1. Line of Duty Death & Critical Incident Stress
Chief Terry Lipinski, Oak Forest Fire Department Bill Neumann, Orland Fire District Communications Joe McGrath, Oak Lawn Emergency Communications Mark Sikorski, R.E.D Center Lee Jones, Orland Fire District Communications

2. Critical Incident Stress
Life Changing Experiences

3. A Life Changing Experience
Anyone can experience a critical incident
The death of a parent, spouse, child, significant family member or friend
Conventional wisdom, law enforcement, fire service and emergency medical services personnel are at greater risk

4. As emergency responders, we portray ourselves as
“tough”
professional
unemotional about our work
We often find comfort with other responders
Tend to believe our families/friends will not understand
(those not involved in public safety)
We use humor as a defense mechanism
“Self medicate” with alcohol or drugs/medications

5. Statistically….
Less than 5% of emergency services personnel will develop long-term PTSD
That percentage increases when responders endure a line of duty death

6. Critical incidents: Traumatic events which those who are exposed to it have powerful, emotional reactions
Every profession can list their own scenarios that can be categorized as critical incidents

7. The Terrible Ten of public safety
Line of duty deaths
Suicide of a colleague
Serious work related injury
Multi-casualty / disaster / terrorism incidents
Events with a high degree of threat to the personnel

8. 6. Significant events involving children
Events in which the victim is known to the personnel
Events with excessive media interest
Events that are prolonged and end with a negative outcome
Any significantly powerful, overwhelming distressing event

9. It is not a question of IF … It is a questions of when
When you, your agency or coworker(s) will experience
An event that will have a profound affect
An impact so great that it will change behavior

10. When your colleague, coworker, friend or you may need help
Signs and Symptoms
When your colleague, coworker, friend or you may need help
Reactions vary, depending on the incident and the person
Symptoms are what is felt, what you feel or told
Signs are what you, or others, see

11. Any of these symptoms may require medical attention
The stress reaction can manifest in the following ways;
physically behavioral
emotional psychological
Any of these symptoms may require  medical attention

12. Physical Grinding of teeth Visual difficulties Vomiting
Grinding of teeth Visual difficulties Vomiting
Profuse sweating Dizziness Headaches
Weakness Chest pain Difficulty breathing
Elevated BP Rapid heart rate Muscle tremors
Chills Thirst Fatigue

13. Thoughts of suicide/homicide
Emotional
Thoughts of suicide/homicide
Inappropriate emotional responses/outbursts
Intense anger

14. Fear
Guilt
Grief
Panic
Agitation
Anxiety
Irritability
Depression
Apprehension
Feeling overwhelmed
Denial

15. Psychological Uncertainty & Suspiciousness Hyper-vigilance, watchful
Intrusive images / Nightmares
Blaming someone
Poor problem solving, concentration & memory
Difficulty identifying objects or person
Increased or decreased awareness of surrounding

16. Behavioral Increased alcohol use/substances abuse
Withdrawal/Change in social activity
Increased alcohol use/substances abuse
Inability to rest/Change in sleep pattern
Pacing / Erratic movements
Change in speech patterns
Loss or increase of appetite
Hyper-alert or sensitive to environment
Change in usual communications

17. Critical Incident Stress Intervention
The purpose of the intervention process
Identify those in trouble
Provide them the assistance they need
Establish or set the new normal stress levels as low as possible

18. Types of intervention
The type of intervention used varies, depending on
The situation
Number of people involved
Their proximity to the event

19. Individual follow-up care
The Approach
Addressing the various stages of progression
Grief Counseling
Defusing
Debriefing
Individual follow-up care

20. Grief Counseling
Designed to: Provide the individual an understanding of their reaction to the event their grief help them move along in their grieving Goal Promote a healthy atmosphere of openness and dialogue

21. Can be presented in a structured group form or individually
Should occur within 3 days of the event
Effective in coping with the lost of a co-worker or fellow employee
Helpful in assisting staff with a personal loss of a friend or family member

22. Defusing Allows the involved an opportunity to vent
Share their emotions and address immediate needs
Defusing is limited to the individuals directly involved
Should be conducted by persons trained in CISM/CISD
Done informally, same day, sometimes at the scene or 1 to 4 hours after
Short in duration, a few informal questions and a great deal of listening

23. Defusing (continued)
Designed to assure the those involved that their feelings are normal
Provides information on what signs & symptoms to look for
Provides information of where they can reach someone they can talk to

24. Debriefing Formal approach to stress intervention
Usually the second level of intervention for those directly affected by the incident
Often the first for those not directly involved
Done within 72 hours of the incident
Conducted by a trained CISD/CISM professional
Can be in a group format or individual bases

25. A Debriefing session is
Designed to mitigate the impact of potential stress
Allows participates to;
Talk about their experience
How it has affected them
Understand coping mechanisms
Identifies individuals at risk
Provides inform about services available
A follow up is performed within 7 days of the debriefing
To ensure they’re safety and are coping well
Refer for professional counseling

26. Critical Incident Stress Management
Critical incident stress management (CISM)
The purpose of CISM is to:
Enable people to return to their daily routine more quickly
Decrease the likelihood of post-traumatic stress
The goal:
Help people deal with their trauma one incident at a time
Allowing them to talk about the incident when it happens
Without judgment Without criticism

27. returning them to a normal level of functioning
Peer-driven
Most are first responders or mental health professionals
All interventions are strictly confidential
If it is determined the person being helped is a danger to them self or to others, appropriate action is taken.
The emphasis is ensuring
their safety
&
returning them to a normal level of functioning

28. Normal is different for everyone
It’s not easy to quantify
Critical incidents raise stress levels dramatically in a short period of time
After treatment a new normal is established
However it is always higher than the old level

29. Where to find help
Your employer Employee Assistance Program (EAP) Health care insurance plan Local health systems Local or community hospital County health services Local EMS system Friends, family and others Church Survivor networks