The Silver Star Families of America

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The Silver Star Families of America

• PTS(D)/TBI-A GUIDE FOR FIRST RESPONDERS

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Disclaimer

• The Silver Star Families of America has been a
  leading advocate for those wounded in the mind by
  PTS(D). In fact we do not call it a disorder so
  you will see us refer to it here as simply PTS.
  We are not physicians or mental health experts
  but we do have some expertise in dealing with
  those wounded by PTS and we do have some
  experience with first responders.This suggested
  class outline for police, fire and other first
  responders came from antidotal cases of PTS and
  FR contacts and is offered as a general, but not
  all inclusive, guide. The Silver Star Families of
  America offers this as a guide only and cannot be
  held liable for any consequence that may or may
  not arise.

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Statistics

• PTS and the Military
• If you are in the military, you may have seen
  combat. You may have been on missions that
  exposed you to horrible and life-threatening
  experiences. You may have been shot at, seen a
  buddy shot, or seen death. These are types of
  events that can lead to PTS.
• Experts think PTS occurs
• In about 30 of Vietnam veterans, or about 30
  out of 100 Vietnam veterans.
• In as many as 10 of Gulf War (Desert Storm)
  veterans, or in 10 veterans out of 100.
• In about 6 to 11 of veterans of the
  Afghanistan war (Enduring Freedom), or in 6 to 11
  veterans out of 100.
• In about 12 to 20 of veterans of the Iraq war
  (Iraqi Freedom), or in 12 to 20 veterans out of
  100.

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Statistics

• Other factors in a combat situation can add more
  stress to an already stressful situation and may
  contribute to PTS and other mental health
  problems. These factors include what you do in
  the war, the politics around the war, where it's
  fought, and the type of enemy you face.
• Another cause of PTS in the military can be
  military sexual trauma (MST). This is any sexual
  harassment or sexual assault that occurs while
  you are in the military. MST can happen to men
  and women and can occur during peacetime,
  training, or war.
• Among veterans using VA health care, about
• 23 out of 100 women (23) reported sexual
  assault when in the military
• 55 out of 100 women (55) and 38 out of 100 men
  (38) have experienced sexual harassment when in
  the military
• Even though military sexual trauma is far more
  common in women, over half of all veterans with
  military sexual trauma are men.

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Resources

• http//www.va.gov/
• http//www.ncptsd.va.gov/ncmain/information/

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How do Americans Celebrate the Day

• By Nancy Spoerke
• How do Americans celebrate the day
• That our nation with fireworks does display
• How can I be a part of all of this now
• When my mind takes me back to the war somehow
• The sound of the sky rockets that cause all the
  glee
• It sounds like mortar rounds to me
• To all that smile at the beautiful sights in the
  sky
• They look like tracer rounds through my eyes
• So how can others not see all of this
• Why can't they see my fears and paralysis
• How much more need I take
• How far can I go before I break
• Am I a rock so solid and strong

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A GUIDE FOR FIRST RESPONDERS

• A GUIDE FOR FIRST RESPONDERSA PROJECT OF THE
  SILVER STAR FAMILIES OF AMERICASECTION
  1Understanding PTS and TBISECTION 2Why this
  is important to you and the Wounded?SECTION
  3Suggested responses for dealing with the
  WoundedSECTION 4Delivering Psychological
  First Aid

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Recommendation

• The SSFOA highly recommends the Crisis
  Intervention Team program started by the Memphis
  Police Department in 1988 who joined in
  partnership with the Memphis Chapter of the
  National Alliance on Mental Illness (NAMI),
  mental health providers, and two local
  universities (the University of Memphis and the
  University of Tennessee) in organizing, training,
  and implementing a specialized unit. This unique
  and creative alliance was established for the
  purpose of developing a more intelligent,
  understandable, and safe approach to mental
  crisis events.This program trains officers to
  recognize mental issues and teaches de-escalation
  techniques. While the SSFOA does not consider PTS
  a disorder or illness, many of the techniques
  used are applicable to those wounded with PTS.

