Critical Incident Stress Management

1. Critical Incident Stress Management Lt Col Sherry Jones, RN, EMTP

2. CISM in Civil Air Patrol • The CISM Program • Setting up a CIS Team • Lessons Learned • Questions

3. The CISM Program Critical Incident Stress Management (CISM) is a comprehensive, multi-component, systematic approach to dealing with the emotional aftermath of trauma. 

4. The CISM Program • Responses to Stress are Variable • Reactions can be alarming/unsettling • Traumatic Stress: • “Any event which has sufficient emotional power to overwhelm a person’s ability to cope.” - Jeffery T. Mitchell, Ph.D. • The physical, emotional, cognitive and behavioral responses to stress are normal reactions that normal people experience after an abnormal event.

5. The CISM Program - History • WWI 1st evidence of early intervention reducing psychiatric morbidity • 1974 Early work on crisis and stress in Emergency Services Personnel • 1980 DSM-III recognizes PTSD • 1982 CISD first use in mass disaster Air FLA 90 • 1987 NW Flight 255 DTW; 2nd Worst Air Disaster in History • 1989 ICISF formed with > 350 teams 1801/1200 • 1994 DSM-IV: Acute Stress Disorder

6. The CISM Program: Tools • Individual Crisis Interventions: • Peer led, 1-3 contacts • 15 minutes to 2 hours • Group Interventions: • Debriefings • MHP led and peer supported • 1½-3 hour group meeting, 7 phases • Defusings • Peer led group meeting • 20 minutes to 1 hour, 3 phases

7. The CISM Program: Tools • Group Interventions: • Demobilization • Peer led for large scale disaster • 30 minutes information, food and rest • Crisis Management Briefing • Large group for non-operations people • Repeated as needed with homogenous groups • Pre-incident Education • On Scene Support • Follow Up and Referral

8. The CISM Program: Goals • Rapid Reduction of Intense Reactions • Keep Affected Members Functioning • Members share information, responses and feelings about the incident • Supply information and skills to help with the coping process • Reaffirm that they are valued and important • Instill confidence in their ability to handle their reactions to this event • Access additional support resources/follow up

9. The CISM Program: Terrible 10 • Suicide of a colleague, friend or family member • Line of duty death; death at the workplace • Serious line of duty/workplace injury • Disaster/multi-casualty incident • Police shootings/accidental killing or wounding of an innocent person/events with extreme threat to participants

10. The CISM Program: Terrible 10 • Significant events involving children • Prolonged incidents, especially with a loss • Events in which the victims are relatives or are known to operations personnel • Events with excessive media interest • Any significant event capable of causing considerable emotional distress in those who are exposed to it

11. The CISM Program • When implemented as prescribed, CISM is a proven effective acute crisis-intervention management program (not psychotherapy). • ICISF Method is the Standard of Care utilized to: • Bring the event to life in a safe setting • Identify and validate intense feelings • Predict and prepare participants for potential after-effects • Normalize reactions, reduce isolation • Prevent PTSD

12. The CISM Program: The Plan • Pre Crisis Preparation (Training) • Acute Crisis Intervention • Individual Crisis Interventions 1:1 • On Scene Support Services • Group Interventions • Post Crisis Applications • Individual Crisis Interventions 1:1 • Group Interventions • Follow up and Referral • Continuing Education

13. Setting up a CIS Team • Gain Support from CC staff (Region CC and Wing CC) • Bond with DO/DOS/IC’s • Include Admin, PIO, SM and Cadet Training, Web master, Sq CC’s and field personnel • Become part of alert roster • Appoint CIS Team Coordinator • Utilize CISTC Guideline • Assign CIS Team Staff • CISTC-A, Admin., Education Director

14. Setting up a CIS Team • Develop and train a CISM team • Identify/use local teams or train your own • ICISF, Web search CISM/CISD (or phone book) • http://www.icisf.org24 hr.hotline410.313.2473 • Contact local EMS/Fire/Police/USAF/ANG/ARC • National (HQ/CAP/DOS) • Arrange for a dedicated course utilizing NHQ CISM Funding • Maintain Team Rosters and Referral Lists • Establish and maintain a wing CISM web site

15. Setting up a CIS Team • Include CISM in existing exercises/activities • Wing Conferences, Encampments, SAR/DR Exercises, Squadron/Staff Meetings, Commanders Calls • Provide on-scene support during actual missions as assigned by the CISTC • Provide educational materials to wing • E-mailings, squadron mailings (post to SQ’s) and website • Brief info-segments on a regular basis

16. Setting up a CIS Team • Be prepared to provide all of the services outlined in the ICISF model of CISM as mandated by the CAPR 60-5: Consistency • Deploy Teams only through the CISTC (as assigned by Region CC/Wing CC): Consistency • Provide on-scene mission support/education as assigned by the CISTC: Consistency • Provide required certificates of licensure, education and training to NHQ/DOS as mandated: Consistency • Complete AAR’s within 30 days (to NHQ/DOS)

17. Lessons Learned • Lack of consistency can destroy the program and render harm to the people we try to help • CISM must be regulated and the CAPR 60-5 gently enforced for clinical consistency (see above) • Only trained and registered CISM members may practice CISM (see above) • CISM is a Senior Members Only Program • CIST Chiefs are not Indians or team leaders, they are specially trained and credentialed MHP’s who oversee the CIS Teams

18. Lessons Learned • Like every other regulation and the practice of CISM, CAPR 60-5 is not perfect and will change; please send your suggestions for consideration • CISM in CAP is a peer program with Mental Health supervision; you’re a peer or a MHP • CISM members need to have Gen ES to participate in missions • CISM members on mission sites are un-marked • As with all CAP staff assignments, CISTC’s credentials and appointments need to be on paper to be recognized and utilized (NHQ/DOS)

19. Lessons Learned • We would like to develop an advisory group from the field with appointees from each region to make sure each is represented in CISM • We are working on developing a specialty track to address CISM specialists, integration into 101 and appointments/promotions • We would like to develop a CISM pamphlet for the field and see more continuing education • The NHQ CISM Mailing List is an excellent tool for communication; please use it (“subscribe CISM” to majordomo@lists.ntc.cap.gov)

20. Lessons Learned • CISM is a “choose your own adventure” series with each mission, crisis and intervention. Pre-incident preparation is paramount to success • We have a team request form for taking ‘the call’ regarding team intervention; email for file • We have a guideline for AAR; email for file • Make sure contact lists for participants at missions, for CAP staff, for CISM contacts are all current; crisis is no time to gather numbers • We are a team in CAP CISM, all working toward the same goal … lets work together

21. CISM in CAP: NB 2004 Questions? cism@cap.gov