Presentation is loading. Please wait.

Presentation is loading. Please wait.

Critical Incident Stress Management Command Officer Course Learning from the Past,... Progressing into the Future Developed by Lt. Col. Sam D. Bernard,

Similar presentations


Presentation on theme: "Critical Incident Stress Management Command Officer Course Learning from the Past,... Progressing into the Future Developed by Lt. Col. Sam D. Bernard,"— Presentation transcript:

1 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

2 Welcome Thank you for attending this session concerning CAP Command Officers

3 Rationale 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.

4 Goals To provide the knowledge to: Mitigate critical incident stress, Mitigate critical incident stress, Prepare for critical incident stress, Prepare for critical incident stress, Identify critical incident stress, Identify critical incident stress, Support interventions for active critical incident stress intervention, Support interventions for active critical incident stress intervention, Recover from a critical incident while supporting members & the organization Recover from a critical incident while supporting members & the organization in CAP members while performing CAP duties.

5 Agenda Jeffrey T. Mitchell, Ph.D., CTS & George S. Everly, Jr., Ph.D., CTS Stress & Types of Stress Stress & Types of Stress Management of Cumulative Stress Management of Cumulative Stress Recognizing Critical Incident Stress (CIS) Recognizing Critical Incident Stress (CIS) Preventing Critical Incident Stress (CIS) Preventing Critical Incident Stress (CIS) Mitigating Op Stress Mitigating Op Stress After Action Support After Action Support Indicators of CIS vs. Disciplinary Problems or Character Disorders Indicators of CIS vs. Disciplinary Problems or Character Disorders CISM Resources CISM Resources General Functions of CISM Teams General Functions of CISM Teams Follow-Up Services Follow-Up Services P.A.S.S. P.A.S.S. CAPR 60-5 & Updates CAPR 60-5 & Updates Liability Liability Charge Charge Contact Information Contact Information

6 CAP Personality Traits

7 Stress

8 Stress is a state of: Physical Cognitive Behavioral Emotional and Spiritual arousal. Take Home Message

9 Chevron Publishing, 2002 Once physical, cognitive, emotional and spiritual arousal occurs, behaviors change.

10 Primary Types of Stress General Stress General Stress Cumulative Stress Cumulative Stress Critical Incident Stress Critical Incident Stress Stress Related Disorder Stress Related Disorder Take Home Message NormalPathological

11 Chevron Publishing, 2002 Having stress is not bad, in itself. What is bad is experiencing excessive or prolonged stress.

12 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. Stressor The stressor may be threatening or exhilarating. Homeostasis The body systems maintain a stable and consistent (balanced) state. Illness and Death The body’s resources are not replenished and/or additional stressors occur; the body suffers breakdowns. Return to homeostasis Illness Death

13 The brain becomes more alert. 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. Muscles tense. Muscular twitches or “nervous tics” can result. Red = immediate response to stress Blue = effects of chronic of prolonged stress

14 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

15

16 Health & Performance Stress arousal Maximum adaptive arousal Stress Curve

17

18 Chevron Publishing, 2002 Cumulative Stress Destructive pathway of stress Destructive pathway of stress Piled up, unresolved general stress Piled up, unresolved general stress Takes time Takes time Produces negative changes in: Produces negative changes in: Mental & physical health Mental & physical health Performance Performance Relationships Relationships Personality Personality

19 Cumulative Stress A chronic state of disturbing stress which can cause physical & changes in personality over time. A chronic state of disturbing stress which can cause physical & changes in personality over time. Takes months or years to develop. Takes months or years to develop. May be a combination of work or home life. May be a combination of work or home life. Often referred to as “burnout”. Often referred to as “burnout”. Often needs professional help for recovery especially if in late stages. continued... Often needs professional help for recovery especially if in late stages. continued...