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Section 1

• UNDERSTANDING PTS/TBIMany of the same symptoms
  can be displayed for both wounds, PTS and TBI.
  This is often the reason why the diagnoses are
  found with one and then later the other.
• PTS(D) is nothing to be ashamed of, embarrassed
  by,feel guilty about or laughed at.PTS(D) --
  Post Traumatic Stressknown as PTSD or Post
  Traumatic Stress Disorder. SSFOA feels that
  PTS(D) is not a disorder but is awound that
  affects thousands of service members and their
  families. We believe PTS(D) sufferers should be
  treated with the same respect, care and honor as
  all wounds and illness receive.

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Cont.

• Basically, Post Traumatic Stress is unconscious,
  automatic physical, emotional reaction(s) brought
  on by a delayed reaction to severe physical and
  psychological experiences that are outside the
  normal human range of emotions. Veterans of
  combat are the most publicized group of
  sufferers.But law enforcement officers
  emergency medical personnel firefighters
  survivors of life threatening accidents, fire,
  flood or natural disasters victims of violent
  crime and victims of domestic, child or sexual
  abuse can and do suffer from PTS(D). ANYBODY can
  be affected by PTS(D). Even family members and
  friends of those who have PTS(D) can suffer from
  what is called Secondary Traumatic Stress
  Disorder (STSD). It is believed that 7-8 of the
  population have PTS(D) at some point in their
  lives.

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Cont.

• The following behavior/reactions are contributed
  to the affects of PTS(D) (not a complete list,
  each person reacts differently and aperson's
  reaction is different due to the source of the
  trauma)- Flashbacks, or reliving the traumatic
  event(s) for minutes or even hours- Feelings of
  shame or guilt- Having upsetting dreams about
  the event(s)- Trying to avoid thinking or
  talking about the event(s)- Feeling emotionally
  numb- Irritability or anger- Poor
  relationships- Self destructive behavior - use
  of drugs or drinking too much- Feeling hopeless
  about the future- Having trouble sleeping-
  Memory problems- Trouble concentrating- Being
  easily startled or frightened- Not enjoying
  activities that once were enjoyed- Hearing or
  seeing things that aren't there

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Cont.

• Signs and symptoms of PTS(D) usually show up
  within 3 months of a traumatic event. However,
  for some, PTS(D) signs may not occur until years
  afterwards. Symptoms can come and go.Usually
  more symptoms become apparent during times of
  higher stress or when experiencing symbolic
  reminders of the event(s). These reminders might
  be something remembered, something seen,
  something heard or even something smelled.There
  is no one cause of PTS(D) and research is ongoing
  in this area. As with any mental health issue,
  the individual's biology and genetics, life
  experiences, temperament and changes in the
  natural chemicals of their brains all play a
  part.To help those with PTS(D) everyone is
  encouraged to do the following - general-
  Become aware of what PTS(D) is- Offer
  understanding and support to those (along with
  their family members and friends) who are living
  with this condition

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TRAMACTIC BRAIN INJURY

• What is Traumatic Brain Injury?Traumatic brain
  injury (TBI), also called acquired brain injury
  or simply head injury, occurs when a sudden
  trauma causes damage to the brain. TBI can result
  when the head suddenly and violently hits an
  object, or when an object pierces the skull and
  enters brain tissue. Symptoms of a TBI can be
  mild, moderate, or severe, depending on the
  extent of the damage to the brain. A person with
  a mild TBI may remain conscious or may experience
  a loss of consciousness for a few seconds or
  minutes. Other symptoms of mild TBI include
  headache, confusion, lightheadedness, dizziness,
  blurred vision or tired eyes, ringing in the
  ears, bad taste in the mouth, fatigue or
  lethargy, a change in sleep patterns, behavioral
  or mood changes, and trouble with memory,
  concentration, attention, or thinking. A person
  with a moderate or severe TBI may show these same
  symptoms, but may also have a headache that gets
  worse or does not go away, repeated vomiting or
  nausea, convulsions or seizures, an inability to
  awaken from sleep, dilation of one or both pupils
  of the eyes, slurred speech, weakness or numbness
  in the extremities, loss of coordination, and
  increased confusion, restlessness, or agitation.

