Critical Incident Stress Critical Incident Stress ManagementManagement

Kelly Burkholder-AllenKelly Burkholder-Allen

Churton BuddChurton Budd

Paul RegaPaul Rega

The responder is often a victim as The responder is often a victim as wellwell

Critical IncidentsCritical Incidents

Are events which have significant power to Are events which have significant power to overwhelm an individual’s normally effective overwhelm an individual’s normally effective ability to copeability to cope

Individuals who experience a critical incident Individuals who experience a critical incident are faced with the demand to respondare faced with the demand to respond

They often respond in ways which require They often respond in ways which require exceptional physical or heroic effortexceptional physical or heroic effort

Critical IncidentsCritical Incidents

Critical Incident Stress Critical Incident Stress affects nearly 90% of all affects nearly 90% of all emergency personnelemergency personnel

Are emotionally charged Are emotionally charged eventsevents

The effects of critical incident The effects of critical incident stress can be intensified, influenced, or mitigated by our stress can be intensified, influenced, or mitigated by our personal, family, and developmental issuespersonal, family, and developmental issues

Symptoms usually subside within a few weeksSymptoms usually subside within a few weeks

Critical Incident StressCritical Incident Stress

No one is immune from responding to the No one is immune from responding to the stress of a critical incidentstress of a critical incident

Critical incident stress may occur hours, Critical incident stress may occur hours, days, or even months after a critical eventdays, or even months after a critical event

You may experience symptoms of stress You may experience symptoms of stress and not even know itand not even know it

Suffering the stress effects following a Suffering the stress effects following a critical incident stress is NORMALcritical incident stress is NORMAL

In the days immediately after a In the days immediately after a critical eventcritical event

Maintain your schedule, alternate physical Maintain your schedule, alternate physical activity with relaxationactivity with relaxation

Remember that you are having normal Remember that you are having normal reactions to an abnormal eventreactions to an abnormal event

Reach out and spend time with others---they Reach out and spend time with others---they carecare

It is ok that you bad and talk about your It is ok that you bad and talk about your feelingsfeelings

After a critical eventAfter a critical event

Do things that feel good to you or provide you with Do things that feel good to you or provide you with comfortcomfort

Avoid drugs and alcohol to numb your emotionsAvoid drugs and alcohol to numb your emotions Keep a journalKeep a journal Don’t make life-altering changes at this timeDon’t make life-altering changes at this time Do make daily decisions and assume control over Do make daily decisions and assume control over

your lifeyour life Get plenty of rest, eat nutritiously, and take care of Get plenty of rest, eat nutritiously, and take care of

yourselfyourself

Normal signs and symptoms of Normal signs and symptoms of stressstress

Physical Symptoms:Physical Symptoms:– NauseaNausea– TremorsTremors– ChillsChills– DiarrheaDiarrhea– Rapid heart rateRapid heart rate– Muscle achesMuscle aches– Dry mouthDry mouth– ShakingShaking– Visual problemsVisual problems– FatigueFatigue

Emotional Symptoms:Emotional Symptoms:– AnxietyAnxiety– DenialDenial– FearFear– Survivor guiltSurvivor guilt– Uncertainty of feelingsUncertainty of feelings– DepressionDepression– GriefGrief– HopelessnessHopelessness– Feeling overwhelmed, lost, Feeling overwhelmed, lost,

or abandonedor abandoned– Wishing to hide or dieWishing to hide or die– AngerAnger– Feeling numbFeeling numb

Normal signs and symptoms of Normal signs and symptoms of stressstress

Behavioral:Behavioral:– Change in activityChange in activity– WithdrawalWithdrawal– SuspiciousnessSuspiciousness– Change in communication Change in communication

patternspatterns– Changes in interpersonal Changes in interpersonal

interactionsinteractions– Variations in food Variations in food

consumptionconsumption– Excessive humorExcessive humor– Excessive silenceExcessive silence– Unusual behaviorUnusual behavior– Increased smoking or Increased smoking or

alcohol consumptionalcohol consumption

Cognitive:Cognitive:– ConfusionConfusion– Inability to pay attentionInability to pay attention– Difficulty calculatingDifficulty calculating– Memory problemsMemory problems– Inability to concentrateInability to concentrate– Repeated flashbacksRepeated flashbacks– NightmaresNightmares– Blaming othersBlaming others– Disrupted logical thought Disrupted logical thought

processprocess

Critical Incident Stress can be Critical Incident Stress can be MANAGED!MANAGED!

