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Learning Lab DO09: CISM for Command Staff & ICs

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1 Learning Lab DO09: CISM for Command Staff & ICs
Critical Incident Stress Management Command Officer Course Learning from the Past, Progressing into the Future Developed by Lt. Col. Sam D. Bernard, Ph.D. CAP CISM National Team Leader Partial content from Chevron Publishing Learning Lab DO09: CISM for Command Staff & ICs Learning Lab DO09: CISM for Command Staff & ICs 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 1

2 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Welcome Thank you for attending this session concerning CAP Command Officers Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 2

3 Learning Lab DO09: CISM for Command Staff & ICs
Rationale 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM To provide Command Staff & Incident Commanders with basic knowledge to: Recognize the need for CISM, Implament the CISM program, Understand basic CISM principles, Identify distressed personnel under their supervision, Access CISM services. Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 3

4 Learning Lab DO09: CISM for Command Staff & ICs
Goals 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM To provide the knowledge to: Mitigate critical incident stress, Prepare for critical incident stress, Identify critical incident stress, Support interventions for active critical incident stress intervention, Recover from a critical incident while supporting members & the organization in CAP members while performing CAP duties. Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 4

5 Learning Lab DO09: CISM for Command Staff & ICs
Agenda 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Stress & Types of Stress Management of Cumulative Stress Recognizing Critical Incident Stress (CIS) Preventing Critical Incident Stress (CIS) Mitigating Op Stress After Action Support Indicators of CIS vs. Disciplinary Problems or Character Disorders CISM Resources General Functions of CISM Teams Follow-Up Services P.A.S.S. CAPR 60-5 & Updates Liability Charge Contact Information Jeffrey T. Mitchell, Ph.D., CTS & George S. Everly, Jr., Ph.D., CTS Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 5

6 Learning Lab DO09: CISM for Command Staff & ICs
CAP Personality Traits 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 6

7 Learning Lab DO09: CISM for Command Staff & ICs
Stress 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 7

8 Learning Lab DO09: CISM for Command Staff & ICs
Stress 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Stress is a state of: Physical Cognitive Behavioral Emotional and Spiritual arousal. Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 8

9 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Once physical, cognitive, emotional and spiritual arousal occurs, behaviors change. Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 9

10 Learning Lab DO09: CISM for Command Staff & ICs
Primary Types of Stress 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM General Stress Cumulative Stress Critical Incident Stress Stress Related Disorder Take Home Message Normal Pathological Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 10

11 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Having stress is not bad, in itself. What is bad is experiencing excessive or prolonged stress. Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 11

12 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Resistance If the stressor continues, the body mobilizes to withstand the stress and return to normal. Exhaustion Ongoing, extreme stressors eventually deplete the body’s resources so we function at less than normal. Alarm The body initially responds to a stressor with changes that lower resistance. Return to homeostasis Homeostasis The body systems maintain a stable and consistent (balanced) state. Stressor The stressor may be threatening or exhilarating. Illness Illness and Death The body’s resources are not replenished and/or additional stressors occur; the body suffers breakdowns. Death Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 12

13 Learning Lab DO09: CISM for Command Staff & ICs
The brain becomes more alert. 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Stress can contribute to headaches, anxiety, and depression. Sleep can be disrupted. Stress hormones can damage the brain’s ability to remember and cause neurons to atrophy and die. Baseline anxiety level can increase. Heart rate increases. Persistently increased blood pressure and heart rate can lead to potential for blood clotting and increase the risk of stroke and heart attack. Adrenal glands produce stress hormones. Cortisol and other stress hormones can increase appetite and thus body fat. Stress can contribute to menstrual disorders in women. Stress can contribute to impotence and premature ejaculation in men. Red = immediate response to stress Muscles tense. Blue = effects of chronic of prolonged stress Muscular twitches or “nervous tics” can result. Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 13

14 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Mouth ulcers or “cold sores” can crop up. Breathing quickens. The lungs can become more susceptible to colds and infections. Immune system is suppressed. Skin problems such as eczema and psoriasis can appear. Cortisol increases glucose production in the liver, causing renal hypertension. Digestive system slows down. Stress can cause upset stomachs. Red = immediate response to stress Blue = effects of chronic of prolonged stress Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 14

