As the most recent Health and Safety Executive statistics reveal, people who work within the emergency services have some of the highest rates of work-related stress,1 highlighted by the harrowing scenes the emergency services had to deal with following the London bombings last July.
But it is not just headline-grabbing acts of terrorism that emergency workers must deal with in the course of their work. For firefighters, there are everyday call-outs to distressing accident scenes.
Gerry Brammer, OH manager at Surrey Fire & Rescue Service, says: “Firefighters already see lots of deaths at road traffic accidents (RTAs), but an incident may involve the death of a child, multiple fatalities, suicides or a protracted incident (for instance, people trapped in vehicles), which might not have resulted in a death but which was difficult and stressful.”
Realising that coping with the aftermath of trauma while being prepared to go out on another run was putting enormous pressure on firefighters, Brammer was instrumental in setting up a Critical Incident Stress Debriefing Service at Surrey Fire & Rescue – one of the first to be established by a UK fire service.
For this and her other innovations at Surrey Fire & Rescue, Brammer recently received Surrey County Council’s Award for Excellence as the County Council employee of the year.
Presenting the award, David Davis, chairman of Surrey County Council, said that it was in recognition of her “leadership and determination,” while in the citation for her achievement, Dick Joslyn, assistant chief fire officer, said: “Gerry has played a fundamental role in establishing various support mechanisms for the benefit of staff across our service. Her enthusiasm and desire to support the service has had a positive impact on all of us.”
The OH department within Surrey Fire & Rescue looks after approximately 1,000 people, three-quarters of whom are uniformed personnel and the rest support staff, including OH. This comprises Brammer as OH manager, a part-time OH physician, a health and fitness adviser and an administration officer.
Brammer has been with the service for six years, joining as an OH adviser straight from an OH training post at Guy’s and St Thomas’s Trust, where she had qualified as an OH specialist practitioner.
“When I moved to the fire service, I realised there wasn’t much set up here, aside from medicals. There was no debriefing or counselling service, and very little health promotion. It was a basic service, which I knew I had to change, and the first thing I had to do was to get out there to see what was needed,” she says.
Brammer began by joining the management groups for both service and non-service personnel to help her compile a list of the issues that needed to be tackled by OH. Of most pressing importance was a lack of psychological support for fire officers following a trauma, so she proposed the setting up of a critical incident debriefing service.
She says: “I didn’t have to do too much persuading to introduce the concept of debriefing, as there were already concerns that counselling was needed.”
A team of 15 debriefers, recruited from within the ranks of the service, have now been trained to offer firefighters the chance to talk through their experiences of a traumatic incident.
The Critical Incident Debriefing process takes the form of a structured discussion, carried out in complete confidentiality. Service personnel are automatically referred to the debriefing co-ordinator (also a firefighter) following incidents that have resulted in the death of a child, a multiple fatality, a suicide, a decapitation or other very traumatic incidents.
In other cases, the head of the watch may request that the debriefing takes place if they feel there is cause for concern. The co-ordinator will arrange for two debriefers to meet with the watch within a 48-hour to four-day period.
“When the service started, there was a lot of resistance,” recalls Brammer. “A lot of the firefighters didn’t want to take part, and it was nicknamed the ‘cuddle club’. We battled through, and I’m very pleased to say it’s now very well received. I was pleased to gain the support of the union after I explained the firefighters could have problems if you don’t address stress levels. We also put out a policy on debriefing and the co-ordinator has been very persuasive.
The OH service also offers a confidential support line for service personnel suffering from stress or other psychological issues, which once contacted, can organise up to six sessions of external counselling provided by a third-party supplier. And any bullying and harassment within the service has also been addressed by a Colleague Supporters Network, made up of fellow firefighters who are there to support bullied, worried or harassed staff by listening to their problems and offering advice where appropriate.
Health and fitness
Aside from addressing mental health and wellbeing issues within the service, over the past six years the OH department has stepped up its health promotion and fitness testing provision.
Brammer says: “When I joined the service, the health and fitness adviser did not report into this department, but after I was made OH manager in 2000, with my own budget responsibility, I’ve been able to integrate that role into OH. We really push fitness testing to all our staff, which hopefully helps to promote the work of OH in a positive way. Firefighters are sometimes nervous of us, that we’ll find them unfit for duty or something. But we would never take anyone off the run lightly.”
OH is now aiming to bring in an external health and fitness expert to carry out fitness tests on all the staff over a two-month period once a year, which will help free up the health and fitness adviser to expand his fitness promotion and rehabilitation programmes.
The OH service continues to carry out medicals, but other areas are now addressed within the OH department, including advising firefighters on what to do in the event of chemical exposure.
No alcohol policy
One of her most recent successes was in pushing through a no alcohol policy. This means that service personnel are not allowed to consume alcohol when they are at work, on call or during any downtime. The policy also includes support staff, which means that no one within the service is allowed to drink at lunchtime.
“There was a lot of resistance to this idea in the beginning, and it did take me a long time to get it through. But I believe it’s a huge step forward, good for the county and the way most organisations should operate,” she says.
Brammer acknowledges that she has been very fortunate in her OH team and in the backing of her line manager, the deputy head of service support, in helping her to establish the award winning initiatives at Surrey Fire & Rescue.
The fact the OH department works alongside, not reporting into HR, has also been an advantage, she says. “I’m equivalent to the HR manager. I feel strongly that to be of equal standing to HR is very important to OH and very positive as we can take the initiative in terms of health at work issues.”
She adds: “I suppose I’m a bit of a go-getter. I love OH and don’t see it as the job of a plodder. You should go into OH if you’re enthusiastic about it and want to push it forward.”