1. EMERGENCY RESPONSE TEAMS AND THE MILITARY ARE NOT THE ONLY ONES AFFECTED BY TRAUMATIC EVENTS…

2. Do you remember where you were
on September 11th 2001 at 8:45 AM (EDT)?
American Airlines Flight 11 & United Airlines Flight 175…

3. 9:40AM (EDT)? American Airlines Flight 77…

4. How about 10:07 AM (EDT)? United Airlines Flight 93…

5. What emotion does this image invoke in you?

6. Who did this one single event affect?
You, me, everyone…
THE WORLD!

7. Got your attention?

8. Do you know where to go to reach out for help?
HOW DID YOU COPE?
When you are involved, either directly or indirectly (even watching TV or radio news, and seeing the headlines in your newspaper may cause trauma too) with trauma it places stress on your mental health. How do you cope or deal with these feelings? How do you “chase away the demons”?
Keeping “it” inside can be the cause of loss of attention, anxiety, thoughts of hurting yourself or others, chemical abuse, depression and
many other clinically diagnosed psychosis similar to that of
combat stress and even PTSD.
Carrying your feelings inside ultimately festers and becomes
a severe burden on you, your family and your friends.
Do you know where to go to reach out for help?
There are many programs which are available but in all cases help is best offered while the events are “fresh” in your mind. You can call your local Law Enforcement Center for contact information of your local area CISM team.

9. WHAT CAUSITIVE REACTIONS DO CRITICAL INCIDENTS PRODUCE?
A Critical Incident is any event that generates such intense
emotional energy that it overwhelms an individual’s or group’s
ability to cope and causes impairment
in work or personal activities
A crisis is an acute emotional reaction to a critical incident
Critical Incident Stress is the cognitive physical, and emotional
state of arousal that is part of the crisis response
Critical Incident Stress (CIS) is also known as
“Post Traumatic Stress”.
This is NOT the same as PTSD.
CIS is a normal response of normal People to an abnormal event

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. How do you react normally to an abnormal event?
What constitutes mental trauma?
Line of duty deaths
Suicide of a colleague
Serious work related injury
Multi-casualty / disaster / terrorism incidents
Events with a high degree of threat to the personnel
Significant events involving children
Events in which the victim is known to the personnel
Events with excessive media interest
Events that are prolonged and end with a negative outcome
Any significantly powerful, overwhelming distressing event
How do you react normally to an abnormal event?
Defusing
Debriefing
Follow-Up

12. HELP IS AVAILABLE! C I S M Critical Incident Stress Management
Psychological
First
Aid P F A
Hope
Compassion Fatigue Therapy

13. WHAT KIND OF HELP IS AVAILABLE?
Incidents come and go but their memories may linger forever…
Military members are apt to see/experience atrocities, older
Veterans just kept the memories to themselves. Perhaps they
were too painful to talk about or it was just the “manly” thing
to do because it was a sign of “weakness”.
Left untreated these memories can manifest into more sever
clinically diagnosed issues such as depression and Post Traumatic
Stress Disorder (PTSD).
These issues have been recognized in many more than just the
military and counseling is routinely performed
following traumatic incidents for Emergency
Responders, Health Care Workers, Family,
and Law Enforcement. These sessions are
referred to as Critical Incident Stress
Management (CISM) & Psychological
First Aid (PFA). There is help for the
caregiver too, Compassion Fatigue Therapy.

14. CISM: Definition
“Critical incident stress management (CISM) is an adaptive short term helping process that focuses solely on an immediate and identifiable problem. It spans pre-incident preparedness to acute crisis to post-crisis follow up. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing Post Traumatic Stress Disorder (PTSD).“

15. What is Critical Incident Stress Management and how does it work?
Assist people to deal with their trauma one incident at a time
Allows conversation about the incident when it happens without judgment or criticism
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
WHAT IS “NORMAL”? “Normal” is different for everyone, and it is difficult to quantify. Any critical incident causes a dramatic raise in stress levels in a short amount of time. Although “normal” may vary between individuals trauma establishes a new normal that is always higher than the previous level.
PURPOSE: The purpose of the CISM intervention process is to establish or set the new normal stress levels as low as possible.
TYPES OF INTERVENTION: It depends upon the situation, the number
of people involved and their proximity to the event. The optimum
is a three-step approach that addresses the trauma at various
stages of progression: defusing, debriefing, and follow-up.
CONFIDENTIALITY
CISM is designed to help people deal with their trauma one incident at a time, by allowing them to talk about the incident when it happens without judgment or criticism. The program is peer-driven and the people giving the treatment may come from all walks of life, but most are first responders or work in the mental health field. All interventions are strictly confidential, the only caveat to this is if the person doing the intervention determines that the person being helped is a danger to themself or to others. The emphasis is always on keeping people safe and returning them quickly to more normal levels of functioning.
Normal is different for everyone, and it is not easy to quantify. Critical incidents raise stress levels dramatically in a short period of time and after treatment a new normal is established, however, it is always higher than the old level. The purpose of the intervention process is to establish or set the new normal stress levels as low as possible.

