Emergency Care & Trauma Symposium 48 th Annual Conference June 23, 2014

Debriefing Strategies to Consider When Coping With Acute Stress Lynnda Zibell Milsap PMH CNS-BC

Identify acute stress & coping responses Review strategies to enhance one’s coping with acute stress Review triggers, interventions to prevent compassion fatigue. Objectives

News headlines on recent cases involving support from EMS /First Responders; 1.The Multiple Stabbing on East Washington with deaths 2.Missing Girl, Tortured Boy, Body of Mother Found at Wisconsin House 3.Foggy pileups kill 2, involve more than 100 vehicles What Do You Read & Hear?

Fear Grief Sorrow Disbelief Numbness Feeling overwhelmed Anguish Key First Responder Stress Reponses

Anger, irritability, sorrow Detachment, guilt ( “I should have done more”). Dreams & nightmares Distractibility, flashbacks Frequent thoughts of what happened Strains in family and work relationships Normal Stress Reactions After a Response

Just like it sounds, when you are unable to relieve stresses that build, they add up & take a toll, which can reach a critical point. Cumulative Stress

Affect our physiological responses Overwhelming emotions can disrupt rational problem-solving Promote adaptive and maladaptive individual and group behaviors Importance of Psychological Responses 8

Potential Stress Responses to a traumatic event Hyper-arousal: Avoidance: Intrusions: Psychic numbing First Responder & Signs of Potential Acute Stress Response

DSM-V, Identifies a traumatic event as one in which we experience: a threat (actual or perceived) of death or serious injury to self or others, with a response of “intense fear, helplessness or horror.” It is not the event itself, but the meaning it has for the individual that makes it traumatic. What is a Traumatic Event?

Causes a rescuer to experience: Unusually strong emotions that interferes with the ability to function either during the incident or after; a highly stressful incident Critical or Traumatic Situation

‘Normal people’ experience a range of normal reactions, including: 1.Anxiety, 2.Feeling “revved up;” 3.Fatigue; irritability; 4.Problems sleeping; 5.Exaggerated startle response, 6.Change in appetite; 7.Feeling overwhelmed; impatience; 8.Withdrawing from family and friends. 9.Might just feel fine What Happens After A Traumatic Event?

Emotional Condition marked by :  Tiredness, feelings of exhaustion  Loss of interest, reduced work effort  Frustration that interferes with job performance.  Result from prolonged stress  No joy left in doing your job  Apathy  “What’s the point?” attitude  Happens over time  Alienation from job activities Burnout

When a friend is experiencing a trauma in their life that you have personal experience with, this can trigger past emotions & feelings Examples; homelessness, physical abuse emotional abuse Secondary Traumatic Stress

1.People who come into continued, close contact with trauma survivors 2.Knowledge about a traumatizing event experienced by a significant other 3.The stress resulting from helping a traumatized or suffering person Bride, B. (2007). Prevalence of Secondary Traumatic Stress Among Social Workers. Social Work: 51(2): Secondary Traumatic Stress

. Cost of Caring

A debilitating weariness brought about by repetitive, empathic response to pain and suffering, `is a result of absorbing & internalizing the emotions of others & sometimes, coworkers …” What is Compassion Fatigue?

Those who have: Trauma – (experience as a witness or as a patient) Unusual recent stressors-long term or life demands Excessive empathy (leading to blurred professional boundaries) Those who are more anxious Poor self care Limited support Daily barrage of trauma material Abendroth, M. & Flannery, J. (2006). Thos Who is at Risk for Compassion Fatigue?

Inability or refusal to control work stressors Lack of satisfaction for the work Previous unresolved trauma Viewing or hearing about abuse and trauma on a routine basis Figley, C. R. (Ed.) (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel. Additional Factors that Make One Vulnerable to CF

Affects many dimensions of your well- being Nervous system arousal (Sleep disturbance) Emotional intensity increases Cognitive ability decreases Behavior and judgment impaired Isolation and loss of morale Compassion Fatigue Symptoms

Depression and PTSD (potentiate) Loss of self-worth and emotional modulation Identity, worldview, & spirituality impacted Beliefs and psychological needs-safety, trust, esteem, intimacy, and control Loss of hope and meaning=existential despair Anger toward perpetrators or causal events Symptoms, continued

