A Description of NDMS Behavioral Health Force Protection

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A Description of NDMS Behavioral Health Force
Protection

• Phil Gruzalski, LCSW Commander IL-2
• Management Working Group

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OBJECTIVES

• Describe the effects of stress on disaster
  responders.
• Provide a functional definition of NDMS
  Behavioral Health Force Protection both in
  examples from the hurricanes and written
  guidelines.

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Effects of Stress on Responders

• Whoever fights monsters
• should see to it in the
• process
• he does not become a
• monster and when you look
• long into the abyss, the abyss
• also looks into you.
• Nietzsche

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Forward TreatmentWW I

• Immediacy
• Expectancy
• Simplicity
• Proximity

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Combat Stress Control (CSC)

• Became U.S. Army doctrine in 1986.
• DoD Directive 6490.5 (1999) directed all services
  to design and implement a CSC program.

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Force Protection

• Critical Incident Stress Management
• American Red Cross
• NDMS
• HHS Guidelines for Pandemic Preparedness

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Mission of NDMS Behavioral Health To Provide
Force Protection

• The mission of NDMS behavioral health force
  protection is to enhance the effectiveness of
  teams by protecting the psychological, cognitive,
  social and spiritual health of team members.
  Behavioral health force protection includes a set
  of strategies, guided by best practices, which
  are implemented before, during and after a
  deployment.

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Stress During Disaster

• Stress can be a silent enemy having adverse
  effects on an emergency programs mission and
  performance.

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Stressors

• Events or conditions that may cause
  physiological and behavioral reactions and
  present coping difficulties for the individual
  experiencing them
• Mental Health and Mass Violence, 2002

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Deployment Stressors

• Felt life was threaten.
• Health concerns due to exposure.
• Experienced injury or serious illness.
• Team co-worker death or serious illness.
• Unable to contact family members.
• Merritt Schreiber, Ph. D

• Responsible for Black triage decisions.
• Experienced death of pediatric patients.
• Direct contact with grieving family members.
• Hazardous working conditions.

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Common Physical Signs of Deployment Stress

• Tension aches, pains
• Jumpiness
• Cold sweat dry mouth
• Upset stomach
• Diarrhea, constipation frequent urination.
• Fatigue feel tired, drained takes effort to
  move.
• Franklin Jones, 95

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Common Mental and Emotional Signs of
DeploymentStress

• Anxiety keyed up, expecting the worst.
• Irritability swearing, complaining, easily
  bothered.
• Difficulty paying attention, remembering details.
• Difficulty thinking, speaking, communicating.
• Feeling badly about mistakes or what had to be
  done.
• Beginning to lose confidence.
• Franklin Jones, 95

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Some Signs of Severe Stress During Deployment

• Hyperactivity
• Trembling or cowering
• Spaced-out appearance
• Rapid speech
• Irritable or angry outbursts, fighting
• Memory loss
• Exaggerated startle response

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Types of Post-Deployment Stress Reaction

• Sub-clinical Stress Disorders
• Boredom, sensation seeking and recklessness,
• Burnout, job change,
• Alcohol/drug misuse (self-medication),
• Family disturbance, abuse, break-up,
• Chronic medical complaints, problems.
• James Stokes, MD

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Long Term Effect of Severe Disaster Stress on
First Responders

• Clinical Disorders
• Clinical Depression
• Post Traumatic Stress Disorder
• Substance Abuse

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MODERATORS

• Antecedent variables such as prior trauma,
  demographics, intelligence, temperament,
  situational stress at home, religious beliefs,
  knowledge of stress mitigation these can be
  negative in terms of increasing vulnerability or
  positive in that they enhance resilience.
• Gal and Jones, 95

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MEDIATORS

• These are real time factors that seem to be
  more changeable and can have either good or bad
  effects unit cohesion, leadership, peer support
  all which affect the individuals appraisal of
  the situation and the individuals coping with
  the realities of the situation.
• Jones and Gal, 95

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Resilience

• EVENT Resilience
• Moderators Mediators

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Hurricanes Katrina and Rita

• Largest Deployment of Behavioral Health Assets
• Katrina 74
• Rita 11

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Hurricanes Katrina and Rita Intervention
Strategy

• Prevention
• Primary
• Secondary
• Tertiary
• Strategy
• Team Behavioral Health
• MST Behavioral Health

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Hurricanes Katrina and Rita

• AARs (230)
• Team Leaders Meeting
• No systematic evaluation
• Assessing
• Resiliency.
• Stress reduction.
• Long-term psychological sequellae.

