1. Critical Incident Stress Management (CISM) Program
This presentation has two main goals:
Increase awareness of Critical Incident Stress (preventive education)
Increase awareness of CISM procedures
EAP Coordinators HSWL Base Seattle
Ms. Kristin Cox – Seattle
Ms. Karen Collins - Astoria

2. Presentation Objectives
Define a critical incident
Review stress response
Explore normal reactions
Review policy
Understand CISM goals and interventions
Understand CISM protocol
The objectives for this presentation are to:
Define a critical incident
Review stress response
Explore normal reactions to stressful incidents
Review policy
Understand CISM goals and interventions
Understand CISM protocol

3. A critical incident is . . .
First responders will typically encounter many of these situations during the course of their career, which can have an emotional impact. The definition of a “critical incident” is: Any event with sufficient impact to produce signficant emotional reactions now or later. It is generally considered extremely unusual in the range of ordinary human experiences.
sudden disruption
short duration
coping may fail
emotional turmoil
disrupted thought
Any event with sufficient impact to produce significant emotional reactions now or later.

4. Stress reaction categories
Fight
Flight
Freeze
Most of you are familiar with the “fight or flight” reactions that spur our actions geared toward survival. Some of you may also know about the less common “freeze” response under high stress situations. These are ways our brain and body attempts to maximize our ability to survive what it perceives as a high-level threat.
The “fallout” from the body’s stress reaction can have impacts that last hours, days or even months depending on a variety of factors.

5. You can think of common Critical Incident Stress reactions as fitting into 5 general categories:
Cognitive symptoms may include:
Confusion
Inability to concentrate
Poor attention span
Difficulties in problem solving
Memory disruptions
Inability to calculate
Impaired decision making
Time distortions
Cognitive
(thinking) 5

6. Emotional Emotional symptoms may include: Crying Withdrawing/isolating
Anger
Depression
Sadness
Emotional

7. Behavioral Behavioral symptoms may include:
Changes in ordinary behavior
Changes in eating
Decreased personal hygiene
Withdrawal
Prolonged silences

8. Physical Physical symptoms may include: Thirst Fatigue Headaches
Racing heart
Gastro-intestinal distress
Sweating

9. Spiritual Spiritual symptoms may include: Anger at God
Loss of meaning and purpose
Questioning of basic beliefs
Importantly, remember that stress symptoms after a critical incident are normal and usually fade in time. 9

10. The Stress Continuum
Another way to view the impact of stress and critical incidents is from the Navy’s OSC program: the stress continuum. This chart is a clear and easy way to identify the impact of stressful events and what is helpful to recover and “get back in the green.”

11. Another possibility: Growth!
Some people actually experience GROWTH & enhanced functioning after an incident – they gain experience, learn new coping strategies, grow their support networks and gain confidence in their abilities.
Kelly McGonigal, Stanford University Health Psychologist, has a great Ted Talk: How to Make Stress Your Friend.

12. Coast Guard Policy COMDTINST 1754.3
Standard of Care
Designed to prevent/mitigate adverse psychological reactions experienced by some people following traumatic events
International Critical Incident Stress Foundation (ICISF) model
So, what is the CG’s policy regarding CISM?
The current Commandant Instruction is and designates Critical Incident Stress Management as the standard of care for the organization, using the International Critical Incident Stress Foundation model.

13. Coast Guard Policy – cont.
Work-Life EAPCs primary POC for CISM inquiries/response
EAPCs are Team Coordinators and provide training, support and peer oversight for the Pacific Northwest
Commands request CISM consultations and services from Work-Life
EAPCs provides CISM, stress and resiliency training for units
The Base Health Safety Work Life Regional Practice Employee Assistance Program Coordinators (or EAPCs) are the primary POC for the program within the region. We provide training and oversight for trained peers, support for units that have experienced a critical incident as well as unit training on stress and resiliency. To access team services, contact the EAPCs.

14. CISM Team Team Leader/Mental Health Professional Chaplains
Peer Facilitators
diverse operational backgrounds
credibility in the field
geographically considered
command recommended
Referral Resources

15. CISM Goals Mitigate impact on personnel
Normalize stress symptoms/reaction
Restore functioning
CISM operates on the assumption that most responders will cope very well with even extremely stressful events. The goals of interventions are to minimize the impact, normalize reactions and restore folks to readiness.
The CISM team has various tools used for various situations.
All interventions are based on principles of Crisis Intervention/Psychological First Aid
(either individual or group)
Goals:
1. Stabilization
2. Symptom reduction
3. Return to adaptive functioning, or
4. Facilitation of access to continued care

16. Types of interventions 1 to 1 contacts
CISM interventions include 1 to 1 contacts,

17. Types of interventions
Defusing
Types of interventions
Defusing
Defusings are less formal and shorter group meetings, usually held immediately after an incident (within hours) used to prevent impact of an event. The focus of a defusing is to validate the groups’ experience, normalize reactions, check in to see how responders are doing and remind them of good coping skills.

18. Types of interventions Debriefings
Group Debriefings are done when a fairly significant incident has impacted a work group. Debriefings are confidential group meetings, typically held 2-3 days after the incident is over, led by a CISM team of peers and leader/mental health professional. Sometimes a chaplain is included.
Some of the indicators that a debriefing may be helpful are . . .
Many individuals appear distressed
There is evidence of significant distress, impairment, and/or dysfunction
One’s usual coping mechanisms have failed
The event is extraordinary
Personnel are requesting help

19. Types of interventions Crisis Management Briefings
Crisis Management Briefings (or CMBs) are more educational in nature. CMBs are structured organizational “all hands” type meetings designed to:
provide information
control rumors
symptoms of distress
basic stress management
identify resources
Photo – CMB provided for USCG and community in Kodiak, AK after murders at Communication Station Kodiak 2012
Types of interventions Crisis Management Briefings

20. Types of interventions Family Interventions
Although CISM does not often provide Family interventions, in certain circumstances such as disasters, line-of-duty death or other situations that impact CG family members, we encourage commands to work with the CISM team to provide an opportunity for family members to hear from the command, learn about stress reactions, coping skills and referral resources.
Photo: Port Security Unit 311 holds a Family Day as preparation for extended deployment.

21. Procedure If you are part of an incident
& think CISM would be helpful,
please request it through your
chain of command!
Chances are, if you are experiencing a reaction, someone else is too.

22. Procedure Crew notify OOD OOD notify OPS, XO, or CO
Command notify Work-Life
EAP Coordinator (Primary)
HSWL Regional Manager (Secondary)
*After hours contact Duty Work-Life Phone

23. What then?
Command consults with Work-Life EAPC Team Coordinator in determining appropriate response
Work-Life EAPC engages CISM peer team members
If you are interested in becoming a CISM peer, please review the Commandant Instruction, then schedule a conversation with an EAPC for more information on the application process.

24. EAP Coordinators HSWL Seattle
CISM Program
EAP Coordinators HSWL Seattle
Ms. Karen Collins
Ms. Kristin Cox