1. DEALING WITH TRAUMA TRAUMA IS TRANSFORMING TRAUMA IS TRANSFORMING IT IS LIKE A SLOW HEALING SICKNESS IT IS LIKE A SLOW HEALING SICKNESS IT ISOLATES US FROM OTHERS IT ISOLATES US FROM OTHERS DEFENCE MECHANISMS ARE STRONG DEFENCE MECHANISMS ARE STRONG WE FEEL INSECURE IN THE WORLD WE FEEL INSECURE IN THE WORLD ALL HAS BECOME UNSAFE ALL HAS BECOME UNSAFE WE FACE AND EXISTENTIAL CRISIS WE FACE AND EXISTENTIAL CRISIS

2. TRAUMATOLOGY SEMINAR NOTES FROM PRESENTATIONS DELIVERED IN 2004 SEMINAR NOTES FROM PRESENTATIONS DELIVERED IN 2004 BY DR JOHN C MCEWAN BY DR JOHN C MCEWAN ALL MATERIAL © DR JOHN C MCEWAN ALL MATERIAL © DR JOHN C MCEWAN 1 JANUARY 2004 1 JANUARY 2004

3. DEFINITIONS 1.FAILURE OF THE G.A.S. TO HANDLE OVERWHELMING DEMANDS = THE HORMONAL SYSTEM COLLAPSES 1.FAILURE OF THE G.A.S. TO HANDLE OVERWHELMING DEMANDS = THE HORMONAL SYSTEM COLLAPSES 2.TOO MUCH STIMULI OVERTAXING COPING ABILITY = NO PROCESSING 2.TOO MUCH STIMULI OVERTAXING COPING ABILITY = NO PROCESSING 3.RESPONSE TO THREAT PARALYZES AS WE PERCEIVE WE ARE UNABLE TO COPE WITH THE DANGERS. 3.RESPONSE TO THREAT PARALYZES AS WE PERCEIVE WE ARE UNABLE TO COPE WITH THE DANGERS.

4. A WORKING DEFINITION “TRAUMA IS WHERE OVERWHELMING DEMANDS ARE PLACED INTENSELY ON AN INDIVIDUAL, SO THAT THEIR COPING RESOURCES ARE EXHAUSTED IN A VERY SHORT TIME. THE STRESS REACTION SWITCHES ON AND GOES INTO OVERDRIVE. IT INVOLVES MULTI FOCAL STRESSORS, HAS A HEAVY GRIEF COMPONENT, AND PROVOKES AN EXISTENTIAL CRISIS”. “TRAUMA IS WHERE OVERWHELMING DEMANDS ARE PLACED INTENSELY ON AN INDIVIDUAL, SO THAT THEIR COPING RESOURCES ARE EXHAUSTED IN A VERY SHORT TIME. THE STRESS REACTION SWITCHES ON AND GOES INTO OVERDRIVE. IT INVOLVES MULTI FOCAL STRESSORS, HAS A HEAVY GRIEF COMPONENT, AND PROVOKES AN EXISTENTIAL CRISIS”.

5. WHAT IT DOES TO US 1.IT TAXES OUR RESOURCES FOR COPING. ASSESSMENT/APPRAISAL. 1.IT TAXES OUR RESOURCES FOR COPING. ASSESSMENT/APPRAISAL. 2.PERCEPTION=WE CANNOT MEET THIS THREAT! HARM AND LOSS! 2.PERCEPTION=WE CANNOT MEET THIS THREAT! HARM AND LOSS! 3.CONSEQUENCES ARE FEARED. 3.CONSEQUENCES ARE FEARED. 4.THE SYSTEM TURNS ON ITSELF AND BY OVER-REVVING RUNS US DOWN 4.THE SYSTEM TURNS ON ITSELF AND BY OVER-REVVING RUNS US DOWN

6. THE VARIABLES 1.THE TYPE OF DISASTER 1.THE TYPE OF DISASTER 2.DURATION AND INTENSITY 2.DURATION AND INTENSITY 3.PERSONAL IMPACT/CONTROL FELT 3.PERSONAL IMPACT/CONTROL FELT 4.POTENTIAL FOR RECURRENCE 4.POTENTIAL FOR RECURRENCE 5.CONTROL PERCEIVED 4 FUTURE 5.CONTROL PERCEIVED 4 FUTURE 6.PREVIOUS EXPERIENCES 6.PREVIOUS EXPERIENCES 7.PERSONAL FITNESS/HEALTH 7.PERSONAL FITNESS/HEALTH 8.AGE/STAGE LIFE TRANSITIONS 8.AGE/STAGE LIFE TRANSITIONS