20 Cumulative Stress - continued Develops in four stages: Develops in four stages: Early Warning Early Warning Mild Symptoms Mild Symptoms Entrenched Entrenched Severe Symptoms Severe Symptoms Characterized by gradually declining performance, increasing problem in job. continued... Characterized by gradually declining performance, increasing problem in job. continued...

21 Cumulative Stress - continued Early Symptoms: Early Symptoms: Vague anxiety Vague anxiety Boredom Boredom General fatigue General fatigue Mild Symptoms: Mild Symptoms: All of the Early Symptoms All of the Early Symptoms Irritability Irritability Chronic tension Chronic tension Depression continued... Depression continued...

22 Mild Symptoms Frustration Frustration Frequent sighs Frequent sighs Sleep disturbance Sleep disturbance Chronic worry Chronic worry Loss of interest in work Loss of interest in work More frequent colds More frequent colds Mild rashes Mild rashes Headaches Headaches Withdrawal from others Withdrawal from others etc.. etc.. Cumulative Stress - continued

23 Entrenched Symptoms Chronic depression Chronic depression Loss of joy of life Loss of joy of life Chronic anger Chronic anger Increased drinking / drugging Increased drinking / drugging Thoughts of suicide Thoughts of suicide Emotional outbursts Emotional outbursts Marital or relationship discord Marital or relationship discord Conflict with fellow workers Conflict with fellow workers Conflict with supervisors Conflict with supervisors Increasing discipline problems continued... Increasing discipline problems continued...

24 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.. (?)

25 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...

26 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..

27 Burnout Changes attitudes Changes attitudes Avoids work Avoids work Or, becomes totally immersed Or, becomes totally immersed Develops negative outlook Develops negative outlook

28 Flame-out Exhaustion, hyperactivity Exhaustion, hyperactivity Overwhelming negative emotions Overwhelming negative emotions Denial of symptoms Denial of symptoms Loss of objectivity Loss of objectivity

29 Stress Reactions Physiological not Characteriological Take Home Message

30 Management of Cumulative Stress Reactions Stress management education Stress management education Balance in life - work - home, etc.. Balance in life - work - home, etc.. Recreation Recreation Vacation Vacation Limiting overtime Limiting overtime Emphasis on home life Emphasis on home life Professional counseling when needed continued... Professional counseling when needed continued...

31 Management - continued Exercise Proper food Clear job expectations Reduction of one worker performing two jobs Effective leadership Administrative support Stress reduction techniques Healthy living Effective training

32 Critical Incident An event that has the power to overwhelm the coping abilities of an individual or group. Chevron Publishing, 2002 Take Home Message

33 The Terrible 10 for CAP Take Home Message... not limited to missions!

34 Crisis An acute reaction to a critical incident. A name of a particular critical incident. Noun vs Verb Take Home Message B o t h

35 Chevron Publishing, 2002 Crisis Characteristics 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,

36 Pre-CRISIS Post CRISIS THOUGHTS FEELINGS THOUGHTS FEELINGS CRISIS

37 Assessing the Need for Crisis Intervention (CISM) 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

38 Critical Incident Stress (CIS) Also called “traumatic stress” Also called “traumatic stress” Not caused by general stress or cumulative stress, but produced by a specific terrible event Not caused by general stress or cumulative stress, but produced by a specific terrible event All people are vulnerable All people are vulnerable Emergency personnel may be more vulnerable because of exposure to traumatic events continued... Emergency personnel may be more vulnerable because of exposure to traumatic events continued...

39 C I S - continued Some may react more strongly than others Some may react more strongly than others Usually resolves in a reasonable period of time Usually resolves in a reasonable period of time May need some form of brief support service May need some form of brief support service Can turn into a serious problem for a few people if it is not resolved Can turn into a serious problem for a few people if it is not resolved Supervisors are able to recognize the problem continued... Supervisors are able to recognize the problem continued...

