1. Critical Incident Stress Management Critical Incident Stress Management: Psychological First Aid for Trauma Disasters, terrorist events and various everyday traumatic events produce stress that can cause emotional and physical debilitation and may result in more serious stress related conditions. Through timely intervention CISM provides support to lessen or eliminate the effects of the traumatic stress. Disasters, terrorist events and various everyday traumatic events produce stress that can cause emotional and physical debilitation and may result in more serious stress related conditions. Through timely intervention CISM provides support to lessen or eliminate the effects of the traumatic stress.

2. Critical Incident Stress Management Disasters, terrorist events and various everyday traumatic events produce stress that can cause emotional and physical debilitation and may result in more serious stress related conditions. Through timely intervention CISM provides support to lessen or eliminate the effects of the traumatic stress. Disasters, terrorist events and various everyday traumatic events produce stress that can cause emotional and physical debilitation and may result in more serious stress related conditions. Through timely intervention CISM provides support to lessen or eliminate the effects of the traumatic stress.

3. Critical Incident Stress Management The need for CISM The need for CISM The value The value The purpose The purpose The components The components Tennessee Emergency Services CISM Team Tennessee Emergency Services CISM Team

4. Critical Incident Stress Management Introductory Story Introductory Story Midland Texas October 14, i987 Midland Texas October 14, i987 Who remembers the date? Who remembers the date?

5. Critical Incident Stress Management Introductory Story Introductory Story Midland Texas October 14, i987 Midland Texas October 14, i987 Who remembers the date? Who remembers the date?

6. Critical Incident Stress Management Introductory Story Introductory Story Midland Texas October 14, i987 Midland Texas October 14, i987 Who remembers the date? Who remembers the date? Jessica McClure Jessica McClure Maybe “Baby Jessica” Maybe “Baby Jessica” Successful rescue Successful rescue The aftermath The aftermath

7. Critical Incident Stress Management CRITICAL INCIDENTS CRITICAL INCIDENTS Unusually challenging event Unusually challenging event Potential to create significant human distress Potential to create significant human distress Overwhelm one’s usual coping mechanisms Overwhelm one’s usual coping mechanisms

8. Critical Incident Stress Management The Need ( a few statistics): The Need ( a few statistics): PTSD IN LAW ENFORCEMENT 10-15% PTSD IN LAW ENFORCEMENT 10-15% Fire suppression 10-30% Fire suppression 10-30% Estimated as many as 45% of those exposed to mass disaster PTSD or depression Estimated as many as 45% of those exposed to mass disaster PTSD or depression U.S. Center for Mental Health: 1.5 million persons in NYC counseling following 9 11 U.S. Center for Mental Health: 1.5 million persons in NYC counseling following 9 11 Critical Incident Stress Serious Matter Critical Incident Stress Serious Matter

9. Critical Incident Stress Management Value of early crisis intervention Value of early crisis intervention May reduce need for more intense Psyc services May reduce need for more intense Psyc services Mitigate acute distress Mitigate acute distress May reduce ETOH use May reduce ETOH use Reduce distress in medical surgical patients Reduce distress in medical surgical patients First responders resistant to tradition Psyc First responders resistant to tradition Psyc Intervention NOT Counseling Intervention NOT Counseling

10. Critical Incident Stress Management History of intervention History of intervention “Shell shock” WW I “Shell shock” WW I “Battle Fatigue” WW II “Battle Fatigue” WW II Viet Nam began to study and work problem Viet Nam began to study and work problem British military: British military: Proximity Proximity Immediacy Immediacy Expectancy Expectancy

11. Critical Incident Stress Management The Purpose of Crisis Intervention The Purpose of Crisis Intervention Stabilization Stabilization Symptom reduction Symptom reduction Return to adaptive functioning and/or Return to adaptive functioning and/or Facilitate access to continued (higher level) care Facilitate access to continued (higher level) care Psychological First Aid Psychological First Aid

12. Critical Incident Stress Management Critical Incident Stress Management Critical Incident Stress Management Comprehensive Comprehensive Integrated Integrated Systematic Systematic Multi-tactic Multi-tactic

13. Critical Incident Stress Management The various components combine to provide broad-based solution to traumatic stress