16. SYMPTOMS
A person has been exposed to a catastrophic event involving actual or perceived death or injury. This event is characterized by intense fear.
The duration of the PTSD symptoms last at least a month but may last a lifetime.
The person experiences significant occupational, social or other distresses.
The person starts to avoid anything that will cause them to re-experience the event. He/she also experiences a numbing effect that interferes with his/her personal relationships.
The person tends to be in a state of hyper arousal that results in being startled very easily and a heightened vigilance to the point of paranoia.
The traumatic event persists as a dominating psychological experience, typically causing a person to experience flashbacks of the event from other stimuli.

17. RECOGNITION & TREATMENT
Many hospitals, corporations, law enforcement and EMS have recognized the importance of CISM. In many cases they have incorporated training and a response team within their organization. If not, they know the LOCAL resources that are available.
Left untreated, traumatic stress will culminate into far greater mental health issues such as PTSD. However, we have come a long way, especially in the Military! We now recognize symptoms of Combat Stress and a focus on its treatment before it evolves into PTSD.
Throughout the years there have been many names for it to include:
Battle Fatigue or Gross Stress Reaction for soldiers who came down with PTSD after World War II
Combat Fatigue or Shell Shock for soldiers who experienced PTSD symptoms after World War I
Soldier's Heart for soldiers who developed the symptoms of PTSD after the Civil War.
Worst of all, it was often mistakably considered to be COWARDICE…
Click Here
to watch short
take from
“Patton”

18. Kyle Housmann-Stokes: ”Now, After”
The producer, Kyle Housmann-Stokes, was an OIF Veteran who was preceded in military
service by his grandfather who is a Lieutenant Colonel serving two tours in Viet Nam and one in Iraq. This film depicts the plight of stress and trauma that many returning service men and women suffer. It’s poignant and it’s direct… Please be aware that there are some parts which are graphic representations but allows you a better understanding, if you are not military or a Vet, of what is war means to those returning.
Regardless of the era, conflict or war, the technologies may change
but the carnage and after effects remain much the same, as does the
camaraderie among Veterans, young and old. You can see from this
film how Veterans are not strangers and regardless of era rally to his side.
Let’s watch the film… (or via Internet: Watch Film)
For Kyle’s latest filmography you can go to:
For a background on Kyle and how this came about you can log on to the following:

19. Kyle Housmann-Stokes: ”Now, After”
Personal observations about the film:
Pride in his military service and accomplishments
He possesses hyper-vigilance
Flashbacks (both good & bad, human carnage and the Iraqi people)
Indications of Obsessive Compulsive Disorder (O.C.D.) (preparing for his school
day as if it were for a patrol)
Anxiety
Sweating
Apprehensive about leaving the safety of his home
Inability to “disconnect” himself from the Military
Hyper-vigilance and flashbacks while driving (speeding up and driving the
middle of the road to avoid possible “IED’s”)
Avoiding others, loner
Uncontrolled outburst of anger, anger management issues
Once at the VA:
Reverence when at the VA parking garage
Realization that he’s not alone…

20. GUIDELINES FOR STRESS MANAGEMENT Diet
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

21. GUIDELINES FOR STRESS MANAGEMENT Exercise
Sweat out the chemicals!
132 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

22. GUIDELINES FOR STRESS MANAGEMENT Let It Run
Your unconscious 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

23. GUIDELINES FOR STRESS MANAGEMENT Breathing
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
Oxygenate!
Oxygenseven just isn’t enough…

24. CISM: Timeline Defusing – Immediately
On-site
Group or One-on-One
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