15 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 15

16 Learning Lab DO09: CISM for Command Staff & ICs
Stress Curve 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Maximum adaptive arousal Health & Performance Stress arousal Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 16

17 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 17

18 Learning Lab DO09: CISM for Command Staff & ICs
Cumulative Stress 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Destructive pathway of stress Piled up, unresolved general stress Takes time Produces negative changes in: Mental & physical health Performance Relationships Personality Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 18

19 Learning Lab DO09: CISM for Command Staff & ICs
Cumulative Stress 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM A chronic state of disturbing stress which can cause physical & changes in personality over time. Takes months or years to develop. May be a combination of work or home life. Often referred to as “burnout”. Often needs professional help for recovery especially if in late stages. continued... Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 19

20 Learning Lab DO09: CISM for Command Staff & ICs
Cumulative Stress - continued 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Develops in four stages: Early Warning Mild Symptoms Entrenched Severe Symptoms Characterized by gradually declining performance, increasing problem in job continued... Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 20

21 Learning Lab DO09: CISM for Command Staff & ICs
Cumulative Stress - continued 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Early Symptoms: Vague anxiety Boredom General fatigue Mild Symptoms: All of the Early Symptoms Irritability Chronic tension Depression continued... Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 21

22 Learning Lab DO09: CISM for Command Staff & ICs
Cumulative Stress - continued 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Mild Symptoms Frustration Frequent sighs Sleep disturbance Chronic worry Loss of interest in work More frequent colds Mild rashes Headaches Withdrawal from others etc.. Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 22

23 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Entrenched Symptoms Chronic depression Loss of joy of life Chronic anger Increased drinking / drugging Thoughts of suicide Emotional outbursts Marital or relationship discord Conflict with fellow workers Conflict with supervisors Increasing discipline problems continued... Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 23

24 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Entrenched symptoms - continued Increased self destructive behaviors (i.e.?) Withdrawal from loved ones Continued... Loss of trust in others Increasing paranoia Loss of ambition Tendency to blame others Inability to take responsibility for one’s own actions Minor property destruction Acting out behaviors etc.. (?) Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 24

25 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Severe Symptoms Rage reactions Homicidal thinking Suicidal thinking / acts Easily angered Verbally violent outbursts Acts of violence Threats to others Excessive drinking / drugging Severe depression Severe paranoia continued... Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 25

26 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Severe Symptoms - continued Break up of relationships over minor issues Compulsive thinking about bothersome topics Easily frustrated Sense of hopelessness Sense of helplessness Seriously declining performance Most symptoms from previous levels etc.. Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 26

27 Learning Lab DO09: CISM for Command Staff & ICs
Burnout 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Changes attitudes Avoids work Or, becomes totally immersed Develops negative outlook Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 27

28 Learning Lab DO09: CISM for Command Staff & ICs
Flame-out 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Exhaustion, hyperactivity Overwhelming negative emotions Denial of symptoms Loss of objectivity Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 28

29 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Stress Reactions Physiological not Characteriological Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 29

30 Learning Lab DO09: CISM for Command Staff & ICs
Management of Cumulative Stress Reactions 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Stress management education Balance in life - work - home, etc.. Recreation Vacation Limiting overtime Emphasis on home life Professional counseling when needed continued... Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 30

31 Learning Lab DO09: CISM for Command Staff & ICs
Management - continued 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Exercise Proper food Clear job expectations Reduction of one worker performing two jobs Effective leadership Administrative support Stress reduction techniques Healthy living Effective training Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 31

32 Learning Lab DO09: CISM for Command Staff & ICs
Critical Incident 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM An event that has the power to overwhelm the coping abilities of an individual or group. Take Home Message Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 32

33 Learning Lab DO09: CISM for Command Staff & ICs
The Terrible 10 for CAP 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM . . . not limited to missions! Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 33

34 Learning Lab DO09: CISM for Command Staff & ICs
Crisis 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Noun vs Verb Both Take Home Message An acute reaction to a critical incident. A name of a particular critical incident. Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 34

35 Learning Lab DO09: CISM for Command Staff & ICs
Crisis Characteristics 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM The relative balance between thought processes and emotional processes is disturbed, The usual coping methods do not work effectively, There is evidence of mild to severe impairment in individuals or groups exposed to the critical incident, Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 35

