An Emotional Band Aid

Making the worst day of someone’s life a little bit better

By Chandrea Serebro

Hatzolah is one of the South African community’s greatest treasures, and when they add to their vault the entire community becomes richer. And now that Hatzolah has added the Crisis Response Unit (CRU) to its glowing chest, the community will be the one that benefits the most. Psychological First Aid is like an “emotional band aid” which helps in ways that medicine cannot, offered on-scene to the people who are the “collateral damage” at every emergency situation.

“Hatzolah has always gone far beyond just stabilising and treating the injured. There are many projects, which are essential to the care of our patients and community, that go much further than simply dealing with the injured person alone – and the quintessential example of this is the CRU,” says Medical Manager Yudi Singer. “As paramedics, we are trained to assist the sick and injured during an emergency. Far too often, we find ourselves in a position where we have to manage and stabilise a critically injured patient, which requires focused attention in order to efficiently assess, monitor, treat, perform procedures, calculate drug dosages and equipment settings, and coordinate the extrication of the patient to the appropriate hospital.”

But, while responders are doing all of that, they also are in charge of managing the broader scene of the incident – a scene that almost always is filled with scared bystanders, witnesses, and other victims. The responders also need to obtain critical information from the patient’s next of kin, people who are in high stress mode, experiencing grief and shock, and even injury or guilt. “Because we take charge of the situation, we also have to try and perform emotional first aid and support the family and witnesses, at the same time as providing much needed information about the status of their loved one, which may not always be good news. As I’m sure you can imagine, this can be extremely challenging to do, as there are multiple essential roles and responsibilities to perform with few resources. The patient requires emergency treatment by the paramedics on scene, and the bystanders and family are often left feeling deserted and alone, struggling to make sense of the absolute chaos and life-changing ramifications of the scene that they have been witness to,” says Yudi.

This enormous gap in the system, and the realisation that a dedicated team of special people committed to providing support to the family, bystanders, or even the potentially uninjured driver of the vehicle which had just critically injured someone, led Yudi to the discovery that United Hatzalah in Israel has just such a system in place – and this propelled the creation of the CRU team. In fact, Hatzolah South Africa is the only other Hatzolah in the world to have a CRU team. After a rigorous screening process, a team of select members that would be able to respond to calls and provide the support required, without themselves becoming distraught and flustered by the emergency, was formed. The team is comprised of some select current Hatzolah members (dispatchers and responders), as well as registered professional social workers, mental health practitioners, occupational therapists, and psychologists from the community.

Hatzolah SA set up a training programme together with United Hatzalah’s ‘Chosen’ Unit, and members of United Hatzalah Psychotrauma and Crisis Response Unit. Rabbi Avi Tennenbaum (the current head of Chosen) and Dr Adam Ballin came here to train the team. Through an intensive course, the team was taught, on both a theoretical and practical level, how to respond to a crisis scene and how to assess and then provide psychological first aid. They were also instructed on the importance of self-care.

“The instructors came with an absolute wealth of experience and information. They provided us with practical and realistic information based on current studies and statistics, and equipped us with essential tools to deal with these difficult calls. The training covered the physiological and psychological responses to trauma, skills enhancement to recognise and deal with incidents, as well as training on how to look after ourselves as members of this challenging but rewarding team. The theoretical material was taught to us with the opportunity to practice during simulation-based training. This training provided us with the critical techniques and processes required to successfully provide containment on scene,” says Yudi. Hatzolah now run periodic training for the CRU team, based on lessons learned from previous incidents as well as current and possible foreseeable scenarios.

And the emotional support that they have already offered to so many has been incredible. “It is a terribly distressing thing to witness and see someone in a state of panic and trauma. I often feel so sad for the person whose family or loved one has just been victim to a contact crime, motor vehicle accident, or house fire. The injured patient gets a lot of support and intervention, but the bystander is so often left distraught, confused, and with very little information about the extent of injury to the patient. It is very comforting providing these very scared bystanders with essential information and with basic needs which are so often neglected. It is empowering to know that even though the person doesn’t realise it, we have made a huge difference to their experience of the incident, as well as their own process of healing and recovery. I know that if we are able to contain the emergency, provide the family with support, and calm the situation at hand, then my team and the injured patient are able to have a much better outcome. I am left with a sense of pride and jubilation knowing that I really improved someone’s most horrendous situation,” says Yudi.

