to increase the effectiveness of our emergency action plan.  These areas for improvement allowed us the opportunity to reinforce the weak points.  Our execution may not have been perfect, but we met the objective.

Five weeks after the event, I had the opportunity to meet the man we were able to save.  He had made a full recovery.  I told him I was so thankful we were able to execute our training and achieve a successful outcome.  He replied with a chuckle, “So am I!”

In reflection, I don’t feel like a hero but now realize that he will always see me and my fellow rescuers as just that.  A large reason why he survived was our quick response, early CPR, and prompt activation of the AED.

You never know how you’re going to respond in an emergency until presented with the situation.  It took 20 years into my career for this magnitude of an incident to occur.  Now I feel more confident in my abilities and know I am able to respond as needed.  This emphasizes the importance of constantly training, keeping certifications current, and remaining familiar with rescue procedures.  I encourage everyone to learn CPR and basic first aid.  You never know when you could make a difference in someone else’s life.

RESOURCES

American National Red Cross. 2016. American Red Cross Lifeguarding Manual USA.

Davis, Joseph A. 2013. Critical Incident Stress Debriefing From a Traumatic Event. Psychology Today. Posted Feb 12, 2013. Accessed at: https://www.psychologytoday.com/us/blog/crimes-and-misdemeanors/201302/critical-incident-stress-debriefing-traumatic-event

 

AUTHOR

Lori Templeman, BA, lives and works for Parks and Recreation in Lincoln City, OR. She is an AEA Aquatic Training Specialist and national presenter who travels the country leading aquatic fitness programs. Lori is a group fitness instructor, Red Cross instructor, personal trainer, and Lifeguard. She is also a successful freelance writer featured in various fitness publications. Lori’s certifications include AEA, ACE, AFAA, and Arthritis Foundation.

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