Critical Incident Stress Management (CISM)

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Critical Incident Stress Management (CISM)
National Guard
Trained Crisis Responder Program

• LTC Clarence Bowser
• State Family Programs Director

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Overview

• Military References
• Trained Crisis Responder (TCR)
• Crisis Intervention
• Critical Incidents
• Post-Traumatic Stress
• TCR Services
• Rationale

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References

• DoD
• 6490.5 Combat Stress Control Program
• Air Force
• AFI 44-153 Critical Incident Stress Management
• AFI 34-1101 Survivor Assistance
• Army
• Field Manual FM 16-1, Annex F-1 "Critical Event
  Debriefings"

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Trained Crisis Responder

• The National Guard TCR Program was
  developed from Critical Incident Stress
  Management (CISM) principles

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Crisis Intervention

• CISM is a subset of the general field of Crisis
  Intervention (CI) and may be thought of as the
  application of Crisis Intervention knowledge and
  techniques to high risk groups, e.g., emergency
  services, military, etc.
• (J.T. Mitchell, G.S. Everly, 1995)

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CISM Services

• Trained Crisis Responders are the first line of
  defense in coping with Post-Traumatic Stress
  Reactions to Crisis events.
• CISM Services extend beyond the training levels
  of Trained Crisis Responders, therefore it is
  important for the TCRs to work in concert with
  military and civilian CISM Teams

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CISM Core Components

• Pre-Crisis preparation
• Demobilization
• Crisis Management Briefing
• Defusing
• Critical Incident Stress Debriefing

• Individual crisis intervention 11
• Family CISM
• Community consultation
• Pastoral Crisis Intervention
• Follow-up/Referral

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Trained Crisis Responder

• Trained Crisis Responders provide psychological
  and emotional Self-Aid and Buddy-Care

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Spectrum Of Care
Incident Crisis
Intervention EAP TCRs
Legal
Chaplain CISM Mental Health
Psychotherapy
Hospitalization
Refer where needed Family
Support
Rehab
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Critical Incidents

• Major Accidents (Air Crashes, etc.)
• Line of Duty Death(s)
• Serious Line of Duty Injury(s)
• Suicide of a Co-Worker
• Disaster / Multi-Casualty Incident(s)
• Shooting(s)

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Critical Incidents

• Significant Events Involving Children
• Prolonged Incident(s) - Especially with loss
• Excessive Community Media Interest
• Any Significant Traumatic Event

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Primary Goal

• CISM and the TCR Program are forms of crisis
  intervention designed to help reduce
  Post-Traumatic Stress Reactions to Critical
  Incidents

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Post-Traumatic Stress

• Post - traumatic stress
• is a normal reaction,
• in a normal person,
• to an abnormal event.

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Hallmarks of Crisis Intervention

• Immediacy
• Proximity
• Expectancy
• Brevity
• Practical
• Its learning how to toss a life raft, not a
  course in ship building

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Post traumatic stress

• Is everyone who experiences traumatic distress
  suffering from the disorder know as Post
  Traumatic Stress Disorder?
• NO.. NO ..NO

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Post Traumatic Stress Disorder

• PTSD represents a contradiction to some
  critically important assumption or belief about
  self and/or the world.
• (G.S. Everly, 1995)

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Post Traumatic Stress Disorder

• A pathological and disabling variant of a normal
  stress reaction
• Very clear criteria symptoms must be over 30
  days and it is impairing function

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Important TCR Concept

• The TCR Program is NOT a stand alone process.
  Rather it is meant to be one part of a
  comprehensive CISM intervention program.

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TCR Services

• TCRs can be in any section (personnel, security
  forces, fire, chaplain, medical, family support,
  etc.)
• TCRs are normally among your first responders to
  an incident
• TCRs can support official military and civilian
  CISM Teams

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TCR Services

• Pre-incident education, preparation
• One-on-one crisis intervention
• Demobilizations (large groups of public safety)
• Crisis Management Briefings large groups of
  primary, secondary (emergency personnel), and
  tertiary (family, co-workers, etc.) victims

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TCR Services

• Family Support
• Organizational / Community intervention,
  consultation
• Follow-up and referral for TCRs CISM services
  and/or continued care

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Rationale

• Why have TCRs and CISM programs?
• We can learn from past experience.

