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Enjoying the good, coping with the bad — Critical Incidentthe bad Critical Incident

Stress Management (CISM)

April 2, 9:15 p.m.Session SCH222

Presented by Kay Werk

Introductions and Background

• Who we are:– Presenters

Participants– Participants

Presented By

• Critical Incident Stress Team Member(s)Member(s)

• City of Columbus, Division of Fire• Kay Werk, LISW

Netcare 614-276-2273 (emergency) kwerk@netcareaccess.org 614-278-0208

Two Kinds of Stress:

• Cumulative Stress (stressors that accumulate over the years in any career)career)

• Critical Incident Stress (stress that is way worse than usual for the work group that is impacted)

City of Columbus Division of Fire

• First brought CISM to mid-west• Major leadership

– Asst. Chief Richard Cline (retired)( )– Asst. Chief Dan Vincent

• Two line of duty deaths:– FF. Maurice Gates– FF. John Nance

• Initiated co-operatively – union and administration

Netcare

• Mental health agency ( Columbus, Ohio) specializing in – Crisis intervention – 24 Hrs– Crisis intervention – 24 Hrs.

• Numerous 24 Hr. Services • Critical Incident Stress Management• Community Crisis Response• Reach Out Workers

– Assessment and referral– Partnering with Emergency Personnel

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Critical Incident :

• Definition: any situation faced by a work group that causes them to experience usually strong emotional reactions which have the potential to interfere with their ability to function, either at the scene or later. All that is necessary is that the incident, regardless of the type, generate unusually strong feelings in the group involved.

Critical incident stress:

• Normal response

N l• Normal person

• Abnormal situation

About CISM • It won’t be needed weekly or even monthly• 90 % of Public Safety Professionals

experience 1 or more critical incidents in their careers: this may be more or fewer incidents in other fieldsin other fields

• When it is needed, it can make a big difference – To employees – To their career– To their families– To the others who work with and matter to them

Does CISM Help?

• Like any tool, you need to know how and when to use it

• It depends on the skill of the people who use it

• It depends on the perspective of the people who receive it

CISM Benefits:San Diego v. Cerritos Air Disasters

San Diego -CISM Cerritos - +CISM

Total killed 124 82

Plane Survivors 0 0

Homes Destroyed 16 16

Emergency Workers >300 >300Emergency Workers >300 >300

Body Parts Recovered >10,000 >10,000

Increase in MH util. 31%/ 1 yr. 1%/ 1 yr.

Loss of Responders >20/ 1 yr. 1/ 1 yr.

Intervention 1 : 1 CISM: hotline, 12

CISD, Follow-up

demobilizations

Impact by Service Type

Service TypeService Type San DiegoSan Diego CerritosCerritos

Ranking Police 5 in 1 year 1Ranking Police 5 in 1 year 1

Fire Personnel 7 in 1 year Total

Paramedics 17 in 1 year All services

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Australian Study CISM : Emergency Personnel

• 843 total personnel studied• 75% found CISM helpful

N f d it h f l• None found it harmful

• Worst comments: “It would have been better if we’d known about it before we needed it.” (Pre-incident Education)

Feedback From Oklahoma City and Littleton

• In Both Cases: – CISM helped– So did massages ☺

Timing was important– Timing was important– Some lessons learned– Taking care of the CISM team was very

important in followup– Time for CISM must be granted from the

school or workplace

Our Team’s Experience

– Almost never harmful– Usually helpful– Biggest impact is possibly informalBiggest impact is possibly informal– Seems to work best when people know

what to expect– How experienced personnel react makes a

big difference

Definitions: Stress

• Stress (in Latin) means “force”, “pressure”, or “strain”

• Wear and tear on the body• Preparation of physical activity (fight/flight)• A response to perceived threat, challenge,

change• A physical and physiological response to any

demand• A state of psychological and physical arousal• Accelerated aging

Two levels of stress:EUSTRESS & DISTRESS

Eustress = Positive, motivating tstress

Distress = Excessive, debilitating stress

It’s not all just Mental!