36 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Pre-CRISIS Post CRISIS FEELINGS THOUGHTS FEELINGS THOUGHTS CRISIS Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 36

37 Learning Lab DO09: CISM for Command Staff & ICs
Assessing the Need for Crisis Intervention (CISM) Learning Lab DO09: CISM for Command Staff & ICs Learning Lab DO09: CISM for Command Staff & ICs 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Is this one of the CAP “Terrible 10”? Are coping mechanisms working effectively for EVERYONE? Is there evidence of mild to severe impairment in individuals or groups exposed to the critical incident? Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 37

38 Learning Lab DO09: CISM for Command Staff & ICs
Critical Incident Stress (CIS) 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Also called “traumatic stress” Not caused by general stress or cumulative stress, but produced by a specific terrible event All people are vulnerable Emergency personnel may be more vulnerable because of exposure to traumatic events continued... Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 38

39 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM C I S - continued Some may react more strongly than others Usually resolves in a reasonable period of time May need some form of brief support service Can turn into a serious problem for a few people if it is not resolved Supervisors are able to recognize the problem continued... Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 39

40 Learning Lab DO09: CISM for Command Staff & ICs
C I S - continued 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Some people have several Critical Incident Stress reactions during their careers Reactions can be reduced by early intervention Critical Incident Stress can be an opportunity for positive change and growth Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 40

41 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 41

42 Learning Lab DO09: CISM for Command Staff & ICs
Reactions to Stress 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Physical Cognitive Emotional Behavioral Spiritual Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 42

43 Learning Lab DO09: CISM for Command Staff & ICs
Physical Signs and Symptoms of Critical Incident Stress Learning Lab DO09: CISM for Command Staff & ICs Learning Lab DO09: CISM for Command Staff & ICs 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Thirst Fatigue Nausea Twitches Vomiting Dizziness Elevated B/P Muscle tremors Grinding teeth Visual difficulties Profuse sweating Difficulty breathing Fainting / LoC Weakness/numbess Chest pain Headaches Rapid heart rate Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 43

44 Learning Lab DO09: CISM for Command Staff & ICs
Cognitive Signs and Symptoms of Critical Incident Stress Learning Lab DO09: CISM for Command Staff & ICs Learning Lab DO09: CISM for Command Staff & ICs 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Confusion Nightmares Uncertainty Hypervigilence Suspiciousness Intrusive images Blaming someone Poor problem solving Poor abstract thinking Change in attention/decision Poor concentration or memory Disorientation Change in alertness Suicide/homicide Hallucinations/delusions Paranoid ideas Disabling guilt Hopelessness Helplessness Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 44

45 Learning Lab DO09: CISM for Command Staff & ICs
Behavioral Signs and Symptoms of Critical Incident Stress 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Withdrawal Inability to rest Intensified pacing Erratic movements Changes in social activity Changes in speech Changes in appetite Hyper-alertness Changes in alcohol or drug consumption Antisocial acts Abuse of others Diminished personal hygiene Immobility Self medication Violence Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 45

46 Learning Lab DO09: CISM for Command Staff & ICs
Emotional Signs and Symptoms of Critical Incident Stress 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Guilt Grief Denial Anxiety Agitation Irritability Depression Anger Apprehension Emotional shock Emotional outburst Feeling overwhelmed Loss of emotional control Inappropriate emotional responses Infantile emotions Panic attacks Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 46

47 Learning Lab DO09: CISM for Command Staff & ICs
Spiritual Signs and Symptoms of Critical Incident Stress Learning Lab DO09: CISM for Command Staff & ICs Learning Lab DO09: CISM for Command Staff & ICs 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Angry at “God” Asking “why” questions Cessation of practice of faith Faith rituals fail to have meaning Religious hallucinations or delusions Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 47

48 Learning Lab DO09: CISM for Command Staff & ICs
Cumulative CIS 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM High frequency of activation Long duration of service High intensity of service provision Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 48

49 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Cumulative CIS Loss of purpose Loss of connection Loss of autonomy Loss of integrity Spiritual depletion Kendall Johnson, 1993 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 49

