BY PAUL J. ANTONELLIS JR.
A line-of-dutY death (LODD)/injury or multiple LODDs/injuries have a devastating impact on the family system and the fire organization involved. The U.S. Fire Administration has reported that over the past 10 years, the fire service has averaged almost 112 deaths per year. In addition, over this same time period, the fire service has averaged almost seven multiple-firefighter fatalities each year, representing 166 deaths.1 According to the Department of Homeland Security Firefighter Casualties 1995-2004 report, in 2003 firefighters reported 78,750 injuries.2 Given the sobering numbers involved, every fire department needs to be fully prepared for a LODD/injury, and adequate preparation goes far beyond developing a policy/guideline. Departments should provide their members with the education and training needed to respond at several levels for a LODD/injury.
After more than 15 years of experience and education related to LODDs/injuries, I feel that the fire service does a great job during a line-of-duty funeral. However, the fire service is significantly lacking in experience and preplanning for the moments immediately after a death/injury and the follow-up post-funeral and organization/family recovery period. More often than not, the shift officer or the chief has not been trained in the proper steps to take once faced with a LODD/injury. This article focuses on the moments immediately after a death/injury and the post-funeral/recovery steps.
Outlined are the proper steps for delivering a death notification after a line-of-duty death/injury. Given that more than 78,000 injuries occurred in 2003, fire service administrators and shift commanders need to be equally prepared for delivering either.
There are many steps that the fire service can take “before” an incident occurs. Preplanning and preparation demonstrate to the organization and family members that the department is concerned about their long-term care and well-being. In addition, there are steps to be taken “after” an incident that will help the family, fire organization, and community to process the loss and grow from the experience.
NOTIFICATION
Several recurring statements made by fire service people who have delivered death notifications of a coworker include, “This is the most difficult task I ever performed,” “It is something I never want to do again,” and “I felt so uncomfortable telling the spouse; I have never done this before.” A large majority of fire service people are unprepared to perform this critical task.
An improperly delivered death notification can result in further complicating and prolonging the grief process for the survivor.3 In an effort to show respect for the family, fire service administrators should familiarize themselves with the proper steps of a notification. The following are the four “As” of a notification.
Advance Preparation
Gather as much information about the incident as possible. Do not attempt to deliver a notification without information about the death/injury. Before delivering the notification, you should know the condition of the body or bodies (burns, blunt trauma, and type of injury), and you should have a general idea as to what led up to the incident (building collapse or explosion).
Notifications should always be performed in teams of two or more persons. The team should then determine what role each person will perform. I recommend that the person who delivers the initial death notification (the person to say “dead” or “died”) be allowed to take a step back from the notification. The family member receiving the news will often shut out that person who initially said “dead” or “died.” Having the second person take the lead position now will allow the family to absorb additional information. The second person will have a different voice, manner, and presence and is not considered the “bad” person who said “dead” or “died.” Having a two-person team is a safety issue; teams can be confronted with emotional and physical outbursts during a notification. In addition, the two-person team can physically and emotionally support each other during the process.4
If confronted with multiple deaths/injuries, the organization must determine who will deliver each notification. It is recommended that multiple notifications be conducted simultaneously. Deciding which survivor is notified first or last can create resentment toward the department later. Experts recommend that the chief be present at each of the notifications and allow fellow administrative staff to conduct the actual notification. The chief should then explain to the family that multiple notifications need to be made and that he will need to leave to assist with other notifications. The family will understand. What they will not understand is if the chief leaves during the notification. So be up front with the family!
Make sure that the fallen firefighter’s name and address have been confirmed and reconfirmed. Mistakes can occur, and this is certainly not the time for a misidentification. It is common for brothers to be in the same fire department, so make sure you have a positive identification. You could be delivering notification of the wrong family member.
Identify the physical address of the survivor. Additionally, find out if the survivor or other family members have any physical or mental disabilities. If possible, find out the emotional maturity and spiritual belief of the surviving family member from coworkers or friends. Emotional maturity, spiritual belief, and past experience with death and dying can impact the notification process. Immediately notify the family’s spiritual leader, and request that the leader be present at the family’s residence.
Medical stand-by should be considered during any notification, in case of an emergency. Team members should be in a clean uniform with proper identification. This is not the time to take the deceased’s personal belongings to the family. They can be delivered at a later time.