40 Chevron Publishing, 2002 C I S - continued 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

41

42 Chevron Publishing, 2002 Reactions to Stress Physical Cognitive Emotional Behavioral Spiritual

43 Chevron Publishing, 2002 Physical Signs and Symptoms of Critical Incident Stress Thirst Thirst Fatigue Fatigue Nausea Nausea Twitches Twitches Vomiting Vomiting Dizziness Dizziness Elevated B/P Elevated B/P Muscle tremors Muscle tremors Grinding teeth Grinding teeth Visual difficulties Profuse sweating Difficulty breathing Fainting / LoC Weakness/numbess Chest pain Headaches Rapid heart rate

44 Chevron Publishing, 2002 Cognitive Signs and Symptoms of Critical Incident Stress Confusion Confusion Nightmares Nightmares Uncertainty Uncertainty Hypervigilence Hypervigilence Suspiciousness Suspiciousness Intrusive images Intrusive images Blaming someone Blaming someone Poor problem solving Poor problem solving Poor abstract thinking Poor abstract thinking Change in attention/decision Change in attention/decision Poor concentration or memory Poor concentration or memory Disorientation Disorientation Change in alertness Change in alertness Suicide/homicide Suicide/homicide Hallucinations/delusions Hallucinations/delusions Paranoid ideas Paranoid ideas Disabling guilt Disabling guilt Hopelessness Hopelessness Helplessness Helplessness

45 Chevron Publishing, 2002 Behavioral Signs and Symptoms of Critical Incident Stress Withdrawal Withdrawal Inability to rest Inability to rest Intensified pacing Intensified pacing Erratic movements Erratic movements Changes in social activity Changes in social activity Changes in speech Changes in speech Changes in appetite Changes in appetite Hyper-alertness Hyper-alertness Changes in alcohol or drug consumption Changes in alcohol or drug consumption Antisocial acts Antisocial acts Abuse of others Abuse of others Diminished personal hygiene Diminished personal hygiene Immobility Immobility Self medication Self medication Violence Violence

46 Chevron Publishing, 2002 Emotional Signs and Symptoms of Critical Incident Stress Guilt Grief Denial Anxiety Agitation Irritability Depression Anger Apprehension Emotional shock Emotional shock Emotional outburst Emotional outburst overwhelmed Feeling overwhelmed Loss of emotional control Loss of emotional control Inappropriate emotional responses Inappropriate emotional responses Infantile emotions Infantile emotions Panic attacks Panic attacks

47 Chevron Publishing, 2002 Spiritual Signs and Symptoms of Critical Incident Stress Angry at “God” Asking “why” questions Cessation of practice of faith Faith rituals fail to have meaning Religious hallucinations or delusions

48 Cumulative CIS High frequency of activation High frequency of activation Long duration of service Long duration of service High intensity of service provision High intensity of service provision

49 Cumulative CIS Loss of purpose Loss of purpose Loss of connection Loss of connection Loss of autonomy Loss of autonomy Loss of integrity Loss of integrity Spiritual depletion Spiritual depletion Kendall Johnson, 1993 Kendall Johnson, 1993

50 Chevron Publishing, 2002 Factors Effecting Crisis Reactions Suddenness Suddenness Intensity Intensity Duration Duration Level of loss Level of loss Age Age Injury or death to relatives or friends Injury or death to relatives or friends Availability of resources Availability of resources Level of education / training Level of education / training Availability of coping mechanisms Availability of coping mechanisms

51 Crisis Intervention An active and temporary entry into the life of an individual or a group during a period of significant distress.

52 Crisis Intervention Emotional “first aid” designed to assist the person in a crisis state to return to adaptive functioning.