50 Learning Lab DO09: CISM for Command Staff & ICs
Factors Effecting Crisis Reactions Learning Lab DO09: CISM for Command Staff & ICs Learning Lab DO09: CISM for Command Staff & ICs 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Suddenness Intensity Duration Level of loss Age Injury or death to relatives or friends Availability of resources Level of education / training Availability of coping mechanisms Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 50

51 Learning Lab DO09: CISM for Command Staff & ICs
Crisis Intervention 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM An active and temporary entry into the life of an individual or a group during a period of significant distress. Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 51

52 Learning Lab DO09: CISM for Command Staff & ICs
Crisis Intervention 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Emotional “first aid” designed to assist the person in a crisis state to return to adaptive functioning. Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 52

53 Learning Lab DO09: CISM for Command Staff & ICs
Objectives of Crisis Intervention 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Stabilize situation Mitigate impact Mobilize resources Normalize reactions Restore to adaptive function Take Home Message Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 53

54 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Dose Response Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 54

55 Learning Lab DO09: CISM for Command Staff & ICs
“1/3 Rule” - Theoretical 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM 1 2 3 8% Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 55

56 Learning Lab DO09: CISM for Command Staff & ICs
Imprint of Horror 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Visual Auditory Olfactory Kinesthetic Gustatory Temporal Psychological / Perceptual Contaminants Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader

57 Learning Lab DO09: CISM for Command Staff & ICs
CISM as Mitigation 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Efforts attempt to prevent hazards from developing into disasters altogether, or to reduce the effects of disasters when they occur. Differs from the other phases because it focuses on long-term measures for reducing or eliminating risk. Implementation of mitigation strategies can be considered a part of the recovery process if applied after a disaster occurs. Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 57

58 Learning Lab DO09: CISM for Command Staff & ICs
CISM as Mitigation 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Structural or non-structural, Is the most cost-efficient method for reducing the impact of hazards. Does include providing regulations and sanctions against those who refuse to obey the regulations potential risks to the public fema.gov A natural mesh with Public Affairs Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 58

59 Learning Lab DO09: CISM for Command Staff & ICs
Mitigating C I S 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Even with all the right programs, briefings, teams, personnel, etc lined up & available – there can still be CIS. We don’t know our member’s baggage. (Pre-existing conditions) Pre-Exposure Training can help ID potential psych/perceptual contaminants Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 59

60 Learning Lab DO09: CISM for Command Staff & ICs
Mitigating Operational Stress (OpStress) 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Frequent information / feedback to staff Frequent rest breaks Cold or hot environments might require more frequent rest breaks Rest areas away from stimuli 12 hour limit for same scene stimuli Assure proper rehabilitation sector Provide lavatory facilities continued... Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 60

61 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Mitigating OpStress - continued Provide hand washing facilities Provide medical support to staff Monitor hyper- or hypo-thermia Proper food Limit fat, sugar and salt Fluid replacement Provide drinking water Provide fruit juices Limit use of caffeine products CISM on scene support services continued... Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 61

62 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Mitigating OpStress - continued Monitor signs of emotional distress Limit overall stimuli at incident Give clear orders to personnel Avoid conflicting orders to staff Delegate authority Frequent rest breaks for all Back up leaders Sectorization of the incident Delegation of authority Credit people for proper actions continued... Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 62

63 Learning Lab DO09: CISM for Command Staff & ICs
Mitigating OpStress - continued 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Limit criticism to absolute minimum Utilize a staging area for uninvolved personnel Limit exposure to event sights, sounds and smells (reminders) Announce time periodically Rotate crews to alternate duties Others ? Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 63

64 Learning Lab DO09: CISM for Command Staff & ICs
Peritraumatic Stress 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Dissociation Depersonalization, derealization, fugue states, amnesia Intrusive Re-Experiencing Flashbacks, terrifying memories or night mares, repetitive automatic re-enactments Avoidance Agoraphobic-like social withdrawal Hyperarousal Panic episodes, startle reactions, fighting or temper problems Anxiety Debilitating worry, nervousness, vulnerability or powerlessness Depression Anhedonia, worthlessness, loss of interest in most activities, awakening early, persistent fatigue, and lack of motivation Problematic Substance Use Abuse or dependency, self-medication Psychotic Symptoms Delusions, hallucinations, bizarre thoughts or images, catatonia Disaster Mental Health Services-A guidebook for Clinicians & Administrators; Dept of Veterans Affairs, 1998 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 64