Actual Notification
Generally speaking, death notifications take two forms: (1) sudden/unexpected deaths and (2) expected deaths. You will most often be delivering a sudden/unexpected death notification. In this case, the family is not prepared for the information. Unexpected deaths cause intense reactions because of the sudden loss of a significant relationship.5 Remember, receiving an unexpected death notification is always traumatic for the family. The team can reduce the trauma for the family by being prepared and sensitive.
Common reactions to sudden death notification include shock, disbelief, despair, confusion, panic, sadness, anger, and guilt. It is natural for the survivor to experience some or all of these common reactions after a notification. The team should not make a judgment about how a survivor expresses emotions and begins the painful process of grieving.
Never deliver a notification in a public area, and certainly never on the front doorstep. The survivor(s) should be given some privacy during this time. However, it is not recommended that a survivor be left alone after delivering a death notification. Experts recommend that a death notification be delivered in increments. When delivered in small doses, the information is better understood, and the survivor is able to take in the news at his/her own rate and level of comprehension. Do not apply time limitations to a death notification. The notification team should be removed from service while engaged in this duty and should not be contacted unless there is an emergency.
Speak directly to the survivor, making good eye contact, and without fire service jargon. Ensure that your voice is heard and that you do not let your voice trail off. Be aware of your own stress reactions and body language; they could send the wrong message to the survivor. (4)
The notification team should use plain language and avoid the use of euphemisms or trite comments. Avoid terms like “gone,” “passed on,” “expired,” and “it was over quickly.” These phrases are vague and leave the window open for the survivor to misinterpret the information to meet his/her own needs. For example, if you use the term “gone,” the survivor may respond with “gone where?”
The California Peace Officers’ Association Line-of-Duty Death Management System Handbook recommends that the notification team be empathetic and supportive. The team should present the notification with compassion. It is not the team’s responsibility to determine what grief response is correct for the survivor. The survivor will begin the grief process when ready, not when team members are ready. This process has no timeline, so do not set expectations about how short or how long survivors’ grief should remain active.6
Knowing how to deliver a proper death/injury notification is a learned process, not an instinctive one. Training programs are a must! This should not be learn-as-you-go training.
Assessment of Survivor
Immediately after delivering the actual notification, begin the assessment stage. During this stage, look for indicators from the survivor to determine the rate and amount of information being processed. This means that you need to be a good listener. Determine if the survivor can process additional information and make decisions. The survivor is going to be called on to make a myriad of decisions over the next 48 hours.
During the assessment stage, determine the mental and emotional state of the survivor. Does the survivor or the family have any special needs? Does the family have any complicating influences? What was the relationship to the deceased? What role did the deceased play in the survivor’s life? The team should allow the survivor ample time to process the notification. The way the information is processed is different for every person.
“Real men don’t cry!” WRONG! Crying is part of grieving. It is okay to cry. As you progress through the notification process, it is natural for you to shed a tear or cry. In fact, it is meaningful to the survivor to see your humanity. Do not be an automaton. Delivering a cold and unemotional notification can be perceived as a lack of compassion. A touch or a hug can be powerful and healing for the survivor.
Denial is a common stage the survivor may go through; although it is a perfectly natural reaction, never reinforce such responses.
Assisting the Survivor
Delivering an unexpected/sudden death notification will leave the surviving family reeling and, more often than not, completely unprepared for such an announcement. The quality of the support the fire department provides to the survivors will have a tremendous impact on the grieving process.
It is a common practice for the fire service to assign a member of the department to the family to act as the “Family Support Liaison (FSL).” The FSL is often responsible for looking after the survivors and family’s needs. An FSL should be a person who had a close relationship with the deceased or the family. The position does not require someone with rank but someone who has had a prior relationship with the survivor and family. Experts recommend that two or more people be assigned to the FSL position because, often, the intensity of grief can blur the boundaries of friendship and the survivor might develop emotional attachments to the FSL with which the FSL may or may not be able to deal with appropriately. Having several people assigned to this sensitive position will ensure a “checks and balance” for all parties involved. The attachment is predictable and preventable. Appointing more than one FSL will ensure a positive and healthy relationship among the family, the FSL, and the department. A supervisor from the department should monitor the activities of each of the individuals assigned as FSL and ensure the proper mental health of each individual. The FSL is a demanding position and places a high degree of emotional strain on the person performing the task.