53 Chevron Publishing, 2002 Objectives of Crisis Intervention Stabilize situation Stabilize situation Mitigate impact Mitigate impact Mobilize resources Mobilize resources Normalize reactions Normalize reactions Restore to adaptive function Restore to adaptive function Take Home Message

54 Dose Response

55 “1/3 Rule” - Theoretical12 3 8%

56 Imprint of Horror Visual Visual Auditory Auditory Olfactory Olfactory Kinesthetic Kinesthetic Gustatory Gustatory Temporal Temporal Psychological / Perceptual Contaminants

57 CISM as Mitigation 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.

58 CISM as Mitigation 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

59 Mitigating C I S 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

60 Mitigating Operational Stress (OpStress) Frequent information / feedback to staff Frequent information / feedback to staff Frequent rest breaks Frequent rest breaks Cold or hot environments might require more frequent rest breaks Cold or hot environments might require more frequent rest breaks Rest areas away from stimuli Rest areas away from stimuli 12 hour limit for same scene stimuli 12 hour limit for same scene stimuli Assure proper rehabilitation sector Assure proper rehabilitation sector Provide lavatory facilities continued... Provide lavatory facilities continued... Take Home Message

61 Mitigating OpStress - continued Provide hand washing facilities Provide hand washing facilities Provide medical support to staff Provide medical support to staff Monitor hyper- or hypo-thermia Monitor hyper- or hypo-thermia Proper food Proper food Limit fat, sugar and salt Limit fat, sugar and salt Fluid replacement Fluid replacement Provide drinking water Provide drinking water Provide fruit juices Provide fruit juices Limit use of caffeine products Limit use of caffeine products CISM on scene support services continued... CISM on scene support services continued... Take Home Message

62 Monitor signs of emotional distress Monitor signs of emotional distress Limit overall stimuli at incident Limit overall stimuli at incident Give clear orders to personnel Give clear orders to personnel Avoid conflicting orders to staff Avoid conflicting orders to staff Delegate authority Delegate authority Frequent rest breaks for all Frequent rest breaks for all Back up leaders Back up leaders Sectorization of the incident Sectorization of the incident Delegation of authority Delegation of authority Credit people for proper actions continued... Credit people for proper actions continued... Mitigating OpStress - continued Take Home Message

63 Mitigating OpStress Mitigating OpStress - continued Limit criticism to absolute minimum Limit criticism to absolute minimum Utilize a staging area for uninvolved personnel Utilize a staging area for uninvolved personnel Limit exposure to event sights, sounds and smells (reminders) Limit exposure to event sights, sounds and smells (reminders) Announce time periodically Announce time periodically Rotate crews to alternate duties Rotate crews to alternate duties Others ? Others ? Take Home Message

64 Peritraumatic Stress Dissociation Dissociation Depersonalization, derealization, fugue states, amnesia Depersonalization, derealization, fugue states, amnesia Intrusive Re-Experiencing Intrusive Re-Experiencing Flashbacks, terrifying memories or night mares, repetitive automatic re-enactments Flashbacks, terrifying memories or night mares, repetitive automatic re-enactments Avoidance Avoidance Agoraphobic-like social withdrawal Agoraphobic-like social withdrawal Hyperarousal Hyperarousal Panic episodes, startle reactions, fighting or temper problems Panic episodes, startle reactions, fighting or temper problems Anxiety Anxiety Debilitating worry, nervousness, vulnerability or powerlessness Debilitating worry, nervousness, vulnerability or powerlessness Depression Depression Anhedonia, worthlessness, loss of interest in most activities, awakening early, persistent fatigue, and lack of motivation Anhedonia, worthlessness, loss of interest in most activities, awakening early, persistent fatigue, and lack of motivation Problematic Substance Use Problematic Substance Use Abuse or dependency, self-medication Abuse or dependency, self-medication Psychotic Symptoms Psychotic Symptoms Delusions, hallucinations, bizarre thoughts or images, catatonia Delusions, hallucinations, bizarre thoughts or images, catatonia Disaster Mental Health Services-A guidebook for Clinicians & Administrators; Dept of Veterans Affairs, 1998