65 Learning Lab DO09: CISM for Command Staff & ICs
Highest Risk for Extreme Peritraumatic Stress 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Life-Threatening danger, extreme violence, or sudden death of others; Extreme loss or destruction of their homes, normal lives, and communities; Intense emotional demands from distraught survivors (rescue workers, counselors, caregivers); Prior psychiatric or marital/family problems; Prior significant loss (death of a loved one in the past year) Cardena & Spiegel, 1993; Joseph et.al, 1994; Kooperman, et.al., 1994&5; La Greca et.al.,1996; Lonigan, et.al., 1994; Schwarz & Kowalski, 1991; Shalev, et.al., 1993 Disaster Mental Health Services-A guidebook for Clinicians & Administrators; Dept of Veterans Affairs, 1998 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 65

66 Learning Lab DO09: CISM for Command Staff & ICs
Effects of Hyper-Arousal 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Trouble sleeping Difficulty concentrating Heightened vigilance Being easily startled Being wary Sudden crying Becoming suddenly angry Being more emotional Panicking Intensified alertness Reminders of the trauma leading to physical reactions Rapid heart beat Sweating etc Increased anxiety Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 66

67 Learning Lab DO09: CISM for Command Staff & ICs
Hyper-Arousal Sleep Disturbances 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Longer to fall asleep Unable to fall asleep More sensitive to noise Awaken more often during the night Have dreams and/or nightmares about the trauma Repetitive trauma dreams may awaken and leave frightened and exhausted Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 67

68 Learning Lab DO09: CISM for Command Staff & ICs
After Action Support 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Thank personnel for their work Consult with CISM team Provide demobilization services on large scale incident Utilize services of CISM teams Arrange defusing for unusual events Consider debriefing for personnel if it appears necessary* continued... Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 68

69 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM After Action Support - continued Allow follow up services by CISM team members Critique incident operationally Teach new procedures from lessons learned Consider the need for family support Other ? Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 69

70 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Indicators of Critical Incident Stress vs. Disciplinary Problems or Character Disorders Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 70

71 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Critical Incident Stress Identifiable traumatic event Reactions begin with an event Reactions worsen after event Reactions follow expected patterns Sudden changes are common in CIS CIS reactions usually reduce with: Peer assistance and, With the passage of time Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 71

72 Learning Lab DO09: CISM for Command Staff & ICs
Characteriological & Disciplinary Problems - continued 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Disciplinary problems have a long and diffuse history Problems may have preexisted entry into the CAP job Identifiable traumatic event(s) missing Problems may exist in several other important areas of the person’s life. Problems do not easily resolve over time even with help. Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 72

73 Learning Lab DO09: CISM for Command Staff & ICs
Addressing C I S 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Acknowledge the existence of CIS Pre-incident education Planning Drills / practice Pre-deployment briefings Avoid avoidance of CIS Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 73

74 Learning Lab DO09: CISM for Command Staff & ICs
Critical Incident Stress Management 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Comprehensive Integrated System utilizing a Multi-Tactical Crisis Intervention Approach to Managing Traumatic Stress Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 74

75 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM CISM: Menu of Services Pre-Crisis Preparation Group Intervention Demobilization Crisis Management Briefing Defusing Critical Incident Stress Debriefing Individual Crisis Intervention Pastoral Crisis Intervention Family CISM Organizational Consultation Follow-up/ Referral “Tactics” Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 75

76 Learning Lab DO09: CISM for Command Staff & ICs
CISM Tactics Must be Available for: Learning Lab DO09: CISM for Command Staff & ICs 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Individuals Groups Organizations Families Significant others Take Home Message Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 76

77 Learning Lab DO09: CISM for Command Staff & ICs
Core Competencies in CISM 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM The ability to properly assess both the situation and the severity of impact on individuals and groups Ability to develop a strategic plan Individual crisis intervention skills Large group crisis intervention skills Small group crisis intervention skills Referral skills Take Home Message Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 77

78 Learning Lab DO09: CISM for Command Staff & ICs
Treatment Referral Options 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Medical Care Professional MD / DO PA / NP Mental Health Care Professional Psychologist Counselor Social Worker Psychiatrist / NP / PA Spiritual Care Professional Faith Leader “Chaplain” Take Home Message CAP Legal: Treat like a physical injury Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 78