7. DEATH AS A STRESSOR 1.CLOSENESS 1.CLOSENESS 2.AGE OF THE DEAD 2.AGE OF THE DEAD 3.ACCEPTANCE, ATTITUDES 3.ACCEPTANCE, ATTITUDES 4.SUPPORT STRUCTURES 4.SUPPORT STRUCTURES 5.EXPRESSION OF EMOTION 5.EXPRESSION OF EMOTION 6.CHANGES THAT DEATH WILL MAKE 6.CHANGES THAT DEATH WILL MAKE 7.NUMBER/MANNER OF DEATH 7.NUMBER/MANNER OF DEATH

8. THE PRIMAL RESPONSE FOCUSSIGHTFEEL FOCUSSIGHTFEEL TEAM WORKFLEXIBILITY TEAM WORKFLEXIBILITY SUSTAINABLE ROUTINESTENACITY SUSTAINABLE ROUTINESTENACITY SMELLSTRENGTHFOOD SMELLSTRENGTHFOOD COMMUNICATIONPLANNING COMMUNICATIONPLANNING DEBRIEFING AROUND THE FIRE DEBRIEFING AROUND THE FIRE SONGS, POEMS, ART, SPEACHES SONGS, POEMS, ART, SPEACHES

9. TRAUMA COPING “VIRTUES” ANCESTRAL VIRTUES HAD COPING VALUE AFTER PRIMAL CONFRONTATIONS WITH DEATH! ANCESTRAL VIRTUES HAD COPING VALUE AFTER PRIMAL CONFRONTATIONS WITH DEATH! CHARACTER SURVIVAL AIDS CHARACTER SURVIVAL AIDS TENACITYSTRENGTH TENACITYSTRENGTH COURAGELOYALTY COURAGELOYALTY JUSTICEHONESTY JUSTICEHONESTY TEAM WORKINDEPENDENCE TEAM WORKINDEPENDENCE

10. COMPLICATORS 1.PHYSICAL ENVIRONMENT 1.PHYSICAL ENVIRONMENT 2.PERCEIVED CONTROL 2.PERCEIVED CONTROL 3.RELATIONSHIPS 3.RELATIONSHIPS 4.HOME BASE 4.HOME BASE 5.RECOGNITION 5.RECOGNITION 6.LIFE CHANGES EXPERIENCED 6.LIFE CHANGES EXPERIENCED 7.PERSONAL PROBLEMS BEFORE 7.PERSONAL PROBLEMS BEFORE

11. STRESS BUFFERS 1.EMOTIONAL SUPPORT 1.EMOTIONAL SUPPORT 2.ESTEEM SUPPORT 2.ESTEEM SUPPORT 3.PHYSICAL SUPPORT 3.PHYSICAL SUPPORT 4.INFORMATION SUPPORT 4.INFORMATION SUPPORT 5.SOCIAL NETWORK 5.SOCIAL NETWORK 6.TEMPERAMENT HARDINESS 6.TEMPERAMENT HARDINESS 7.CONDITIONED HARDINESS 7.CONDITIONED HARDINESS 8.PERCEIVED CONTROL 8.PERCEIVED CONTROL

12. HARDINESS PROFILE 1.LEADERSHIP 1.LEADERSHIP 2.THEY GET STUCK INTO TASKS 2.THEY GET STUCK INTO TASKS 3.SUPPORT WITHOUT COMPLAINT 3.SUPPORT WITHOUT COMPLAINT 4.INTELLIGENT 4.INTELLIGENT 5.CALM UNDER PRESSURE 5.CALM UNDER PRESSURE 6.EMOTIONALLY STABLE 6.EMOTIONALLY STABLE 7.RELATIONSHIPS STABLE 7.RELATIONSHIPS STABLE 8.GOOD HEALTH 8.GOOD HEALTH 9.FAST WITH MOTOR SKILLS 9.FAST WITH MOTOR SKILLS 10.EXTROVERT 10.EXTROVERT 11.NOT THE OLDEST IN FAMILY 11.NOT THE OLDEST IN FAMILY 12.FULLY TRAINED 12.FULLY TRAINED

13. CONTROL ENHANCERS 1.ACTIVITY 1.ACTIVITY 2.INFORMATION 2.INFORMATION 3.FAITH/PHILOSOPHY 3.FAITH/PHILOSOPHY 4.RELAXATION STRATEGIES 4.RELAXATION STRATEGIES 5.PERSONAL LIFE GOALS 5.PERSONAL LIFE GOALS 6.NO UNSOLVED ISSUES 6.NO UNSOLVED ISSUES 7.GOOD ROLE MODELS 7.GOOD ROLE MODELS

