Critical Incident Stress Management

Chuck Russo, PhDAmerican Military University

Daytona Beach Police DepartmentSPS Group, LLC

July 2011

FBI NAASummer Conference

Chuck Russo, PhD

• Professor – AMU

• Police Officer– Daytona Beach PD

• Team Leader– RDBHAT (ESF-8)

• Team Member:– Volusia County CISM

– Daytona Beach PD CISM

Why I’m Here…

NY Daily News Newsday

•Identify the importance of dealing with critical incident stressors

– Psychological and physiological responses related to traumatic stress

•Addressing how to break the code of silence

Goal of Presentation

•Critical Incident Stress Management (CISM) is a brief intervention utilized to mitigate the stressors associated with exposure to a traumatic event

•CISM is frequently confused with Critical Incident Stress Debriefing (CISD)

– Debriefing just one component of the overall response

What is Critical Incident Stress Management?

Stress and Law Enforcement

• Police officers address their sworn duties and responsibilities with dedication and valor

• Sometimes the compounded stresses of daily tragedies can become overwhelming and can lead to personal and professional stressors

• Other first responders tend to respond to critical incidents in a team structure; police officers frequently do not

Sources of Stress and Law Enforcement

• Organizational/administrative stressors

• Daily field/job related stressors

• Interaction with the criminal justice system

• Personal stressors including the co-existence of the officer’s personal life and their professional life

How Has Law Enforcement Become More Stressful?

• Unfortunately with current reductions in community resources, officers are faced with more complex emergencies

• Community policing has intensified the level of responsibility placed on officers

• Police officers have to react quickly to solve a multitude of problems

How Does Stress Impact Law Enforcement Officers?

• Heightened divorce rates

• Substance dependence/abuse

• Depression

• Financial difficulties

• High rates of suicide

Critical Incident Stress & Traumatic Stress

•Critical Incident Stress = Traumatic Stress

•These terms are frequently used interchangeably

•A critical incident usually occurs suddenly, is disturbing, or is an unusually challenging event that generates a strong emotional and/or reaction

Examples of Critical Incidents

•Events that overwhelm an individuals normal coping mechanisms

– Officer involved shootings– Line of duty injuries/deaths– Incidents when a child is a victim– Incidents involving death/serious injury to others– Disasters– Employee suicide

Impact of Traumatic Stress

Engaging in response efforts during a critical incident is often stressful for all those involved in emergency response efforts; regardless of the responder’s ability to acknowledge the impact of their involvement

Impact of Traumatic Stress

While this type of work is personally rewarding and challenging, it also has the potential for affecting responders in negative psychological and physiological ways

Commonly Recognized Definition of Stress

The most commonly accepted definition:

•Stress is a condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilize

Definition of Traumatic Stress• In the line of duty, first responders are

trained to utilize tactical strategies in crisis situations, and they are quick to respond to protect the lives and property of those they serve

• Unfortunately, a hidden danger is often ignored:

TRAUMATIC STRESS!

What is Traumatic Stress?Precipitated by stressors that include sudden, disturbing, or unusually challenging events that generate a strong emotional and/or cognitive reaction

Stressors Include:– Gruesome crashes– Homicides– Vicious crimes against a child/children– A close personal brush with death/injury– Officer involved shooting

Return

Psychological and Physiological Responses to Traumatic Stress

Exposure and side effects to traumatic stress are individualized and may include:

•Physical symptoms

•Psychological symptoms

•Reoccurrence or re-victimization can occur if the first responder does not address the symptomology

Physiological Responses

Examples encountered may include:• Increased fatigue – poor sleep and/or nightmares

• Headaches

• Muscle twitches

• Unexplainable body aches and pain

• Gastrointestinal distress

Physiological Responses

Additional examples encountered include:• Weight loss or gain

• Grinding of teeth

• Chest pain

• Difficulty breathing

• Elevated heart rate and blood pressure

Psychological Responses

Examples encountered may include:• Emotional detachment

• Withdrawal from social situations

• Mood swings, anger and aggression

• Intrusive thoughts/obsessive compulsive behaviors

• Anxiety, panic attacks, and nervous energy

Additional Psychological Symptoms

More examples encountered may include:• Attention difficulties

• Feelings of helplessness/hopelessness

• Burnout

• Depression

• Grief

• Interpersonal difficulties

Exposure to Traumatic StressOften challenges an individual's sense of:

• Sense of self-worth or self-esteem

• Personal safety or sense of control

• Impairs an individual’s ability to control their emotions

• Increases their feelings of vulnerability

Frequent Exposure to Traumatic Stress

Can lead to hypervigilance:

• A heightened state of alert; whereby an individual is constantly awaiting additional real or perceived threats

• An individual is constantly on guard and this is also referred to as increased arousal

How to Alleviate Symptoms Associated with Traumatic Stress?

