The Underlying Factor

An internal memo provides a striking glimpse behind the scenes of history.

Among the memorials and reflections of the late President Kennedy that crop up this time each year, a colleague recently shared an internal memorandum from the administrator of the Dallas County Hospital District—one that was sent to the employees of Parkland Memorial Hospital on November 27, 1963. It reads as follows:

DALLAS COUNTY HOSPITAL DISTRICT
Office Memorandum
November 27, 1963

To: All Employees

At 12:38 p.m., Friday, November 22, 1963, President John F. Kennedy and Texas' Governor John Connally were brought to the Emergency Room of Parkland Memorial Hospital after being struck down by the bullets of an assassin.

At 1:07 p.m., Sunday, November 24, 1963, Lee. H. Oswald, accused assassin of the late president, died in an operating room of Parkland Memorial Hospital after being shot by a bystander in the basement of Dallas' City Hall. In the intervening 48 hours and 31 minutes Parkland Memorial Hospital had:

1. Become the temporary seat of the government of the United States.
2. Become the temporary seat of the government of the State of Texas.
3. Become the site of the death of the 35th President.
4. Become the site of the ascendency of the 36th President.
5. Become site of the death of President Kennedy's accused assassin.
6. Twice become the center of the attention of the world.
7. Continued to function at close to normal pace as a large charity hospital.

What is it that enables an institution to take in stride such a series of history jolting events? Spirit? Dedication? Preparedness? Certainly, all of these are important, but the underlying factor is people. People whose education and training is sound. People whose judgement is calm and perceptive. People whose actions are deliberate and definitive. Our pride is not that we were swept up by the whirlwind of tragic history, but that when we were, we were not found wanting.

(Signed)

C. J. Price
Administrator

It’s a striking glimpse behind the scenes of history, and yet it reminds us that even half a century later, the challenges of responding to a crisis remain largely the same. Even though professionals are trained to respond to emergencies, they can still face extreme demands on their skills in the wake of violent crises. Simultaneously, they must facilitate significant stability and calm to provide effective crisis intervention. And even in the immediate aftermath of a world-changing event, C.J. Price seemed acutely aware that this remarkable resilience needed to be acknowledged. “The underlying factor is people,” he wrote. “People whose education and training is sound.”

Debriefing matters more than ever—just ask our Certified Instructors.

These days, we might consider this memo a type of debriefing—a recap of what happened during crisis intervention, and an acknowledgment of what supported the effectiveness of staff in facilitating meaningful care. In the wake of a crisis, debriefing can function as a structured review of a crisis event, giving staff an opportunity to clarify:

• what factors may have contributed to the crisis
• what could have been done better
• what changes or insights might be implemented going forward
• what was done well—and how the team came together to succeed

When sharing the memo, my colleague pointed out that there’s also a sad relevance to this document beyond its initial purpose. It’s become a rather unfortunate necessity for all kinds of professionals to be especially resilient in the face of violence. As horrific events continue to punctuate our headlines, it’s all too easy to become numb to the devastating trauma they leave in their wake. It seems that we’re losing sight of the immense toll that is taken on those who respond to these crises. The modern news cycle inundates our consciousness in unrelenting waves of information and subsequent squalls of conflicting opinion and analysis, which leaves one little time to pause and reflect on the true impact of a tragedy.

Even back in 1963, taking the time to debrief was a daunting task for a busy urban hospital. Parkland Hospital notes on their website that as many as 30 additional patients were in the emergency room for treatment along with the president and governor on the day of the assassination. In fact, the hospital’s average daily patient load at that time was approximately 272 individuals—or “a patient every five minutes”. Still, a collective moment of thoughtful reflection and gratitude in the immediate aftermath of the crisis helped reconnect the staff to the value of their work and their purpose as professionals.

In reading this memo, I was inspired to ask some of our many Certified Instructors across the country how they’ve found debriefing to be beneficial for staff. CPI Certified Instructor Charles said of debriefing, “Overall, it [leads] to positive staff training and re-establishing confidence amongst coworkers.” He shared that he’s had success facilitating checklist-style debriefings with staff at his organization using the COPING Model^℠, which guides participants through a six-step process following a crisis incident.