 (2) The community has suffered a loss and often will show its respect by lowering flags to half staff. Involve the community in the grieving process. |
However, the FSL position is not a decision-making position. The FSL should be an advocate for the family to ensure that the wishes of the family come first. It is important to remember that the family’s wishes come FIRST. Some survivors have reported feeling that the FSL was pressing the fire department’s agenda and, subsequently, influenced the family’s decisions. In some cases, the families felt they had made poor decisions because of this conflict of interest. It is not unusual for an unprepared FSL to lose sight of his role as family advocate and to become an advocate for his desires or those of the department for honoring a fallen firefighter. It is strictly up to the family members to decide what they want to do to honor their loved one.
OVERALL SUPPORT
Many firefighters in the department will be looking to the chief for direction, reassurance, and support because, just as the family and survivors are affected by a LODD, so is the department. The chief sets the pace and the environment for the department. With his leadership, a standard of care can be instituted that can offer psychological assistance to the survivor, family, and department members. This may be in the form of contacting the local critical incident stress management (CISM) team, the department employee assistance program (EAP), pastoral support, or the local mental health service unit at the local hospital for assistance.7 The emotional and physical well-being of the department can be covered in a “wellness program,” each piece of which is critical to the overall health of the organization.
The International Critical Incident Stress Foundation (ICISF) recommends that the Five-Phase LODD model debriefing be used the day of or the day after the death occurs. The Five-Phase model eliminates the thought and symptoms phases for the initial debriefing. At this point, it may be too soon for people to experience any thoughts or symptoms. After the funeral, the full Seven-Phase debriefing should be performed. It is recommended that debriefings not be performed the day of the funeral. (4)
Regardless of the type of assistance selected, do not get tunnel vision. Psychological services can be supervised by the department chaplain. Beneath this umbrella can be encompassed the peer support team, the CISM team, and the EAP units. It is critical that all services be monitored and evaluated periodically for additional needs throughout the grieving process. The department should remain flexible regarding all services offered, and it is critical that the services be offered. It should be at no cost to the employee. The goal is to maintain a healthy workforce and family.
Much like emergency incidents, an LODD/injury will need an incident management system. I would recommend that each assignment be written down along with the name of the person responsible for performing that task. All assignments can be tracked on an incident management status board. In addition, I recommend staff meetings twice a day. The first meeting should take place first thing in the morning to review developments that occurred overnight and identify emerging needs that need to be addressed. The second meeting should be held at the end of the day, to determine what has been completed and what other tasks need to be assigned. These meetings help the department monitor its progress and can prevent mistakes. If things are not written down, they are often forgotten, with disastrous results.
During this period, the fire department must stay open for business. There is no such thing as a sign reading, “Due to a death, we will be closed.” The chief should ask neighboring departments to assist with daily operations and to ensure proper coverage for emergency calls and that no area is stripped of fire protection. Critical shift coverage should be considered at the time of the incident, for shifts prior to the funeral, when psychological services are scheduled, and for shifts during the funeral.
During this time, the department must maintain an atmosphere appropriate for the event. The public, the family, and the media are constantly watching the department and how its members are responding to the event. (4)
POST-FUNERAL ISSUES
The funeral is over, and for some it has served as a means of closure. Now, the organization needs to consider how it will support the survivor, the family, and the organization. Survivors have reported that this is the time most fire departments fail-only to learn from their mistakes at the cost to the survivor.
How the funeral is handled often will dictate how the family, the department, and the community will view the fire department for years to come. For many, the funeral will serve as a form of closure; but for others, the grieving and healing process will take months and years. People grieve at their own pace. This is the time for the fire department administration to be supportive and understanding of these differences. The chief, while always looking out for his employees and the survivor, should not forget about his own psychological well-being. Emotional support is close by in the form of clergy, close friends, a spouse, coworkers, and peers. It is easy to underestimate the impact these people can have on your life.
Family support professionals recommend that the department make sure that emotional support is offered to the surviving family. The family may need assistance in processing the death and may not know where to turn. Family members may think they are alone in their devastation and that something is wrong with them. It must be reiterated to them that they are not abnormal and nothing is wrong with them. They are experiencing natural feelings that accompany losing a loved one. The department can contact local support groups for the family.