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Hurricanes Katrina and Rita

• No Concept of Operations
• No guidelines or procedures for mission
  implementation.
• No defined capabilities for various field
  responses.
• No clinical operational competencies for
  behavioral health personnel.
• No defined incident management command control.
  

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Behavioral Health Force Protection Guidelines

• Operations Working Group
• Sub-working Group
• Timeframe
• Began November 29, 05
• Finished February 28, 06

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Behavioral Health Sub Working Group Force
Protection

• Chegwidden,Tom CA-3
• Barrett, Richard TX-1
• Dodgen, Dan SME
• Dougherty, Rebecca MO-1
• Edit-Person, Lauren MA-2
• Flynn, Brian SME

• Gordon, Thomas MI-1
• Gruzalski, Phil IL-2
• Hastings, Donna DMORT
• Kane, Terry VMAT
• McClure, Dave KY-1
• Schreiber, Merritt CA-1
• Sullivan, Irene FL-5
• Vohr, Fritz RI-1

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Behavioral Health Force Protection Guideline

• Mission
• Pre-deployment
• Deployment
• Post-deployment

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Pre-deployment

• The mastery of stress reduction techniques.
• Identify a personalized anticipated list of
  stressors.
• Including family and significant others.
• Including home employer.

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Pre-deployment

• The training of family members.
• Provide information on stressors due to team
  members deployment.
• Identifying personalized anticipated list of
  stressors.
• Identifying personalized baseline stress
  levels.
• Develop a family resiliency plan.
• Including anticipated stress and how to manage
  it.
• Including a variety of circumstances or
  conditions.
• Including information specific to children.

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Deployment

• Provide concurrent use of individual triage
  and team surveillance activities to include
• Assess status of basic needs such as food, water,
  shelter, and various environmental conditions
  affecting the team.
• Assess team cohesion.
• Determine current history of patient acuity and
  length of time deployed.

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Deployment

• Secondary Prevention includes surveillance
  and mitigation activities involving personal
  behavioral health contacts with workers'
  identified as having possible warning signs or
  pre-diagnostic disaster or operational stress.

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Post-deployment

• Primary Prevention educational classes and
  informational materials including handouts,
  flyers, and other materials distributed to the
  teams.
• Increase an understanding of stress reactions.
• Review individual and family resiliency plans.
• Provide information on referrals including types
  of services, location, and fees.

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Post-deployment

• Secondary Prevention includes surveillance and
  mitigation activities involving personal
  behavioral health contacts with workers'
  identified as having possible warning signs or
  pre-diagnostic disaster or operational stress.
• Assess need in no more than three sessions per
  individual or family served.
• Provide referral and linkage when necessary.

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Evidence-based practice

• Process of searching for the best evidence.
• Critically appraising that evidence and deciding
  in collaboration with the teams what the evidence
  implies for action.
• Mechanism for quality assurance.

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Stress Programs need to be Organic

• To enhance positive identification cohesion,
• To understand the teams they are helping.

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Stress Control is the Second Business of

• Every nurse.
• Every police officer.
• Every firefighter.
• Every leader.
• Every environmental health worker.
• Every public affairs officer.
• Every support staff.

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Second Business (cont.)

• Everyones Second Business is no-ones business
  when First Business must be done.
• Stress control throughout the event, both
  response and recovery, is behavioral healths
  First Business.

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Ground Zero Cross
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Questions?pgruzalski_at_aol.com