1. IT’S A TOUGH JOB: DEALING WITH TRAUMATIC STRESS AND BURNOUT ANN K. OSHEL, MS ALLIANCE BEHAVIORAL HEALTHCARE DONALD GARNER, WAKE EMS HELEN TRIPP, DURHAM EMS

2. Why should First Responder stress be part of every CIT curriculum?  High rates of suicide amongst First Responders  Culture that sees vulnerability as a sign of weakness and “can’t handle the job”  High rates of divorce  High rates of alcohol and drug use  High rates of depression  High rates of PTSD and Acute Stress Disorder that often go unrecognized and untreated  Creates an opportunity to discuss traumatic exposures and build resiliency

3. “PTSD is a greater cop killer than all the guns ever fired at police officers.” Lt. James F. Devine, NYPD

4. Topics covered in PTSD modules  The effects of stress  Clinical criteria for PTSD  Clinical complexity of trauma exposure and PTSD  Co-occurring disorders  Accumulated trauma  Manifestations of untreated trauma and the consequences for First Responders  Discuss common themes amongst First Responders but specifics to EMS and law enforcement as well  Tipping points and Breaking points  Trauma prevention and early intervention  Identifying triggers  Peer support  CISD  Avoiding burnout and building resiliency

5. LEO Definition of Stress That feeling and desire along with the ensuing bodily effects, experienced by a person who has a strong and true longing to choke the living shit out of someone who desperately deserves it, but you can’t. Dan Goldfarb, Police Officer  Included in First Responder Stress module

6. “As police officers, we have a very real problem. We don’t recognize how what we see, hear, smell, taste and feel affects us on a daily basis. Our responses to violence are so subtle and long-term that we do not realize what is happening to us until we begin to lose what is most important in our lives – our families, friends, health, spirituality, honor, commitment and self-worth.” Det. William Martin, LAPD  Included in First Responder Stress module

7. DSM Criteria for PTSD 1.An existence of a recognizable stressor outside the range of usual human experience 2.The traumatic event is persistently re-experienced 3.Stimuli associated with the trauma are avoided 4.Persistent symptoms of increased arousal 5.Associated symptoms last at least one month  Included in PTSD module

8. Co-occurring Diagnosis for Adults with PTSD MEN ◦88% will meet criteria for 1 additional diagnosis and 59% will meet criteria for at least 3 additional diagnoses ◦Alcohol Abuse or Dependence (51.9%) ◦Major Depressive Disorders (47.9%) ◦Conduct Disorders (34.5%) ◦Drug Abuse or Dependence (34.5%)  Included in PTSD module

9. Co-occurring Diagnosis for Adults with PTSD Women ◦79% will meet criteria for 1 additional diagnosis and 44% will meet criteria for at least 3 additional diagnoses ◦Major Depressive Disorders (48.5%) ◦Simple Phobias (29%) ◦Social Phobias (28.4%) ◦Alcohol Abuse or Dependence (27.9%)  Included in PTSD module

10. “The thing that upsets people is not what happens but what they think it means.” Epictetus

11. Considerations when training PTSD to First Responders  This issue is personal to them. Handle with care…  Keep it interactive and engaging  Have to establish trust before you ask them the hard questions  Normalize, normalize, normalize  Have a sense of humor  Co-present with other CIT officers/paramedics  End with a positive and uplifting message

12. To burn out you had to have once been on fire

13. Don’t Be Afraid to Ask for Help “It is, I think, an officers job and duty, especially to his family, not to crash. Too much is at stake. Staying psychologically fit means committing to take care of yourself. It takes work. For the average officer possibly the hardest job of staying healthy is to admit that he/she has a problem. The second hardest feat is the willingness to get help. I have often marveled at how police officers, whose careers are centered on helping others, have so much trouble accepting help.” Dan Goldfarb, Police Officer