• Stress is Mental and Physical• Neurons are Changed• Change is Reversible• Understanding Stress Response Helps

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All Stress Is Not Negative

• Stress can be debilitating• It can also help build strength:

“Eustress”Eustress• Many challenged by stress• Many are “pressure performers”• Stress can help us feel alive• Excessive stress is the reason for stress

training

Facts About Stress

• Stress is always:– Interactive

Symbolic– Symbolic

KINDS OF STRESSGeneral Cumulative CIS PTSD

Eustress

Constant

Prolonged

Builds Up

Overwhelming Incident

Immediate or Delayed

Severe Distress

Severe Trauma

Lasting Change

Life

Brief

Adverse Mental Consequences

Adverse Physical Consequences

Delayed

Normal Reaction

Normal Person

Abnormal Event

Lasting Change Possible

Unresolved CIS

Professional Tx. Needed

Cumulative Stress

• Stress resulting from repeated exposures to non traumatic stressors

• Builds up over time• Builds up over time• Often called “burnout”• Mixes home and work stress• Deterioration of person over time,

downward cycle of functioning

Cumulative Stress(Continued)

• Erodes personal resources• Important to distinguish cumulative

stress from “irresponsible behaviors”stress from irresponsible behaviors

3 Phases of Cumulative Stress:

(P. 32, ICISF manual )

• Stress arousal phase• Energy conservation phase

E h ti h• Exhaustion phase

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Stress Arousal Phase which may include:

a. anxietyb. panicc. difficulty concentratingd. feeling out of control or overwhelmede. stress related physical symptoms such as

tachycardia, arrhythmias,gastrointestinal distress, rashes, acute elevation in blood pressure, muscle tension syndromes/spasms, headaches, etc.

Energy Conservation Phase which consists of:

a. procrastinationb l tb. latenessc. absenteeismd. increased coffee, tea, soda, tobacco

consumptione.withdrawal, avoidance

Exhaustion Phase which may include:

a. feelings of hopelessness and/or helplessnessb. fully developed depressionc serious consideration of changing job statusc. serious consideration of changing job statusd.serious consideration of changing personal living

situatione.desire to withdraw, take a "geographic cure"f. contemplation of self-destruction actionsg.substance abuse

Attention:

“Due to the current limitations in perspective, the light at the end of the tunnel will be turned off until furthertunnel will be turned off until further notice.”

CISM may not end cumulative stress

• Cumulative Stress involves a break (vacation, time off, different assignmnet, or “burn-in!”or burn in!

• Maybe church or spiritual experience will help FF/paramedics re-dedicate their careers to the things that attracted them at first

• Counseling/therapy may be appropriate Page 67

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“Terrible Ten”Automatic CISD Triggers

• Line of duty death• Serious line of duty injury

E k i id• Emergency worker suicide• Multi –casualty incident• Police shooting or injury or death to a

civilian as a result of operational procedures

“Terrible Ten” (Continued)Potential CISD Triggers

• Significant events involving children• Victim relative or known helper

F il d i i ft t i ff t• Failed mission after extensive effort• Excessive media interest• Any powerful event

Misc. Triggers

• Repetitive horrible events• Symbolic events

M lti l t• Multiple events• Events with personal meaning• Threatening events• Administrative abandonment• Other

PTSD

– Increased arousal– Symptom duration more than one month– Social and occupational impairmentSocial and occupational impairment– Can result in personality changes or

physical illness

Model of Normal Neurons

Balance of Excitatory & Inhibitory Neurotransmitters Available

The balance varies according to what is needed

Hypersensitized Neurons(Sensitized, Kindled, Action-Biased)

Increased Excitatory Neurotransmitters and Decreased Inhibitory Neurotransmitters

Dendrites (Receivers) can actually multiply and increase up to 1200%

Mitchell and Everly, 1994

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No crisis intervention services just because an event has

occurred.There must be evidence of distress, impairment or dysfunctiondysfunction.

Therefore, one of the most important skills = is the ability to properly assess the group and the individuals who make up that group. Do not focus on the event alone. Look most at the reactions of the people.