14. Critical Incident Stress Management Pre-incident education and preparation Pre-incident education and preparation Assessment/strategic planning Assessment/strategic planning Demobilization Demobilization Crisis management briefing Crisis management briefing Defusing Defusing Critical Incident Stress Debriefing Critical Incident Stress Debriefing

15. Critical Incident Stress Management Significant other/Family support Significant other/Family support Organizational/community consultations Organizational/community consultations Pastoral crisis intervention Pastoral crisis intervention Follow-up services and/or referals Follow-up services and/or referals

16. Critical Incident Stress Management Pre-incident education and preparation Pre-incident education and preparation

17. Critical Incident Stress Management Pre-incident education and preparation Pre-incident education and preparation Assessment/strategic planning Assessment/strategic planning Used for pre-planning and/or choosing and setting up proper interventions for major sized crises Used for pre-planning and/or choosing and setting up proper interventions for major sized crises

18. Critical Incident Stress Management Pre-incident education and preparation Pre-incident education and preparation Assessment/strategic planning Assessment/strategic planning Demobilization Demobilization Used in large on-going operations at the end of the first shift when workers have to return to operations next day Used in large on-going operations at the end of the first shift when workers have to return to operations next day

19. Critical Incident Stress Management Pre-incident education and preparation Pre-incident education and preparation Assessment/strategic planning Assessment/strategic planning Demobilization Demobilization Crisis management briefing Crisis management briefing Town meeting used to inform a population of the status Town meeting used to inform a population of the status

20. Critical Incident Stress Management Pre-incident education and preparation Pre-incident education and preparation Assessment/strategic planning Assessment/strategic planning Demobilization Demobilization Crisis management briefing Crisis management briefing Defusing Defusing Small group crisis intervention normally on shift often follow-up later with CISD Small group crisis intervention normally on shift often follow-up later with CISD

21. Critical Incident Stress Management Pre-incident education and preparation Pre-incident education and preparation Assessment/strategic planning Assessment/strategic planning Demobilization Demobilization Crisis management briefing Crisis management briefing Defusing Defusing Critical Incident Stress Debriefing Critical Incident Stress Debriefing Team lead group intervention 24 – 72 hours Team lead group intervention 24 – 72 hours

22. Critical Incident Stress Management Significant other/Family support Significant other/Family support Organizational/community consultations Organizational/community consultations Pastoral crisis intervention Pastoral crisis intervention Follow-up services and/or referrals Follow-up services and/or referrals

23. Critical Incident Stress Management Significant other/Family support Significant other/Family support Obvious point—not just emergency service worker affected Obvious point—not just emergency service worker affected

24. Critical Incident Stress Management Significant other/Family support Significant other/Family support Organizational/community consultations Organizational/community consultations Meetings like this, school systems disaster groups Meetings like this, school systems disaster groups

25. Critical Incident Stress Management Significant other/Family support Significant other/Family support Organizational/community consultations Organizational/community consultations Pastoral crisis intervention Pastoral crisis intervention Recently recognized the value of faith- based spiritual support (crisis of faith) Recently recognized the value of faith- based spiritual support (crisis of faith)

26. Critical Incident Stress Management Significant other/Family support Significant other/Family support Organizational/community consultations Organizational/community consultations Pastoral crisis intervention Pastoral crisis intervention Follow-up services and/or referrals Follow-up services and/or referrals We teach refer, refer, refer we provide first-level care We teach refer, refer, refer we provide first-level care

27. Critical Incident Stress Management Pre-incident education and preparation Pre-incident education and preparation Assessment/strategic planning Assessment/strategic planning Demobilization Demobilization Crisis management briefing Crisis management briefing Defusing Defusing Critical Incident Stress Debriefing Critical Incident Stress Debriefing

28. Critical Incident Stress Management Significant other/Family support Significant other/Family support Organizational/community consultations Organizational/community consultations Pastoral crisis intervention Pastoral crisis intervention Follow-up services and/or referrals Follow-up services and/or referrals

29. Critical Incident Stress Management Tennessee Federation of Fire Chaplains Affiliated Federation of Fire Chaplains Tennessee Emergency Services Chaplains Association Chaplains Association Provides training using FFC standards and CISM Team and services