Certified Instructor Mark added that while busy organizations like hospitals often claim that they don’t have the time to debrief after an event, he’s observed real benefits for staff that take a short interval to do a simple debriefing. “I find there is a direct correlation between failure to debrief and increased staff turnover,” he said. “I find staff are somewhat more self-critical than deserved. I remind staff often of what they have done well or correctly, and ironically, praise is sometimes harder to accept than criticism. Because of staff's past, vicarious trauma certainly can be a factor. If the emotions are not processed, it is much more likely to become a long-term issue for staff.”

In his blog post about staff debriefing strategies, CPI Global Professional Manager Bill Badzmierowski writes, “The COPING Model^℠ provides a simple, flexible, and adaptable template for summarizing currently verified facts about the incident while acknowledging various strengths that enable people’s coping mechanisms. It offers a supportive forum within which anyone involved may express some of the challenges they faced. It may introduce the opportunity to further explore potential difficulties that could affect employee job responsibilities following the crisis. It helps in identifying possible areas of growth and change in preventing similar crises in the future.”

No matter how busy your team might be, time spent debriefing is never wasted.

It might feel like you don’t have the time, but time spent debriefing is never wasted. The December 9, 1963 issue of Hospital Highlights, an internal staff newsletter for the Dallas County Hospital District, offered a sobering reflection on the aftermath Parkland’s staff faced days after handling a particularly violent crisis alongside their full patient load:

Parkland is a hospital where the struggle between life and death, disease and health, is our bread and meat. Rarely a 24-hour period passes that doesn’t bring to our doors someone with a story of tragedy, suffering, injustice, or violence. To each of these we offer an outstretched hand—sometimes to cure, often to relieve, and always to comfort…

Although the hospital personnel performed as a highly skilled team, we experienced the shock and the deep hurt of an intense grief feeling. The traumatic invasion of evil and destruction is not new to us, but the scope of these events have left our feelings bruised and grieving.

Crisis prevention training, education, and personal resilience are critical components of effectively responding to an emergency, but the impact of a crisis can last well beyond the duration of a shift of duty, a business day, or a news cycle—and that’s where debriefing becomes a vital practice. Coming together as a team to regroup, even if it’s as brief as a simple documentation process, can have long-reaching benefits for staff that face repeated exposure to vicarious trauma.

Thoughtful debriefing can transmute seemingly senseless events into an opportunity for learning, growth, healing, and connection. On the final page of the newsletter, administrators wrote: “Every employee of the Dallas County Hospital District, whether working with the President, the Governor, another patient, or performing regular duties contributed to the successful handling of the situation.” This statement was part of a list following up on the events of that week, aptly titled Maybe You Haven’t Realized.

The underlying factor is people. It’s all about people.

As Certified Instructor Mark commented, “Staff want to do the right things. They want to do the best that they can and keep everyone safer—I remind staff that we do not keep the healing milieu safe, but safer. Helping staff put the events at work in perspective can take some time and discussion. It helps everyone to hear what went well, to keep the sense of accomplishment moving forward with an eye to doing it better.”

That hospital administrators acknowledged the efforts of the entire team—not just those working in the emergency room—indicates that there was immense value to their organization in reviewing the effectiveness of their team approach on the day the crisis took place. It also helped them determine how best to support traumatized staff in the wake of horrific events, and opened a channel of support to professionals who were doing their job “under the most trying circumstances”.

Debriefing, no matter how your staff facilitates it, can curate a similarly powerful conversation about how to best facilitate Care, Welfare, Safety, and Security^℠—not only for the populations that your organization supports, but for the staff who serve those individuals. What was relevant this time 54 years ago still stands today—effective crisis intervention is all about people. People whose education and training is sound. People whose judgement is calm and perceptive. People whose actions are deliberate and definitive. No matter the crisis they face, such people will not be found wanting.