HOW DO WE DEAL WITH DEATH AND serious injury in UK Fire and Rescue Services (FRS) in terms of procedures for notifying and supporting families of personnel? This paper draws on experiences and lessons learned in relation to line of duty deaths in the US, including the issues arising from the mass loss of Fire Service personnel on 9/11. Given our contingency plans for dealing with mass fatality events and other areas of risk management, the paper asks what plans and procedures are and should be in place for addressing both single and multiple loss of emergency service personnel in the UK.

First Thoughts

Earlier this year I attended a trauma conference in the US where I heard a powerful presentation by a representative of an organisation called COPS (Concerns of Police Survivors). Members of COPS have all lost family members through death at work (‘in the line of duty’) and founded their own organisation to improve the ways in which family notification and support is delivered following the sudden, unexpected and usually violent death of loved ones working for the US police service.

The presentation was powerful and moving, not least because of the personal reflections of the speaker and the appalling treatment meted out, sometimes unintentionally, by organisations in the past. It struck a chord with me given the work I do here in the UK with police services training those officers who are called on to deliver death messages and provide liaison to families after sudden death (in particular following road death, murder and major incidents).

In the UK, in recognition of the impact of death notification and other initial contact made in the immediate aftermath of sudden death, much effort has been made to improve the way in which such encounters and follow on work is provided by specially trained police Family Liaison Officers (or FLOs).

However, I had not given much thought to how the families of officers themselves are treated in such circumstances, and in particular by their employers and colleagues should death or serious injury occur while at work. I started asking colleagues in UK police and fire services about this and, like me, some remarked that it was the first time they had really thought about this. Meanwhile I was awarded a 2006 Travelling Fellowship by the Winston Churchill Memorial Trust (www.wcmt.org.uk). This gave me the opportunity to meet those developing and implementing support strategies after disasters, with particular focus on the impact of 9/11 on local communities in New York and New Jersey.

Given the large scale loss of life amongst emergency service and other personnel who were either at work or travelling to work on that fateful morning, the questions about family support, and indeed support for surviving colleagues, seemed to me to be as relevant as ever. During my visit I was able to ask those directly involved on and after 9/11 how they had responded and about the lessons they learned for dealing with mass fatalities. I started to reflect on our own

Understanding Cultures

During my research I met, among others, members of New York’s Fire Dept (FDNY), the New York Police Department (NYPD) and the Port Authority Police, all of whom lost large numbers of colleagues at 9/11. Our conversations and their approaches highlighted the importance of understanding and addressing the cultural context of death and serious injury in terms of both attitudes and customs in the workplace and in wider society.

In the NYFD for example, the concept of the workforce and colleagues as a family is strong and for many members reflects both a literal as well as symbolic reality. Consequently family loyalties and expectations govern their expectations of each other and the department in responding to tragedy impacting on their own.

Through my research I learned how policies and procedures for dealing with death in the workplace have developed in recognising and in response to this cultural context as well as wider public attitudes and expectations, particularly after disasters and those involving the deaths of responding personnel. The ‘hero’ mentality was and remains very strong in relation to those killed on 9/11 and the fact that this was a deliberate act of terrorism also influenced expectations relating to the management of the disaster.

In the UK we have seen many resources and much effort go into responding to potential terrorist attacks in which first responders are amongst those targeted, for example in the New Dimensions programmes and in mass fatalities planning as well as in the contingency planning of particular industries such as airlines. I started to wonder what measures these organisations have taken in responding to the risk of death/serious injury amongst their own staff and the implications for family and colleagues’ support

Policies and Procedures in Your Organisation?

In this paper I ask readers to consider what protocols do and should exist within your own organisation for dealing with the death of staff and other critical incidents? What happens in principle and in practice? What is specified in policies and what are the implications for notifying and supporting families and colleagues?

Consider the following hypothetical scenarios:

• A firefighter is killed and another seriously injured at a large fire which has attracted the attention of the media. How and when will the next of kin be informed?

• A member of staff is seriously injured in a car accident on the way to work. The attending crew recognise them and realise their partner is working in the control room. What happens next?

• A popular member of staff who has worked for many years in the Service dies suddenly.

A Fire Service funeral is offered. The family is divided – some wish for this and others are opposed. Who decides and who liaises on behalf of the Fire Service?