There are times that the family will decide to end its affiliation with the department. This is the family’s choice. It has the right to end the affiliation with the department at any time. Regardless of how the family feels, the department must respect its wishes and let the family know that the department would welcome them back at any point down the road. Some survivors have requested, “Please leave the door open for us to return later.”
After a death, it is common for people to offer things to families. If you make any offers, make sure to follow through on them. A broken promise to a family-especially children-at this time can inflict significant emotional pain that may take a very long time to heal or may never heal. On the flip side, do not overwhelm the family with too many offerings. It is okay to support the family, but make sure it is the family’s choice. Empower and assist the family.
The survivor, the family, and the department have experienced a significant loss. The community has also experienced a loss. The community should be afforded access to at least one memorial and all department activities. This will allow the public to offer its support to the department and feel a part of the process. The dead firefighter may have been very active and well-known to the community, so others may be grieving the death. It is very common for the community to send cards and gifts to the department and the family.
It would be nice if the department could send “thank-you” notes for all the offerings made during this time. I recommend that the department save all the cards and letters in a scrapbook and later present it to the family. It will serve as a lasting memory for the family to treasure. Local groups can help with this endeavor. The Boys Scouts, Girl Scouts, soccer teams, and the like are more than willing to help address envelopes for thank-you cards.
The department should be proactive when it comes to “shrines.” It is common for people to want to honor the dead firefighter, and a shrine can be rewarding to some people but distressing to others. Be flexible when it comes to memorials. It is okay to establish a time limit for a display; however, the deadline should be established and announced as soon as possible so everyone will know beforehand when it will be removed.
Various organizations will contact the department about honoring the firefighter. The department can serve as the point of contact for any person or group wishing to participate. It can determine if the request is legal/proper/appropriate and forward the information onto the family through the FSL. The final choice is up to the family. These offerings often have two sides: They can be very healing for the family, but they can also revive painful memories.
The department should make an effort to review and revise policies surrounding the incident. I will often ask, “How can we grow from this experience?” or “What have we learned from this experience, and how will it help us do our job now?” This allows the people closest to the incident to offer recommendations for positive changes. The past events will forever be a powerful history for the department, and the chief and every employee need to know that the department is going to learn and grow and not just go back to business as usual. It will take a long time to heal, but it is possible for a department to become stronger and more responsive to the needs of the firefighters and their families.
• • •
A line-of-duty death or injury is one of the most traumatic events a fire department experiences. How the death/injury notification, funeral, memorials, support, and follow-up are handled will determine if the process promotes healing. For those called to deliver a death notification, it will be the toughest task they will ever perform and yet the most meaningful to them and the survivor.
Now that you have read this article, what are you going to do with the information? Don’t just put the magazine down and forget about it, because your department may be next to have a line-of-duty death/injury. You need not go down this path alone. There are many organizations and resources to tap into for help. Don’t wait. Start developing your line-of-duty death/injury policy guidelines now, or revise those dusty policies no one has looked at in some time. My goal is to ensure that another survivor is not delivered a poor notification and left without any support after the funeral. It is up to you to take this information and spread it. ■
References
1. Firefighter Fatalities in the United States in 2004, Department of Homeland Security, US Fire Administration (2005). Retrieved November 1, 2005 from http://www.usfa.fema.gov/download_pub.jsp?id=&mc=&sc=&ol=&it=9/.
2. Firefighter Casualties 1995-2004, Department of Homeland Security, US Fire Administration (2005). Retrieved November 1, 2005 from http://www.usfa.fema.gov/fatalities/statistics/casualties.shtm/.
3. How to do a death notification, Fallen Emergency Service Personnel Program (2005). Retrieved November 1, 2005 from http://www.fallenfirefighter.com/deathnotification.htm/.
4. Jackimo PV, Paul Antonellis Line of Duty Death: Preparing the Best for the Worst. course book, self-published, 2002.
5. Weisman, AD, “Coping with Untimely Death,” Psychiatry; 1973: 366-378.
6. Line of Duty Death Management System Handbook, California Peace Officers’ Association, self-published, 2000.
7. Antonellis, PJ, Shannon G. Mitchell. Posttraumatic Stress Disorder in Firefighters: The Calls That Stick with You (Ellicott City, MD: Chevron Publishing, 2005).
