AN INTRODUCTION TO CRITICAL INCIDENT STRESS MANAGEMENT

1. AN INTRODUCTION TO CRITICAL INCIDENT STRESS MANAGEMENT

2. Who is the Central Region CISM Team? • ~30 Volunteers that have a background in • EMS • Fire • Law Enforcement • First Response • or Mental Health • Have CISM certification from ICISF • Cover Benton, Cass, Crow Wing, Kanabec, Mille Lacs, Morrison, Pine, Todd, Sherburne, Stearns, Wadena and Wright

3. Who do we serve? Fire Ambulance Law Enforcement First Responders Dispatch ED/Hospital Members

4. STRESS  The pattern of specific and nonspecific responses an organism makes to stimulus events that disturb its equilibrium and tax or exceed its ability to cope. -American Psychological Association

5. EUSTRESS vs. DISTRESS • Eustress= positive, motivation stress • Distress= excessive, debilitating stress

6. STRESS REACTION CATEGORIES • FIGHT • Gear Up, Lock Down And Rumble • FLIGHT • Get Up, Fire Up, And Fly • FREEZE • What The Hell Am I Still Doing Here?

7. TWO TYPES OF DISTRESS • Cumulative Stress “burnout” • Slow erosion of functioning • Cynicism • Incomplete work • Lateness • Impulsive need for change • Chronic physical illness • “Critical Incident Stress” • Normal coping mechanism overwhelmed • Adaptive functioning interrupted • Symptoms of post traumatic distress evident

8. WHAT ARE CRITICAL INCIDENTS? • “Powerful traumatic events that initiate the crisis response. These events are usually outside of the usual range of normal human experiences on the job or in one’s personal life”. -ICISF

9. THE TERRIBLE TEN! • Suicide of a colleague. • Line of duty death. • Serious line of duty injury. • Disaster/Multiple Casualty incident. • Police Shootings/Accidental death or wounding of an innocent person. • Significant events involving children. • Prolonged incidents especially with a loss. • Personally threatening situations. • Events with excessive media interest. • Any significant event capable of causing considerable emotional distress for those who are exposed to it.

10. Domestic Violence Crime Riots and Terror Rape Fire There are many everyday events which may cause personal psychological stress, it’s not just war & violence that professionals deal with, we are all vulnerable… Natural Disaster Weather War Accidental Tragedy

11. What’s Critical Incident Stress? • A state of cognitive, physical, emotional and behavioral arousal that accompanies the reaction to a crisis. This is NOT the same as PTSD. Critical Incident Stress is a normal response of normal people to an abnormal event

12. BRIEF HISTORICAL TIMELINEFOR CRISIS INTERVENTION • 1906 National Save a Life League formed for suicide prevention • 1914-1918 First documented evidence that early intervention reduces chronic psychiatric morbidity. • 1939-1945 Process of Urgency, Location and Expectation identifies as important “active ingredients” in effective emergency psychological response. • 1980 Formal recognition of post traumatic stress disorder PTSD legitimizes an examination of crisis and traumatic events as threats to long term mental health. • 1982 Air Florida 90 disaster in Washington DC prompts re-examination of psychological support for response personnel. First large scale disaster use of the small group crisis intervention CISD which was originally formulated in 1974. • 1999 Mass shooting in Columbine high school in Colorado leads to an establishment of school crisis response programs • 9-11-2001 Enormous and prolonged (1 ½ years) crisis intervention response to victims, families, businesses, communities and emergency personnel.

13. Critical Incident Stress Management: Definition • A comprehensive, systematic and integrated multi-tactic crisis intervention approach to manage critical incident stress after traumatic events. CISM is a coordinated program of tactics that are linked and blended together to alleviate the reactions to traumatic experiences -ICISF

14. CISM: How it works. • The CISM intervention process that helps to establish or set the new normal stress levels as low as possible. • Assist people to deal with their trauma one incident at a time • Allows conversation about the incident when it happens without judgement or criticism

15. CISM: How it works. • CISM is peer driven and those providing CISD may be from all walks of life • All interventions are strictly confidential • Caveat: If person is deemed to be a danger to themselves or others • Emphasis: Keeping people safe and returning them to more normal levels of functioning as quickly as possible

16. There’s been a Critical Incident…Now What? • Contact the local CISM team • 1-800-556-4911

17. There’s been a Critical Incident…Now What? • Provide Dispatch with basic details • Contact Person, agency & phone number • Very basic description of incident • Dispatch contacts the CISM on-call Team member

18. There’s been a Critical Incident… Now What? • Team Member will follow-up the Contact person • Description of the incident • Rough estimate of number or attendees • Types of responders that responded • Location for the debriefing

19. There’s been a Critical Incident… Now What? • Decide on the type of CISM intervention fits your needs. • TYPES OF INTERVENTION: It depends upon the situation, the number of people involved and their proximity to the event. The optimum is an approach that addresses the trauma at various stages of progression: • defusing • debriefing • CMB • one-on-ones • follow-up

