3References DoD: 6490.5 – Combat Stress Control Program Air Force: AFI – Critical Incident Stress ManagementAFI Survivor AssistanceArmy:Field Manual FM 16-1, Annex F-1 "Critical Event Debriefings"
4Trained Crisis Responder The National Guard TCR Program was developed from Critical Incident Stress Management (CISM) principles…
5(J.T. Mitchell, G.S. Everly, 1995) Crisis Intervention“CISM is a subset of the general field of Crisis Intervention (CI) and may be thought of as the application of Crisis Intervention knowledge and techniques to high risk groups, e.g., emergency services, military, etc.”(J.T. Mitchell, G.S. Everly, 1995)CISM Critical Incident Stress Management
6CISM ServicesTrained Crisis Responders are the first line of defense in coping with Post-Traumatic Stress Reactions to Crisis events.CISM Services extend beyond the training levels of Trained Crisis Responders, therefore it is important for the TCR’s to work in concert with military and civilian CISM Teams…CISM Critical Incident Stress ManagementHowever it begins with AWARENESS!!!!!
8Trained Crisis Responder Trained Crisis Responders provide psychological and emotional “Self-Aid and Buddy-Care”
9Spectrum Of Care Incident Crisis Intervention EAP TCR’s Legal ChaplainCISM Mental HealthPsychotherapyHospitalizationRefer where needed… Family SupportRehabAn incident can be actions in combat, being shot at, fear of dying, suicide or death of a friend, (Ask audience!!!! What are some other examples of crisis incidents etc…. (Air crashes, vehicle accidents, disasters, multiple casualties, shootings, etc.)EAP????
10Critical Incidents Major Accidents (Air Crashes, etc.)… Line of Duty Death(s)…Serious Line of Duty Injury(s)…Suicide of a Co-Worker…Disaster / Multi-Casualty Incident(s)…Shooting(s)…
11Critical Incidents Significant Events Involving Children… Prolonged Incident(s) - Especially with loss…Excessive Community Media Interest…Any Significant Traumatic Event…Significant events involving children (lack of patience) All these events bring on added stress…
12Primary GoalCISM and the TCR Program are forms of crisis intervention designed to help reduce Post-Traumatic Stress Reactions to Critical Incidents…CISM Critical Incident Stress ManagementTCR Trained Crisis Responders
13Post-Traumatic Stress is a normal reaction,in a normal person,to an abnormal event.
14Hallmarks of Crisis Intervention ImmediacyProximityExpectancyBrevityPracticalIt’s learning how to toss a life raft, not a course in ship building
15NO.. NO ..NO Post traumatic stress Is everyone who experiences traumatic distress suffering from the disorder know as Post Traumatic Stress Disorder?NO.. NO ..NO
16Post Traumatic Stress Disorder PTSD represents a contradiction to some critically important assumption or belief about self and/or the world.(G.S. Everly, 1995)
17Post Traumatic Stress Disorder A pathological and disabling variant of a normal stress reactionVery clear criteria …symptoms must be over 30 days and it is impairing function
18Important TCR ConceptThe TCR Program is NOT a stand alone process. Rather it is meant to be one part of a comprehensive CISM intervention program.TCR Trained Crisis ResponderCISM Critical Incident Stress Management
19TCR Services…TCR’s can be in any section (personnel, security forces, fire, chaplain, medical, family support, etc.)…TCR’s are normally among your first responders to an incident…TCR’s can support official military and civilian CISM Teams…Trained Crisis RespondersCISM Critical Incident Stress Management
20TCR Services… Pre-incident education, preparation… One-on-one crisis intervention…Demobilizations (large groups of public safety)…Crisis Management Briefings [large groups of primary, secondary (emergency personnel), and tertiary (family, co-workers, etc.) victims]
21TCR Services… Family Support… Organizational / Community intervention, consultation…Follow-up and referral for TCR’s & CISM services and/or continued care…Trained Crisis RespondersCISM Critical Incident Stress Management