HANDOUTS

• “Common Signs & Symptoms Of A StressReactionReaction

Signs and symptoms of stress,

DO NOT IMPLY;that the victim is,

weakweakcrazy

Common Signs and Symptoms Of Excessive Stress: Cognitive

Confusion in thinkingDifficulty making decisionsDifficulty making decisionsLowered concentrationMemory dysfunctionLowering of all higher cognitive functions

Common Signs and Symptoms Of Excessive Stress: Physical

Excessive perspirationDizzy spellsIncreased heart rateElevated blood pressureRapid breathing

Common Signs and Symptoms Of Excessive Stress: Emotional

Emotional shockAAngerGriefDepressionFeeling overwhelmedHopelessness & Helplessness

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Common Signs and Symptoms Of Excessive Stress: Behavioral

Changes in eatingDecreased personal hygieneDecreased personal hygieneWithdrawal from othersProlonged silencesChanges in ordinary behavior patterns

Stress Resistance Pyramid

ExerciseExercise

Source: Everly, George. Training For Trainers, Copyright 1995

Rest Food

Attitude

Stress Management

Is there anything that we can do about

St ?Stress?

Yes!Yes!

Some CISM Tools:

Pre-incident Education

• Possibly most important• Possibly most important• Stress training for any target group (new

recruits, new staff, students, management)

• CIS and cumulative stress

• Ongoing in-service stress education

CISD - Debriefing

• Post trauma group meeting• Discussion

N t h th• Not psychotherapy– Goals much less in-depth– Not uncovering or exposing defenses – Support defenses as much as possible!

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Debriefing (CISD)

• Structured group intervention• Provided by specialized team – mental

health and peershealth and peers• Reduces stress reaction• Accelerates recovery• Usually 1.5-3 hours long

Debriefing (Cont.)

• Seven phases• Requires training

U ll i f ll• Usually requires follow - up

CISD – Use When:

• Significant changes in behavior in group• Regression to less effective

performanceperformance• Symptoms continue• Symptoms intensify• Group–wide symptoms

CISD - Best Time

• 24 - 72 hours is ideal• Earlier in extraordinary cases (including

line of duty death)line of duty death)• Later when requirements of situation

warrant it• Generally loses effectiveness with

increased time from the incident

CISD - Basic Rules

• Only provided by a team• For emergency personnel, both peer

support and mental health personnelsupport and mental health personnel required

• CISD lasts 2.5 – 3.0 hours on the average

• Seven (7) phases should be followed• Event should be significant

CISD - Basic Rules (Cont.)

• Not psychotherapy • Peers play an active role for an

emergency services debriefingemergency services debriefing• Never done on the scene• No one is required to speak• Not all the work can be done in a

debriefing

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Debriefing (Cont.)

• Seven phases• Requires special training

U ll i f ll• Usually requires follow - up

Defusing

• Shortened version of debriefing• Provided for small core groupProvided for small core group• May eliminate need for debriefing• May enhance debriefing if it is still

necessary

Individual Consults

• Individual consult or one on one

• Provided by trained CISM team membersProvided by trained CISM team members

• When necessary to support an individual’s need

• Follow -up

Significant Other Support

• A CISM responsibility

Ed ti l f i ifi t• Educational programs for significant others

• Debriefings (CISD) for significant others of emergency operations personnel

What does this mean for you ?

• Awareness is a good idea.• If you have a critical incident stress

reaction you may feel like you’re “goingreaction, you may feel like you re going crazy” but you are not.

• There are a number of things that help you and can help whoever you work with.

Tips for Managing CIS

• See handout!• Know it’s normal.• Don’t feel like you’re alone – or the only• Don t feel like you re alone – or the only

one.• Talk to someone trustworthy.• Exercise. Work out. • Do some other things – things you like

to do.

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Initiating CIS Intervention:

• Identify who on your battalion is on the team (ahead of time)

• Get to know them or at least observe Get to know them or at least observe them if possible

• Contact them, your officer, the alarm office or Kay directly

• Depending on timing and numbers impacted, may be 1-1; defusing; debriefing

If you’re in a debriefing

• You can speak or not – listen a bit and decide if you wish to speak or not

• Just listening respectfully may help Just listening respectfully may help someone else – and you as well!

