What a firefighter taught a neurosurgeon about handling traumatic stress

A few months ago, Philadelphia Fire Commissioner Adam Thiel committed a remarkable act of leadership. It didn’t make news, but I noticed it on his Twitter feed. He personally visited the crews who responded to the devastating Fairmount fire in a process called critical incident stress debriefing or CISD. The fire destroyed lives, and also was hard for the first responders who worked the catastrophe.

I’d passed the scrutiny of my peers. I hadn’t made a mistake, but there is no absolution in M&M. I rehashed the case in my head over and over again that summer, listening to way too much Sarah McLachlan. It cost me sleep and health, and I felt less effective than I should have been for my other patients. I was a zombie.

Recently, Harvard otolaryngologist Jo Shapiro gave a talk on peer support for physicians after adverse events. She pointed out that 88% of physicians would like to talk to a peer, 48% wanted a mental health professional and 29% would contact an employee assistance program. Although CISD is a formal process, oftentimes informal support can move us through grief — that’s what it is — but we don’t initiate.

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