By Gavin Francis
Air Line Pilot, April 2004, p.23

Pilots representing the Critical Incident Response Program Committees of a number of ALPA master executive councils, as well as other representatives from various airlines, gathered in Herndon, Va., in February to take part in an annual conference of CIRP chairpersons. Approximately 35 pilots attended the 3-day event in which participants discussed CIRP issues, underwent recurrent training, and gained important knowledge about traumatic stress and grief intervention.

ALPA’s CIRP is designed to educate pilots about critical incident stress, as well as to provide peer support to flightcrew members suffering from the detrimental effects of a traumatic event. Peer support volunteers are trained in debriefing techniques that help flightcrew members resolve emotional stress. A number of ALPA pilot groups have adopted the program, which is credited with helping many pilots return to the cockpit after an accident or incident.

"At its heart, the program is about helping pilots," said First Officer John McFadden (United), who serves as his MEC’s CIRP Committee chairman.

"I think that misconstruing the program as some kind of group therapy is easy, but CIRP is not like that at all. It’s really about creating an environment and a structure in which pilots feel safe working through the sometimes confusing emotions that arise after a critical incident occurs."

This year’s conference marks an important anniversary for the CIRP Committee, which traces its roots back more than a decade. ALPA officially began training peer support volunteers in critical incident response in 1994. However, what many consider to be the seminal event leading to the creation of the Committee occurred several years earlier.

On April 28, 1988, Aloha Airlines Flight 243 to Honolulu lost a 20-foot section of its upper fuselage after the airplane suffered explosive decompression upon reaching FL240. As debris flew around the cockpit, Capt. Robert Schornstheimer and First Officer Madeline "Mimi" Tompkins quickly assessed the situation and ran through their emergency checklists. The two pilots managed to safely land the Aloha Boeing 737 at Kahului Airport on Maui. Tragically, a flight attendant was lost, and all 89 passengers were injured (see "All I Could See Was Blue Sky," July 1988).

After the accident, F/O Tompkins had considerable difficulty dealing with the experience. Both pilots immediately became the focus of national news media attention, which gave them very little time to come to grips with what they’d been through.

F/O Tompkins threw herself back into her work, upgrading to captain soon after the accident. However, signs of emotional stress became evident as she struggled with chronic sleeplessness and occasional flashbacks. Capt. Tompkins sought the help of ALPA’s Aeromedical Advisor, Dr. Donald Hudson, who encouraged her to take advantage of resources that ALPA offered.

Although the Association provided valuable assistance, it quickly became apparent that ALPA needed to develop a specific program designed to help pilots who had experienced a traumatic event. Capt. Tompkins eventually became involved with ALPA’s Human Performance Committee (now the Human Factors Committee). The Committee formed a task force to look into critical incident response and charged Capt. Tompkins, along with Capt. Alan Campbell (Delta, Ret.), Capt. Robert Sumwalt (US Airways), and ALPA attorney Jim Johnson, among others, with researching existing programs that might be beneficial to pilots.

Capt. Tompkins believes that the existence of the program today is due in large part to the talents of the people who served on the task force with her. "We all had different skills," she said. "People would listen to what I had to say because of the accident, but the program would never have gotten off the ground without the hard work of the capable people I served with on the project team."

Through the team’s inquiries, it became aware of Dr. Jeffery Mitchell, founder of the International Critical Incident Stress Foundation (ICISF). He was a former firefighter/paramedic who had created a debriefing program that emergency service providers were using to help their personnel. Firefighters, paramedics, EMTs, and police officers had all used the program successfully, and the task force thought it might work for pilots as well.

After carefully studying the effectiveness of Dr. Mitchell’s techniques, the group proposed that ALPA adopt the ICISF program. ALPA approved the program for its members and began teaching the debriefing model to its first class of peer support volunteers in September 1994. One month later, Simmons (now American Eagle) Flight 4184 crashed, killing all 68 people aboard. The Committee was called in to debrief accident investigators who had worked at the crash site.

"It was pretty frightening," said Capt. Tompkins. "We’d been through the training, and we’d all been certified, but suddenly we were faced with a real-life crisis. We were going to have to prove ourselves."

Capt. Rick Bicknell (now a Northwest Airlines first officer) was the peer support volunteer who responded to the crisis. But the group also needed a professional counselor to help with the debriefings. Capt. Tompkins made several late-night calls and eventually located Dr. Carolyn Burns, a mental health professional certified by the ICISF to conduct critical incident stress debriefings (CISD). Together, she and Capt. Bicknell conducted ALPA’s first CISD.

Ten years later, Dr. Burns is still actively involved with ALPA’s CIRP efforts and regularly trains pilot peer support volunteers in CISD techniques. "I’ve been conducting debriefings a long time," she said. "I started working with firefighters and paramedics in 1988 and then began working with pilots in 1994. Since then, we’ve trained more than 250 ALPA peer support volunteers in critical incident response."

"The real value of peer support is that most people are just more comfortable discussing their feelings with someone who knows their situation," said Capt. Tompkins, who served as chairperson from 1996, when the CIRP group received committee status, until 2002. "Talking to someone who shares your experience is easier."