• Talking probably will help even more

THANKS!

• For what you do.F h• For who you are.

• For your willingness to assist in stress reduction – which maximizes health and minimizes negative outcomes in the workplace and for employees

SIGNS & SYMPTOMS OF TRAUMA-RELATED STRESS Signs and symptoms of critical incident and cumulative stress are similar - partly by-products of Adrenalin - psychological and physical. This response is good for dealing with emergencies, but there are some stressful side effects as well! There are three groups of symptoms:

Event Re-Experienced

1 - Intrusive thoughts, memories 2 - Dreams 3 - Flashbacks 4 - Distress at something that symbolizes trauma

Hyper-Arousal

1 - Sleep problems 2 - Anger outbursts, irritability 3 - Trouble concentrating 4 - Hypervigilence 5 - Exaggerated startle response 6 - Physiological reactivity at symbolic event

Avoidance or Numbing

1 - Avoid associated thoughts/feelings 2 - Avoid activities that trigger memory 3 - Can't remember important parts of trauma 4 - Not able to have fun as usual 5 - Detachment from others 6 - Unable to have loving feelings 7 - Foreshortened future

SSS:p.KW2

COMMON SIGNS AND SYMPTOMS OF A STRESS REACTION* Emotional Anxiety Fear Guilt Grief Depression Sadness Feeling numb or "cold" Denial of reality Shock Feeling Isolated Feeling unappreciated Feeling lost or abandoned Intense worry about others Wanting to withdraw Anger Irritability Stubborn Intensified or inappropriate emotions

Mental Slowed thinking Difficulty with making decisions Difficulty with problem- solving Confusion Disorientation (time and places) Difficulty with figures Difficulty concentrating Memory problems Difficulty naming objects Repeated visions of the incident Distressing dreams Poor attention span Blaming self or others Increased vigilance - easily startled Making mountains out of molehills Mental rigidity React to criticism as if attacked

Behavioral Sleep problems Less humor Intensified fatigue Withdrawal/isolation - "others don't understand" Angry outbursts Suspiciousness Change in communications Change in interactions with others Change in food consumption Increase in alcohol con- sumption Change in activity level Change in speech patterns Overactive vigilance to environment Changes in overall health Antisocial acts

PHYSICAL RESPONSE TO STRESS

Signs and symptoms can show up in almost any body system. Common places for problems are:

- The cardiovascular system (chest pain - get it checked!!) rapid heartbeat, increase in blood pressure - The gastrointestinal system (nausea, upset stomach, diarrhea and other intestinal distress, appetite changes) - The immune system (increased colds, viruses) - The endocrine system (thyroid problems, diabetes) - The musculoskeletal system (less coordinated, muscle aches, muscle spasms) - The central nervous system (anxiety, headaches) - Integumentary (skin-hives) - The cognitive system (extreme or irrational thoughts suspicion) - The affective system (emotions, irritability, "short fuse," depression, etc.)

*from Connecticut CISD Network and Mitchell, Jeffery T., Ph.D. Emergency Care Quarterly, May 1986 Questions: NETCARE CORPORATION

199 South Central Avenue Columbus, OH 43223-5300 Kay Werk, MSW, LISW Manager, Community Crisis Response Direct Line: 278-0208 (614) 274-9500

or Crisis Calls: (614) 276-CARE (2273) SSS.p.KW2

STRESS RESPONSE*

EVENT

+

INTERPRETATION

-----

NEUROLOGICALTRIGGERS

-----

STRESS

RESPONSE (nerves & biochemistry

-----

BODY’S RESPONSE

-----

COPING THEN RELAXING

-OR- WEAR & TEAR AND DISEASE

CONTROLLING THE STRESS RESPONSE*

MODIFY EVENTS

Reduce Stressor Exposure When Possible Relax on Time OFF Relaxing Vacations Reduce Stimulant Consumption (caffeine and nicotine) Social Support

