Emergency Responding to the Emergency Responder

1. Emergency Responding to the Emergency Responder Stress, Coping and Surviving in the Emergency Services Officer Joel Fay Psy.D(415) 720-6653 Joel.Fay@SRPD.0rg

2. Post Traumatic Stress Disorder –An Assault on the Mind, Body and Spirit

3. PTSD • PTSD is a total person experience • Symptoms effect • Mental Health • Physical Health • Family and Friends • Work • Spirit

4. PTSD – Diagnostic Criteria Must be exposed to a traumatic event Person's response to the event must involve intense fear, helplessness, or horror

5. The event must be re-experienced by distressing recollections, dreams, flashbacks, etc.

6. Avoidance of locations, persons, etc • Sense of isolation • “No one else knows what I am going through” • “I can’t burden other people with this.”

7. Persistent Problems With Increased Arousal • Withdrawal • Irritability • Insomnia • Hyper-vigilant

8. Symptoms of the Spirit • Hopelessness • Helplessness(Locus of Control) • Meaning of life • Questioning faith

9. How The Brain Processes Threats And why it’s NOT our Fault

10. How It Works • Thalamus – is a routing station for all incoming sensory impulses except smell

11. How It Works • Thalamus – Routes information from eyes and ears to the brain

12. Amygdala • Small almond shaped structure near the middle of the brain. • Attaches meaning to memory • Places the experience into the context of an emotion.

13. The Amygdala is the command center of the brain’s fear system.

14. A rat lacking an Amygdala will not respond to a threat.

15. Brain’s Response • Works with Hippocampus by evaluating threats and placing them in the context of a previous experience. • Prefrontal Cortex – Reins in the Amygdala if the threat is deemed to be insignificant.

16. What Happens Next? • Amygdala – If threat is sufficient the body shuts down non-emergency services (I.e., digestion and immunity) • Triggers body wide emergency response within seconds

17. Hypothalamic-Pituitary-Adrenal System (HPA) • Release of Cortisol to activate the bodies defense systems • Release of Catecholamines -dopamine, norepinephrine, and epinephrine

18. Catecholamines • Suppress activity in areas at the front of the brain concerned with short-term memory, concentration, inhibition, and rational thought. • This allows a quick reaction to the threat

19. What is Memory? The use of past experiences to affect future behavior.

20. Heightened alertness in the brain – which in effect tells the memory centers, “Remember what occurred.”

21. Although cognitively you know that the event is over, part of you (your nervous system) still feels that the event is happening. This constant state of alertness taxes your body and spirit.

22. “What makes an incident Critical?” • Perceived threat / trauma • Your body’s reaction • What else is happening in your life • The meaning you attribute to an event

23. EVENT “Once you crossed over that line – there is no going back.”

24. Coping

25. Stress vs. Critical Incident Stress • Daily stress • Stress v. Distress

26. Organizational/ PersonalBetrayal “It’s about the system” How a person recovers from trauma depends on the support system available after an event. “Don’t punish the victim.”

27. How Do We React to Trauma • “I think I am going crazy” • “There is something wrong with me.” • “My inability to control my symptoms shows how weak I am” • Fearing Fear – The anticipation of experiencing the symptoms can be almost as debilitating as the symptoms themselves.

28. How Do We React to Trauma We have trouble controlling emotions because reminders lead to sudden anxiety, anger, or upset • We feel anger or aggressive feelings and feel the need to defend ourselves • We get upset when we are reminded about the trauma (by something the person sees, hears, feels, smells, or tastes)

29. You cannot predict and you cannot control your life to the extent that would make you feel comfortable and safe. To adjust to this lack of control – you check out, numb yourself become unavailable.

30. The Cost of Denying Emotions • In 2002, 437 paramedics were tested to look at long term effects of suppressing emotions. • The greater the emotional suppression – the greater the physical and psychological stress symptoms. Wastell, 2002

31. Our strengths are the other side of our weaknesses Self- Control – Physical and Psychological Not affected by what we experience Command presence

32. Commonly Used Maladaptive Coping Techniques • Harder, Faster, Better • Hyper-Activity • Counter Phobic Behavior • Impulsive and Reckless Behavior w/o Thought

33. Commonly Used Maladaptive Coping Techniques • Multiple Romantic Relationship • To obtain positive mirroring • “I can’t be bad, look how much she loves me”

34. More… • Overcompensation • Token attempts seeking professional help. • Alcohol / Substance Use

35. What These Coping Strategies Have in Common • An attempt to recapture the ability for denial • They work – for a while – for some • They are avoidance techniques • They do not include conscious grappling with the issues and fears generated by Cognitive Dissonance

36. Often the symptoms of a stress reaction are misdiagnosed by supervisors, families, doctors and the individual. Anger, Somatic Reactions, Frustration, Burn Out Person Self-Blame Guilt Second Guessing

37. The Aftermath of Failed Repaired Efforts • Each failed attempt at restoring the Self-Concept further “proves” fraudulence • Isolation • From work, friends, family and prior activities. • Occurs because there are fewer and fewer people you can reveal one’s self to. • There is a fear of being found “fraudulent”

38. What Do We Do? AVOIDANCE • Alcohol/ Drugs • Thought Suppression • Risky Behavior • Excess Work This works until it doesn’t

39. The Aftermath of Failed Repair Efforts • Panic Attacks • Fear of Fear • Self-Blame and Self- Guilt • Depression • Psychic Exhaustion • Global Negative Self Appraisal • Job Site Becomes Toxic Emergency Responder Exhaustion Syndrome

40. Survival What Can You Do?

41. Peer Goals • Provide acceptance, validation and empowerment • Breaks the fallacy of uniqueness by demonstrating that they are not alone and that what they are experiencing is normal

42. Peer Goals • Help clients cope with the myth of invulnerability which has been shattered • Provides hope

43. Police Chaplains International Conference of Police Chaplains

44. EAP • Are they culturally competent? • Do you have a list of clinicians you could call on in case of an emergency? • Create a program where local clinicians go on ride-a-longs, do FATS, etc

46. Who Attends WCPR • Police, fire and emergency services personnel are the typical residents. • People affected by the CI for whom a debriefing or individual therapy has not been sufficient to reduce symptoms. • Most clients come because they are in crisis and “not coming” was not an alternative.

47. Why Residential Treatment ? • Program must be of sufficient impact / relevance to effectively challenge long held faulty self-concepts. • Robust peer-support network. • VERY culturally competent mental health professionals. • A true collaboration which is peer driven and clinically informed.

48. Primary Goals • Keep the person alive / Do no harm • Restore psychological and emotional functioning • Reduction of physical symptoms • Restore ability to participate in their own recovery • Link client to appropriate resources

49. Program Components • Initial Phone Intake • Intake – First, Worst and Last, DAPS • 5 CISD Phases • Education Modules • Family/Relationship Debriefings • Individual / Group* • EMDR • Chaplain • AA • 90 Day Relapse Prevention Plan

50. Some Data • Gender: 75% male • Substance Abuse Issue: 43.7% Yes • How They Came: • 29% Worker’s Comp • 13% Department Training Funds • 28% - Self Pay • 20% - Scholarships • 6% - Donations (Police Associations)