65 Highest Risk for Extreme Peritraumatic Stress Life-Threatening danger, extreme violence, or sudden death of others; Life-Threatening danger, extreme violence, or sudden death of others; Extreme loss or destruction of their homes, normal lives, and communities; Extreme loss or destruction of their homes, normal lives, and communities; Intense emotional demands from distraught survivors (rescue workers, counselors, caregivers); Intense emotional demands from distraught survivors (rescue workers, counselors, caregivers); Prior psychiatric or marital/family problems; Prior psychiatric or marital/family problems; Prior significant loss (death of a loved one in the past year) 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

66 Effects of Hyper-Arousal Trouble sleeping Trouble sleeping Difficulty concentrating Difficulty concentrating Heightened vigilance Heightened vigilance Being easily startled Being easily startled Being wary Being wary Sudden crying Sudden crying Becoming suddenly angry Becoming suddenly angry Being more emotional Being more emotional Panicking Panicking Intensified alertness Intensified alertness Reminders of the trauma leading to physical reactions Reminders of the trauma leading to physical reactions Rapid heart beat Rapid heart beat Sweating Sweating etc etc Increased anxiety Increased anxiety

67 Hyper-Arousal Sleep Disturbances Longer to fall asleep Longer to fall asleep Unable to fall asleep Unable to fall asleep More sensitive to noise More sensitive to noise Awaken more often during the night Awaken more often during the night Have dreams and/or nightmares about the trauma Have dreams and/or nightmares about the trauma Repetitive trauma dreams may awaken and leave frightened and exhausted Repetitive trauma dreams may awaken and leave frightened and exhausted

68 After Action Support Thank personnel for their work Thank personnel for their work Consult with CISM team Consult with CISM team Provide demobilization services on large scale incident Provide demobilization services on large scale incident Utilize services of CISM teams Utilize services of CISM teams Arrange defusing for unusual events Arrange defusing for unusual events Consider debriefing for personnel if it appears necessary* continued... Consider debriefing for personnel if it appears necessary* continued... Take Home Message

69 After Action Support - continued Allow follow up services by CISM team members Allow follow up services by CISM team members Critique incident operationally Critique incident operationally Teach new procedures from lessons learned Teach new procedures from lessons learned Consider the need for family support Consider the need for family support Other ? Other ? Take Home Message

70 Indicators of Critical Incident Stress vs. Disciplinary Problems or Character Disorders Take Home Message

71 Identifiable traumatic event Identifiable traumatic event Reactions begin with an event Reactions begin with an event Reactions worsen after event Reactions worsen after event Reactions follow expected patterns Reactions follow expected patterns Sudden changes are common in CIS Sudden changes are common in CIS CIS reactions usually reduce with: CIS reactions usually reduce with: Peer assistance and, Peer assistance and, With the passage of time With the passage of time Critical Incident Stress Take Home Message

72 Characteriological & Disciplinary Problems - continued Disciplinary problems have a long and diffuse history Disciplinary problems have a long and diffuse history Problems may have preexisted entry into the CAP job Problems may have preexisted entry into the CAP job Identifiable traumatic event(s) missing Identifiable traumatic event(s) missing Problems may exist in several other important areas of the person’s life. Problems may exist in several other important areas of the person’s life. Problems do not easily resolve over time even with help. Problems do not easily resolve over time even with help. Take Home Message

73 Addressing C I S Acknowledge the existence of CIS Acknowledge the existence of CIS Pre-incident education Pre-incident education Planning Planning Drills / practice Drills / practice Pre-deployment briefings Pre-deployment briefings Avoid avoidance of CIS Avoid avoidance of CIS Take Home Message

74 Critical Incident Stress Management C omprehensive I ntegrated S ystem utilizing a M ulti-Tactical Crisis Intervention Approach to Managing Traumatic Stress Take Home Message

75 CISM: Menu of Services Pre-Crisis Preparation Pre-Crisis Preparation Group Intervention Group Intervention Demobilization Demobilization Crisis Management Briefing Crisis Management Briefing Defusing Defusing Critical Incident Stress Debriefing Critical Incident Stress Debriefing Individual Crisis Intervention Individual Crisis Intervention Pastoral Crisis Intervention Pastoral Crisis Intervention Family CISM Family CISM Organizational Consultation Organizational Consultation Follow-up/ Referral Follow-up/ Referral “Tactics”

