Denton County CERT Team Understanding CISM Denton County CERT Team

What is CISM ? Critical Incident Stress Management

STRESS RESPONSE to a stimulus characterized by increased psychological AROUSAL Physical is the body’s response to some powerful stimulus. Psychological has two parts. One is the intellectual response (or level of arousal) and the other is the emotional level of arousal. In essence, a stress reaction is made up of physical, emotional and intellectual factors.

In SIMPLE terms Stress Is: NORMAL reaction by a NORMAL person to a ABNORMAL situation.

Two Types of Stress EUSTRESS = Positive, motivating stress (increases performance) DISTRESS = Excessive, debilitating stress (decreases performance) Not all stress is bad. Stress is bad when it is prolonged or intense.

Physiological Aspects of Stress

Responses To Stress Hormonal dump into the bloodstream Increased heart rate & respiration Increased blood flow to larger muscles Tension of large muscles

Reasons For These Reactions FIGHT ! FLIGHT ! What happens when we can’t fight or flee?

Common Symptoms of Stress (US Army Study, 1944) Nausea Feeling faint Cold sweats Loss of bowel control

Psychological Aspects of Stress

Ingredients For Distress In order for an event to become stressful, it must be interpreted or appraised as being: CHALLENGING, THREATENING, or ADVERSE, and MEANINGFUL.

Critical Incident Stress (CIS) AKA: Post Traumatic Stress (PTS) NORMAL reaction by a NORMAL person to a ABNORMAL situation.

Signs and Symptoms of Distress I. Cognitive (Thinking) II. Emotional III. Behavioral IV. Physical V. Spiritual

I. COGNITIVE (Thinking) DISTRESS Sensory distortion Confusion (“dumbing down”) Inability to concentrate Difficulty in decision making Guilt Preoccupation (obsessions) with event Inability to understand consequences of behavior Suicidal/homicidal thoughts Psychosis Instructor, please do not get bogged down in going over the lists of symptoms. Your aim here is a quick overview. The students have the lists of symptoms in the student manual. It is recommended that you caution the students against memorizing lists of symptoms. Every person reacts somewhat differently. There are some common reactions as pointed out in these slides, but there will be some variation as well.

II. EMOTIONAL DISTRESS Anxiety Irritability ANGER ! Panic (often associated with self -medication) Vegetative Depression Fear, Phobia, Phobic Avoidance Post-Traumatic Stress (PTS) Grief (Mourning associated with loss)

III. BEHAVIORAL DISTRESS Impulsiveness Risk - taking Excessive Eating Alcohol/Drug Use Hyper-startle Violence Sleep Disturbance Withdrawal Family Withdrawal Crying Spells 1000 - yard Stare Antisocial Behavior

IV. PHYSICAL DISTRESS Tachycardia, Bradycardia Headaches Hyperventilation Muscle Spasms Psychogenic Sweating tach·y·car·di·a - A rapid heart rate, especially one above 100 beats per minute in an adult. brad·y·car·di·a - Slowness of the heart rate, usually fewer than 60 beats per minute in an adult human.

IV. PHYSICAL DISTRESS (Con’t.) Fatigue/ Exhaustion Indigestion, Nausea, Vomiting Blood in stool, sputum, vomit, urine Chest pain Loss of Consciousness

V. SPIRITUAL DISTRESS Anger at God Withdrawal from Faith-based Community Loss of moral compass Instructors, please note: It is a bad idea to get into long discussions about the spiritual reactions. State them and move on in the course. Type and intensity of symptoms will vary from person to person. Some may not suffer spiritual symptoms at all. Others will experience an increase in faith after a tragedy. All of these outcomes are possible.

