1. Critical incident stress management

2. Stress vs Critical Incident Job Stress or Life Stress The harmful physical and emotional responses that occur when the requirement of the job do not match the capabilities, resources, or needs of the worker The harmful physical and emotional responses that occur when the requirement of the job do not match the capabilities, resources, or needs of the worker

3. Critical Incident A Stressor event that appears to cause a crisis response A Stressor event that appears to cause a crisis response

4. Critical incident An event that has a powerful emotional impact on a rescuer that can cause an acute stress reaction An event that has a powerful emotional impact on a rescuer that can cause an acute stress reaction Can effect a single crew or entire agency Can effect a single crew or entire agency The event tends to generate rapid onset stress responses The event tends to generate rapid onset stress responses

5. Examples of critical incident events Injury or death of: Injury or death of: - an infant or child - someone known to EMS personnel - an EMS worker - of a civilian caused by EMS operations Extreme threat to an EMS worker Extreme threat to an EMS worker Disasters or MCI Disasters or MCI Incidents that draw unusual media attention Incidents that draw unusual media attention

6. Signs & symptoms of CIS Usually starts within 48 hours of the event Usually starts within 48 hours of the event May feel excessive fatigue because of sleep disturbances (too much or too little, nightmares) and because the events is all consuming May feel excessive fatigue because of sleep disturbances (too much or too little, nightmares) and because the events is all consuming May experience flashbacks May experience flashbacks May experience amnesia of the event May experience amnesia of the event Vague health issues such as headaches or GI upset Vague health issues such as headaches or GI upset

7. CIS - CIS - REACTIONS Normal reaction By a... Normal person to An... Abnormal event

8. CIS Physical - Reactions Hyper or hypoactivity or depression Hyper or hypoactivity or depression May be oversensitive and have ‘hair trigger’ anger May be oversensitive and have ‘hair trigger’ anger May withdraw and seek isolation May withdraw and seek isolation Strong feelings of guilt, fear and helplessness Strong feelings of guilt, fear and helplessness Inability to concentrate Inability to concentrate What are some others?

9. Self help Reach out and talk with others; family, colleagues Reach out and talk with others; family, colleagues If no one available, ‘talk’ to a journal If no one available, ‘talk’ to a journal Exercise Exercise Maintain a normal routine Maintain a normal routine Be careful to not ‘drown your sorrows’ in alcohol or drugs Be careful to not ‘drown your sorrows’ in alcohol or drugs

10. CIS management A system of related interventions usually performed by regional, non-partisan, multidisciplinary teams comprised of EMS peers, police, fire & dispatchers and specially trained mental health professionals A system of related interventions usually performed by regional, non-partisan, multidisciplinary teams comprised of EMS peers, police, fire & dispatchers and specially trained mental health professionals These interventions must not be implemented casually or improperly These interventions must not be implemented casually or improperly The most widely recognized model for CSIM is the Mitchell Model, developed by Jeffrey Mitchell in 1983 The most widely recognized model for CSIM is the Mitchell Model, developed by Jeffrey Mitchell in 1983

11. CIS debriefing Designed specifically to address the special personalities, jobs and family related stressors and the support needs of emergency service workers Designed specifically to address the special personalities, jobs and family related stressors and the support needs of emergency service workers Being a paramedic does not shield you. You experience distress like anyone else Being a paramedic does not shield you. You experience distress like anyone else Important note: participation in any CIS process is strictly voluntary! Personnel may be offered help but are not compelled to take it. Important note: participation in any CIS process is strictly voluntary! Personnel may be offered help but are not compelled to take it.

12. CISD team members Mental health professionals Mental health professionals Peer support personnel – may include police, fire, paramedics, nursing, dispatch, disaster management and other emergency oriented organizations Peer support personnel – may include police, fire, paramedics, nursing, dispatch, disaster management and other emergency oriented organizations May include clergy May include clergy

13. CISD team members CISD team may have between 20-40 members. CISD team may have between 20-40 members. 1/3 mental health professionals and 2/3 peer support personnel A response team usually consists of 4 members. One mental health care professional and 3 peer support personnel A response team usually consists of 4 members. One mental health care professional and 3 peer support personnel

14. On scene support services Peer support personnel briefly assist obviously distressed co-workers usually by moving them away from the scene and notifying supervisory personnel Peer support personnel briefly assist obviously distressed co-workers usually by moving them away from the scene and notifying supervisory personnel May also assist victims, family members and bystanders to reduce interference with operations May also assist victims, family members and bystanders to reduce interference with operations

15. Demobilization services Usually reserved for large scale events Usually reserved for large scale events EMS personnel go to a separate area before leaving the scene EMS personnel go to a separate area before leaving the scene The process takes about 30 minutes. About 10 minutes is information about stress and about 20 minutes is for feeding and resting of crews The process takes about 30 minutes. About 10 minutes is information about stress and about 20 minutes is for feeding and resting of crews May include some venting of feelings May include some venting of feelings

16. Defusing Usually occurs within 1-4 hours of the event Usually occurs within 1-4 hours of the event Lead by peer support personnel Lead by peer support personnel Goal – to stabilize the crew(s) so they can return to normal service or go home at the end of the shift Goal – to stabilize the crew(s) so they can return to normal service or go home at the end of the shift A small group process that usually takes 30- 45 minutes A small group process that usually takes 30- 45 minutes Involves the initial venting of feelings Involves the initial venting of feelings

17. Still Defusing Involves an educations component about stress and stress related reactions to the event Involves an educations component about stress and stress related reactions to the event Concentrates on the most seriously affected personnel Concentrates on the most seriously affected personnel Either eliminates the need for a formal debriefing or enhances the debriefing process Either eliminates the need for a formal debriefing or enhances the debriefing process

18. Debriefing Structured, confidential group meetings Structured, confidential group meetings Best when offered 24-72 hours post event Best when offered 24-72 hours post event Last about 3 hours Last about 3 hours Includes all 4 members of the CISD team Includes all 4 members of the CISD team Goal – to reduce the impact of the critical event and to accelerate the normal recovery process Goal – to reduce the impact of the critical event and to accelerate the normal recovery process Emphasizes ventilation of emotions and other reactions to the event Emphasizes ventilation of emotions and other reactions to the event

19. More on Debriefing Emphasizes educational and informational elements to help understand and deal with the stress generated from the event Emphasizes educational and informational elements to help understand and deal with the stress generated from the event Provides an opportunity for: stress reduction, education, emotional reassurance, enhancement of group cohesiveness and interagency co-operation Provides an opportunity for: stress reduction, education, emotional reassurance, enhancement of group cohesiveness and interagency co-operation Provides referral for individuals to other services Provides referral for individuals to other services

20. CISD may also include the following: Follow-up services with additional meetings Follow-up services with additional meetings Special debriefings for non-emergency community groups Special debriefings for non-emergency community groups Special debriefings for the spouses and family members of EMS workers Special debriefings for the spouses and family members of EMS workers Individual consultations Individual consultations

21. Emergency Response to Crisis CISD teams also provide ongoing educations about stress and how it affects EMS personnel CISD teams also provide ongoing educations about stress and how it affects EMS personnel These may be separate education sessions or subsequent training sessions after a critical incident These may be separate education sessions or subsequent training sessions after a critical incident