CRISIS REACTIONS FOLLOWING TRAUMATIC INCIDENTS JUNE 18, 2009 NUI MAYNOOTH

1. CRISIS REACTIONS FOLLOWING TRAUMATIC INCIDENTSJUNE 18, 2009NUI MAYNOOTH

2. Helping the traumatized .... through education, certification and deployment. www.greencross.org

3. Dr. Dan Casey, CTDirector, UMTTI 11959 77th St. Clear Lake, MN 55319320-282-2436320-743-4119 F dlcasey@frontiernet.net www.jec-counseling.com

4. ICISF & Green Cross Trained trainer – International- Basic, Advanced, Individual, School, College & Suicide trainings, Compassion Fatigue, Field Traumatology, ICS Green Cross & ICISF Board member Coordinator for three Crisis teams 25 years wild land fire fighter- incident commander 800+ fires 7 years University instructor/ counselor SJU, UMM, UMB Provide 100 interventions per year on average 22 years -2000 interventions- trained 10,000 Dr. Daniel Casey, CT

5. DEALING WITH Emergency Services Personnel • ON SCENE • SOON AFTER - a few days • LATER - a few weeks

6. Auto accident Abuse Robbery Injury death to ones child or a child Suicide Line of duty death homicide (s) Tornadoes Earthquake Hurricane Fires Flood Pollution Multiple injury/fatality Terrorism Community disasters Traumatizing events

7. A Model Response…Katrina’s Coming!!!!! • Phone call among • Dr. Jeffrey Mitchell – ICISF, • Director – American Red Cross, • Dr. Charles Figley – Green Cross • “Let’s Not Compete” • ICISF – Serve First Responders • Red Cross – Serve Victims/Evacuees • Green Cross – Serve Volunteers and Non Traditional First Responders

8. WHAT IN THE WORLD IS HAPPENING ??? • PSYCHOLOGICAL FIRST AID (PFA) • COMPASSION FATIGUE (CF) • CRITICAL INCIDENT STRESS MANAGEMENT

9. Psychological First Aid A set of skills that helps community residents care for their families, friends, neighbors, and themselves by providing basic psychological support in the aftermath of traumatic events…

10. Psychological First Aid • A model that: • Integrates public health and community and individual psychology. • Includes preparedness for communities, work places, schools, faith communities, and families. • Does not rely on direct services by mental health professionals. • Uses skills you probably already have…

11. Psychological First Aid Skills Part I – Understanding common symptoms and responses associated with trauma Part II - Active Listening Improving a skill you already possess Part III – Resource Awareness

12. COMPASSION FATIGUE “There is a cost to caring. People who listen to others’ stories of fear, pain, and suffering may feel similar fear, pain and suffering because they care. Sometimes we feel we are losing our sense of self to … those we serve…” It is the cost of working with people. The better you are at your work, the more compassion is expended, and the more compassion fatigue is experienced.

13. COMPASSION FATIGUE Post-Traumatic Stress Disorder • Exposure is core factor in risk • Sympathy is the vehicle of transmission

14. COMPASSION FATIGUE • A state of tension and preoccupation with traumatized individual(s) by • Re-experiencing the traumatic events, • Avoidance/numbing of reminders, and • Persistent arousal (e.g., anxiety)

15. signs of COMPASSION FATIGUE • Loss of sense of humor • Difficulty separating work and personal life • Lowered frustration tolerance • Dread (of working with certain clients or of certain calls) • Disruption of one’s frames of reference (sense of identity, world view, and spirituality) • Ineffective or self-destructive self-soothing behaviors

16. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) A comprehensive, integrated, systematic, and multi - component approach to crisis / disaster intervention.

17. The Brain EMOTION REASON AUTOMATIC

19. Disasters and CISM • Situations beyond the resources of the local community • Produce a great deal of emotional response usually requiring CISM services • Victims, survivors, rescuers and community members need a variety of types of assistance

20. Disasters are Different • Know Crisis services before you work a disaster • Requires a high level of skill • Needs most highly experienced • Tendency towards overreaction • Timing is essential • Group processes out of place initally

21. COST OF CARINGHow we know we are stressed CHEMICAL & PHYSIOLOGICAL STRESS REACTIONS

22. Chemistry of Survival Catecholamines • Excites the system • Triggers increased nervous system • “flight or fight” response Corticosteroids • Moderates and controls extremes of catecholamines • Keep ‘flight or fight’ in check

23. Endogenous Opiods Creates heightened threshold of pain Causes dissociative reactions Causes blunting of emotions Causes feelings of euphoria with catecholamines, causes amnesiac reactions

