Grenfell Tower - How should psychologists respond?

As I write this, much has been written and commented on about the Grenfell Tower fire, even before the fire has been fully extinguished.  Discussion points so far have ranged across the subjects. From the initial queries of the physical sciences: How did the fire spread so quickly? What was the initial point of ignition? Is the building stable? Through to the social science questions: How are the survivors being supported? What impact will this have on the community? How can this community recover and rebuild? Although I share these questions, I also find myself asking a few other questions for the immediate time frame, and which also extend in to the near future. 

This Fire Commissioner of London has stated that the focus of her concern for her staff is not their physical wellbeing, but their emotional wellbeing following the experiences they witnessed throughout their attendance at this incident. I support her assessment of this situation. 

This first fire engines were in attendance within six minutes of the first call to the emergency services (something we should never underestimate in terms of positively influencing outcomes). This means they will have been exposed to a range of sights, smells, and sounds from the moment they stepped out of the cabs of their fire engines. There would have been an unknown number evacuating who needed to be directed safely away from the building and an unknown number who were staying in their flats as instructed. As time went on so the knowledge of possible numbers of people still inside the building would be filtering through. As the building became more compromised so they would have to navigate falling debris, unstable parts of the structure, shouts from the building above them, and shouts from survivors behind them who were trying to locate relatives they had been separated from whilst evacuating. There would have been interactions with members of the public who started to gather at the cordons. They would have been witness to people who jumped or fell from the building. This kind of incident they train for regularly, but the scale and complexity of this fire brought with it some extra challenges, which I feel are likely to be potential risk factors when it comes to their emotional response to this incident. 

At incidents that Fire and Rescue Service respond to where people are trapped, there are two priority actions: to search the building and extricate the casualties as soon as it is safe to do so. As the fire continued to develop so they would be able to understand, well before the media, the increasingly precarious conditions for those inside. Talk to any fire fighter and they will say that their ultimate purpose is to protect life. For those 200 fire fighters that night, they could not do this freely due to the limited number of entry/exit routes and the speed and intensity of the fire. We know that traumatic reactions are more likely to be chronic and severe when the experience is accompanied by a feeling of helplessness. Although the fire fighters at this scene would have been going in to search the building and rescue residents where and when it was safe (enough) to do so, the intensity of the fire meant that they did not (as a service) have the opportunity to do this to the full extent. Knowing there are potentially hundreds of residents still inside the building, knowing the likely conditions inside and not being able to locate and evacuate them quickly is likely to ruminate with most fire fighters in attendance. 

Alongside this, the experience of people jumping or falling from the building would be another exacerbating factor. The biggest loss to the international fire fighting community was the 9/11 World Trade Centre. We know now that the experience of people jumping to try and save their life, or end it through their choice, was particularly difficult for those fire fighters who survived that experience. I see no reason why we would not expect a similar response from fire fighters attending the Grenfell Tower incident.

Whilst a greater number of fire fighters were in attendance at this incident, some of this population are also recovering from things they witnessed in the recent terrorist attack on Westminster Bridge.    

After the initial response, they will then move to a protracted search and recovery operation alongside the other blue light services. We have learnt from 9/11 and natural disasters that protracted searches for body recovery come with a risk of burnout. The repetition of searching through that environment, carefully and purposefully, risks emotional exhaustion. 

Further down the timeline that will now unfold from this sad incident for years to come, there will be fire investigations, coroner court proceedings, parliamentary enquiries and probable court cases. This means the support offered to colleagues needs to continue for those individuals through the rehearsal and examination of their actions in these processes.There has been some work completed about the traumatic reactions which present alongside these kind of procedural, judicial proceedings and sometimes we see an increase in distress when emergency service personnel participate in these processes. 

With these risk factors in mind, I will return to my question about the supporting the fire fighters who attended. Two days after the Grenfell Tower fire, I chaired the first National Trauma Support Conference for the UK Fire and Rescue Services hosted by Tyne and Wear Fire and Rescue Service. Just to be clear, this conference had been planned for 6 months, it just happened to occur at this time, it was not in response to the Grenfell Tower incident. The UK Fire and Rescue Services are all too aware of the psychological risks their profession presents to them. The conference was not arranged to ask what they can do to support their colleagues, but to share existing good practice between the Services. Most services have peer-to-peer support of some kind which they use to diffuse colleagues after incidents which have effected them. Tyne and Wear are, in my opinion, one of the national leaders in their approach of providing trauma support to their fire fighters. The questions being asked at that conference were not what should they do, but how can they continue to share practice, develop, and improve. 

This changes our response as a profession of psychologists to an incident such as this. After other major incidents in other parts of the world we have seen psychologists offering to assist where they can. Although very noble, the knowledge that sound, evidence based practice already exists in the UK Fire and Rescue Service steer us away from claiming that space as ours, and instead leads us to the question of seeing how our offer as psychologists can complement existing, embedded good practice within the Fire and Rescue Servicecommunity. This is how our profession can support the fire fighters both in the immediate days after the fire, and longer term over the coming months and years.

- Dr. Rowena Hill is a Principal Lecturer at Nottingham Trent University who has worked with the Fire and Rescue Service and other blue light services for 13 years.