76 Chevron Publishing, 2002 CISM Tactics Must be Available for: Individuals Individuals Groups Groups Organizations Organizations Families Families Significant others Significant others Take Home Message

77 Chevron Publishing, 2002 Core Competencies in CISM The ability to properly assess both the situation and the severity of impact on individuals and groups The ability to properly assess both the situation and the severity of impact on individuals and groups Ability to develop a strategic plan Ability to develop a strategic plan Individual crisis intervention skills Individual crisis intervention skills Large group crisis intervention skills Large group crisis intervention skills Small group crisis intervention skills Small group crisis intervention skills Referral skills Referral skills Take Home Message

78 Treatment Referral Options Medical Care Professional Medical Care Professional MD / DO MD / DO PA / NP PA / NP Mental Health Care Professional Mental Health Care Professional Psychologist Psychologist Counselor Counselor Social Worker Social Worker Psychiatrist / NP / PA Psychiatrist / NP / PA Spiritual Care Professional Spiritual Care Professional Faith Leader Faith Leader “Chaplain” “Chaplain” Take Home Message CAP Legal: Treat like a physical injury

79 Chevron Publishing, 2002 Essential CISM Courses (2 Days Each) Assisting Individuals in Crisis Assisting Individuals in Crisis Basic Critical Incident Stress Management: Group Crisis Interventions Basic Critical Incident Stress Management: Group Crisis Interventions Suicide Suicide Grief Following Trauma Grief Following Trauma Advanced Critical Incident Stress Management: Group Crisis Interventions Advanced Critical Incident Stress Management: Group Crisis Interventions T.E.A.M. T.E.A.M. Emotional & Spiritual Care in Disasters Emotional & Spiritual Care in Disasters Take Home Message

80 CISM Components Before an Incident Education (PEP) Education (PEP) Team training Team training Planning Planning Administrative support Administrative support Protocol development Protocol development Guideline development Guideline development Networking with other teams & resources Networking with other teams & resources Take Home Message

81 CISM Components During an Incident On-scene support services On-scene support services One-on-one crisis intervention One-on-one crisis intervention Advice to supervisors/IC Advice to supervisors/IC Support to primary victims (CAP) Support to primary victims (CAP) Provision of food, fluids, rest and other services to operations personnel Provision of food, fluids, rest and other services to operations personnel Organizational Consultation (CC) Organizational Consultation (CC) Take Home Message

82 CISM Components After an Incident One-on-one crisis intervention One-on-one crisis intervention Demobilization (post-disaster, large group) Demobilization (post-disaster, large group) Crisis Management Briefing (CMB, large group) Crisis Management Briefing (CMB, large group) Defusing (small group) Defusing (small group) Critical Incident Stress Debriefing (CISD, small group) Critical Incident Stress Debriefing (CISD, small group) Significant other support services Significant other support services... more... Take Home Message

83 Post-incident education Post-incident education Follow-up services Follow-up services Referrals according to needs Referrals according to needs CISM Components After an Incident continued Take Home Message

84 CISM Typically: 3-5 contacts Typically: 3-5 contacts After that, After that, Recovery is evident Recovery is evident Referral is indicated Referral is indicated Take Home Message

85 CISM Is not psychotherapy Is not psychotherapy Is not a substitute for psychotherapy Is not a substitute for psychotherapy Is not a stand-alone Is not a stand-alone Is not a cure for PTSD, Depression, Anxiety, etc Is not a cure for PTSD, Depression, Anxiety, etc Take Home Message

86 CISM has far more to do with group support and assessment (triage) than it does with treatment and cure. Take Home Message