Anxiety / increased negative arousal Numbness / flooding Lowered frustration tolerance / irritability Grief symptoms Anger Sadness Depression Emotional Indicators

Intrusive thoughts / images Headaches GI symptoms Insomnia / nightmares / sleep disruptions Decreased immune response Lethargy Becoming more accident prone Physical Indicators

Decrease in sense of safety ( 911) Self isolation Difficulty separating work life from personal life Diminished functioning in non-professional circumstances Increases in ineffective or self destructive self soothing behaviors Personal/Work Indicators

Discuss a case that caused you to take it home with you- or caused some symptoms of compassion fatigue Identify what factors caused you to identify with the person/victim/family/event Note commonalities and choose a person to share these findings with the larger group Panos, A Small Group Exercise #1

Substance abuse Sleep disturbances Blaming Low self-esteem Frequent headaches Increased irritability Less ability to feel joy Although symptoms vary, these may indicate that you or coworkers have compassion fatigue Depression Anger Chronic lateness Hypertension Extra work Exhaustion (physical or emotional)

Overwhelmed by unfinished personal business Stress affects you deeply Personal concerns often intrude on work Feeling vulnerable all the time Association with trauma affects you deeply Small changes are enormously draining How Do You Feel?

A daily act of self-centering can “bring you back” to awareness of the goodness of the world. Set an alarm for the same time each day and take four deep breaths Create another act where you can sink into the experience, feel the sensations, and note, “I am worthy of my own time.” Daily self-centering

Mindfulness meditation Reconnect with others Boundary maintenance Up to date education Routine Supervision Time to Keep Healthy

Spend time daily on an activity you find meaningful that is not related to work. Examples include; reading, writing, walking, listening to music, building, playing - whatever re-energizes you. Your Self Care Plan

A= Awareness Issues and Contributing Factors What types of cases contribute to your stress level increasing your vulnerability to compassion fatigue?

Being attuned to ones needs, limits, emotions and resources Knowing your “renewal zones” Accepting and acknowledging that we are changed by what we do Awareness

Self Care Find someone to talk to Understand that the pain is normal Start exercising and eating properly Get enough sleep Take some time off Develop interest outside of work Identify what’s important

Suggestions of What Not To Do Blame others Fall into the habit of complaining Hire a lawyer Work harder and longer Self medicate Neglect personal needs and interests

Even Mother Teresa Understood Compassion Fatigue Effects Wrote in her plan to her superiors that it was MANDATORY for her nuns to take an entire year off from their duties every 4-5 years to allow them to heal from the effects of their care- giving work.

1.Have quiet alone time in a calm place- a safe retreat where you feel safe & renewed 2.Have an awareness of what restores and replenishes you. 3.Find ways to acknowledge loss and grief 4.Stay clear with commitment to career goals or your personal mission 5.Learn to focus on what you can control 6.Look at situations as entertaining challenges and opportunities, not problems or stresses Balancing Yourself

Long-term sleep disturbances Feelings of isolation or depression Rage Sudden change in life attitude Sudden catastrophic decision-making ( quit job, divorce) Potential Serious Signs of Distress After An Event

Be as non judgmental & accepting of yourself as you would in dealing with those your treat who have undergone a traumatic event Remember that the symptoms you are experiencing as a result of the traumas are related to the experience itself not that you are a weak person The need to support you is ongoing Hey You Are A Strong Person!

When should I seek outside support for dealing with a tough case? Approximately 2-3 months

Who is responsible for your self-care? What are barriers listed in priority that keep you from self-care activities? What is your current level of energy? How does your team care for each other with challenging patient care issues? Draw a circle…represent 24 hours a day…. Your Self-Care Plan

Local; Red Cross, Chaplains, Social Workers, Area Hospitals, professional counselors, “Your team” National; 1. International Critical Incident Stress Foundation 2. SAMHSA ( Substance Abuse & Mental Health Services Administration)-free handout for coping for your team Resources

Mental health screening & triage Crisis intervention Emotional care and support Problem solving & referrals Advocacy & education Red Cross Resources for You & Your Team

Compassion Fatigue Awareness Project Compassion Fatigue Google “compassion fatigue” and you will find many other helpful resources SAMHSA ICISMF Red Cross On-line resources

Thanks For All You Do….

Thank You For Allowing Me to Participate in Your Conference