Learning from Experiences

Organisations like COPS were set up in response to similar scenarios to these and the poor experiences and treatment of families of emergency service personnel that followed.

Through adversity they became collectively motivated to improve ways in which those bereaved through line of duty deaths would deal with such devastating news and its aftermath. Their distressing experiences often started with death notification (or lack of it) and continued in relation to other forms of support leaving families bitter about the department and compounding their loss.

Other emergency service organisations, such as the National Fallen Firefighters Association in the US, have also developed programmes to support colleagues after deaths at work. As the examples below highlight, in the emergency services the issues associated with dealing with a death at work are often compounded by the risks and particular circumstances these personnel might face. This includes the fact that there is a greater likelihood of colleagues being with them at a critical incident and thus faced with difficult and urgent choices about who to contact first, and the fact that the death/serious injury of firefighters/police officers at an incident might be more likely to attract media attention, often very quickly.

The experiences of COPS members have included:

• Finding out about the incident through the TV (rather than through the department even though colleagues were there and messages could have been relayed in advance of the media).

• Receiving a death message by phone from the hospital rather than in person even though colleagues were aware and had helped dispatch/accompany the officer to hospital.

• A family calling the control room having heard rumours of an incident and realising that everyone there knew but no one had told the family.

COPS was established in 1984 and each year helps new families cope with the trauma of line-of-duty death. The National Fallen Firefighters Association was established in 1992. Such organisations have grown to develop activities such as national training for law enforcement agencies and officers on dealing with grief, developing general orders following line of duty death, promoting prevention and peer support strategies and sponsoring national commemorative activities.

Of course such organisations originated not in the UK but in the US (where the rate of line of duty fatalities amongst law enforcement officers and fire personnel is significantly higher). However, the risk of serious injury/fatality of first responders and other personnel clearly exists both in the emergency services and other organisations within the UK too. And, as personal testimony powerfully highlights, it only takes one poor procedure to make a significant difference to those directly affected. In terms of risk assessment then, these are probably low frequency but high impact events if notification and support are poorly delivered.

In the case of multiple fatalities the impact in terms of those affected may be broader and in the case of mass fatalities or major disaster there may well also be a public interest in organisational approaches and performance and additional demands associated with media interest.

Death Notification and Contacting Families: Getting it Right

In addition to formal responsibility for notifying next of kin resting with the police, both COPS and the NFFA emphasise the importance of organisations making proactive contact with families after a death at work. COPS stress that this should be done in person, in pairs and in a timely fashion. They emphasise the importance of using clear and compassionate language and why it is important to get the tone and delivery right.

They state that a poorly handled notification can compound the trauma of the bereaved (‘survivors’) and be a source of pain for years: ‘Departments need to understand that the notification sets the tone for the survivors... It makes a difference how they receive the worst news of their lives, and it will make a difference in how well they recover… If they hear it on the radio because nobody at the department remembered to personally notify them, that’s a tragedy. If they send a rookie who has never done a notification before, who stumbles and fumbles and never quite says what really happened, it makes matters so much worse’. (Clark 1992: 2).

In terms of getting it right and the importance of pre-planning, it is argued that basic risk assessment principles apply here: we acknowledge the risk of death/serious injury at work and take preventive measures, so what about assessing the risk of delivering poor notification after death/serious injury and addressing this through mitigative measures? Given the crisis that such events may present for the workplace too (in terms of staff welfare and support as well as business continuity), there are clearly implications for other aspects of policy and procedure too. Pre-planning and training is the key to preparedness here.

‘There’s no way to guarantee that, in a time of confusion and pain, notifications will always be handled properly. But COPS stresses that having general orders, or policies and procedures in place ahead of time will help departments avoid making matters even worse’. (Clark 1992:2).

Clark recognises that most badly handled notifications occur not because of malicious intent but due to ignorance or lack of planning on the part of organisations: ‘Departments want to do the right thing for the survivor. But so much else must be dealt with at the same time that… dealing with survivors was not always a top priority.’ (Clark 1992:7).

How Prepared is Your FRS?

Responsibility rests with individual fire and rescue services to have the necessary plans and procedures in place to deal with such eventualities. So how prepared is your organisation? Both COPS and the NFFA have developed guidelines for organisations preparing to handle death and other critical incidents. To what extent do your organisational polices and procedures cover the following areas?

