Critical Incident Stress

San Luis Obispo County Fire Chiefs Association CISM Team

Overview

• Responder Culture • Stress • CIS Symptoms • Intervention • Resources for responders

Emergency Responder Culture

• Traits and Beliefs – What we believe about ourselves and why • Problem solvers

• Action Oriented • Can control ourselves and environments

• People are better off because we were there

• Why do we believe these things?

Cognitive Dissonance • In psychology, cognitive dissonance is the excessive mental stress and

discomfort[1] experienced by an individual who holds two or more contradictory beliefs, ideas, or values at the same time

I am a rescuer Belief

A rescuer saves people

Concept Incident

I was able to save that person

Reality

A rescuer saves people

Concept

I am a rescuer Belief

I was unable to save that person

Reality

Incident

The model breaks down

What is an example of a healthier model?

STRESS: good or bad? Low levels can Enhance memory and reaction Exhilaration Fight or flight Long term effects?

Critical Incident Stress / PTSD

• Distress overwhelms ability to cope

Categories of Incident Stress

Acute Stress (major incidents)

Cumulative stress

(combination of micro traumas)

Chronic stress (body can rarely relax)

Emergency responder exhaustion syndrome

Critical Incident Signs and Symptoms

Common signs and symptoms of critical incident stress show up in four main categories

Cognitive

Physical Emotional

Behavioral

Coping with Stress - Trauma • Give yourself time to heal, try to be patient with changes in your emotional state

• Ask for support from people who care about you and who will listen and empathize with your situation

• Participate in CISM and or find groups led by appropriately trained and experienced professionals

• Engage in healthy behaviors to enhance your ability to cope with excessive stress

• Eat well-balanced meals and get plenty of rest

• Avoid alcohol and drugs

• Establish or reestablish routines like eating meals at regular times and following an exercise program

• Take some time off from the demands of daily life by pursuing hobbies or other enjoyable activities

• Avoid major life decisions if possible because these activities tend to be highly stressful

Many experiences can be traumatic Some are traumatic to some, but not to all

Various factors may make some more vulnerable than others Traumas create reactions now and later Experiencing these reactions means the situation was serious for you Reactions sometimes get worse before they get better Sometimes they reappear later

Critical Incident Basics

An active, short-term, supportive, helping process.

Acute intervention designed to mitigate the crisis response.

NOT psychotherapy or a substitute for psychotherapy.

Crisis Intervention (CI)

Critical Incident Stress Management

Post disaster crisis intervention (CISM) was associated with reduced risk for: ▫ major depression (d=.81) ▫ anxiety disorder (d=.98) ▫ global impairment (.66) ▫ compared with comparable individuals who did not receive

this intervention (Boscarino, et al, IJEMH, 2005).

San Luis Obispo County Fire Chiefs Association CISM Team Services

Pre-crisis Preparation

Rest Information Transition Services (RITS)

Crisis Management Briefings (CMB)

Defusing

Critical Incident Stress Debriefing

Individual Crisis Intervention

Family Crisis Intervention

Follow-up and Referral

Civilian Assistance

Relative Intensity of Interventions

Demobilization

Defusing

5 Phase CISD

7 Phase CISD

Reaction

Introduction Information

Exploration

Reaction

Fact

Fact

Thought Symptoms

Reentry

Teaching

Teaching

Pre-crisis Preparation • Includes stress management education, stress resistance, and crisis

mitigation training for both individuals and organizations

Rest Information Transition Services (RITS)

• A brief intervention prior to release of employee(s) following a large-scale incident or disaster.

Crisis Management Briefing (CMB)

• A large group meeting to provide information about the incident.

• control rumors

• discuss potential symptoms of distress and the components

of stress management. • identify available resources for affected individuals who

may later elect to seek CISM support.

Defusing

A small group intervention applied within 12 hours of a critical incident, preferably during

the same shift. • A shorter, informal version of the debriefing process. • Most incidents that are defused do not need to be

debriefed.

Critical Incident Stress Debriefing

Structured 7 – phase group discussion conducted 2-10 days post incident with the support of mental

health care professional, trained peers and chaplains

• Designed to mitigate distress, facilitate

psychological closure, or facilitate access to continued care.

Individual Crisis Intervention

• One-on-one counseling or psychological support throughout the timeline of the critical incident.

Family Crisis Intervention

• Includes organizational consultation, as needed

Follow-up and Referral

• Intervention components for follow-up assessment and treatment, if necessary. This can include use of mental health providers, and other specialized programs

Civilian Assistance • Although assisting victims, survivors, and families is

not the primary function of the CISM Team, it may be necessary to provide interim support services to these individuals so that the emergency service crews may perform their duties without being hampered.

• CISM team will act as Liaison to gather local

resources for civilians. (Red Cross, County Mental Health, etc.)

Critical Incident Stress Management

• “There is now emerging evidence that prompt delivery of brief, acute phase services in the first weeks after an event can lead to sustained reduction in morbidity years later, reducing the burden of secondary functional impairment, presumed daily average life years lost (DALYS), and costs to both the individual and the public” (p. 15). Schreiber, M. (Summer, 2005). PsySTART rapid mental health triage and incident command system. The Dialogue: A Quarterly Technical Assistance Bulletin on Disaster Behavioral Health, 14-15.

Critical Incident Debriefing Literature suggests value in “debriefing” CISD (“debriefing”) should only use group format CISD should be offered as part of a larger integrated intervention

system (CISM) Participation is Voluntary and involves informed consent CISD contraindicated if basic physiological, shelter, & safety needs not

met Positive outcome may be other than prevention of PTSD (provides

information, support, may increase cohesion, positively viewed)

▫ Review for Canadian Armed Forces Ritchie, P. (2002)

Solutions

CISM 24-72 hrs :

Educate about stress and

stress reactions

Normalizes feelings Cathartic relief

Peer support

Referral

Medical care Medication

Counseling EMDR

Recovery

Remember

• CISM interventions are not substitutes for psychotherapy.

• Rather, they are elements within the emergency

mental health system.

• Designed to precede and complement psychotherapy, i.e., part of the full continuum of care.

San Luis Obispo County Fire Chiefs Association CISM Team Activation • Any responder can activate the request for assistance. • The incident commander, chief officer, or duty chief is responsible to determine

need for any of the following team services. • Initiate CISM services automatically for the Critical Incidents identified in the policy.

• All CISM Team members are to serve as lookout for peers and request CISM team

services when necessary. Contact CAL FIRE/San Luis Obispo County Fire Dispatch emergency line at 805-543-4242

Dispatch will contact CISM Team Coordinator

CISM Team Coordinator will contact Agency for details and determine need(s)

CISM team contacted via text message for deployment Critical Incident Services for emergency

responders, chaplains, clinicians.

Summary • There are many forms of stress, while natural,

critical incident stress can be detrimental.

• There is no one size fits all solution, CISM has many components that can be utilized to best fit the needs of the responders.

• The demands of our profession can tax us both physically and emotionally. We must understand what options are available to ensure we are doing our very best to support our most precious resource.

Questions?

Additional information regarding the San Luis Obispo County Interagency Critical Incident Stress Management Team Can be found at : http://calfirepilots.com/CISD/index_draft.html