Amidst her 35+ year career as a firefighter, first stationed abroad in the military and then here in the Fort Worth Fire Department, Cameron Brown showed an aptitude for lending a compassionate ear to her peers and received training to administer Critical Incident Stress Debriefings to all branches of first responders. She now holds the position of Staff Care Chaplain at Cook Children’s Medical Center.
*Warning* This piece includes multiple 1st hand accounts of experiences as a first responder that some may find upsetting. Reader discretion is advised.
Cameron Brown in the Meditation Chapel at Cook Children’s Medical Center
I'd like to talk about your background a bit first. Could you speak to the experience of being a female firefighter back when, I can only assume, there weren’t very many?
Cameron Brown: Today, in 2019, the national statistics show 1% of all firefighters are female.
Wow. 1%, and that’s in 2019.
CB: Yep, that's the figure today.
What was your interest in becoming a firefighter in the first place?
CB: Well basically I was tired of being poor! I wanted to get an education and figured the military would be a good route for that. I went to see the recruiter and I said "I want to do something that's different. I want every day to be unique. I don't want to be behind a desk, I want something that's exciting." I really wanted to be a paratrooper but of course, that was a combat role and wasn't yet even an option for women.
So the recruiter told me they had just begun accepting women applicants for firefighting positions, as long as you could pass the physical evaluation. I thought, sure, no problem, because I grew up on a farm. I knew body mechanics from throwing bales of hay onto a tractor and all that stuff, so I actually found the physical to be really easy.
So I got the guaranteed job in the military and was eventually stationed in Okinawa (Japan). At our station there were 12 Japanese male firefighters, 2 American male G.I.s, and me. It was challenging. The culture, then: the females still walked a few feet behind the males. When we had training exercises or when we had a fire, they would literally grab tools out of my hands.
So I decided to study Okinawan Kempo, a form of karate. And every day off from the fire station I would go to the dojo to train. And at the fire station I would beat my knuckles on the big tires there to build calluses and do knuckle pushups and things like that. I got really serious about it.
Wow!
CB: *Laughs* Yes, and so one day, we were unloading these 55 gallon drums of protein foam. The smell is so horrible, if you get it on your clothes it's basically impossible to get it out. So I had a mallet and I was making sure the lids on the drums were secure. One of the Okinawan firefighters came over and grabbed the mallet out of my hand. Now, do you believe everybody has a breaking point?
*Eyebrows raised, holding breath*
CB: Well I sure do. I grabbed him and put him on my shoulders, I spun around and I slammed him on the ground.
*Jaw dropped*
CB: Everyone in the room was blank-faced, staring, and I pointed my finger at each one of them and said "If you ever take anything out of my hands again I will totally humiliate you."
YESSS!!!
CB: *Laughs* So that was my lesson in assertiveness. Maybe a bit aggressive, I guess...And that totally changed their attitudes. They started calling me Cameron-San. They invited me to their homes. And they never took anything out of my hands again.
That was a...learning experience for all of us.
So then I came to Texas. The fire chief of Fort Worth heard about me and came to recruit me. I told him I didn't want a job, that I'd saved my money from the military to go get my education, I intended to go to college. So he said, “How about this: come work for us and the City of Fort Worth will pay for your college after you complete the academy.” And that's what they did! They paid for my Bachelor's and my Master's at TCU. They didn't pay for my Doctorate but that's ok, they held up their end of the bargain and I was a firefighter with them for 35 years. So I also fulfilled my end.
Wow. Thank you so much for that fascinating backstory. Can you speak to some of the unique difficulties & stresses of being a firefighter?
CB: No problem at all. Yes, certainly shift work is a challenge. Working a 24 hour shift can throw your sleep schedule completely out of whack.
There's also a changing family dynamic today that is affecting firefighters. Out of necessity often or sometimes by choice, many more households have dual-earner parents, and so it's very common now for firefighters, on their alternating full days off (intended for rest and recovery after working a full 24 hours), to take on the primary caregiver roles for their children, and also oftentimes for their aging parents. The potential negative result of all of this is that they may not be getting adequate rest to prepare physically, emotionally, and psychologically for the potentially dangerous and traumatic events they may face the next day. Research also shows that this lack of rest can weaken their immune system, which is hugely important when they're dealing with inhalation of smoke and other potentially carcinogenic materials on a regular basis.
There are all kinds of stress-inducing fears associated with the work. You could have a heart attack, go down in a fire, you could get shot, that was one of my most frightening experiences on the job.