22Why have TCR’s and CISM programs? We can learn from past experience. RationaleWhy have TCR’s and CISM programs?We can learn from past experience.Trained Crisis RespondersCISM Critical Incident Stress Management
23141 ARW Suicide December 1998 - Fairchild AFB WA Just-retired Wing CommanderPrior incidents in unitImpact on unitChaplains from outside called in for first UTA following incidentMinistered to entire wingUTA Unit Training Assembly
24141 ARW CRASH Six weeks after suicide of commander Four members killed in GermanyChaplains called from outside; some had just been thereAssigned to each family to assist local clergy and chaplainsMemorial Service and Funerals
25Red Horse Crash March 2001 Army NG Sherpa crashed over Ga. 18 ANG and 3 ARNG members killedChaplains called in for ministryMemorial Service and FuneralsContinuing care for families
26Red Horse, cont’d Late July - Early August report Some possible questionsChaplains and Line Colonels formed teams for each familyTrained at Langley then deployedThere to walk families through report and to offer pastoral care
30Comparison Total Killed 125 82 Plane Survivors 0 0 San Diego, CAAir CrashCerritos, CAAir CrashTotal KilledPlane SurvivorsHomes DestroyedKilled On GroundEmergency PersonnelBody Parts Found 10,000 10,000
31Support Services Provided ComparisonSupport Services ProvidedSan Diego, CAAir CrashSporadic One on OneCerritos, CAAir CrashOn Scene One on OneDemobilizations12 DebriefingsHot Line NumberOne on One Follow UpSince 1978 to 1986 more services were available and provided
32Comparison Personnel Lost in 1 Year San Diego, CAAir CrashCerritos, CAAir CrashPolice 5 -Fire 7 - 1Paramedics 17 -Increase inMental HealthServices increase of 31% increase of 1%With increased emphasis and support provided the result is significant….
33RationaleTrauma and stress-related disorders are sometimes disabling and costly to treat…Interventions are designed to assist in preventing “burnout” and PTSD…Healthy employees are more productive and effective on the job…PTSD Post Traumatic Stress Disorder
34Friedman, et al, EAP Digest, 1988 Example 1…100 trauma victimsIntervention began after 6 monthsAverage cost = $46, ea.94% filed civil litigationFriedman, et al, EAP Digest, 1988
35Friedman, et al, EAP Digest, 1988 Example 2…100 trauma victimsIntervention began within 6 monthsAverage cost = $8, ea.13% filed civil litigationWith action and support the cost and the civil litigation filed is lower….. Result savings in Medical costs and litigationFriedman, et al, EAP Digest, 1988
36RationaleOn any given trauma/disaster, 4%-97% of the individuals exposed will develop Symptoms similar to PTSD.16-30% of emergency responders are at risk of developing PTSD symptoms.
37Yandrick, EAPA Exchange, 1990 RationaleDisaster / Trauma planning (including CISM protocols) is appropriate for not only emergency response personnel and institutions, but for all business and industrial (and military) settings as well.Yandrick, EAPA Exchange, 1990CISM Critical Incident Stress Management
38Trained Crisis Responders help Main GoalTrained Crisis Responders helpkeep your teamon the job!
39Academy for Innovative Ministry WHERE YOU CAN LEARN THIS STUFF!Ch, LtCol Charles E. WoodsChief, Crisis InterventionMcGhee Tyson ANG Base, TN
40AIM COURSES AIM course offerings available on-line: https.//tys.tnknox.ang.af.mil/AAIM/AAIM.HTMThis web site is accessible from a ".mil" computer only!
41CHAPLAIN SERVICE AND FAMILY SUPPORT WHY DO CHAPLAINS EXIST?- First Amendment- ‘Provision without establishment’RequirementsSkills‘neutral zone’100 % ConfidentialityFIRST Amendment (Protects religious freedom, guarantees free speech, freedom of the press and assembly and the right to petition the government). PROVISION WITHOUT ESTABLISHMENT??????? (id what this is?)