Application of the U.S. Military Combat Stress Control to Civilian Emergency Teams in Catastrophic Events

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Application of the U.S. Military Combat Stress
Control to Civilian Emergency Teams in
Catastrophic Events

• Philip Gruzalski, LCSW
• Commander, IL-2

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Objectives

• To describe
• The likely stressors and their affects in a
  catastrophic event.
• 2. The key components of the U.S. Militarys
  CSC.
• 3. The application of CSC to civilian
  responders.

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WMD
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Anticipate High Stress from WMD

• Technical and unfamiliar Uncontrollable
• Tendency to overestimate and overreact
• Tendency to deny and ignore
• Agents and deliveries are AMBIGUOUS
• Many FALSE ALARMS
• High ambiguity and bad consequences lead to high
  stress reactions.
• James Stokes, MD

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WMD Terrorism

• Sense of Wrongfulness Immoral, unfair
• Indiscriminate
• Attacks the innocent and defenseless
• Hooks in the sense of victimhood.
• James Stokes, MD

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WMD Terrorism

• Will be catastrophic.
• Will produce extreme stress and trauma.
• Will require a critical need for stress control.

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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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Stress Reaction

• The physiological and behavioral response to
  stressors, such as fatigue, high blood pressure,
  anger, and psychological distress.
• Mental health and Mass Violence, 2002

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A Traumatic Event

• An event or events that involve
• Actual or threatened death or
• Serious injury or
• A threat to the physical integrity of self or
  other
• DSM IV

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Immediate Common Signs of Extreme Stress

• 1. Anxiety
• 2. Irritability
• 3. Attention
• 4. Thinking
• 5. Sleep
• 6. Sadness
• 7. Anger
• 8. Lost Confidence

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Some Early Warning Signs of Severe Stress

• 1. Hyperactivity
• 2. Trembling or cowering
• 3. Spaced-out appearance
• 4. Rapid speech
• 5. Irritable or angry outbursts
• 6. Memory loss
• 7. Exaggerated startle response

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Stress

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

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Types of Post-Mobilization 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

• PTSD
• Depression

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Dual Effect of Extreme Stress

• Effects response performance.
• Has long-term consequences.

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Some Objective Factors Affecting the Victim

• 1. Proximity to the event.
• 2. Duration of the Stressor.
• 3. Degree of physical harm.
• 4. Intentionality of the injury.
• 5. Exposure to grotesque, mutilating death of
  others.
• 6. Suddenness of the event.
• 7. Death and injury to children
• (Meichenbaum, 94)

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MODERATORS

• Antecedent variables such as prior trauma,
  demographics, intelligence, temperament,
  situational stress at home, religious beliefs
  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 present items that seem to be more
  changeable and can be both good or bad 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

• An adaptive, good mix of moderators and
  mediators that helps a person to adapt and
  recover.

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Combat and Operational Stress Control (COSC)

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

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Directive 6490.5

• to minimize the short and long-run adverse
  effects of combat on the physical ,
  psychological, intellectual and social health of
  the service members.

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TRISERVICE CSOC UNITS MH TEAMS

• USAF COSC includes
• Mental Health Rapid Response Team (MHRRT),
• Mental Health Augmentation Team (MHAT) - -
  Aeromed Evacuation Squadron
• NAVY / USMC COSC includes
• --Special Psych Rapid Intervention Team Marine
  Div, Med Battalion Tm

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Other Uniformed Services Programs

• Royal Marines Fleet Risk Management Program
  (TRIM).
• Royal Netherlands Marines Corp Stress Program.

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Positive Aspects of COSC for Civilian Teams
Preparing for Catastrophic Events

• Designed to mitigate stress throughout a
  deployment from the beginning to the end.
• Designed to be implemented in highly stressful
  situations, i.e. Combat.
• Designed to have high rates of RTD.
• May mitigate long-term effects of extreme stress.

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Il-2 COSC Training

• Ft. Gordon, with the 785th COSC, 2000
• Camp Bullis, 2003
• Ft. Snelling, 88th RRC, 2003
• Ft. McCoy, 88th RRC, 2004

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COSC Measures and Activities Primary Prevention

• Surveillance and Mitigation activities to
  reduce or avoid stressors, and increase
  workers/victims tolerance and resilience to stress

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COSC Measures and ActivitiesSecondary Prevention

• Surveillance and Mitigation activities 11s
  with individuals identified as having possible
  warning signs of stress reactions with the goal
  of returning them to work ASAP.

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COSC Measures and ActivitiesTertiary Prevention

• Mitigation/stabilization activities to reduce
  long term effects in workers/victims with
  pre-existing mental health conditions with the
  goal of returning them to work ASAP.

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COSC Measures and Activities Forward Tx

• Proximity
• Immediacy
• Expectancy
• Simplicity

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COSC Measures and Activities The 5 Rs

• Reassure (of normality).
• Rest (respite).
• Replenish physiologic needs.
• Restore confidence (work, talk).
• Return (reunite) to duty team.

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Application of COSC WTC

• Preventive Measures included
• Education on stress
• Secondary and Tertiary
• prevention.

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Deployments since 9/11

• Hurricane Isabel
• Hurricane Charley
• Hurricane Ivan

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Stress Control General Plan

• Consultation
• Introductions
• Briefings on Stress
• TBWA

• Consultation
• Briefings on Stress
• Secondary and Tertiary Prevention

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Command Staff
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Points of Distribution

• Staff may not show up.
• Greater risks.
• Stigmatization issues.
• Problems at the home front.
• Reinforcements from the Outside?

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Controlling Worker Stress

• Limit exposure to traumatic stimuli
• Ensure reasonable hours
• Provide reasonable rest, sleep, diet, exercise
• Allow private time
• Make counseling available
• Provide an identifiable end for involvement

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Stress Programs ought to be Organic

• To enhance positive identification cohesions,
• 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 mental healths First
  Business.

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Ground Zero Cross
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Questions?