IMPROVE &

INTERPRETATION Interpret Differently (Albert Ellis, Wayne Dyer) Use Relaxed Language When Possible Look for Silver Lining Use your Spiritual Beliefs Be Flexible in Expectations (“I prefer”) (“Perfection”) (“I Demand”)

DECREASE “TRIGGERS”

Diaphragmatic Breathing Muscle Relaxation, Massage, Hot Tub, etc. Imagery Meditation Biofeedback Medication if Necessary

EXPAND STRESS RESPONSE

HARMLESSLY Moderate Exercise (best Within 24 hours of stressor) Talk (Catharsis) Hobbies Social Activity & Support Since Stress Prepares Body for Activity, Activity Releases Stress

BODY RESPONDS

AND THEN RELAXES

Adequate Sleep Rest Naps Relaxation Training (see “Triggers” section Exercise Helps Some Organs (heart, etc.)

RECOVERING FROM EXCESSIVE STRESS Avoid or Reduce Further Stress Choose Proper Diet Increase Rest Rebuild with Exercise

Role Reversal Trial & Error Learning is a Fact Counseling (Get a Different Perspective)

DECREASE GUILT

DECREASE BLAME DECREASE NEGATIVE THOUGHTS

*Adapted from Everly, G.S. (1989) – A Clinical Guide to the Treatment of the Human Stress Response. NY: Plenum & Everly, George, 1989 & Everly 1990 conferences of “Advanced CISD” & “Teaching Stress Management.” NetCare Access 199 South Central Avenue Columbus, OH 43223-5300 Crisis Calls: 614-276-CARE (2273) Kay Werk, LISW Critical Incident Stress Management Services

Stress Response.np.KW4 04/04

The purpose of learning about stress is so we can manage it instead of it managing us.

CRITICAL INCIDENT STRESS DEBRIEFING What?

Structured Group Process - Not group counseling or group therapy

Assists Individuals involved in a traumatic incident in dealing with the associated stress.

Participants will have a chance to discuss the event as they experienced it.

Not a critique (not what could have or should have been done)

Educational material is presented on stress and stress management as applied to the incident.

Facilitated by mental health professionals specially trained and experienced in the debriefing process.

Who Should Attend?

Personnel in the unit affected are generally encouraged but not require to attend.

Only personnel who were present should attend.

No one will be pressured to speak if they choose not to. Their presence still may help someone else.

Supervisors or administrators should be present only if they were part of the incident. If their presence may keep other participants from speaking freely, or if they weren't part of the incident, a separate debriefing can be held for them if desired.

When?

Most effective 24-72 hours after the incident. (Shorten time frame if employee died at the workplace. In this case 2 debriefings may be needed: within 24 hours and about 1 week later.) This is individualized depending on the workplace and the response of personnel.

Effectiveness declines as time passes.

Time?

Lasts 1-4 hours (usually about 2-2 1/2 hours) depending on several factors.

It's important that participants be present from the beginning to end. Leaving early or arriving late may undermine the effect of the debriefing. Since the time for each group varies greatly, schedules should be flexible the day of the debriefing.

Where?

A comfortable environment free from interruptions, usually at the workplace.

If possible, arranged so participants can face and talk to one another. Referrals?

Referral for further consultation and/or treatment is available. Fee?

Hourly fee varies according to number of debriefers needed. Special fees may be available for non-profit human service organizations if the usual fee is prohibitive.

NETCARE CORPORATION 199 South Central Avenue Columbus, OH 43223

(614) 274-9500 or

(614) 276-CARE (2273) (open 24 hours/day)

Questions - Call Kay Werk, MSW, LISW (If your call is urgent and Kay is not in,

ask for Crisis Intervention Services)

FLYER.ADV

CRITICAL INCIDENT STRESS DEBRIEFING What?

Structured Group Process - Not group counseling or group therapy

Assists Individuals involved in a traumatic incident in dealing with the associated stress.

Participants will have a chance to discuss the event as they experienced it.

