Critical Incident Stress Management (CISM)

1. National Guard Critical Incident Stress Management (CISM) Trained Crisis Responder Program LTC Clarence Bowser State Family Programs Director

2. Overview • Military References… • Trained Crisis Responder (TCR)… • Crisis Intervention… • Critical Incidents… • Post-Traumatic Stress… • TCR Services… • Rationale…

3. References • DoD: • 6490.5 – Combat Stress Control Program • Air Force: • AFI 44-153 – Critical Incident Stress Management • AFI 34-1101 Survivor Assistance • Army: • Field Manual FM 16-1, Annex F-1 "Critical Event Debriefings"

4. Trained Crisis Responder The National Guard TCR Program was developed from Critical Incident Stress Management (CISM) principles…

5. Crisis Intervention “CISM is a subset of the general field of Crisis Intervention (CI) and may be thought of as the application of Crisis Intervention knowledge and techniques to high risk groups, e.g., emergency services, military, etc.” (J.T. Mitchell, G.S. Everly, 1995)

6. CISM Services • Trained Crisis Responders are the first line of defense in coping with Post-Traumatic StressReactions to Crisis events. • CISM Services extend beyond the training levels of Trained Crisis Responders, therefore it is important for the TCR’s to work in concert with military and civilian CISM Teams…

7. Pre-Crisis preparation Demobilization Crisis Management Briefing Defusing Critical Incident Stress Debriefing Individual crisis intervention 1:1 Family CISM Community consultation Pastoral Crisis Intervention Follow-up/Referral CISM Core Components

8. Trained Crisis Responder Trained Crisis Responders provide psychological and emotional “Self-Aid and Buddy-Care”

9. Spectrum Of Care Incident Crisis Intervention EAP TCR’sLegal Chaplain CISM Mental Health Psychotherapy Hospitalization Refer where needed… Family Support Rehab

10. Critical Incidents • Major Accidents (Air Crashes, etc.)… • Line of Duty Death(s)… • Serious Line of Duty Injury(s)… • Suicide of a Co-Worker… • Disaster / Multi-Casualty Incident(s)… • Shooting(s)…

11. Critical Incidents • Significant Events Involving Children… • Prolonged Incident(s) - Especially with loss… • Excessive Community Media Interest… • Any Significant Traumatic Event…

12. Primary Goal CISM and the TCRProgram are forms of crisis intervention designed to help reduce Post-Traumatic Stress Reactions to Critical Incidents…

13. Post-Traumatic Stress Post - traumatic stress is a normal reaction, in a normal person, to an abnormal event.

14. Hallmarks of Crisis Intervention • Immediacy • Proximity • Expectancy • Brevity • Practical It’s learning how to toss a life raft, not a course in ship building

15. Post traumatic stress Is everyone who experiences traumatic distress suffering from the disorder know as Post Traumatic Stress Disorder? NO.. NO ..NO

16. Post Traumatic Stress Disorder PTSD represents a contradiction to some critically important assumption or belief about self and/or the world. (G.S. Everly, 1995)

17. Post Traumatic Stress Disorder • A pathological and disabling variant of a normal stress reaction • Very clear criteria …symptoms must be over 30 days and it is impairing function

18. Important TCR Concept The TCR Program is NOT a stand alone process. Rather it is meant to be one part of a comprehensive CISM intervention program.

19. TCR Services… • TCR’s can be in any section (personnel, security forces, fire, chaplain, medical, family support, etc.)… • TCR’s are normally among your first responders to an incident… • TCR’s can support official military and civilian CISM Teams…

20. TCR Services… • Pre-incident education, preparation… • One-on-one crisis intervention… • Demobilizations (large groups of public safety)… • Crisis Management Briefings [large groups of primary, secondary (emergency personnel), and tertiary (family, co-workers, etc.) victims]

21. TCR Services… • Family Support… • Organizational / Community intervention, consultation… • Follow-up and referral for TCR’s & CISM services and/or continued care…

22. Rationale Why have TCR’s and CISM programs? We can learn from past experience.

23. 141 ARW Suicide • December 1998 - Fairchild AFB WA • Just-retired Wing Commander • Prior incidents in unit • Impact on unit • Chaplains from outside called in for first UTA following incident • Ministered to entire wing

24. 141 ARW CRASH • Six weeks after suicide of commander • Four members killed in Germany • Chaplains called from outside; some had just been there • Assigned to each family to assist local clergy and chaplains • Memorial Service and Funerals

25. Red Horse Crash • March 2001 • Army NG Sherpa crashed over Ga. • 18 ANG and 3 ARNG members killed • Chaplains called in for ministry • Memorial Service and Funerals • Continuing care for families

26. Red Horse, cont’d • Late July - Early August report • Some possible questions • Chaplains and Line Colonels formed teams for each family • Trained at Langley then deployed • There to walk families through report and to offer pastoral care

30. Comparison Total Killed 12582 Plane Survivors 00 Homes Destroyed 1616 Killed On Ground 1515 Emergency Personnel 300300 Body Parts Found 10,00010,000 San Diego, CA Air Crash - 1978 Cerritos, CA Air Crash - 1986

31. Cerritos, CA Air Crash - 1986 On Scene One on One Demobilizations 12 Debriefings Hot Line Number One on One Follow Up Comparison Support Services Provided San Diego, CA Air Crash - 1978 • Sporadic One on One

32. ComparisonPersonnel Lost in 1 Year Police 5 - Fire 7 - 1 Paramedics 17 - Increase in Mental Health Services increase of 31% increase of 1% San Diego, CA Air Crash - 1978 Cerritos, CA Air Crash - 1986

33. Rationale • Trauma and stress-related disorders are sometimes disabling and costly to treat… • Interventions are designed to assist in preventing “burnout” and PTSD… • Healthy employees are more productive and effective on the job…

34. Example 1… • 100 trauma victims • Intervention began after 6 months • Average cost = $46,000.00 ea. • 94% filed civil litigation Friedman, et al, EAP Digest, 1988

35. Example 2… • 100 trauma victims • Intervention began within 6 months • Average cost = $8,300.00 ea. • 13% filed civil litigation Friedman, et al, EAP Digest, 1988

36. Rationale • On any given trauma/disaster, 4%-97% of the individuals exposed will develop Symptoms similar to PTSD. • 16-30% of emergency responders are at risk of developing PTSD symptoms.

37. Rationale Disaster / Trauma planning (including CISM protocols) is appropriate for not only emergency response personnel and institutions, but for all business and industrial (and military) settings as well. Yandrick, EAPA Exchange, 1990

38. Main Goal Trained Crisis Responders help keep your team on the job!

39. Academy for Innovative Ministry WHERE YOU CAN LEARN THIS STUFF! Ch, LtCol Charles E. Woods Chief, Crisis Intervention McGhee Tyson ANG Base, TN

40. AIM COURSES AIM course offerings available on-line: https.//tys.tnknox.ang.af.mil/AAIM/AAIM.HTM This web site is accessible from a ".mil" computer only!

41. CHAPLAIN SERVICE AND FAMILY SUPPORT • WHY DO CHAPLAINS EXIST? - First Amendment - ‘Provision without establishment’ • Requirements • Skills • ‘neutral zone’ • 100 % Confidentiality

42. Chaplain Service and Family Support LET’S TALK!