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Critical Incident Stress Management (C.I.S.M.) A Basic Introduction Montgomery County CISM Team

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Montgomery County Critical Incident Stress Management Montgomery County Critical Incident Stress Management Who takes care of the caregivers?

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Critical Incidents Events that have the potential to create significant human distress and can overwhelm ones usual coping mechanisms.

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What is a Critical Incident? n Death or injury of a coworker n Death or major injury to a child n Situations involving extensive media coverage n Prolonged situation with negative outcome n Mistakes, real or imagined n Victim previously known to person n Natural Disasters

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What is Critical Incident Stress? n Emotional, mental, and/or physical response which interferes with behavior, or the ability to function either on scene or after the incident is over. As defined by Dr. Jeffrey T. Mitchell Ph.D.

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n The type of stress you experience is dependant on 4 Ps n Perception - How one views an event n Planning - Training and preparation n Preparedness - Ones expectations of the stimuli n Past - The baggage you carry from previous experiences What Determines How You Will React?

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Coping Mechanisms n Denial (Things just dont bother me) n Titanic Syndrome (Im invincible and unsinkable) n Image Armor (Admission of pain is seen as a sign of weakness) n Anger n Blame n Dark Humor

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Exposure Control n While working with a patient... You may have gotten exposed to an infection n Would you seek treatment?

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Exposure Control After an exposure, a physician may prescribe some prophylactic medication CISM is the prescription following an exposure to stress

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The Goals of CISM are: n Early Recognition Identifying a potentially stressful situation n Activation Page the CISM Coordinator n Suppression Set up an Intervention n Prevent burnout n Encourage the well being of personnel, careers, and families

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San Diego vs. Cerritos

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The Tale of Two Plane Crashes San Diego n 125 killed-no survivors n 16 homes destroyed n 15 civilians killed on ground n 300 EMS personnel n > 10,000 body parts Cerritos n 82 killed-no survivors n 16 homes destroyed n 15 civilians killed on ground n 300 EMS personnel n > 10,000 body parts

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Impact of CISM San Diego n No CISM Services provided n Lost police - 5 in one yr. n Lost fire - 5 in one yr. n Lost paramedics - 15 in one yr. n Increase in mental health services - 31% Cerritos n 12 CISM Demobilizations n Hotline Follow-up n No loss of police or fire personnel n 1 paramedic loss n Increase in mental health services - 1%

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What is Stress? n Your reaction to stimuli Physical Mental/Cognitive Emotional n Stress comes in two forms Eustress Distress

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What is Distress? n A disruptive force that negatively impacts daily health- Mitchell & Bray Physical- Change in eating patterns Mental/Cognitive- Inability to recall simple information Emotional- Hypersensitivity

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What is Eustress? n The positive, motivating reactions to situations Driving force to do your best Physical - Exercise Mental - Academics Emotional - Optimism

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Psychological Crisis An acute response to a trauma, disaster, or other critical incident wherein: 1) Psychological balance is disrupted 2) Ones usual coping mechanisms have failed 3) Evidence of significant distress, impairment, dysfunction

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Terrorism represents a form of psychological warfare The war will ultimately be won or lost not on the battlefield, but in the mind

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Crisis Intervention was developed in response to the acute mental health needs of those in crisis

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Crisis Assessments

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Acute Mental Status Assessment n Orientation n Long-term Memory n Concentration n Emotion

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What is cumulative stress? n Chronic progressive culmination of small stressors May result in P.T.S.D., if not managed. n Warning: Contents under extreme pressure!

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Cumulative and Long-Term Effects of Stress n Hindrance of performance n Decreased ability to make decisions n Memory problems n Interpersonal Conflicts n Morale problems n Accident prone n Absenteeism n Depression n Burnout and Attrition n Suicide

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P.T.S.D. (Post -Traumatic Stress Disorder) n This is a pathological reaction to an abnormal situation Symptoms inhibit the person from functioning at his/her job May have day or night terrors

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More P.T.S.D. Hypersensitivity May experience intrusive thoughts (flashbacks) Symptoms MUST last for over 30 days n Early Recognition and intervention may prevent the domino effect

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Critical Incident Stress Management n ...is a comprehensive, organized approach for the reaction, and control of harmful aspects of stress. Jeffrey T. Mitchell Ph.D. Forms of intervention: Pre-incident Education Debriefing (C.I.S.D.) Defusing Crisis Management Briefing (CMB) Demobilization 1:1

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For Whom is C.I.S.M. Targeted? n Normal people experiencing normal reactions to abnormal situations

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C.I.S.M. is not for CRAZY People! n C.I.S.M. is not designed to be therapy or a replacement for therapy

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Critical Incident Stress Debriefing n is a method for mitigating the harmful effects of work-related trauma, and ultimately preventing P.T.S.D. Jeffrey T. Mitchell Ph.D.