“I had often found certain types of emergency calls challenging, not necessarily because of the patient’s condition, but because I was juggling with treating the critically ill patient and also counselling the family during their very understandable panic-ridden moment. Throughout my time in Hatzolah, I have learned that the family of the critically ill often suffer more than the patient, as the suffering of the family is emotional and psychological and, if not dealt with appropriately, can cause life altering behaviours and stressors. Hatzolah has always been good in training their responders not to neglect the family of the critically ill, but it could never be the focus as the critically ill patient always requires 100% of our attention.

I have been on a few emergency calls where the CRU (Crisis Response Unit) have been activated to assist the critical ill patient’s family and friends. The role is essential and has already proven very successful. We are not providing trauma counselling on the scene; we are providing crisis containment on the scene. The family are cared for while the paramedics can continue working on the critically ill patient without having to worry about the family. The more emergency calls I am on that require CRU, both as a paramedic and a CRU responder, I wonder how we ever managed without them.”

Uriel Rosen, Operations manager

“I attended a shooting scene where a father was killed. The CRU’s responsibility on scene was to stabilise and support the family members, to create order out of a crime scene – including dealing with a neighbour’s questions and helping the wife find documents that were requested by the police. We had to ensure that there were resources available for the family to get support, which involved contacting other family members to provide this. I feel that CRU had a big impact on this case. The family probably would have coped without us, but we made things easier and more manageable. As we say in CRU – it is our job to make the worst day of somebody’s life a little bit better. Small touches can make a big difference to somebody’s life.”

Andi Bengis, CRU responder

“Being a dispatcher at Hatzlolah, that first voice that a caller hears when they are calling for medical assistance, often panicked and emotional, has shown me how important compassion and empathy is when dealing with people in distress. A calm and sincere professional voice that is compassionate yet strong is often critical to getting a caller to focus on giving us the correct information so that our medical response can be the best it can be. My experience in the CRU has been life changing. Not only do we see the almost palpable relief in our “patients” when they realise that we are on scene to assist, but our ability to act as a cohesive team on scene is critical to the wellbeing of the bystander.

When someone experiences a medical trauma, the fallout is often panic and absolute anxiety. Our role is to attempt to contain that anxiety, assist in general management of the distress, and act as a conduit between the medical team and the family, doing things such as ensuring that the patients ID book and medical aid card are at hand, calling significant others, translating complex medical jargon, and even making a cup of tea for the traumatised family/bystander. The value of doing such things cannot be underestimated for the general well-being of our patients and their families.

While adhering to the important notion of strict confidentiality and my experience in assisting bystanders/families in distress has made me feel like my input really made a difference to them in that moment. Talking through their anxiety and distress and helping them to move forward from that traumatic moment can be inspiring and uplifting. I know that our presence on scene is calming and therapeutic.”

Caron Levy, CRU Responder

“I would often leave a scene wishing I could stay behind to help the family deal with the situation, but we did not have the resources to do so. The skills and tools that we have been given are life changing, not only for the people who we help, but for us as responders as well. They are skills that we use on every call in which there is emotional trauma so that we can deal with our emotions as well. There is no greater feeling than being able to leave a scene knowing that you touched someone’s life and that, when you walk out the door, you are leaving the people behind in a stable, safe, and better emotional state than when you arrived.”

Alon Joseph, CRU and Hatzolah Responder

“I never really realised the vital importance and deep value of the CRU until I personally saw them in action myself. I had just dealt with a fatal call and standing in front of me was a heartbroken, devastated, and confused family. My medical treatment for the patient was complete and the shattered family began to lean on me for emotional support and direction. As I began briefing the family and giving them a slight sense of direction, in walked a calming, sensitive group of people – the CRU team. Qualified, gentle, and companionate young ladies took over and began to give the family the guidance, advice, clarity, and emotional support that they needed. I took a deep breath, stepped back, and watched this incredible group take action and perform in the utmost professional and dedicated way.

The CRU team’s presence also allowed me to refocus and prepare my jump bag and response car should I be urgently needed in another emergency, G-d forbid. As I walked away, I felt a huge sense of comfort knowing that not only had the patient received the very best medical treatment from our responders, but the patient’s loved ones’ emotional needs were being cared for as well. The CRU team fills a huge void, which both the paramedics of Hatzolah, as well as the community will now be experiencing and feeling.”

Alon Crouse, Hatzolah Responder

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