Lahaina Maui Fire EMS CISM Debriefing

The fires in Lahaina were some of the most devastating wild fires in modern day history. Before I start, Iʻd like pay homage to those who perished in the fire and their families, as well as folks who lost their homes and livelihoods. Our hearts and prayers continue to go out to them all. I would like to honor the EMS providers who responded that evening to Lahaina. They risked their lives time and time again to go into the fire scene to care for and transport the burn victims. 

Almost immediately after the fire, EMS CISM members from around the state of Hawaiʻi were raring to go to Maui to lend assistance. Folks from Kauaʻi, Oʻahu, and Hawaiʻi Island all reached out. AMR Hawaiʻi graciously thanked us all for our offer and requested we stand by, as the disaster continued even though the fires had subsided considerably. In the meantime, AMR national activated a strike team to lead the provider mental health and wellness process. 

After making their initial assessment, AMR national requested a local team to be mobilized. CISM trained peers from Oʻahu and Hawaiʻi Island were summoned. Because the AMR national team had experienced large scale mass disasters before, the Hawaiʻi team stepped back and allowed the national team to take the lead. 

From the start the national team was sensitive to the local needs of the providers. Rather than coming in and setting their own pace and tone, they took the time to assess the culture and dispostion of the Maui AMR personnel. The national team matched the pace and tone of the group, eased their way in, and made strong connections with everyone. After introductions, the national team explained the frame work they normally follow, but left it open for the Hawaiʻi team to build a long term plan as we saw fit for the situation. We all decided that a debriefing for the crews on the night of the fire would be the best first step. We decided to set the first debriefing to be done the next day. 

At this juncture, we suggested that the Hawaiian way of gathering would be to hold the debriefing session at a park on the ocean front. It would also be important to share a meal once the session was completed. The national team wholeheartley welcomed the idea. Seeing that they were open, I suggested one more key component. 

The Hawaiian culture pervades throughout the islands. Rather than a sideshow, it is a baseline. I recommended to heighten the effectiveness of the debriefing to include a Hawaiian cultural piece using the ocean prior to the session. For Hawaiians, the ocean sybolically and spiritually cleanses and heals. The national team graciously agreed to combine the cultural piece with the debriefing. 

That afternoon, I found a Hawaiian cultural practitioner to come to the debriefing. She suggested an isolated beach park. Later that evening, it was decided that weʻd hold the debriefing separate from the ocean experience. Some folks felt that the beach park would be too much of a distraction for the debriefing process. We wanted to hold both pieces at the beach park, but were happy that we could still do the ocean experience. We knew that the notice was short, but felt that it was important to start the debriefing process right away. 

The next morning, 4 EMS responders who were on the night of the fires showed up. As I greeted each of the attendees, I felt their appreciation for having something for their well-being. Although folks were cordial, there was a heaviness that pervaded them all. 

The practitioner gathered us together and welcomed everyone. She spoke on how Hawaiians throughout time, past and present, use the ocean to cleanse and heal. She led us to the beach and had us all find a pohaku (rock), to hold it, and to put all that we wanted and needed to release into the rock. She further explained that once we felt ready to let it all go, to place the rock into the ocean and to enter the water to cleanse ourselves. 

The breeze that morning was cool and gentle. The ocean calm and the water crystal clear. Our practitioner commenced to chant in Hawaiian calling to the ancestors and to the natural environment that surrounded us for permission and assistance. Folks then spread out across the white sandy beach distancing themselves from each other. Everyone took a good amount of time holding our rocks tightly, infusing all that we wanted and needed to let go. Some moved quickly, while others took their time, seemingly releasing all that happened the night of the fire. Once releasing their rock, folks entered the water. Some waded partly into the ocean, while others entered and fully immersed themselves. Everyone appeared to be engaged at a high level. 

As the last person came back to our initial gathering place, the practitioner explained the last step. She passed around a small bag of Hawaiian salt and instructed us all to take a pinch, place it on our tongues, allow it to dissolve, and take a drink of water. She explained that salt is a cleansing agent. By taking it orally we cleanse ourselves internally. 

We departed the beach park by embracing each other. There was a strong sense of connection between everyone. It was truly a moment of brotherhood and sisterhood. We fully expected all 4 attendees to show up at the formal debriefing at the agencyʻs headquarters, but only one chose to attend. At the office, 2 new providers showed up. During the CISD, the one provider that attended the ocean experience led the way. She was very open with her sharing and described her experience of the fires in detail. As a result the other two members followed in suit. AMR Hawaiʻi air division's support dog was also present and her calming affect influenced everyone. It was a powerful experience. 

Soon after the debriefing, it was decided to hold another ocean experience and debriefing the next day to catch the remaining crew members. Everyone agreed that we would hold the entire session at the beach. We wanted all who participated in the ocean experience to also experience the formal debriefing. 

That morning, the winds were blowing briskly. The water was more textured than the previous day. The beach was still pretty empty, with only a few free divers getting ready to go spear fishing. Folks slowly filtered in one by one. All in all we had 12 crew members show up. I overheard that the medic who took the role of IC, strongly encouraged everyone to attend. Three of the providers from the previous day came again. 

We also had members from the AMR national CISM team attend. In total, there were about 16 folks at the beach. The Hawaiian cultural practitioner greeted us all and facilitated the same experience as the previous morning for everyone once again. 

The second morning's ocean experience was equally as powerful. Following the cleansing, we gathered together and formed our circle. The sun was out so we found a nice shaded patch of grass. In attendance for the debriefing were the 12 crew members, a mental health professional, and 3 peers. Hoku, the support dog was present once again. As we moved through the debriefing every individual in the circle gave their account of that evening. Folks shared openly and at a deep level. From my perspective, there appeared to be a significant catharsis for individuals, as well as the entire group. 

The ocean experience and support dog combined with the CISM debriefing was a unique and powerful experience. More importantly, the combination helped providers to off load stress at multiple levels. Not only were they able to benefit from the CISM debriefing process, but they also were able to physically and spiritually cleanse themselves in the ocean. 

Over the years Iʻve learned that talking about an experience allows for a release for some individuals. However, others may struggle with verbally expressing their thoughts and feelings. Having an experience in the ocean, or any place in nature, gives everyone a chance to cleanse and release. It gives people the opportunity to internalize and grapple with their thoughts and emotions to release them without having to formulate them in their heads to verbalize it. There's also a natural release just by being in nature. 

I wanted to commend the national AMR CISM team for not only responding, but also for their humility. They came with an open mind and a high level of sensitivity to our local ways. It was clear that their priority was to serve the Maui community. Their egos were in check. By allowing us to blend the Hawaiian culture with the CISD process, not only was attendance high (I donʻt believe these intial meetings were mandatory), but more importantly the combination of the two allowed the providers to have a deep cathartic experience.