What is Crisis Intervention ? First Aid for emotional distress caused by a traumatic experience: Allowing people to “vent” (explain) their thoughts about the incident Helping people understand they are “OK” Teaching them good coping skills Assessing if additional care is needed

Crisis Intervention Characterized by: PROXIMITY – close to incident IMMEDIACY – early intervention (“trauma membrane”) EXPECTANCY – belief this can help SIMPLICITY – simple, concrete strategies BREVITY – interventions short, not long- term care PRACTICALITY – easy to implement

(adapted from Caplan, 1964, Preventive Psychiatry) Crisis Intervention Goals: STABILIZATION of symptoms (keep things from getting worse) REDUCTION of symptoms (stress relief) RESTORATION of independent function (“back on the street”) ACCESS to additional care (if needed) (adapted from Caplan, 1964, Preventive Psychiatry)

Crisis Intervention What crisis intervention is NOT: NOT Psychotherapy NOT Counseling NOT Psychotherapy NOT Substitute for Counseling or Psychotherapy

Types of Stress Which is most likely to cause greatest harm? Cumulative Stress Unresolved everyday stressors (“Burnout”) Critical Incident Stress Result of a single, traumatic event Which is most likely to cause greatest harm? Cumulative – silent & slow

TWO TYPES OF STRESS Cumulative Stress (“Burnout”) slow erosion of functioning incomplete work lateness impulsive need for change chronic physical illness “Critical Incident” (Traumatic) normal coping overwhelmed adaptive functioning interrupted symptoms of posttraumatic distress evident Unresolved every day stressors produce cumulative stress. Critical Incident Stress (CIS), on the other hand, arises only as a result of a traumatic event.

Stress Response Syndromes Cumulative Stress Normal Stress Path General Stress All Normal Eustress Distress Pathological Path Cumulative Stress Piles up Takes time “Burnout” Destructive Changes in health, performance, relationships, and personality The four categories of stress listed on this slide and the next one are just an attempt to simplify and summarize the huge field of stress. There are two “normal” pathways of stress and there are two pathological pathways of stress. Each slide contains a normal pathway and a pathological pathway of unresolved stress. Note: solid arrows in the both the slide above and in this one indicate the normal stress path for the vast majority of people (toward resolution and recovery). The broken or hashed arrows indicate the path of a much smaller percentage of people (toward pathology). Recovery

Continuum of Care RESISTANCE – Ability to resist the effects of stress RESILIENCE – Ability to bounce back from stress RECOVERY – Ability to return to “normal” within reason

RESISTANCE Psychological/behavioral immunity (“psychological body armor”) to distress and dysfunction. (Pre-incident training/preparation may be best way to build resistance.)

RESILIENCE Refers to the ability to rapidly and effectively rebound from psychological and/or behavioral effects of stress. Resilience does not mean that a person does not have stress. It only means that they can bounce back from that stress and then continue on with their lives.

RECOVERY The ability to literally recover the ability to adaptively function after stress. Recovery implies that some shock or damage may have been caused by the stressful experience, but that the person or the group is able to overcome the damage and eventually recover their ability to function in an adaptive manner.

ELEMENTS (TOOLS) OF CISM Pre-incident education, preparation Assessment Strategic Planning Large Group Crisis Intervention: Demobilizations (large groups of rescue/recovery) Rehab Sectors Crisis Management Briefings (CMB)

ELEMENTS (TOOLS) OF CISM Small Group Crisis Intervention: Defusings (small groups) Small group CMB Debriefing (CISD) Individual, one-on-one intervention Family CISM Organizational/Community intervention, consultation Pastoral crisis intervention Follow-up and referral for continued care

Things To Do To Cope with Stress Exercise Spend quality time with others Avoid alcohol Eat a healthy diet Get plenty of rest Drink plenty of water Most of all --- TALK !

How important are your health & relationships with others? How important is CISM ? How important are your health & relationships with others?

When to Call For CISM Anytime you think you have a stressful event during your shift. Anytime you notice problems within your shift after a stressful event or cumulative events. Anytime you notice an individual that is having problems dealing with a stressful event.

How to call for CISM Contact EMS Division Chief Todd Jamison at The Little Elm Fire Department. Office # 214-975-0429 Cell # 469-853-3070 Email tjamison@littleelm.org Brenda Gormley 940-349-2855 brenda.gormley@dentoncounty.com

Little Elm CISM Team EMS Division Chief Todd Jamison Pastor Richard Stevens - Fire Dept. Chaplain Dan Phleps - Little Elm Police EMS Lieutenant Glen Phipps –Aubrey Fire Department. Matt Moore – Little Elm Fire Department Jeremy Fuller – Little Elm Fire Department