14. ACUTE STRESS DISORDER PTSD IS NOT SPOKEN OF BEFORE THREE MONTHS PTSD IS NOT SPOKEN OF BEFORE THREE MONTHS ACUTE STRESS DISORDER INVOLVES ACUTE STRESS DISORDER INVOLVES HIGH INTRUSION – DREAMS, FLASHBACKS MEMORIES COMING IN UNWANTED HIGH INTRUSION – DREAMS, FLASHBACKS MEMORIES COMING IN UNWANTED AVOIDANCE AND NUMBING RESPONSES AS WE TRY TO BLOCK OUT DISTRESS AVOIDANCE AND NUMBING RESPONSES AS WE TRY TO BLOCK OUT DISTRESS HYPER-AROUSAL – STARTLE RESPONSE AND IRRITABILITY AND ANGER HYPER-AROUSAL – STARTLE RESPONSE AND IRRITABILITY AND ANGER

15. CISM CRITICAL INCIDENT STRESS MANAGEMENT INVOLVES MANY FACTORS WORKING TOGETHER. CRITICAL INCIDENT STRESS MANAGEMENT INVOLVES MANY FACTORS WORKING TOGETHER. CLEAR POLICIES /ACCOUNTABILITY CLEAR POLICIES /ACCOUNTABILITY EDUCATION ON STRESS/TRAUMA FOR ALL EDUCATION ON STRESS/TRAUMA FOR ALL PEER SUPPORT PROGRAM PEER SUPPORT PROGRAM TRAINING/SUPPORT FOR PEERS TRAINING/SUPPORT FOR PEERS COUNSELLING ONE TO ONE COUNSELLING ONE TO ONE DEBRIEFINGS/DEFUSINGS DEBRIEFINGS/DEFUSINGS SPOUSAL SUPPORT SPOUSAL SUPPORT

16. DEBRIEFING Part 1 STAGE ONEINTRODUCTION STAGE ONEINTRODUCTION ACKNOWLEDGE, SUPPORT, HEAR, ACKNOWLEDGE, SUPPORT, HEAR, REASSURE, STRESS MANAGE, NOT AN REASSURE, STRESS MANAGE, NOT AN OPERATIONAL BRIEF. OPERATIONAL BRIEF. CONFIDENTIALITY CONFIDENTIALITY NO BREAKS UNTIL FINISHED NO BREAKS UNTIL FINISHED QUESTIONS QUESTIONS

17. DEBRIEFING Parts 2 and 3 STAGE 2FACTS STAGE STAGE 2FACTS STAGE INTRODUCE YOURSELF INTRODUCE YOURSELF EXPLAIN WHAT YOUR ROLE WAS EXPLAIN WHAT YOUR ROLE WAS STAGE 3THOUGHTS STAGE STAGE 3THOUGHTS STAGE WHAT WERE YOUR FIRST THOUGHTS WHAT WERE YOUR FIRST THOUGHTS WHAT WERE YOU THINKING AT THE TIME WHAT WERE YOU THINKING AT THE TIME WHAT THOUGHTS DID YOU TAKE AWAY WHAT THOUGHTS DID YOU TAKE AWAY WHAT THOUGHTS HAVE STAYED WITH YOU WHAT THOUGHTS HAVE STAYED WITH YOU

18. DEBRIEFING STAGES 4 AND 5 STAGE 4REACTIONS STAGE STAGE 4REACTIONS STAGE WHAT WAS THE WORST THING FOR YOU WHAT WAS THE WORST THING FOR YOU WHAT HAD THE GREATEST IMPACT WHAT HAD THE GREATEST IMPACT IF YOU COULD ELIMINATE ONE THING IF YOU COULD ELIMINATE ONE THING STAGE 5SYMPTOMS STAGE STAGE 5SYMPTOMS STAGE HOW DO YOU KNOW THIS HAD IMPACT HOW DO YOU KNOW THIS HAD IMPACT HOW HAS YOUR BEHAVIOUR CHANGED HOW HAS YOUR BEHAVIOUR CHANGED ANYTHING DIFFERENT ABOUT YOU ANYTHING DIFFERENT ABOUT YOU ANY DISTRESS SINCE THE INCIDENT ANY DISTRESS SINCE THE INCIDENT

19. DEBRIEFING STAGES 6 AND 7 STAGE 6TEACHING STAGE STAGE 6TEACHING STAGE PHYSIOLOGY OF STRESS/TRAUMA PHYSIOLOGY OF STRESS/TRAUMA SYMPTOMS - DANGERS - GP SYMPTOMS - DANGERS - GP RECOVERY STRATEGIES RECOVERY STRATEGIES STAGE 7RE-ENTRY STAGE STAGE 7RE-ENTRY STAGE ACTIVE NOT PASSIVE ACTIVE NOT PASSIVE SUPPORT NETWORKS SUPPORT NETWORKS WHAT IFSQUESTIONS WHAT IFSQUESTIONS