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Section 2

• WHY IS THIS IMPORTANT TO YOU AS A FIRST
  RESPONDER?Your personal safety and the safety
  of by standers is your prime responsibility.
  Refer to your training. However taking a few
  simple steps can protect you and the person
  wounded with PTS.Remember that the person with
  combat PTS has fought for his country and if you
  can defuse a situation without harm to anyone you
  have served your country as well.

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Section 3

• SUGGESTED RESPONSES IN DEALING WITH PTS
  WOUNDEDThe following is information that may be
  helpful when dealing with someone with combat
  related PTS(D) These recommendations come
  directly from combat veterans.When in contact
  with someone who has combat related PTS(D) or you
  think has it- Be calm- Keep the number of
  people involved to a minimum- Do away with
  unnecessary noise, bright lights- Do not move
  quickly toward them- Be patient- Speak slowly
  with frequent pauses- Avoid interruptions when
  they are speaking, as they may forget what they
  are trying to sayCrowds, loud noise, bright
  lights, fast movement, yelling are all things
  reminiscent of combat and can trigger a flashback
  or intensify the situation if the individual is
  currently experiencing a flashback.Anything
  that can be done to keep the conditions affecting
  the personwith PTS(D) as non-threatening as
  possible will go a long way in defusing a
  potential confrontation.If possible remove
  sunglasses. Being able to see someone's eyes
  helps build trust

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Section 4

• Delivering Psychological First AidProfessional
  Behavior
• Introduce themselves and give their job
  title.....police, EMT, paramedic, etc.
• Model healthy responses be calm, courteous,
  organized, and helpful.Be visible and
  available.Maintain confidentiality as
  appropriate.Remain within the scope of your
  expertise and your designated role.Make
  appropriate referrals when additional expertise
  is needed or requested by the survivor.Be
  knowledgeable and sensitive to issues of culture
  and diversity.Pay attention to your own
  emotional and physical reactions, and practice
  self-care.

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Cont.

• Guidelines for Delivering Psychological First
  AidPolitely observe first, don't intrude. Then
  ask simple respectful questions to determine how
  you may help. Ask if they know where they
  are.Often, the best way to make contact is to
  provide practical assistance (food, water,
  blankets).Initiate contact only after you have
  observed the situation and the person or family,
  and have determined that contact is not likely to
  be intrusive or disruptive.Be prepared that they
  will either avoid you or flood you with
  contact.Speak calmly. Be patient, responsive,
  and sensitive.Speak slowly, in simple concrete
  terms don't use acronyms or jargon.If the
  wounded want to talk, be prepared to listen. When
  you listen, focus on hearing what they want to
  tell you, and how you can be of help.Give
  information that directly addresses the wounded
  immediate goals and clarify answers repeatedly as
  needed.Give information that is
  accurate.Remember that the goal of Psychological
  First Aid is to reduce distress, assist with
  current needs, and promote adaptive functioning,
  not to elicit details of traumatic experiences
  and losses.

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Cont.

• Some Behaviors to AvoidDo not make assumptions
  about what wounded are experiencing or what they
  have been through.Do not pathologize. Most acute
  reactions are understandable and expectable given
  what the wounded have experienced. Do not label
  reactions as symptoms,or speak in terms of
  diagnoses,conditions,pathologies, or disorders.

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Credit

• The Silver Star Families of America also operate
  the Law Enforcement Equipment ProgramSpecial
  thanks to the National Center for
  PTSDhttp//www.ncptsd.va.gov/ncmain/index.jspNat
  ional Institute of Neurological Disorders and
  Strokehttp//www.ninds.nih.gov/http//www.memphi
  spolice.org/crisis20intervention.htm

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STAY SAFE!

• REMBERING, HONORING AND ASSISTING THE WOUNDED AND
  ILL OF THE ARMED FORCES

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THANK YOU

• The end