• Protocols and training for notification/initiating formal contact with family (including consideration of factors such as timing, and who should make the notification, including in cases of the multiple deaths/injury).

• Contact lists (including 24 hour availability and the question of who, if anyone, beyond the next of kin should be included as well as methods for keeping lists current?).

• Family assistance at hospitals/mortuaries (including supporting family members in visiting the loved one if s/he is still alive, and visiting the body of the deceased).

• Supporting the family during the funeral/memorial services (with funeral policies explicitly recognising the importance of liaising with families on this and respecting their wishes).

• Providing information and assistance to the family regarding benefits (pension, medical insurance coverage etc) and where to go to for further information as appropriate.

• Supporting the family during an inquest, trial or other investigations (bearing in mind the need to manage potential conflicts of interest here).

• Supporting other staff in dealing with the loss of their colleague(s) (including critical incident and bereavement support).

The Fire Service ‘Family’: Support Issues

All good policies and procedures should be embedded in the cultural context of an organisation and its members. This is especially important in organisations like fire and rescue services where a sense of belonging and community can be strong. Research has highlighted the strong links between firefighters, their families and the workplace (Hill & Brunsden 2006) and the impact of the workplace culture on the private lives of firefighters and their relatives. It is not unusual, for example, for firefighters to work closely with others on a watch throughout their career, spending as much or even more time with them as with their family, such that when a colleague leaves or dies it has a profound impact on the rest of the crew. Given this environment, expectations of organisational support for firefighters’ family members might be expected to be high after a workplace death or critical incident.

This sense of family is particularly marked in the New York Fire Department (FDNY) where firefighters talk about their colleagues as brothers (both literally and metaphorically). Members of the NYFD Counselling Service Unit have reflected on this: ‘Firefighters have two families, one in the firehouse and one at home. The firehouse of co-workers is a Brotherhood. The family at home includes the nuclear family of the firefighter and the extended family or family of origin, which often influenced the decision to join the department’. (Greene et al 2006:57).

(There are of course dimensions of gender and ethnicity here in relation to identity and belonging which, while beyond the scope of this paper, is also a significant and relevant area for discussion). In discussing the functionality of this family, and the particularly high rate of firefighter fatalities in the FDNY, one might ask how much and how effective has support offered to firefighters been after the death or serious injury of one of their colleagues, both historically and since 9/11? On average five members of the NYFD die in the line of duty each year (Greene et al 2005:26). In fact the tradition of support after death has always been very strong there with a colleague known as a ‘family liaison’ traditionally being deployed after such a death (though similarly named, this is different from the concept and role of a police family liaison officer in the UK):

‘A family liaison is a firefighter or fire officer, generally known to the family of the perished, who volunteers to work directly with the family. The work is extremely personal. It involves assessing and meeting the practical needs of the family on a daily basis while mediating the services that the FDNY has available to the family… The family liaison is part of the cultural tradition of the FDNY and exemplifies the moral obligation that each firefighter feels to care for the family of the perished firefighter’. (Greene et al 2006:27). This moral obligation has included the tradition of not leaving the scene of an incident without rescuing a fallen colleague.

Such traditions, expectations and support structures came under severe stress during and after the events of 9/11. Although this involved an extreme set of events, its lessons have since influenced the development of family liaison and support in the NYFD with implications for UK fire and rescue services planning for New Dimensions and potential mass fatality events.

Dealing with Mass Fatalities: Lessons from 9/11

According to the 9/11 Commission Report, that day witnessed the largest loss of life of any emergency response agency in history (Greene et al 2006:1). NYFD alone lost 343 of its members from across its ranks: one chief of department, one first deputy commissioner, two assistant chiefs, five deputy chiefs, 19 battalion chiefs, 53 lieutenants, four fire marshals, 236 firefighters, one chaplain, two paramedics. These 343 left behind wives, fiancés and girlfriends; mothers, fathers, and siblings; and children young and old and yet to be born.