Every person reacts differently to the stresses that a traumatic event causes. A stressful reaction to a traumatic event is normal; however, post-traumatic stress disorder (PTSD) is a more serious psychological condition that requires treatment. Only about 5 percent of pilots who have experienced a traumatic event seem to cope well enough without help to return to work. Far more need outside support. In fact, statistics indicate that PTSD is one of the primary reasons that some pilots choose to leave the profession prematurely. According to ALPA’s Aeromedical Office, 82 percent of pilots who suffer from PTSD and do not seek treatment leave the airline industry within 4 years.

"Disregarding the effects of psychological stress can be extremely detrimental to good mental health," said Bill Edmunds, senior human performance specialist with ALPA’s Engineering and Air Safety Department. "Early intervention is the key. Dealing with traumatic stress as soon as possible after the event can greatly reduce recovery time and the expense of treatment."

The CIRP process usually begins with a defusing. This is an initial contact with a person who has undergone a traumatic event in which the peer support volunteer decides whether a debriefing should take place. A defusing may last for about 30 minutes and is usually done within 24 hours of the event. When the peer support volunteer cannot interact with the crewmember in person, a defusing can take place over the telephone.

If a full debriefing is necessary, peer support volunteers will usually schedule a formal debriefing session with affected crewmembers within 3 to 4 days after a critical event occurs. A typical debriefing may last several hours, and will include at least one mental health professional in addition to peer support volunteers.

A critical incident stress debriefing is basically a structured discussion among peers. The peer support volunteer’s role is that of facilitator, directing the discussion in a way that promotes useful communication among participants. This type of discussion can help to mitigate the effects of the stress and expedite the recovery process.

"Pilots tend to be more comfortable in a structured environment," said F/O McFadden. "We’re used to checklists and procedures, and we’re familiar with the debriefing process, so this approach has been successful for us."

For a debriefing to be effective, participants must feel secure. Taking notes is prohibited, confidentiality is protected, and disciplinary action cannot be taken as a result of a crewmember’s participation. Additionally, the framework of a debriefing allows for no rank structure.

A debriefing has seven phases: introduction, facts, thought, reactions, symptoms, teaching, and re-entry. Each of these phases is designed to prompt responses that allow participants to work through their emotional reactions to an event. After a debriefing, peer support volunteers normally follow up with crewmembers to provide additional support and assess their recovery. CIRP volunteers suggest that crewmembers keep support phone numbers for at least 6 months.

"Critical incident response work is not the kind of thing we conduct the day after an event and then walk away from," said Capt. Rob Neighbour (Mesa), who serves as chairman of the ALPA-wide CIRP Committee. "It’s an ongoing process. We stay in contact with the crewmembers whom we work with until they no longer need us."

Over the years, the Program has received strong support from ALPA members, as well as from many airlines. That most carriers recognize the value of the Program, and maintain good working relationships with their ALPA CIRP Committees, is a testament to the success of the program. But the folks who are involved with CIRP are not content to rest on their laurels. The group is actively looking to the future to see how they can better serve ALPA pilots and their families.

"What we do today is not necessarily what we’ll do ten years from now," said Capt. Neighbour. "As techniques are developed, and we learn more about the needs of our pilots, we hope our program will evolve."

In fact, the Committee has recently begun looking into other aspects of intervention, such as grief and depression. Dr. Larry Fishel, a mental health professional who specializes in grief counseling, led a seminar on grief support during the conference. "While peer support volunteers are not counselors," said Dr. Fishel, "grief is frequently a factor in critical incident debriefing situations. It’s very important that volunteers participating in a debriefing have a thorough understanding of grief."

Capt. Neighbour stressed that the Committee’s primary mission should always be to provide peer support in critical incident situations, but he acknowledged that grief training is something that the group is well equipped to examine. "This is something that we’ve had to get into because of the huge need for this type of support, and nobody else seems to be doing it."

But Capt. Neighbour doesn’t foresee that grief support will be something his Committee takes on indefinitely. "It’s something we will probably want to cross-train in until a pilot assistance committee is created to handle the issue. It’s complementary training because both grief support and critical incident response share their basis in listening skills, but the two situations require a very different approach."

First Officer Rich Alter (US Airways) deals with grief regularly in his capacity as chairman of his MEC’s Survivor Committee. F/O Alter spoke to participants about the similarities between ALPA’s CIRP and Survivor Committees and urged cooperation between the two groups.

"Before the CIRP program existed, those of us who were involved with the Survivors Committee at US Airways were doing many of the same things that the CIRP folks are doing now," said F/O Alter. "We should really explore some of the ways that our Committees can work more closely together in the future."

Capt. Neighbour also recommended that the group begin to prepare for situations that peer volunteers may have to contend with in the future, such as the possibility of a federal flight deck officer discharging a firearm in defense of the cockpit.

"Whenever police officers discharge a firearm in the line of duty, they get debriefed by a critical incident response peer," Capt. Neighbour noted. "It only makes sense that a pilot would receive the same type of support. We need to be prepared to deal with that situation when that day comes."