Chaplain (Capt) Chad Kline, CAP CISM Officer, Maryland Wing

1. Understanding, Mitigating, and Responding to the Psychological Impact of Search and Rescue and Disaster Relief Missions Chaplain (Capt) Chad Kline, CAP CISM Officer, Maryland Wing Capt Christopher Hiles, RN BSN, MS, CAP Nurse Officer, Maryland Wing

2. Introduction: Course Goals • Identify how people react to a stressful event • Identify how cadets may respond differently than adults • Identify symptoms of a negative response • Be able to help members at the scene and post-mission

3. Introduction: What This Course Is Not • Critical Incident Stress Management training • Medical or psychological certification or continuing education course

4. Introduction: Overview • Psychology 101 • Before the Mission • During the Mission • After the Mission

5. Psychology 101

6. Psychology 101 • Acute Disequilibrium/Psychological Crisis • Post Traumatic Stress Disorder • Response in Teenagers

7. Acute Disequilibrium/Psychological Crisis “A state of emotional turmoil wherein one’s usual coping mechanisms have failed in the face of a perceived challenge or threat.” –Everly and Mitchell, 2000

8. Acute Disequilibrium/Psychological Crisis • There are four ways crisis effects an individual: • Physically • Emotionally • Behaviorally • Cognitively All of these signs are ABOVE normal levels

9. Physical Effects of Crisis • Feeling faint or dizzy • Hot or cold sensations • Tightness in throat, stomach, or chest • Agitation, nervousness, or hyper arousal • Fatigue or exhaustion • Stomach distress or nausea • Increased or decreased appetite • Headache • Worstening of previous condition

10. Behavioral Effects of Crisis • Sleep disturbances or nightmares • Jumpiness or being easily startled • Hyper-vigilance, scanning for danger • Crying or tearful for no apparent reason • Conflicts with family, friends, and coworkers • Avoidance of reminders of trauma • Inability to express feelings • Isolation or withdraw from others • Increased use of drugs (including prescription medication) or alcohol

11. Emotional Effects of Crisis • Shock or disbelief • Anxiety, fear, or worry about safety • Numbness • Sadness or grief • Longing or pining for the deceased • Feel powerless, helpless, or vulnerable • Disassociation or “shellshock” • Anger, rage, or desire for revenge • Irritability or shortness of temper • Hopelessness or despair • Blame self and/or others • Survivor guilt • Unpredictable mood swings • Re experiencing pain associated with previous trauma

12. Cognitive Effects of Crisis • Confusion or disorientation • Poor concentration or memory problems • Impaired thinking or decision making • Complete or partial amnesia • Repeated flashbacks or intrusive thoughts and images • Obsessive self criticism or self doubts • Preoccupation with protecting loved ones • Questioning of spiritual or religious beliefs

13. What is PTSD? “Post-traumatic stress disorder is a type of anxiety disorder. It can occur after you've seen or experienced a traumatic event that involved the threat of injury or death.”* *National Institutes of Health

14. PTSD Symptoms • Re-experiencing the traumatic event • Flashbacks and nightmares • Similar events triggering a large response • Avoidance and emotional numbing • Stop activity in CAP • Withdrawn from family, friends, and team members • Increased arousal • Bursts of anger • Inability to concentrate or becomes forgetful • Anxiety symptoms as listed before

15. Effects of Stress on Adolescents • Have same concerns as adults except: • Varying levels of cognitive development • May not fully understand the “why” • May not have the same amount of experience or types of experiences as adults • May have lower thresholds of resistance and resilience

16. Before the Mission

17. Before the Mission: Resistance/Resilience Resistance: The ability to resist psychological effects of a traumatic experience Resilience: The ability to recover from the effects of a traumatic experience

18. Before the Missions: Factors Effecting Resistance/Resiliency • Previous Experience • History of Psychological and Substance Abuse • Natural “Fight or Flight” Response • Family Stability • Cognitive Development • Faith in Leadership • Effective Use of Social Support Systems

19. Before the Mission: Building Resistance/Resilience • Get Experience • Training at the Squadron Level • Training through Exercises • Build Social Support • Build Relationships in the Squadron • Use the Working Relationships Built within the Ground Team/Air Crew

20. Before the Mission: Knowing If You’re Ready • The best person to know if you’re ready is you • How have you responded to crisis in the past? • How have you responded to SAR exercises? • How have you responded to previous SAR missions? • Have you attempted desensitization?