They also left behind more than 13,000 surviving members of the FDNY community (Greene et al 2006:1-2). Out of 300 units, 61 suffered the loss of at least one firefighter and several of those units suffered the loss of 7-10 fellow firefighters (Greene et al 2006: 10). Overall FDNY lost roughly three per cent of its workforce and six per cent of command staff in less than one hour (ibid 2006:2). The trauma continued for the nine long months of digging for the remains of those lost and then having to leave without bringing all of their colleagues home.

The immediate impact and longer term aftermath of these events and their consequences brought unique and unprecedented challenges for the FDNY Counselling Service Unit tasked with providing death notification and family/peer support services. On the day itself the very large numbers of missing personnel and the impossibility of tracking those on scene (due in part to the breakdown of communications) reinforced the chaotic conditions. This was compounded by the prolonged identification and body recovery processes which endured beyond days to weeks, months and years. The task of replacing personnel and managing career advancement through promotion opportunities thus brought about by the disaster was clearly an emotionally loaded exercise and a further aspect of business continuity that was difficult to anticipate and prepare for. In addition to this, the tradition of family liaison encountered difficulties.

The tradition had not been tested under conditions of multiple deaths from multiple units all at the same time. Furthermore, liaison in these circumstances was a much more complicated, lengthy and emotionally turbulent process given the difficulties associated with mass loss, complex body recovery and return, the psychological issues for colleagues as survivors and the dynamics within bereaved families. In the absence of clear guidelines difficult situations arose including, in extreme circumstances, family liaisons becoming emotionally involved with widows. In learning lessons the FDNY has developed new guidelines on family liaison including support for the liaison staff themselves. (Greene et al 2006:29).

The approach of the FDNY may be unique in terms of its practices and recent experience, but it serves to highlight the role of culture, history and tradition in addressing current and future expectations and challenges. The events of 9/11 and more recent terrorist scenarios have led to active planning, training and exercising by the UK Fire and Rescue Service and other agencies planning for major incidents and other worse case scenarios.

Given the greater expectations these days of support services for families after sudden traumatic death in UK, and especially after such major incident or disasters, the question is: what would be the expectation and experiences within your organisation managing multiple death or serious injury should such an event occur today?

Summary

This paper has highlighted important questions about the nature, extent and suitability of policies and procedures for addressing critical incidents involving death and serious injury within UK fire and rescue services. It has asked whether operational orders include specific and effective protocols for family notification and support (linked also to training for any staff required to carry out such duties), as well as other strategies for peer and other staff support.

These ideas were initially presented at the Fire Service College’s 2006 Annual Conference on Fire Related Research and Developments (RE06), see pg 30 for full report. During the discussion session and in informal feedback afterwards, a number of delegates commented to me that not only was this issue an important one to discuss, it was one that they had never really considered before. They had never thought ‘who would notify my family if something happened to me? How would it be done and what would I wish to be done for my loved ones?’ It reminded me of a comment by a US Chief Police Officer cited by Clark: ‘There are lots and lots of management courses for officers and deputies, but I have never, ever seen one hour devoted to the question, ‘what is your role when one of your officers dies in the line of duty’ (Clark 1992:75). It is suggested here that more work needs to be done to determine the answers to these questions and the practical implications for the development of policy, practice and review within UK fire and rescue services. Where the rate of fatalities and serious injuries is few, and the risk of poor notification and support may be higher, the need may be all the greater.

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Further Reading and Resources

• Clark C (1992) Better not Bitter: The Story of Concerns of Police Survivors, Concerns of Police Survivors Inc, Camdenton, MO Concerns of Police Survivors (COPS) - www.nationalcops.org (includes references to their handbook Support Services to Surviving Families of Line-of-Duty Death and how to access samples of general orders dealing with line-of-duty death)

• Eyre A (2006) Community Support After Disasters – Report of Winston Churchill Travelling Fellowship, 2006 (www.wcmt.org.uk – see Fellows Reports 2006 for a copy of this report)

• Greene P, Kane D, Christ G, Lynch S & Corrigan M (2006) FDNY Crisis Counselling: Innovative Responses to 9/11 Firefighters, Families and Communities, John Wiley & Sons, New Jersey

• Hill R & Brunsden V (2006) I Love a Firefighter: Experiences of Operational FRS Staff’s Relatives Paper presented at the Annual Conference on Fire-Related Research & Developments (RE06) Fire Service College November 15-16, 2006