20. CISM: Timeline • Defusing – Immediately • On-site • Group or One-on-One • Prior to the first sleep cycle post event • Debriefing – Within 72 hours of the incident • Formal setting for group • Formal/informal setting for one-on-one • Follow-up – Within approximately 30 days • Comfortable setting • Preferably in person

21. CISM: Defusing • WHO: Individuals who were directly involved in the incident • HOW: These are generally informal and often performed at the scene • WHEN: The day of the event before the person gets to sleep • WHAT: Designed to assure those involved that their feelings are normal: • It’s a process of “talking it out “ • Explanation of what symptoms to watch for over the short term • Offering a lifeline (phone number where they can reach someone with whom they can talk)

22. CISM: Debriefing • WHO: Those who were directly affected by the incident • HOW: Formal process in a group setting • WHEN: Within 72 hours of the incident • A chance to “vent” feelings - in an informal, positive and supportive atmosphere. • It is NOT psychotherapy nor is it to serve as a critique of the situation • WHAT: Structured to allow participants to “talk it out” and “reflect” on the event(s) to help them identify with how one another reacts to an abnormal event, everyone’s normal reactions are different • Group debriefing provides the group the opportunity to talk about their experience, how it has affected them, brainstorm coping mechanisms, identify individuals at risk • Provides an explanation of what symptoms to watch for over the short term • The team members are always on watch for individuals who are not coping well and additional assistance is offered at the conclusion of the process

23. CISM: Follow-up • Follow-up is the most important final step to the process • Follow-up is generally done within the week (or up to 30 days) following the intervention. During a follow-up, additional intervention or a referral may be provided to the original participant.

24. Special Considerations • High Profile cases • Departmental Policies • Public participants

25. GUIDELINES FOR STRESS MANAGEMENTLet It Run • Your subconscious has to find a “fit” • Your mind must find a “fit” for the event in your memory so your memory can accept it • It will “run” at your request or when it feels it is necessary • Let it run when YOU control it • If it is overwhelming now, “set it up” to run at another day or time

26. GUIDELINES FOR STRESS MANAGEMENTDiet • Mind what you eat… • Focus on the following: • High Protein, raw fruits, vegetables • Stay away from: • Carbohydrates, low sugar, low fat and low salt • Why? • Cortisone levels rise when you are stressed • Immune system depletes • Brain tells our body that it’s starving to death

27. GUIDELINES FOR STRESS MANAGEMENTExercise • Sweat out the chemicals! • Over 100 chemicals mix together when your body goes into the stress response • Sweat is the only way to remove these quickly • Recommend physical therapy massage to ease the pains in the body • Chemistry of survival: • Catecholamine • Excites the System • Triggers increased nervous system • “Flight or Fight” response • Cortico-Steroids • Moderates and controls extremes of catecholamine • Keeps “Flight or Fight” response in check • Endogenous Opioids • Creates Heightened threshold of pain • Causes dissociative reactions • Causes blunting of emotions with catecholamine’s, causes amnesiac reactions • Causes feelings o f euphoria

28. GUIDELINES FOR STRESS MANAGEMENTAcute Stress Symptoms • Intense fear due to exposure to a catastrophic event • Significant occupational, social or other distress • Avoiding things that causes you to re-experience the event • A numbing effect that interferes with personal relationships • Hyper state of arousal that causes you to be easily startled • Hyper vigilance

29. GUIDELINES FOR STRESS MANAGEMENTBreathing • Deep Breathing • Generally you only use 1/3 of your lung capacity • Deep Breathing, using more than 2/3 of your lung capacity: • Increases oxygen flow to your brain • Dumps the Carbon Monoxide in our lungs • This allows us to breath better • Allows us to think with more clarity • Deep Breathing also increases the serotonin levels in our body • Practice deep breathing techniques

30. CISM: Referral Team members are trained in CISM techniques, however there may be times when that it is obvious that one or more person’s needs are beyond the scope of the CISM program. The referral action is considered an essential component of CISM that supports and enhances the care provided for these people. There are many links in the chain of concern that are dedicated to assist you…

31. Compassion Fatigue Compassion fatigue plagues caregivers worldwide. When providing care to others without incorporating authentic, sustainable self-care practices into our daily lives, destructive symptoms surface. Isolation, emotional outbursts, substance abuse and reoccurring nightmares are just a few of the symptoms that can distress the life of a caregiver. With awareness and knowledge, compassion fatigue can be recognized and managed. For more information about Compassion Fatigue please visit: www.compassionfatigue.org • Compassion Fatigue is the cost of caring… • You must care for yourself and allow others to help you care for yourself • Locate and utilize a Compassion Fatigue Therapist • It is care for the caregiver…

32. CONFIDENTIALITY • The members of the Central Minnesota CISM Team firmly believe that confidentiality is essential to the CISM process and are committed to providing the highest level confidentiality. We ask our participants to practice the highest level of confidentiality as well.

33. Questions, Comments, Observations? Marion Larson Regional EMS Coordinator 320-656-6122 Sue Feldewerd Regional EMS Assistant 320-656-6603