Not a critique (not what could have or should have been done)

Educational material is presented on stress and stress management as applied to the incident.

Facilitated by mental health professionals specially trained and experienced in the debriefing process.

Who Should Attend?

Personnel in the area affected are generally encouraged but not require to attend.

Only personnel who were present should attend.

No one will be pressured to speak if they choose not to. Their presence still may help someone else.

Supervisors or administrators should normally be present only if they were part of the incident. If their presence may keep other participants from speaking freely, or if they weren't part of the incident, a separate debriefing can be held for them if desired.

When?

Most effective 24-72 hours after the incident. (Shorten time frame if employee seriously injured at the workplace. In this case 2 debriefings may be needed: within 24 hours and about 1 week later.) This is individualized depending on the workplace and the response of personnel.

Effectiveness declines after 72 hours.

Time?

Lasts 1-4 hours (usually about 1-1 1/2 hours).

It's important that participants be present from the beginning to end. Leaving early or arriving late may undermine the effect of the debriefing. Since the time for each group varies greatly, schedules should be flexible the day of the debriefing.

It is very helpful to decide ahead of time how phone calls will be handled during the debriefing. Otherwise the process can become quite chaotic.

Where?

A comfortable environment free from interruptions, usually at the workplace.

If possible, arranged so participants can face and talk to one another. Referrals?

Referral for further consultation and/or treatment is available. Fee?

Hourly fee varies according to number of debriefers needed. Special fees may be available for non-profit human service organizations if the usual fee is prohibitive.

NETCARE CORPORATION 199 South Central Avenue Columbus, OH 43223

(614) 274-9500 or

(614) 276-CARE (2273) (open 24 hours/day)

Questions - Call Kay Werk, MSW, LISW Direct Line: 278-0208

(If your call is urgent and Kay is not in, ask for Crisis Intervention Services)

BANK ONE FLYER.ADV

SUGGESTED POST TRAUMA DO'S AND DON'TS DEPENDING ON THE SITUATION AND POST-TRAUMA CONSEQUENCES, THESE ARE EXAMPLES OF COPING SKILLS WHICH MAY ASSIST RECOVERY: DO ALLOW YOURSELF TO FEEL HOWEVER YOU FEEL - ANGRY, SAD, HURT, OR VULNERABLE. IT'S OKAY TO FEEL HOWEVER YOU FEEL AND IT'S BEST WHEN YOUR FEELINGS FLOW AT A PACE THAT SEEMS NATURAL FOR YOU RATHER THAN ANY ONE FEELING "STICKING." DO ALLOW YOURSELF TO FEEL BETTER, SEE HUMOR AND HOPE AND JUST FUNCTION CALMLY BASED ON WHATEVER YOU'RE DOING AT THE MOMENT. FEELING BETTER DOESN'T MEAN YOU DON'T CARE ABOUT THE PERSON(S) OR SITUATION INVOLVED. DO BE AWARE THAT IF SEVERAL PEOPLE ARE AFFECTED, YOU'LL PROBABLY FEEL DIFFERENT WAYS AT DIFFERENT TIMES. ONE MAY FEEL HURT AND SAD, ANOTHER MAY FEEL ANGRY, ANOTHER MAY TRY TO "JUST KEEP ON." PEOPLE WILL HAVE MOMENTS OF HUMOR OR BREAKS IN THE TENSION AT DIFFERENT TIMES. TRY NOT TO JUDGE YOURSELF OR ANYONE ELSE FOR THEIR EXPRESSION OF FEELINGS OR THEIR NOT EXPRESSING THEIR FEELINGS. DO MAINTAIN A GOOD DIET AND EXERCISE. (EXERCISE THE FIRST 24 HOURS MAY ESPECIALLY HELP REDUCE STRESS-RELATED CHEMICALS IN YOUR BLOOD STREAM BUT USE CAUTION: YOU ARE ALREADY TAXED PHYSICALLY AND EMOTIONALLY). WALKING IS EXCELLENT FOR ANXIETY AND/OR DEPRESSION AND SAFER THAN MANY OTHER EXERCISES. EVEN AFTER 24 HOURS IT WILL HELP IF YOU DO IT AT LEAST THREE TIMES A WEEK (IT MAY TAKE 2-3 WEEKS TO TAKE EFFECT.) DO TAKE TIME FOR RELAXING ACTIVITIES EVEN THOUGH YOU MAY FEEL THAT IT'S DIFFICULT OR IMPOSSIBLE TO ENJOY THEM AT FIRST. DO REMIND YOURSELF THAT POST-TRAUMA CONSEQUENCES ARE NORMAL. DO LEARN AS MUCH AS POSSIBLE ABOUT STRESS AND STRESS REDUCTION. DO EAT SEVERAL VERY SMALL MEALS EACH DAY OF LIGHT FOODS LIKE BROTH, JELLO, APPLE JUICE, ETC., IF YOU'RE UNABLE TO EAT NORMALLY. SOME PEOPLE FIND VITAMINS B & C HELP COMBAT STRESS. DO SPEND TIME WITH FAMILY, FRIENDS AND CO-WORKERS. DO TALK TO OTHERS WHO ARE GOOD LISTENERS AND OTHERS WHO WERE INVOLVED BUT BE CAREFUL TO NOT "JUDGE" OTHERS OR YOURSELF. Community Crisis Response Netcare Corporation