Fear of getting shot? As a firefighter?
CB: I worked on the North side of Fort Worth and in the 80s there were quite a lot of gang shootings which would lead to retaliation shootings and so on. One Sunday afternoon we get on the scene and there are two adult men who’ve been shot. One is obviously dead, the other has an abdominal gunshot wound but is alive. We start attending to the one with the abdominal wound, well, suddenly, a third guy comes up with a pistol and says "what are you doing?!", and we explain we're trying to save his life. The guy says "No! You get over here and try to save his life!" And so he puts his gun on us and forces us to go over and perform CPR on the guy who's clearly already dead.
Oh, my goodness.
CB: Yes. The guy with the gun had the power. I remember my hands just shaking while I was performing compressions on this corpse. Eventually, the police came and secured the scene, and it was Ok. People often assume that my most frightening experience would have been in a fire, but no, it was having a gun held on me.
Wow. We have such a notion of firefighters being everyone's heroes, I never even considered the potential of a firefighter's life to be threatened in that way.
Could you speak to the current attitude among firefighters regarding personal mental health, and has it changed over time?
CB: There's definitely still a stigma attached. There's a fear that exists in which, if I, as a firefighter, express any problems I'm having, that I'll be perceived as weak. There's still a lot of that but with the younger generation, they're more likely to admit when they need help. When I first joined, you just had to 'suck it up', no matter what the cost. You would never let anyone perceive you as weak or vulnerable. And that caused so many problems for so many people, not addressing their emotional problems.
But I really do think people are more open to it today. The fire department now has a peer support team, and they're doing so much more education regarding behavioral health. The department is actively trying to help mitigate burnout and compassion fatigue and suicide problems. There's way more awareness of these issues now, no doubt.
You mentioned earlier that 99% of firefighters are male, and with the work being so tough and physically demanding would you say that a 'macho' attitude influences whether firefighters seek mental health treatment?
CB: Without a doubt, that's a part of it. Even beyond mental health, you very often find that firefighters diagnosed with cancer choose to hide the diagnosis as long as possible. They don't want to be perceived as being unable to perform and do their job.
A couple months ago I spoke with a male firefighter who was devastated by his cancer diagnosis. He was getting treatment and still attempting to come in to work, but found he was just physically unable to perform the tasks. He told me he constantly considered suicide because suddenly his identity was swept out from under him. It sends cold chills over me to hear him tell his story. It creates so many losses. Loss of his relationship with his coworkers. Loss of identity as a hero going out rescuing people every day. And then he felt like he couldn't even rescue himself.
Let’s speed up in time to your current position now.
CB: Currently I work at Cook Children's Medical Center and my job is staff care chaplain. That means that I get to be the caregiver for the physicians and nurses and other staff members. I facilitate a lot of critical incident stress debriefings and provide education on compassion fatigue, on burnout, on critical incidents. And then I do 1 to 1 interventions as well as group interventions. When someone is under a lot of stress or it may be a bereavement debriefing following the death of a chronically ill patient.
And how did you get to that position from initially being a firefighter?
CB: Back in the mid-80’s the first training happened in which a small team at the department became critical stress incident debriefers. Firefighters would talk to me about different things, things going on at home, things going on while on the job, and it felt like a natural fit. I listened to them and I could provide, simply, a compassionate ear.
So then I got heavily involved with the critical incident stress management and started teaching, probably in about 1988 or '89. And since then, I've facilitated well over a thousand debriefings throughout my career. Not only with the fire service but also with law enforcement and also with civilians.
Could you explain what you mean by a ‘debriefing’?
CB: Critical Incident Stress Debriefings address the tertiary impact of a critical incident that can occur. So in a formal debriefing—which is multi-organizational, multidisciplinary—we will invite: the dispatcher, the firefighters, the police officers, the ambulance personnel, and the emergency room staff. Really anyone that participated in the care of the patients or the patients’ families.
For example, we have a debriefing tomorrow because we had a number of shootings recently. In this particular case a child that was lost was an organ donor, and so we will have the life-gift team here to talk about the organs that were donated. And that kind of brings it full-circle. A lot of times, the first responders feel like their effort was futile, that they kept providing CPR even though it felt like a lost cause. So when these first responders hear directly from the organ transplant team that their work performing excellent CPR preserved those organs so that now 6 other dying people have a chance at life, you see their affect change on the spot. They hadn't seen their actions as having value, but now they know it did, and that it can in the future too.
So everyone involved in an incident is invited. Does the stigma surrounding mental health often stop people from attending?