21. Before the Mission: Are Your Team Members Ready? • Don’t just check your team for skills proficiency • How do they handle stress? • How do they act at the squadron? • Have they talked to you about previous issues • Get to know your team • Discuss their concerns about possible psychologically stressing scenarios • Use discretion to determine discussions at a group or individual level

22. Before the Mission: Are Your Cadets Ready? • Do not make decisions in a vacuum, talk to: • Cadet and senior staff working with the cadet • The cadet’s parents or guardians • Ground team members and leaders working with the cadet • The cadet • Age may not be best way to determine readiness • As a cadet gets older, they should be reevaluated

23. You and Your Squadron • How do you know if you’re ready? • Does your squadron evaluate psychological preparedness? • How can this information be applied to your squadron? • Remember, MDWG CISM Team can assist you and your unit by providing training and advice

24. During the Mission

25. During the Mission: Critical Incident Stress Management “Critical Incident Stress Management (CISM) may be defined as a comprehensive, integrated, multi-component crisis intervention system.” – CAPR 60-5

26. During the Mission: How CISM Helps • Demobilization and Staff Consultation: Consultation to the incident or activity commander who believes a CISM response may be necessary • Crisis Management Briefing: A briefing with the incident or activity commander about the best ways to support responders • Defusing: A session held within 12 hours of an incident, usually in small groups, that are designed to allow people who may been exposed to a traumatic event used to determine if a member will require some follow up or further assistance

27. During the Mission: How CISM Helps • Critical Incident Stress Debriefings:  A group session held between 1 and 10 days after an incident where members are evaluated for trauma and referred to further services • Individual Crisis Intervention: A one on one discussion with an effected member that can occur anytime and at any place requested • Family CISM: A session with family members of an effected member designed to provide the family with resources to help support the member

28. During the Mission: How to Reach the CISM Team • During a mission/activity: Request CISM services through the chain of command. The Incident or Activity Commander will contact the MDWG CISM Officer. • What if I can’t get anyone on the CISM team? Contact the NHQ Duty Officer at 1-888-211-1812

29. During the Mission: CISM and Privacy • Any provided CISM services are considered confidential • National Headquarters requires the number of people provided services and the number of referrals made • No identifying information is recorded or reported to anyone outside the CISM team (this includes names, ranks, home units, CAP ID’s, etc.)

30. During the Mission: Scenarios • Read the scenario • You will control our actors by suggesting courses of action

31. During the Mission: Scenario 1 During a missing aircraft search, a ground team discovers the wreckage with human remains on board. A senior member, a 32 year old male GTM 3, immediately turns away, throws up, and stands, facing away from the site, trembling. As the GTL, what should you do?

32. During the Mission: Scenario 1 • Expected Actions • Approach the GTM in a caring manner • Removing member from scene while completing mission tasks (e.g. cordoning of the site, relaying information to mission base) • Get member to mission base • Request CISM support • Maintain member confidentiality

33. During the Mission: Scenario 2 After finding the scene, a ground team relays crash site details to mission base including the finding of the remains of the two people on board. None of the information is graphic. A 15 year old female cadet in the radio room records the information. An hour later, the cadet begins to withdraw. A friend of the cadet, also in the radio room, approaches you and becomes concerned stating that it isn’t her normal way of acting.

34. During the Mission: Scenario 2 • Expected Actions • Report concern up the chain of command • Request CISM assistance • Watch cadet and gently approach if necessary

35. After the Mission

36. After the Mission: How Long Will Symptoms Remain • Initial reaction symptoms may last weeks, months, or even years after the event • Symptoms of anxiety may disappear and reappear months later • Be wary of any sudden changes of behavior, even months after the incident

37. After the Mission: Where to Get Help • Local resources • Squadron Chaplain • Squadron Health Services Officer • Wing resources (All contact information is online at www.mdcap.org) • Wing Critical Incident Stress Management Officer • Wing Chaplain • Wing Health Services Officer • NHQ Duty Officer at 1-888-211-1812

38. After the Mission: Getting Back on the Horse • Don’t force it • Members may want to pursue other issues within the ES mission or in Aerospace Education or Cadet Programs • Forcing a member back into the field may cause them to quit altogether • Take it slow • It may be better to only participate in exercises and work back to a mission • Be honest with yourself

39. After the Mission: How CISM Helps • Organizational consultation: Consultation with a unit to help foster communications and support for potentially effected members • Follow-up/Referral: One-on-one consultation with effected members who have already been evaluated in one of the previous intervention

40. After the Mission Scenario After locating a crash scene, the ground team cordons off the site and begins crash site surveillance. A half hour later, the local coroners office clears the remains and a new ground team relieves the original team. This team stays in place for 6 hours until the mission is closed and, without incident, return home. At the next squadron meeting, a 16 year old male cadet on the crash site surveillance team begins to act out, not an unusual occurrence. However, when redirected, he normally responds well. This time he continues to act out and threatens cadet staff with violence when they try to correct them, which has never happened before. You are the Deputy Commander for Cadets and were not on the mission. What do you do?

41. During the Mission Scenario • Expected Action • DCC alerts CC • Approach cadet gently • Isolate cadet from general cadet corps • Contact cadet’s parents • Request CISM support and/or unit chaplain

42. Questions

43. Contact Information Chaplain (Capt) Chad Kline, CAP CISM Officer Maryland Wing 443-794-7186 lothenkline@earthlink.net Capt Chris Hiles, RN BSN, MS, CAP Nurse Officer Maryland Wing 410-926-6840 410-255-5041