24. PHYSIOLOGICAL REACTIONS Ch. 7 RER • ADRENAL GLANS KICK IN • Cortisone levels rise +-protects from reactions - Immune system depleted -Body goes into starvation mode • Thyroid kicks in + everything is working at peak performance – burnout faster

25. Physiological reactions • Endorphins + nature’s opium- no pain - little hurts become big

26. Physiological reactions Shutdown of digestive tract + Blood diverted to muscles and engine room - no lubrication • Sex Drive is reduced + Survival mode - Menstrual cycles disrupted - Erectile disfunction

27. Physiological reactions • Sugar + short distance energy – tough on diabetics • Cholesterol + long distance energy –loads arteries

28. Physiological reactions • Heart + pumps thickened blood beats harder and faster – bad heart/ blood pressure? • Lungs + collecting more oxygen - tough on smokers

29. PHYSIOLOGICAL REACTIONS • Skin + largest organ protects us - dry skin and scaly • All six senses + more acute and focused – more prone to accident

30. COMPASSION “a feeling of deep sympathy and sorrow for another who is stricken by suffering or misfortune, accompanied by a strong desire to alleviate the pain or remove its cause.” - Webster-EUDEL

31. COMPASSION STRESS The cost of providing compassionate care. What we invest of ourselves to do our work

32. COMPASSION SATISFACTION • What we gain by the work we do. • What keeps us doing what we do. • What defines how we are mentally, physically, emotionally, spiritually, and behaviorally

33. COMPASSION FATIGUE “There is a cost to caring. People who listen to (and witness) others’ stories of fear, pain, and suffering may feel similar fear, pain and suffering because they care. Sometimes we feel we are losing our sense of self to … those we serve…” Charles Figley

34. COMPASSION FATIGUE “Those who have enormous capacity for feeling and expressing empathy tend to be more at risk of compassion fatigue.” (Compassion Fatigue: Coping with Secondary Stress Disorder in Those Who Treat the Traumatized, Charles Figley, Editor, 1995)

35. COMPASSION FATIGUEResults • Diminished sense of purpose/ enjoyment of career • Reduced ego functioning (time, volition, identity, language, cognition) • Lowered functioning in non- professional situations • Diminished capacity for intimacy • Loss of hope

36. More RESULTS • Subtle manipulation to avoid painful/traumatic material • Loss of confidence • Diminished effectiveness • Dread • Victim < …. > Perpetrator • Diminished capacity to listen and communicate

38. WHAT DOES IT MEAN? • Not a reflection of the helper’s inadequacy, nor indicative of the toxicity or badness of the client Is a result of one’s strengths: empathy, involvement and helping • Is an occupational hazard for trauma workers, regardless of their profession • Is a form of PTSD, and can be repaired.

39. CISM is a strategic intervention system.It possesses numerous tactical interventions

40. All CISM Services Must Be: • Timely • Efficient • Consistent • Thorough

41. Never Interfere With On-going Operations • Ability to function is more important than a display of emotions • Low profile CISM services • Do only what is necessary • Do not “push” your support • Go easy

42. Basic /Advanced CISM training Peer support / Family Training Psychotraumatology training Disaster response training Strategic planning Written plans Training and practice Carefully select staff Drill Critique Rewrite the plan Practice again Continue In-Service training Planning and Education

43. CISM protocols are likely to break down if they have not been preplanned and practiced

44. ACCOMPLISHED? • NATIONAL INTERAGENCY INCIDENT MANAGEMENT SYSTEM [NIIMS] • INCIDENT MANAGEMENT SYSTEM [ICS] • IRELAND HEALTH SERVICES USES MIMS

45. Positive Redundancy • Two separate groups working on identical information with the intention of developing a comprehensive plan of action • Some overlap • Some new ideas • Clarification of potential problems

46. SCENARIO FIRE AMBULANCE GARDAI

47. CISM INTERVENTIONS • DEMOBILIZATION • CRISIS MANAGEMENT BRIEFINGS • INDIVIDUAL INTERVENTIONS • SMALL GROUP INTERVENTIONS • FOLLOW UP • IMMEDIATELY- & AFTER

48. Demobilization • Quick information and rest session • 10 minutes of information 20 minutes of food and rest • Applied at 1.) end of first shift or 2.) before teams are released from incident • Provided to teams of workers • Provided by CISM team members

49. Crisis Management Briefing This large group process is one of the most versatile tools to be used in disaster related CISM services. It lowers anxiety and guides people toward effective action

50. Crisis Management Briefing • Keep groups as homogeneous as possible • Representative of organization presents information • Sometimes question / answer period is allowed • CISM team member presents information • Specific practical advice is presented to manage the stress associated with the situation