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141 ARW Suicide

• December 1998 - Fairchild AFB WA
• Just-retired Wing Commander
• Prior incidents in unit
• Impact on unit
• Chaplains from outside called in for first UTA
  following incident
• Ministered to entire wing

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141 ARW CRASH

• Six weeks after suicide of commander
• Four members killed in Germany
• Chaplains called from outside some had just been
  there
• Assigned to each family to assist local clergy
  and chaplains
• Memorial Service and Funerals

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Red Horse Crash

• March 2001
• Army NG Sherpa crashed over Ga.
• 18 ANG and 3 ARNG members killed
• Chaplains called in for ministry
• Memorial Service and Funerals
• Continuing care for families

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Red Horse, contd

• Late July - Early August report
• Some possible questions
• Chaplains and Line Colonels formed teams for each
  family
• Trained at Langley then deployed
• There to walk families through report and to
  offer pastoral care

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Comparison
San Diego, CA Air Crash - 1978
Cerritos, CA Air Crash - 1986

• Total Killed 125 82
• Plane Survivors 0 0
• Homes Destroyed 16 16
• Killed On Ground 15 15
• Emergency Personnel 300 300
• Body Parts Found 10,000 10,000

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Comparison
Support Services Provided

• Cerritos, CA
• Air Crash - 1986
• On Scene One on One
• Demobilizations
• 12 Debriefings
• Hot Line Number
• One on One Follow Up

• San Diego, CA
• Air Crash - 1978
• Sporadic One on One

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ComparisonPersonnel Lost in 1 Year
San Diego, CA Air Crash - 1978
Cerritos, CA Air Crash - 1986

• Police 5 -
• Fire 7 - 1
• Paramedics 17 -
• Increase in
• Mental Health
• Services increase of 31 increase
  of 1

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Rationale

• Trauma and stress-related disorders are sometimes
  disabling and costly to treat
• Interventions are designed to assist in
  preventing burnout and PTSD
• Healthy employees are more productive and
  effective on the job

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Example 1

• 100 trauma victims
• Intervention began after 6 months
• Average cost 46,000.00 ea.
• 94 filed civil litigation

Friedman, et al, EAP Digest, 1988
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Example 2

• 100 trauma victims
• Intervention began within 6 months
• Average cost 8,300.00 ea.
• 13 filed civil litigation

Friedman, et al, EAP Digest, 1988
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Rationale

• On any given trauma/disaster, 4-97 of the
  individuals exposed will develop Symptoms similar
  to PTSD.
• 16-30 of emergency responders are at risk of
  developing PTSD symptoms.

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Rationale

• Disaster / Trauma planning (including CISM
  protocols) is appropriate for not only emergency
  response personnel and institutions, but for all
  business and industrial (and military) settings
  as well.
• Yandrick, EAPA Exchange, 1990

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Main Goal
Trained Crisis Responders help keep your team on
the job!
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Academy for Innovative Ministry

• WHERE YOU CAN LEARN THIS STUFF!
• Ch, LtCol Charles E. Woods
• Chief, Crisis Intervention
• McGhee Tyson ANG Base, TN

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AIM COURSES

• AIM course offerings available on-line
• https.//tys.tnknox.ang.af.mil/AAIM/AAIM.HTM
• This web site is accessible from a ".mil"
  computer only!

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CHAPLAIN SERVICE AND FAMILY SUPPORT

• WHY DO CHAPLAINS EXIST?
• - First Amendment
• - Provision without establishment
• Requirements
• Skills
• neutral zone
• 100 Confidentiality

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Chaplain Service and Family Support

• LETS TALK!