Understanding CISM

1. Understanding CISM Denton County CERT Team

2. What is CISM ? Critical Incident Stress Management

3. STRESS RESPONSE to a stimulus characterized by increased psychological AROUSAL

4. In SIMPLE terms Stress Is: NORMAL reaction by a NORMAL person to a ABNORMAL situation.

5. Two Types of Stress EUSTRESS = Positive, motivating stress (increases performance) DISTRESS = Excessive, debilitating stress (decreases performance)

6. Physiological Aspects of Stress

7. Responses To Stress • Hormonal dump into the bloodstream • Increased heart rate & respiration • Increased blood flow to larger muscles • Tension of large muscles

8. Reasons For These Reactions FIGHT ! FLIGHT !

9. Common Symptoms of Stress(US Army Study, 1944) • Nausea • Feeling faint • Cold sweats • Loss of bowel control

10. Psychological Aspects of Stress

11. Ingredients For Distress In order for an event to become stressful, it must be interpreted or appraised as being: CHALLENGING, THREATENING, or ADVERSE, and MEANINGFUL.

12. Critical Incident Stress (CIS)AKA: Post Traumatic Stress (PTS) NORMAL reaction by a NORMAL person to a ABNORMAL situation.

13. Signs and Symptoms of Distress I. Cognitive (Thinking) II. Emotional III. Behavioral IV. Physical V. Spiritual

14. I. COGNITIVE (Thinking) DISTRESS • Sensory distortion • Confusion (“dumbing down”) • Inability to concentrate • Difficulty in decision making • Guilt • Preoccupation (obsessions) with event • Inability to understand consequences of behavior • Suicidal/homicidal thoughts • Psychosis

15. II. EMOTIONAL DISTRESS • Anxiety • Irritability • ANGER ! • Panic (often associated with self -medication) • Vegetative Depression • Fear, Phobia, Phobic Avoidance • Post-Traumatic Stress (PTS) • Grief (Mourning associated with loss)

16. Impulsiveness Risk - taking Excessive Eating Alcohol/Drug Use Hyper-startle Violence Sleep Disturbance Withdrawal Family Withdrawal Crying Spells 1000 - yard Stare Antisocial Behavior III. BEHAVIORAL DISTRESS

17. IV. PHYSICAL DISTRESS • Tachycardia, Bradycardia • Headaches • Hyperventilation • Muscle Spasms • Psychogenic Sweating

18. IV. PHYSICAL DISTRESS(Con’t.) • Fatigue/ Exhaustion • Indigestion, Nausea, Vomiting • Blood in stool, sputum, vomit, urine • Chest pain • Loss of Consciousness

19. V. SPIRITUAL DISTRESS • Anger at God • Withdrawal from Faith-based Community • Loss of moral compass

20. What is Crisis Intervention ? First Aid for emotional distress caused by a traumatic experience: • Allowing people to “vent” (explain) their thoughts about the incident • Helping people understand they are “OK” • Teaching them good coping skills • Assessing if additional care is needed

21. Crisis Intervention Characterized by: PROXIMITY – close to incident IMMEDIACY – early intervention (“trauma membrane”) EXPECTANCY – belief this can help SIMPLICITY – simple, concrete strategies BREVITY – interventions short, not long- term care PRACTICALITY – easy to implement

22. Crisis Intervention Goals: STABILIZATION of symptoms (keep things from getting worse) REDUCTION of symptoms (stress relief) RESTORATION of independent function (“back on the street”) ACCESS to additional care (if needed) (adapted from Caplan, 1964, Preventive Psychiatry)

23. Crisis Intervention What crisis intervention is NOT: NOT Counseling NOT Psychotherapy NOT Substitute for Counseling or Psychotherapy

24. Types of Stress Cumulative Stress Unresolved everyday stressors (“Burnout”) Critical Incident Stress Result of a single, traumatic event Which is most likely to cause greatest harm? Cumulative – silent & slow

25. Cumulative Stress (“Burnout”) slow erosion of functioning incomplete work lateness impulsive need for change chronic physical illness “Critical Incident” (Traumatic) normal coping overwhelmed adaptive functioning interrupted symptoms of posttraumatic distress evident TWO TYPES OF STRESS

26. Normal Stress Path General Stress All Normal Eustress Distress Pathological Path Cumulative Stress Piles up Takes time “Burnout” Destructive Changes in health, performance, relationships, and personality Stress Response SyndromesCumulative Stress Recovery

27. Continuum of Care • RESISTANCE – Ability to resist the effects of stress • RESILIENCE – Ability to bounce back from stress • RECOVERY – Ability to return to “normal” within reason

28. RESISTANCE Psychological/behavioral immunity (“psychological body armor”)to distress and dysfunction. (Pre-incident training/preparationmay be best way to build resistance.)

29. RESILIENCERefers to the ability to rapidly and effectivelyreboundfrom psychological and/or behavioral effects of stress.

30. RECOVERYThe ability to literally recover the ability to adaptively functionafter stress.

31. ELEMENTS (TOOLS) OF CISM • Pre-incident education, preparation • Assessment • Strategic Planning • Large Group Crisis Intervention: • Demobilizations (large groups of rescue/recovery) • Rehab Sectors • Crisis Management Briefings (CMB)

32. ELEMENTS (TOOLS) OF CISM • Small Group Crisis Intervention: • Defusings (small groups) • Small group CMB • Debriefing (CISD) • Individual, one-on-one intervention • Family CISM • Organizational/Community intervention, consultation • Pastoral crisis intervention • Follow-up and referral for continued care

33. Things To Do To Cope with Stress • Exercise • Spend quality time with others • Avoid alcohol • Eat a healthy diet • Get plenty of rest • Drink plenty of water • Most of all --- TALK !

34. How important is CISM ? How important are your health & relationships with others?

35. When to Call For CISM • Anytime you think you have a stressful event during your shift. • Anytime you notice problems within your shift after a stressful event or cumulative events. • Anytime you notice an individual that is having problems dealing with a stressful event.

36. How to call for CISM • Contact EMS Division Chief Todd Jamison at The Little Elm Fire Department. • Office # 214-975-0429 • Cell # 469-853-3070 • Email tjamison@littleelm.org • Brenda Gormley • 940-349-2855 brenda.gormley@dentoncounty.com

37. Little Elm CISM Team • EMS Division Chief Todd Jamison • Pastor Richard Stevens - Fire Dept. Chaplain • Dan Phleps - Little Elm Police • EMS Lieutenant Glen Phipps –Aubrey Fire Department. • Matt Moore – Little Elm Fire Department • Jeremy Fuller – Little Elm Fire Department