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What is a Defusing? n A small group process which is initiated after any traumatic event that is powerful enough to overwhelm ones usual coping mechanisms n Short version of a Debriefing

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What Does Defusing Mean? n Means to render something harmless before it can do damage n Overall objective is to reduce the potential for harm to those who were exposed to a critical incident

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Usual Effects of Defusings n May possibly eliminate need for formal Debriefing n It will enhance effectiveness of Debriefing process if one is needed

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Defusing Goals n Achieve a rapid reduction in the intense reactions to a traumatic event n Attempt to normalize the experience n Attempt to re-establish the social helping network of the group n Assess need for formal Debriefing process

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Additional Goals of Defusings n Information transfer between members n Re-focusing of thinking process; getting your act together n Education as to survival skills over next few days n Identifying support resources/personnel

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Debriefing - What is It? n A formal peer group discussion designed to help alleviate the effects of critical incident stress n A prevention program for burn-out

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What Happens at a Debriefing? n Team n Location n Phases Introduction Fact Thought Reaction Symptom/teaching Re-entry

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Introduction Phase n Introduce members n Establish ground rules n Explain process

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Fact Phase n Who are you and what was your job, or how were you involved in the incident? n What happened from your point of view?

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Thought Phase n What was your first or most prominent thought once you came off auto pilot?

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Symptom Phase n The group is asked to describe: Any cognitive, physical, emotional or behavioral symptoms they experienced at the scene Symptoms they experienced in the following days Symptoms they continue to experience

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Teaching Phase n All team members teach about symptoms one may experience n Find a positive outcome, or gift that may have come out of tragedy n Utmost concern for group

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Re-entry Phase n Clarify issues n Answer questions n Team members make summary comments

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Follow-up and Referral n May return for another debriefing if group decides n May have an individual who may ask for further help

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Signs and Symptoms n Physical Chest Pain Elevated BP Headaches Muscle tremors n Cognitive Confusion Poor attention Intrusive images Nightmares

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Signs and Symptoms n Emotional Guilt Anxiety Depression n Behavior Withdraw Loss of or increase in appetite Changes in sleep patterns Increased alcohol consumption

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The Keys to Unlocking a Successful Career After a Critical Incident: Helping a Peer n Listen carefully n Spend time with the traumatized person n Help with everyday tasks n Know your limitations as a peer supporter

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The Keys to Unlocking a Successful Career Helping yourself * Eat well-balanced and regular meals Drink plenty of water * Get plenty of rest * Structure your time - Keep busy * Allow yourself to be emotional * Look to your peers and family for support

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Pre-Incident Strategies n Eat Properly n Exercise n Rest n Talk Must practice/do/engage in regularly

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Post-Incident Strategies n Eat Properly n Exercise n Rest n Talk

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Montgomery County Critical Incident Stress Management Team Department of Public Safety Division of EMS and the Office of Mental Health

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History of the Montgomery County CISM Program n Trained Emergency Services Peers n Mental Health Professionals n All Volunteers n Services are free

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Main goals of CISM n To jump start your natural support systems n To help keep your baggage at a manageable level n To get you back to work and functioning at an optimal level after a critical incident

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Team Make-up n Mental Health Professionals n EMS/ Medical Professionals Peers First Responders, EMTs, Paramedics, PHRNs, Nurses, Physicians n Police Officers Peers Active, and retired n Firefighters, Rescue, Water Rescue Peers n Dispatcher Peers n Clergy n Community Service Peers

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The expanding role of CISM n Services for families of Emergency Services Personnel n Industrial First Responders n Proactive Training & Education n Community Group Crisis

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Who Can Activate CISM? n CISM may be activated by any member of any Emergency Service in Montgomery County It is advised that these requests go through a supervisor or an administrator n CISM may be activated by other community service groups

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How to Access the Team n CISM can be activated through: n Montgomery County Emergency Dispatch Service 911or610-631-6541

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STRESS IMPAIRS THE ABILITY TO CARE AND PERFORM

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Special thanks to Marc Borish, NYC Regional EMS CISM Coordinator (and formerly the Chester County CISM Coordinator) for the preparation of the text portion of this presentation

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