Kay Werk, Manager, 278-0208 (direct line)

614-274-9500 or

Crisis Call: 276-CARE (2273)

DO CONSIDER ATTENDING A SUPPORT GROUP OF OTHERS WHO HAVE EXPERIENCED TRAUMAS SIMILAR TO YOURS. FIRST LINK (221-2255) SHOULD HAVE A LIST OF SUCH GROUPS OR THE CRISIS WORKER WHO BROUGHT YOU THIS HANDOUT MAY HELP IDENTIFY A GROUP. DO RECOGNIZE AND REDUCE YOUR GUILT. YOU DID WHAT YOU THOUGHT WAS BEST TO DO AT THE TIME. LATER IT'S EASY TO SECOND GUESS YOURSELF. THIS IS NORMAL BUT HARMFUL. IF IT GOES ON TOO LONG, TALK TO A HELPFUL FRIEND OR GET TO A PROFESSIONAL CRISIS COUNSELOR. DO TRY TO REST MORE THAN USUAL. IF YOU CAN'T SLEEP, YOU MAY WANT TO GET UP RATHER THAN LYING IN BED WATCHING THE CLOCK. WHEN YOU DO GET UP, DO SOMETHING CALMING TO YOU. WARM MILK DOES IMPROVE SLEEP BECAUSE OF THE CHEMICALS IT RELEASES. COFFEE AND COLAS MAKE SLEEP MORE DIFFICULT. BREATHING AND RELAXATION EXERCISES WILL IMPROVE SLEEP IF PRACTICED FOR 2-3 WEEKS. THEY CHANGE THE CHEMISTRY IN YOUR BODY TO HELP YOU HEAL FROM THE STRESS. THE CRISIS COUNSELOR WHO GAVE YOU THIS HANDOUT CAN TEACH YOU RELAXATION EXERCISES IF YOU ARE WILLING TO PRACTICE THEM A FEW MINUTES A DAY. DO CALL YOUR COMMUNITY CRISIS RESPONSE WORKER IF YOU HAVE PROBLEMS OR YOU WANT TO TALK. <><><><><><><><><><><><><><><><> DON'T THINK YOU ARE "CRAZY" - STRESS REACTIONS TO TRAUMATIC SITUATIONS ARE NOT THE SAME AS "BEING CRAZY." DON'T WITHDRAW FROM FAMILY, FRIENDS AND CO-WORKERS. TALKING TO THOSE WHO LISTEN WITHOUT TRYING TO TELL YOU WHAT YOU SHOULD FEEL IS AN EXCELLENT STRESS REDUCER. DON'T AUTOMATICALLY STAY AWAY FROM WORK OR OTHER USUAL ACTIVITIES. DON'T DRINK ALCOHOL EXCESSIVELY. DON'T USE LEGAL OR ILLEGAL SUBSTANCES TO NUMB POST-TRAUMA CONSEQUENCES. DON'T TRY TO WORK OR BE BUSY CONSTANTLY. TAKING TIME TO YOURSELF IS OFTEN FEARFUL BECAUSE YOUR FEELINGS MAY CATCH UP, BUT CONSTANT ACTIVITY FOR LONG PERIODS DEPLETES YOUR ABILITY TO RECOVER AND USUALLY LEADS TO PHYSICAL ILLNESS AS THE BODY'S WAY TO GUARANTEE REST. DON'T EXPECT YOURSELF TO REACT A CERTAIN WAY. (FEELINGS USUALLY COME AND GO LIKE WAVES. IF YOU LET THEM, THEY WILL TEND TO COME AND GO NATURALLY. IF YOU FIGHT AGAINST THEM, THEY'LL TEND TO GET STUCK.) IT IS GOOD TO AVOID GETTING "STUCK" IN ANY ONE PARTICULAR FEELING. *Adapted from Critical Incident Stress handouts used throughout the U.S. Suggested Post Trauma.p.KW1

