CRITICAL INCIDENT STRESS MANAGEMENT CISM

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(No Transcript)
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Objectives

• Understand the definitions of crisis, critical
  incident, and psychological crisis
• Understand the need for crisis services in the
  aftermath of disaster
• Understand the common signs and symptoms of
  trauma-related stress

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CrisisA temporary disruption of psychological
balance wherein usual coping mechanisms fail.
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Critical Incidents

• Events that have the potential to create
  significant human distress and can overwhelm
  ones usual coping mechanisms.

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Psychological Crisis

• An acute response to trauma, disaster, or other
  critical incident wherein
• Psychological balance is disrupted
• Ones usual coping mechanisms have failed
• Evidence of significant distress, impairment,
  dysfunction

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The Need for Crisis Services

• After Oklahoma City, 25-30 increase in divorce
  rate, OKC Police Department
• 300 increase divorce rate, OKC Fire
  Department
• 5 suicides in personnel who worked on
  disaster response

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FIRST RESPONDER STUDY 2003 --Schorr, NIOSH,
May, 2003

• Pentagon area communications center, FDs, PDs,
  Sheriff, trades workers
• Shanksville/Somerset PA vol. FDs
• FDNY personnel and retirees
• 82 response rate

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FIRST RESPONDER STUDY 2003

• 14 35 had PTSD, moderate to extreme
• Repeated memories, images
• Avoided thinking about it
• Upset when reminded, avoided reminders
• Disturbing dreams
• Irritable, angry
• Hyper-alert
• Difficulty concentrating
• Feel distant
• Feel numb

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FIRST RESPONDER STUDY 2003

• 10 - 30 had health symptoms new or worsened
• Sleep problems
• Fatigue
• Sudden mood changes
• Anxious/upset
• Depressed
• Coughing

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FIRST RESPONDER STUDY 2003

• 18 - 24 had problems functioning
• Anger
• Problems with spouse/partner
• Difficulty relaxing
• Difficulty enjoying work
• Feeling upset at work

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The Need for Crisis Services

• Up to 35 disaster victims develop PTSD
• Mass disasters and terrorism
  will create more psychological casualties than
  physical casualties

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The Need for Crisis Services

• Over 50 of disaster workers can be expected to
  develop significant post-traumatic
  distress
• (Wee Myers, 2001)

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Crisis Related Symptoms

• Anxiety, Tension
• Anger
• Helplessness
• Depression
• Sadness
• Suicidal Ideation

• Violence
• Impulsivity
• Self-Medication
• Sleep Disruption
• Irritability
• Fatigue

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Crisis Related Symptoms

• Difficulty Concentrating
• Headaches, Nausea
• Memory Problems
• Trigger Reactions

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Common Forms of Self-Medication

• Stimulants (caffeine, amphetamine, cocaine,
  chocolate, nicotine)
• Depressants (alcohol)
• Hallucinogens
• Antihistamines, Sleep
• Food, Sex, Shopping and Gambling

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Goals of Crisis Intervention

• Stabilization
• Symptom reduction
• Return to adaptive functioning
• Facilitation of access to continued care

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Keys to Crisis Intervention
(Slaby, Lieb Tancredi, 1975)

• Immediacy
• Innovation
• Pragmatism
• Proximity

• Brevity
• Expectancy
• Simplicity

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CISM

• Critical Incident Stress Management is a
  comprehensive, systematic, and multi-component
  approach to the management of traumatic stress.

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Core Elements of CISM Program

• Demobilization
• Crisis Management Briefing
• Defusing
• Critical Incident Stress Debriefing (CISD)

• Pre-incident Preparation / Education
• On-Scene Support Services
• One-on-One Crisis Intervention

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Core Elements of CISM Program (continued)

• Organizational / Community Support
• Family Support
• Pastoral Crisis Intervention

• Follow-up/ Education/ Referral

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Pre-Incident Preparation/Education

• Provides general information on stress and trauma
• Sets expectations for actual experience (physical
  and psychological)
• Teaches acute and long-term coping techniques

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On-Scene Support Services

• Outreach to where people work, live, congregate
• One-on-one interactions
• No interference with operations
• Over a cup of coffee conversation, curbside
  counseling, therapeutic schmoozing, Stealth
  Counseling

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Crisis Management Briefings

• Structured large group community /organizational
  town meetings
• Designed to provide information about the
  incident, control rumors, educate about symptoms
  of distress, inform about basic stress
  management, and identify resources available for
  continued support.

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Defusing

• Structured small group (less than 20) discussion
  of crisis event
• Provided on same day as event (up to 12 hours)
• 20-45 minutes in duration
• Homogeneous work groups

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Used within the context of CISM, the term
debriefing refers to a 7-phase structured
small group crisis intervention more specifically
named Critical Incident Stress Debriefing (CISD).
Critical Incident Stress Debriefing (CISD)
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Family Support

• The person in crisis may spread intense feelings
  to family members
• Family support is an important aspect of CISM
• Family support is typically provided by
  those with special training

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www.icisf.org 410-750-9600
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www.massfatalities.com