79 Learning Lab DO09: CISM for Command Staff & ICs
Essential CISM Courses (2 Days Each) Learning Lab DO09: CISM for Command Staff & ICs 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Assisting Individuals in Crisis Basic Critical Incident Stress Management: Group Crisis Interventions Suicide Grief Following Trauma Advanced Critical Incident Stress Management: Group Crisis Interventions T.E.A.M. Emotional & Spiritual Care in Disasters Take Home Message Chevron Publishing, 2002 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 79

80 Learning Lab DO09: CISM for Command Staff & ICs
CISM Components Before an Incident 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Education (PEP) Team training Planning Administrative support Protocol development Guideline development Networking with other teams & resources Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 80

81 Learning Lab DO09: CISM for Command Staff & ICs
CISM Components During an Incident 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM On-scene support services One-on-one crisis intervention Advice to supervisors/IC Support to primary victims (CAP) Provision of food, fluids, rest and other services to operations personnel Organizational Consultation (CC) Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 81

82 Learning Lab DO09: CISM for Command Staff & ICs
CISM Components After an Incident 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM One-on-one crisis intervention Demobilization (post-disaster, large group) Crisis Management Briefing (CMB, large group) Defusing (small group) Critical Incident Stress Debriefing (CISD, small group) Significant other support services . . . more . . . Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 82

83 Learning Lab DO09: CISM for Command Staff & ICs
CISM Components After an Incident continued 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Post-incident education Follow-up services Referrals according to needs Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 83

84 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Typically: 3-5 contacts After that, Recovery is evident Referral is indicated Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 84

85 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Is not psychotherapy Is not a substitute for psychotherapy Is not a stand-alone Is not a cure for PTSD, Depression, Anxiety, etc Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 85

86 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM CISM has far more to do with group support and assessment (triage) than it does with treatment and cure. Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 86

87 Learning Lab DO09: CISM for Command Staff & ICs
Follow-Up 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Must be provided after every CISM service: Assess impact of intervention Assess for uncovering prior issues Assess trajectory of reactions Decreasing Same Increasing Assess for possible referral: Health Care Professional Mental Health Care Professional Spiritual Care Professional Can be accomplished telephonically Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 87

88 Learning Lab DO09: CISM for Command Staff & ICs
P. A. S. S. Post Action Staff Support Dennis Potter, LCSW Learning Lab DO09: CISM for Command Staff & ICs Learning Lab DO09: CISM for Command Staff & ICs 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 88

89 Learning Lab DO09: CISM for Command Staff & ICs
Goals For PASS 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Increase longevity of CISM team members Increase learning from the experience Increase stress management skills Decrease the chance for personal reactions To take care of ourselves (too) Increase effectiveness of team members Monitor team for any adverse reactions Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 89

90 Learning Lab DO09: CISM for Command Staff & ICs
Why Do It? Learning Lab DO09: CISM for Command Staff & ICs 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM To Prevent: Vicarious Traumatization Cumulative Stress Critical Self Judgment To Teach To Practice What We Teach “The same professionalism we provide to others, we deserve ourselves” SDB Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 90

91 Learning Lab DO09: CISM for Command Staff & ICs
Important Notice: 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM All CISM services should be provided only by people who have been properly trained in Critical Incident Stress Management courses, Having attained an advanced academic degree alone does NOT indicate knowledge of CISM or related protocols. Take Home Message Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 91

92 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM International Critical Incident Stress Foundation Pine Orchard Lane Suite 106 Ellicott City, MD (410) Fax: (410) Emergency: (410) Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 92

93 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 93

94 Learning Lab DO09: CISM for Command Staff & ICs
CAPR 60-5 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Administratively authorizes CISM, Provides background information and “how to” information, Mandates each Wing to name a CISM Officer, Please read and review 60-5 Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 94

95 Learning Lab DO09: CISM for Command Staff & ICs
CAP Personality Traits 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Need to rescue or be needed Strong intrinsic motivation Stimulation seeking/easily bored Need for immediate feedback Action oriented Desire to do a perfect job Need to be in control Strive for consistency Risk taker High dedication Likes uniforms Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 95