AFTER CRITICAL INCIDENTS: HOW TO HELP THOSE YOU CARE ABOUT

(For families of those who have been in a critical incident)

1. Traumatic events affect the person involved and their family as well. This is part

of the reality of family life and, with some tips, it’s possible for the family to grow stronger as a result of the adversity rather than weaker.

2. If possible, talk ahead of time about what is helpful to the person you care about.

Let them know you will do your best to respect however they want you to help. 3. Be aware of your style of communicating AND THEIRS. If they differ, make

yourself a note to remind yourself of what is helpful TO THEM. The tendency is to do what makes YOU feel better. A note reminds you of what THEY consider to be helpful.

4. Ask the person to alert you that something serious has happened. You will know

they’re acting differently and, if they don’t alert you, you’re likely to blame them or yourself, making the problem worse. (Once they alert you, be open and concerned, but DON’T PRY!)

5. Many people “go into their personal cave” when they’re upset. This needs to be

respected. This style is natural to many people in emergency service professions and it is not your fault.

6. Even though their pain affects the family, you don’t have to let it stop what you

enjoy. Going ahead with your own fun doesn’t mean you don’t care. It may relieve their pressure to know you are still taking care of you.

7. One way you can encourage the person affected to talk about the incident is to

tell them you’d like to talk about their feelings, BUT DON’T PUSH THEM TO SAY MORE THAN THEY ARE WILLING TO. Respect their privacy as much as you respect their pain.

8. Tell the person how you feel: that you are sorry they are suffering over the

incident. 9. It’s OK to remind them that their confused feelings are normal. 10. Don’t attempt to tell them either of the following:

“It’s OK.” “I know how you feel”

11. Don’t attempt to impose your explanation of why this has happened on the person affected.

12. Be willing to say nothing. Often just being present is the biggest help. 13. Don’t be afraid to encourage the person to talk to a peer or get port-trauma

counseling from a specially trained mental health professional. 14. If the person affected agrees, be willing to go with them to court hearings,

investigations, meetings with insurance companies, etc. 15. Don’t be afraid to ask how someone is doing. This provides the person

opportunity to tell you as much or as little as needed. NOTE: Many of us feel anxious when someone we care about is in pain, especially if they won’t communicate with us or we can’t make it better. We may feel we’ve done something wrong or that we should somehow make them feel better if we care about them. This can cause immense problems in our families: the more we push, the more the other person withdraws or both parties blame each other and themselves. There is a much-quoted saying that can help us when this is happening:

I didn’t cause this. I can’t control it. I can’t cure it. I CAN cope with my own life and not take it personally. This may be a huge contribution, whether I see it immediately or not.

NETCARE CORPORATION

199 S. Central Avenue Columbus, OH 43223

614-274-9500 or 614-276-CARE (2273)

Critical Incident Stress Management Services Kay Werk, Manager

How to Help Those You Care About.KW3