CISMCISM

Critical Incident Stress Management was Critical Incident Stress Management was first recognized and techniques to respond first recognized and techniques to respond were developed in the 1980’swere developed in the 1980’s

The first team was in Virginia, today there The first team was in Virginia, today there are hundreds of teams worldwideare hundreds of teams worldwide

A seven phase process developed A seven phase process developed to:to:

Minimize the emotional and physical impact of an Minimize the emotional and physical impact of an eventevent

Prevent burn-outPrevent burn-out Educate participants regarding normal stress Educate participants regarding normal stress

reactionsreactions Mitigate stress responsesMitigate stress responses Help to keep careers, relationships, and Help to keep careers, relationships, and

physical/mental health intact with little residual physical/mental health intact with little residual damagedamage

Can be delivered in a 6 hour courseCan be delivered in a 6 hour course

A formal debriefing:A formal debriefing:

Ideal debriefing time is between 24 and 72 Ideal debriefing time is between 24 and 72 hours post eventhours post event

Generally lasts for 2-3 hoursGenerally lasts for 2-3 hours Is a seven stage processIs a seven stage process

The seven phases of a formal The seven phases of a formal debriefing:debriefing:

1.1. IntroductionIntroduction

2.2. Fact phaseFact phase

3.3. Thought phaseThought phase

4.4. Reaction phaseReaction phase

5.5. Symptom phaseSymptom phase

6.6. Teaching phaseTeaching phase

7.7. Re-entry phaseRe-entry phase

DefusingDefusing

Defusing:Defusing:– An abbreviated version of a debriefing in a small group processAn abbreviated version of a debriefing in a small group process– Helpful when a full debriefing cannot be organizedHelpful when a full debriefing cannot be organized– Is held very soon after the event—ideal time within first 3 hours Is held very soon after the event—ideal time within first 3 hours

post eventpost event– Three main segments:Three main segments:

IntroductionIntroduction ExplorationExploration informationinformation

– Four main goals:Four main goals: Rapid reduction in the intensity to reactionsRapid reduction in the intensity to reactions A normalizing experienceA normalizing experience Re-establishment of the social network of the groupRe-establishment of the social network of the group To assess whether a full debriefing will be necessaryTo assess whether a full debriefing will be necessary

DemobilizationDemobilization Demobilization:Demobilization:

– A very brief intervention that takes place immediately following the eventA very brief intervention that takes place immediately following the event– Primary stress prevention and intervention techniquePrimary stress prevention and intervention technique– Two main segments:Two main segments:

Brief period where personnel are given information to assist them with Brief period where personnel are given information to assist them with management of stress reactionsmanagement of stress reactions

A rest and nutrition/rehydration period prior to return to dutiesA rest and nutrition/rehydration period prior to return to duties– Goals of demobilization:Goals of demobilization:

To provide a transition from the traumatic event or critical incident to the routineTo provide a transition from the traumatic event or critical incident to the routine To reduce the intensity of immediate stress-related reactionsTo reduce the intensity of immediate stress-related reactions Assessment of group for additional needsAssessment of group for additional needs To educate the group about potential stress reactionsTo educate the group about potential stress reactions To provide information about additional supportTo provide information about additional support To establish positive expectations about outcomeTo establish positive expectations about outcome

What makes defusings and What makes defusings and debriefings effective?debriefings effective?

Early interventionEarly intervention Opportunity for catharsisOpportunity for catharsis Opportunity to verbalize about the trauma with Opportunity to verbalize about the trauma with

those who experienced itthose who experienced it Behavioral structureBehavioral structure Psychological structurePsychological structure Group supportGroup support Peer supportPeer support Promotes follow-upPromotes follow-up

CISMCISM

Was designed to assist in the prevention, Was designed to assist in the prevention, management, and recovery from a management, and recovery from a significant stresssignificant stress

Include pre-incident education, defusing, Include pre-incident education, defusing, debriefings, support services, follow-up debriefings, support services, follow-up services, individual consults, peer services, individual consults, peer counseling, and disaster managementcounseling, and disaster management

CISM interventions are provided be CISM interventions are provided be especially trained individualsespecially trained individuals

CISM increases the rate of normal CISM increases the rate of normal recovery, in normal people, who are recovery, in normal people, who are having normal reactions to abnormal having normal reactions to abnormal

eventsevents

Professionals trained in CISM can Professionals trained in CISM can provide:provide:DefusingDefusing

DemobilizationDemobilizationDebriefingDebriefing

Recommendations for follow-upRecommendations for follow-up

Know your community’s resources!Know your community’s resources!Find out who provides CISM Find out who provides CISM

services and make contact, if you or services and make contact, if you or some one that you care about has some one that you care about has

experienced a critical incidentexperienced a critical incident