96 Learning Lab DO09: CISM for Command Staff & ICs
CAP Personality Traits 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Those 10 traits make us very good at what we do – our jobs in CAP, Those same 10 traits put us at high risk: Cumulative Stress Critical Incident Stress Depression Anxiety Panic Attacks PTSD Substance Abuse Relationship Problems Antisocial traits (isolation, etc) Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 96

97 Learning Lab DO09: CISM for Command Staff & ICs
Questions . . . 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Do CAP members have the potential for attaining physical injury? Yes What is done to address this potential? Safety briefings, Regulations, Checklists, Medical Officers, First Aid kits, Disciplinary actions, etc. Do CAP member have the potential for attaining psychological injury? Yes – direct and indirect What is done to address this potential? CISM program, Regulation 60-5, PEP Talks, Briefings Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 97

98 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM “Deliberate Indifference” U.S. Supreme Court concluded that inadequacy of police training may serve as a basis for municipal liability where failure to train amounts to deliberate indifference for the rights of persons with whom the police come into contact. The Court said that the City of Canton, Ohio was negligent in failing to train their police officers in first aid on a regular basis because the probability of needing to use first aid in police work was so high. Lt. Michael S. Woody, Ret. Akron Ohio Police Dept, Jan 6, 2003 Let’s not put CAP at risk – acknowledge and support the CAP CISM program. Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 98

99 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM “Knowledge itself is power” Sir Francis Bacon “Action is the proper fruit of knowledge” Thomas Fuller Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 99

100 Learning Lab DO09: CISM for Command Staff & ICs
What “Actions” from here? Learning Lab DO09: CISM for Command Staff & ICs 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Acknowledge the CAP CISM program Designate a CISM Officer or Coordinator Incorporate CISM into each mission Designate CISM specific taskings during evals Allow CISM to support your team and staff by: Triaging mental health issues Helping them cope with their experiences, Getting them back into service Offer referrals if needed Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 100

101 Learning Lab DO09: CISM for Command Staff & ICs
Feedback 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Thoughts Comments Reactions Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 101

102 Learning Lab DO09: CISM for Command Staff & ICs
National Staff 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Lt Col Sam D. Bernard, PhD National CISM Team Leader (423) Maj Chris Latocki Administrative Officer ( 813) Customize for National CISM Staffers Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 102

103 Learning Lab DO09: CISM for Command Staff & ICs
Region Staff 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM ________Name____________ Region CISM Officer Telephone / Region Clinical Director Customize for Region CISM Staffers Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 103

104 Learning Lab DO09: CISM for Command Staff & ICs
Wing Staff 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM ________Name____________ Wing CISM Officer / Coordinator Telephone / Wing Clinical Director Customize for Wing CISM staffers Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 104

105 Learning Lab DO09: CISM for Command Staff & ICs
9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Who’s needs am I meeting, Just because you can, doesn’t mean you should, Everything that is countable, doesn’t always count; everything is counts is not always countable, Do not confuse effort with results, Listen to the words for the underlying meaning, Have a good day, unless you have made other plans, Timing is all, Bring cognition to chaos, It’s not about you, No one is immune, You will walk with a limp, Hear with your ears, see with your eyes, and think with your brain, It’s bigger than you, Sam’s Pearls of Wisdom Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 105

106 Learning Lab DO09: CISM for Command Staff & ICs
Critical Incident Stress Management 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Lt. Col. Sam D. Bernard, Ph.D. National CAP CISM Team Leader (423) Cell cism.cap.gov This slide should be customized for the presenter to provide specific contact information for participants. Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 106

107 Learning Lab DO09: CISM for Command Staff & ICs
. . .and just one more thing. . . 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Thank You! Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 107

108 Learning Lab DO09: CISM for Command Staff & ICs
Critical Incident Stress Management Command Officer Course Learning from the Past, Progressing into the Future Developed by Lt. Col. Sam D. Bernard, Ph.D. CAP CISM National Team Leader Partial content from Chevron Publishing Learning Lab DO09: CISM for Command Staff & ICs Learning Lab DO09: CISM for Command Staff & ICs 9/4/09 3:30-5:00 PM 9/4/09 3:30-5:00 PM Sam D. Bernard, PhD (LtCol); National CISM Team Leader Sam D. Bernard, PhD (LtCol); National CISM Team Leader 108


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