Engage in:

• Debriefing

• Defusing

• Seek peer or supervisory support

• Speak with a chaplin

• Access EAP

Minimizing the Effects of Traumatic Stress

Goal:

• To facilitate a normal recovery process

• To restore an individual’s level of adaptive functioning to their normal state of functioning

CISM

• Definition of a Critical Incident

• The Role of CISM

• What CISM Does Not Do

• How CISM Helps the First Responder

• The CISM Team

Break Time

We will begin again in 5 minutes.

Definition of a Critical Incident

A critical incident is defined as:

• A sudden or disturbing event

• That generates a strong emotional and cognitive reaction

Critical Incidents Examples encountered in may include:• Officer involved shootings• Line of duty injuries/deaths• Incidents when a child is a victim• Incidents involving death/serious injury to others• Disasters• Employee suicide

What is CISM

CISM is:

• Early psychological support for First Responders

Goals of CISM

• To mitigate the impact of the event

• Facilitate normal recovery processes

• Restoration to adaptive function

Role of CISMTo provide:

• Temporary

• Active

• Supportive

• Confidential

Assistance to aid the individual in crisis

What CISM Does Not Do

CISM is NOT a function of/to:

• Professional standards/internal affairs

• Determine fitness for duty

• Determine if policy was followed

• Determine if state law was followed

• Pass judgment on someone’s actions

How CISM Helps First Responders

CISM helps by providing:

• One-on-one peer support

• Demobilization of information

• Crisis management briefings

• Defusing

• Critical incident stress debriefings

One-on-One Peer Support

Peer support is provided to individuals:

• Mitigate symptoms

• Return to previous level of functioning

• Provide referrals if needed

Demobilization InformationThis occurs:

• At shift disengagement

• To inform and consult

• Provide psychological decompression

• Stress management

• Typically occurs in large groups

Crisis Management BriefingsThis occurs:

• At anytime post crisis

• To inform and consult

• Provide psychological decompression

• Stress management

• Typically occurs in large groups

DefusingThis occurs:

• Post crisis (within a 12 hour time period)

• To address symptom mitigation

• To assist with providing possible closure

• Triage of services and presenting symptoms

• Typically occurs in small groups

Critical Incident Stress DebriefingThis occurs:

• Post crisis (occurs within 1-10 days, 3-4 weeks following mass disasters)

• Facilitates psychological closure

• To address symptom mitigation

• Triage of services and presenting symptoms

• Typically occurs in small groups

Advantages of a CISM Team

• Temporary

• Active

• Supportive

• Confidential

• Assistance to aid individuals involved in crisis situations

CISM TeamThe CISM Team consists of:

• Team Coordinator

• Team Leader

• Team Members

• Mental Health Professional

• Police Chaplin Volunteers

Member Training

• Specialized crisis intervention training

• Small or large group crisis tactics

• Recommended 50 to 80 hours of crisis intervention training in specialized areas

CISM TeamTeam members:

• Have a responsibility and duty to keep information confidential

• Shall not accuse or blame others of wrong doing

• Shall refrain from engaging in any discussion involving responsibility or blame

CISM Team Activation• Responsibility of On-Scene Commander

• Notify the CISM Team Coordinator of:– Officer involved shootings

– Employee suicide

– Mass casualty incident

– Death or life threatening injury to a child

– Incidents producing a high level of immediate or delayed emotional reaction

When ActivatedTeam members should:• Avoid direct involvement in the incident• Make contact with the involved employees• Separate the employee from the scene if approved• Ensure involved employees are allowed to contact

family members if desired• Assist the involved employee until stabilized

When ActivatedTeam members should ensure employees:• Are allowed to stabilize/calm down in a private

environment

• Permitted to shower and change when approved for such action

• Have clergy and other spiritual needs met

• Have food and drink if desired

• Encouraged to seek follow up counseling, if needed

Consequences of Failure to Address Critical Incident Stress

• Negatively impacts all involved

• Can lead to faulty decision making

• Increased disciplinary problems

Consequences of Failure to Address Critical Incident Stress

• Excessive use of sick leave, tardiness, and on-the-job accidents

• Increased citizen complaints

• Re-occurring officer turnover

CISM• Is for the employee experiencing a normal

reaction to an abnormal event

• Is to help the employee recover quicker from such an event

• Is temporary, active and supportive

• Is confidential

Every year, hundreds of officers experience intense, traumatic events that can have

serious long-term consequences for them, their families, and their departments.

It is incumbent upon police administrators

to ensure that their officers and their departments have the tools at

hand to cope with such.

Conclusions

• Discussed the importance of dealing with critical incident stressors immediately following the traumatic event

• Identified the deleterious impact of psychological and physiological stressors on first responders who frequently encounter traumatic stress

Conclusions

• Discussed the importance of seeking CISM services to break the code of silence among first responders

Questions

Questions concerning CISM should be directed to:

Daytona Beach Police Department CISM Team

Chuck Russo, PhD

russoc@dbpd.us

CharlesRusso7@mycampus.apus.edu

ChuckRusso@SPSGrp.com