25. CISM: Defusing
WHO: Individuals who were directly involved in the incident
HOW: These are generally informal and often performed at the scene
Steps used in this process are:
Introduction; Exploration; Information
WHEN: The day of the event before the person gets to sleep
Initial Defusing: Initial informal defusing sessions should be held within 8-12 hours after the incident. A defusing session is a brief, spontaneous, non-evaluative discussion coordinated and conducted by a minimum of two peer supporters and held immediately following a critical incident. The defusing may be considered an emotional “triage”, in which a person can begin to talk about and explore their thoughts concerning the incident - a chance to “vent” feelings - in an informal, positive and supportive atmosphere.
It is NOT to serve as a critique of the situation
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)

26. CISM: Group Debriefing
WHO: Those who were directly affected by the incident and often the first for those not directly involved
HOW: Formal, in a group setting
“Seven Step Process” is generally used in this setting
Introduction; Facts; Thoughts; Reactions; Symptoms; Teaching; Re-Entry
No notes taken or paper/pen allowed
Facilitator and intervenor are the only two in the room besides those participating
WHEN: Within 72 hours of the incident
A chance to “vent” feelings - in an informal, positive and supportive atmosphere.
It is NOT 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
It also serves to inform the group about services available to them in their community
Provides an explanation of what symptoms to watch for over the short term
The “intervenor” is always on watch for individuals who are not coping
well and additional assistance is offered at the conclusion of the process

27. CISM: One-on-One Debriefing
WHO: An individual who was directly, or possibly indirectly, affected by the incident
HOW: In a quiet & comfortable setting
“Seven Step Process” is generally used in this setting
Introduction; Facts; Thoughts; Reactions; Symptoms; Teaching; Re-Entry
No notes taken or paper/pen allowed
Facilitator and intervenor are the only two in the room besides the participant
WHEN: Within 72 hours of the incident
A chance to “vent” feelings - in an informal, positive and supportive atmosphere.
It is NOT 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
It also serves to inform the group about services available to them in their community
Provides an explanation of what symptoms to watch for over the short term
The “intervenor” is always on watch for individuals who are not coping
well and additional assistance is offered at the conclusion of the process

28. 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 debriefing
Follow-up is for participants as well as CISM team members as a check-in to make sure they are OK too
During a follow-up additional intervention or a referral may be provided to the original participant. It may also be provided for the caregiver(s) to ensure the
Caregiver(s) does not demonstrate the symptoms of Compassion Fatigue.

29. CISM: Referral There are many links in the chain of concern
Referrals are recommended any time that it is obvious that one or more persons 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…

30. Compassion Fatigue Compassion Fatigue is the cost of caring…
You must care for yourself and allow others to help you care for yourself
Use your Compassion Fatigue Therapist
It is care for the caregiver…
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:

31. Psychological First Aid
WHO:
HOW:
WHEN:
WHAT:

32. Discovering you’re OK… PRICELESS!

33. CONFIDENTIALITY CISD’s are like visiting Las Vegas…
What is said, what is heard & what is seen during a CISD will remain at the CISD! Everything is CONFIDENTIAL.
Don’t “monkey around” with another person’s life…

34. Critical Incident Stress Management (CISM): Group Crisis Intervention (4th Edition) Jeffery T. Mitchell, Ph.D., C.T.S. International Critical Incident Stress Foundation,
JEC Counseling, Dr. Dan Casey, Traumatologist
“Green Cross Academy of Traumatology”, Charles R. Figley, Ph.D.,
Green Cross Academy of Traumatology,
International Red Cross,

35. Thank You. SPREAD THE WORD… THE WORD IS “FAC”
Thank You! SPREAD THE WORD… THE WORD IS “FAC”! (FAC = “Family Assistance Center”)
Your Presenter: Jeff Gay
Minnesota Military Family Assistance Center
500 Timmerman Drive
Marshall, MN
Office or Cellular
You make the call;
We’ll make the difference!
8 Locations! To locate your nearest FAC go to:

36. IN REVIEW Question, Comments, Observations, Conversation,
Constructive Criticism, Blasphemous Comments
about the Presenter, Praise, Adoration, Accolades…
To locate your local CISM team, contact your local
Law Enforcement Center or EMS
Do You wish to become a CISM Volunteer?
If you wish to become involved in volunteering in the area of CISM
locally or, becoming Green Cross certified and travel to disaster
areas worldwide, please contact Dr. Dan Casey at
or on-line at for upcoming classes in
your area.
It feels good to help and the best feeling you can have
is knowing that you “made a difference” in someone’s life…
Catch that feeling! Become a peer volunteer!