87 Follow-Up Must be provided after every CISM service: Assess impact of intervention Assess impact of intervention Assess for uncovering prior issues Assess for uncovering prior issues Assess trajectory of reactions Assess trajectory of reactions Decreasing Decreasing Same Same Increasing Increasing Assess for possible referral: Assess for possible referral: Health Care Professional Health Care Professional Mental Health Care Professional Mental Health Care Professional Spiritual Care Professional Spiritual Care Professional Take Home Message Can be accomplished telephonically

88 P. A. S. S. Post Action Staff Support P. A. S. S. Post Action Staff Support Dennis Potter, LCSW

89 Goals For PASS Increase longevity of CISM team members Increase longevity of CISM team members Increase learning from the experience Increase learning from the experience Increase stress management skills Increase stress management skills Decrease the chance for personal reactions Decrease the chance for personal reactions To take care of ourselves (too) To take care of ourselves (too) Increase effectiveness of team members Increase effectiveness of team members Monitor team for any adverse reactions Monitor team for any adverse reactions

90 Why Do It? 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

91 Important Notice: 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

92 International Critical Incident Stress Foundation 3290 Pine Orchard Lane Suite 106 Ellicott City, MD (410) Fax: (410) Emergency: (410)

93

94 CAPR 60-5 Administratively authorizes CISM, Administratively authorizes CISM, Provides background information and “how to” information, Provides background information and “how to” information, Mandates each Wing to name a CISM Officer, Mandates each Wing to name a CISM Officer, Please read and review 60-5 Please read and review 60-5

95 CAP Personality Traits 1. Need to rescue or be needed 2. Strong intrinsic motivation 3. Stimulation seeking/easily bored 4. Need for immediate feedback 5. Action oriented 6. Desire to do a perfect job 7. Need to be in control 8. Strive for consistency 9. Risk taker 10. High dedication 11. Likes uniforms

96 CAP Personality Traits 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)

97 Questions Do CAP members have the potential for attaining physical injury? Yes 2. What is done to address this potential? Safety briefings, Regulations, Checklists, Medical Officers, First Aid kits, Disciplinary actions, etc. 3. Do CAP member have the potential for attaining psychological injury? Yes – direct and indirect 4. What is done to address this potential? CISM program, Regulation 60-5, PEP Talks, Briefings

98 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. 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. 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 “Deliberate Indifference” Let’s not put CAP at risk – acknowledge and support the CAP CISM program.

99 “Knowledge itself is power” Sir Francis Bacon “Action is the proper fruit of knowledge” “Action is the proper fruit of knowledge” Thomas Fuller

100 What “Actions” from here? Acknowledge the CAP CISM program Acknowledge the CAP CISM program Designate a CISM Officer or Coordinator Designate a CISM Officer or Coordinator Incorporate CISM into each mission Incorporate CISM into each mission Designate CISM specific taskings during evals Designate CISM specific taskings during evals Allow CISM to support your team and staff by: Allow CISM to support your team and staff by: Triaging mental health issues Triaging mental health issues Helping them cope with their experiences, Helping them cope with their experiences, Getting them back into service Getting them back into service Offer referrals if needed Offer referrals if needed

101 FeedbackThoughtsCommentsReactions

102 Lt Col Sam D. Bernard, PhD National CISM Team Leader (423) Maj Chris Latocki Administrative Officer ( 813) National Staff

103 ________Name____________ Region CISM Officer Telephone / ________Name____________ Region Clinical Director Telephone / Region Staff

104 ________Name____________ Wing CISM Officer / Coordinator Telephone / ________Name____________ Wing Clinical Director Telephone / Wing Staff

105 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

106 Critical Incident Stress Management Lt. Col. Sam D. Bernard, Ph.D. National CAP CISM Team Leader (423) Cell cism.cap.gov

107 Thank You!...and just one more thing...

108 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


Download ppt "Critical Incident Stress Management Command Officer Course Learning from the Past,... Progressing into the Future Developed by Lt. Col. Sam D. Bernard,"

Similar presentations


Ads by Google