A Description of NDMS Behavioral Health Force Protection

1. A Description of NDMS Behavioral Health Force Protection Phil Gruzalski, LCSW Commander IL-2 Management Working Group

2. OBJECTIVES • Describe the effects of stress on disaster responders. • Provide a functional definition of NDMS Behavioral Health Force Protection both in examples from the hurricanes and written guidelines.

3. Effects of Stress on Responders “Whoever fights monsters should see to it in the process he does not become a monster and when you look long into the abyss, the abyss also looks into you.” Nietzsche

4. Forward TreatmentWW I • Immediacy • Expectancy • Simplicity • Proximity

5. Combat Stress Control (CSC) • Became U.S. Army doctrine in 1986. • DoD Directive 6490.5 (1999) directed all services to design and implement a CSC program.

6. Force Protection • Critical Incident Stress Management • American Red Cross • NDMS • HHS Guidelines for Pandemic Preparedness

7. Mission of NDMS Behavioral Health: To Provide Force Protection The mission of NDMS behavioral health force protection is to enhance the effectiveness of teams by protecting the psychological, cognitive, social and spiritual health of team members. Behavioral health force protection includes a set of strategies, guided by best practices, which are implemented before, during and after a deployment.

8. Stress During Disaster Stress can be a silent enemy having adverse effects on an emergency program’s mission and performance.

9. Stressors “ Events or conditions that may cause physiological and behavioral reactions and present coping difficulties for the individual experiencing them” Mental Health and Mass Violence, 2002

10. Felt life was threaten. Health concerns due to exposure. Experienced injury or serious illness. Team co-worker death or serious illness. Unable to contact family members. Merritt Schreiber, Ph. D Responsible for “Black triage decisions.” Experienced death of pediatric patients. Direct contact with grieving family members. Hazardous working conditions. Deployment Stressors

11. Common Physical Signs of Deployment Stress • Tension: aches, pains • Jumpiness • Cold sweat; dry mouth • Upset stomach • Diarrhea, constipation; frequent urination. • Fatigue: feel tired, drained; takes effort to move. Franklin Jones, ‘95

12. Common Mental and Emotional Signs of DeploymentStress • Anxiety: keyed up, expecting the worst. • Irritability: swearing, complaining, easily bothered. • Difficulty paying attention, remembering details. • Difficulty thinking, speaking, communicating. • Feeling badly about mistakes or what had to be done. • Beginning to lose confidence. Franklin Jones, ‘95

13. Hyperactivity Trembling or cowering Spaced-out appearance Rapid speech Irritable or angry outbursts, fighting Memory loss Exaggerated startle response Some Signs of Severe Stress During Deployment

14. Types of Post-Deployment Stress Reaction • Sub-clinical Stress Disorders • Boredom, sensation seeking and recklessness, • Burnout, job change, • Alcohol/drug misuse (self-medication), • Family disturbance, abuse, break-up, • Chronic medical complaints, problems. James Stokes, MD

15. Long Term Effect of Severe Disaster Stress on First Responders • Clinical Disorders: • Clinical Depression • Post Traumatic Stress Disorder • Substance Abuse

16. MODERATORS Antecedent variables such as prior trauma, demographics, intelligence, temperament, situational stress at home, religious beliefs, knowledge of stress mitigation: these can be negative in terms of increasing vulnerability or positive in that they enhance resilience. Gal and Jones, ‘95

17. MEDIATORS These are real time factors that seem to be more changeable and can have either good or bad effects: unit cohesion, leadership, peer support all which affect the individual’s appraisal of the situation and the individual’s coping with the realities of the situation. Jones and Gal, 95

18. Resilience EVENT = Resilience Moderators + Mediators

19. Largest Deployment of Behavioral Health Assets Katrina: 74 Rita: 11 Hurricanes Katrina and Rita

20. Prevention Primary Secondary Tertiary Strategy Team Behavioral Health MST Behavioral Health Hurricanes Katrina and Rita: Intervention & Strategy

21. AARs (230) Team Leaders’ Meeting No systematic evaluation Assessing Resiliency. Stress reduction. Long-term psychological sequellae. Hurricanes Katrina and Rita

22. Hurricanes Katrina and Rita • No Concept of Operations • No guidelines or procedures for mission implementation. • No defined capabilities for various field responses. • No clinical & operational competencies for behavioral health personnel. • No defined incident management command & control.

23. Behavioral Health Force Protection Guidelines • Operations Working Group • Sub-working Group • Timeframe • Began: November 29, 05 • Finished: February 28, 06

24. Chegwidden,Tom CA-3 Barrett, Richard TX-1 Dodgen, Dan SME Dougherty, Rebecca MO-1 Edit-Person, Lauren MA-2 Flynn, Brian SME Gordon, Thomas MI-1 Gruzalski, Phil IL-2 Hastings, Donna DMORT Kane, Terry VMAT McClure, Dave KY-1 Schreiber, Merritt CA-1 Sullivan, Irene FL-5 Vohr, Fritz RI-1 Behavioral Health Sub Working Group: Force Protection

25. Mission Pre-deployment Deployment Post-deployment Behavioral Health Force Protection Guideline

26. Pre-deployment • The mastery of stress reduction techniques. • Identify a personalized anticipated list of stressors. • Including family and significant others. • Including home employer.

27. Pre-deployment • The training of family members. • Provide information on stressors due to team member’s deployment. • Identifying personalized anticipated list of stressors. • Identifying personalized “baseline” stress levels. • Develop a family resiliency plan. • Including anticipated stress and how to manage it. • Including a variety of circumstances or conditions. • Including information specific to children.

28. Deployment Provide concurrent use of individual triage and team surveillance activities to include: • Assess status of basic needs such as food, water, shelter, and various environmental conditions affecting the team. • Assess team cohesion. • Determine current history of patient acuity and length of time deployed.

34. Deployment Secondary Prevention includes surveillance and mitigation activities involving personal behavioral health contacts with workers' identified as having possible warning signs or pre-diagnostic disaster or operational stress.

35. Post-deployment • Primary Prevention: educational classes and informational materials including handouts, flyers, and other materials distributed to the teams. • Increase an understanding of stress reactions. • Review individual and family resiliency plans. • Provide information on referrals including types of services, location, and fees.

36. Post-deployment • Secondary Prevention includes surveillance and mitigation activities involving personal behavioral health contacts with workers' identified as having possible warning signs or pre-diagnostic disaster or operational stress. • Assess need in no more than three sessions per individual or family served. • Provide referral and linkage when necessary.

37. Evidence-based practice • Process of searching for the best evidence. • Critically appraising that evidence and deciding in collaboration with the teams what the evidence implies for action. • Mechanism for quality assurance.

38. To enhance positive identification & cohesion, To understand the teams they are helping. Stress Programs need to be Organic

39. Stress Control is the Second Business of … • Every nurse. • Every police officer. • Every firefighter. • Every leader. • Every environmental health worker. • Every public affairs officer. • Every support staff.

40. Second Business (cont.) • Everyone’s Second Business is no-one’s business when First Business must be done. • Stress control throughout the event, both response and recovery, is behavioral health’s First Business.

41. Ground Zero Cross

42. Questions?pgruzalski@aol.com