CB: There is definitely a stigma still, but I think they are overcoming it in certain ways. Especially when I talk with the police officers and firefighters, I say to them "I am sure that you are not having any problems with this incident at all, but what you can say, in sharing your piece of the puzzle, can help someone who is struggling." And so, of course with them being caregivers, they respond very positively to the idea of helping someone else, as opposed to helping themselves.
We ensure everyone in a debriefing that this is not an investigation nor a critique of what was done or not done, this is simply an opportunity for every person to come in and share their story so that together we have a better or broader picture of what it was like at the scene, as well as what took place.
In essence, it helps to bring that sense of closure to everyone involved. It's an educational process too. We talk about the normal reactions to a critical incident and we discuss what they're doing for self-care and we talk about whether they're healthy enough to go back to work soon or not. We always emphasize is that it's completely normal to have these reactions, and discussing these things together helps many people who might have feared they were the only ones experiencing them.
Could you give me a basic run-through of what a critical incident stress debriefing entails?
CB: It's always helpful to put the pieces of the puzzle together in chronological order. So I ask, who was it that received the call first? If a dispatcher is present, naturally this will be them. What information did you receive from the caller? And then, whoever's next. Who got the call to action then and what specific info did you learn about the situation? This is a key factor because often first responders are surprised by unknown info upon arriving to the scene. Like coming across a pediatric victim as opposed to an adult one. So then we ask the emergency (medical) services team what information they had upon arrival. Sometimes they don't receive any info at all prior to arrival.
So as you see, we go all the way through the events that occurred so that everyone involved has a full picture of how the entire incident transpired. The firefighters get to hear that indeed this person did receive surgery or whatever the outcome, and on the other end, those in the ICU get to hear details of what transpired on the scene, possibly answering some of the details that were unclear to them.
Could you speak to the unique stresses that emergency dispatchers face which we in the public aren't aware of?
CB: Right. Oftentimes dispatchers are listening to someone who is under such great duress, you know, they're screaming, yelling, and oftentimes the dispatcher begins to viscerally visualize the scene they're hearing about and then suddenly they finish the call and immediately another one is coming in with little or no time to process in between.
I think of this one case where this guy had killed a young boy and had stabbed his young brother and that boy was playing like he was dead until the man left, so then he's on the phone to the dispatcher crying "Please protect me...he's killed my brother...I'm afraid he's gonna come back!" and so the dispatcher was very in-tuned with this little boy and she was able to be that calming voice putting him at ease. Then the police arrived and the call ended abruptly, and the dispatcher panicked that the boy was hurt further, that she wasn't able to protect him, and it distressed her such that she was getting ready to quit her job. "I can't do this any more, I feel so guilty..." and she had no reason to feel guilty, she did the best she could. And so the beauty of the debriefing is that, for this specific case, mid-meeting one of the doctors present excused himself for a few minutes—I didn't know what he was doing—the very little boy that had made the call was getting discharged from the hospital that day, so the doctor went and called the father and explained about the debriefing going on and asked if they might want to meet the first responders involved and the father and boy as well, ecstatic, said absolutely! So the doctor took all the first responders, including that dispatcher who feared the child had been killed, up to meet the child and his father.
So that's an example of a debriefing offering complete closure that otherwise probably wouldn't occur. And that dispatcher is still working today. She felt that she did make a difference and considers this profession a calling. It was a really powerful experience for her. And this comes from unifying the different branches that are usually too preoccupied to talk together about these potentially troubling experiences.
And also for that little boy! That he was able to meet and thank these people that kept him safe. That he was able to put a face to this dispatcher, and the same for her, that was really great.
But yes, being a dispatcher is difficult because their imagination can run so wild.
Would you consider your position, dedicated to the wellbeing of the staff specifically, to be common throughout hospitals? Or are there too few?
CB: Definitely too few. We were actually the first medical center (Cook Children's) to have a dedicated staff care Chaplain. Other hospitals and healthcare systems have chaplains that focus their care on the patients and patient families.
First in the country to have a Staff Care Chaplain?
CB: Yes, that's right. And absolutely I think it should be commonplace throughout healthcare systems everywhere.
Finally, what advice would you give to the public in regards to their treatment and understanding of first responders?
CB: Just understanding that all first responders are human beings. They don't possess superpowers. It's a calling, the work and the risks involved, into a field where you regularly encounter strangers going through their very worst experiences. I think it's important to respect first responders, especially those out on the front line. Respect goes a long way.
Images and interview by Dyar Bentz
