11/26/2018Southwest Region CAP CISM PEP Talk1 Critical Incident Stress Management (CISM) Headquarters Southwest Region Civil Air Patrol/USAF-Auxiliary

11/26/2018Southwest Region CAP CISM PEP Talk2 CISM PEP Talk Pre-Exposure Preparation Talk A

11/26/2018Southwest Region CAP CISM PEP Talk3 Objectives of this presentation: A review of the causes and effects of stress Some cues to identify stress and tools to manage it An overview of critical incident stress, crisis management, and critical incident stress management (CISM) An orientation to CAP’s CISM program To provide the participants with...

11/26/2018Southwest Region CAP CISM PEP Talk4 CISM is a Mandated Operations Program! It is not just a Chaplain’s program!

11/26/2018Southwest Region CAP CISM PEP Talk5 Just What is Stress? arousal “A state of physical and emotional arousal.”

11/26/2018Southwest Region CAP CISM PEP Talk6 Where Does Stress Come From? Stimulus Stressor stimulus/demand Response Stress Response

11/26/2018Southwest Region CAP CISM PEP Talk7 Some Definitions... Stressor -- a stimulus that causes, evokes, or is otherwise strongly associated with the stress response Stress response -- Nonspecific response of the body to a demand(s) Target organ(s) -- The part of the body, or mind, that is the recipient of the stress response and which develops the signs & symptoms of over-arousal

11/26/2018Southwest Region CAP CISM PEP Talk8 For example... stressorsWhile flying, the stressors of heat and G-forces affect the body. stress responseNext a stress response occurs in the inner ear leading to a condition known as “vertigo.” target organThen the target organ of the stomach is over-aroused and decides to “get rid of food!” … airsickness

11/26/2018Southwest Region CAP CISM PEP Talk9 2 “Varieties” of Stress... Good “Eustress”equalsGood Stress --- Positive, motivating stress Bad “Distress”equalsBad Stress --- Negative, excessive, debilitating stress

11/26/2018Southwest Region CAP CISM PEP Talk10 Some Generic Sources of Stress... Biogenic Environmental Personality

11/26/2018Southwest Region CAP CISM PEP Talk11 Some Biogenic Stressors... Caffeine Nicotine Amphetamines Cold & allergy medicines Theophylline Illness Lack of sleep

11/26/2018Southwest Region CAP CISM PEP Talk12 Some Environmental Stressors... Rain Temperature extremes Sounds --- screams Mud Smells G-forces Time of day

11/26/2018Southwest Region CAP CISM PEP Talk13 Personality The way people are “hard-wired.”

11/26/2018Southwest Region CAP CISM PEP Talk14 Stress is Cumulative It builds up over time...

11/26/2018Southwest Region CAP CISM PEP Talk15 Cumulative Stress Piles up (snowballs). Increases with time. Deteriorates: * Performance * Relationships * Health Is stress that...

11/26/2018Southwest Region CAP CISM PEP Talk16 We Used to Call it “Burnout” Increased cynicism. Increased physical lethargy. Procrastination. In the extreme … even … suicidal or homicidal thoughts or ideations.

11/26/2018Southwest Region CAP CISM PEP Talk17 Some Signs & Symptoms of Cumulative Stress Tardiness Fatigue Detachment Depression Medication or drug use. Irritability “Gallows” humor Paranoia, or irrational fears. Derogatory speech or labeling of others. Denial Increased workplace absences. Irresponsibility

11/26/2018Southwest Region CAP CISM PEP Talk18 An Example of Cumulative Stress... The De Havilland “Comet” -- The World’s First Commercial Jet Airliner

11/26/2018Southwest Region CAP CISM PEP Talk19 Like With The Airliner... Stress is the “wear and tear” on our human coping systems. Over time minor stresses can have major and damaging effects. This is the cumulative effect of stress. … and we can crash too!

11/26/2018Southwest Region CAP CISM PEP Talk20 Critical Incident Stress “Any event in which there is a stressful impact sufficient enough to overwhelm the usually effective coping skills of either an individual or a group.” (Everly & Mitchell, 1999)

11/26/2018Southwest Region CAP CISM PEP Talk21 can Cumulative stress can exacerbate critical incident stress.

11/26/2018Southwest Region CAP CISM PEP Talk22 Critical Incidents are events that have the potential to create significant human distress and can overwhelm the usual coping mechanisms of individuals and/or groups.

11/26/2018Southwest Region CAP CISM PEP Talk23 How to Recognize Excessive Stress?

11/26/2018Southwest Region CAP CISM PEP Talk24 Manifestations of Distress Can Take a Number of Forms... Physical Cognitive Emotional Behavioral

11/26/2018Southwest Region CAP CISM PEP Talk25 Physical Manifestations Excessive sweating Nausea and/or vomiting Elevated pulse rate Elevated blood pressure Rapid breathing Dizziness

11/26/2018Southwest Region CAP CISM PEP Talk26 Cognitive Signs Confusion. Mumbling of words Difficulty making decisions Decreased concentration Memory dysfunction

11/26/2018Southwest Region CAP CISM PEP Talk27 Emotional Signs Emotional Shock Anger Grief Depression Feeling totally overwhelmed

11/26/2018Southwest Region CAP CISM PEP Talk28 Behavioral Signs Changes in ordinary behavior Changes in eating habits Decreased personal hygiene Prolonged silences Withdrawal

11/26/2018Southwest Region CAP CISM PEP Talk29 Stress Response Timelines Immediate -- up to 24 hours post event. Delayed to 72 hours post event. Cumulative -- buildup of stress over time.

11/26/2018Southwest Region CAP CISM PEP Talk30 Post-Traumatic Stress is... abnormal event “… a normal reaction in a normal person, to an abnormal event.” “… a survival mechanism, whereas (PTSD) pathogenic (PTSD) is a pathogenic (unhealthy) variation of that normal survival mechanism.” Post-Traumatic Stress Disorder

11/26/2018Southwest Region CAP CISM PEP Talk31 Examples of Critical Incidents Line of duty death or death at workplace Serious line of duty injury or workplace injury Suicide of coworker, friend, family member Multiple casualty incidents (MCI’s), disasters Significant events involving children Prolonged events especially with loss Any powerful event which overwhelms a person’s normal coping mechanisms

11/26/2018Southwest Region CAP CISM PEP Talk32 A Crisis One’s normal psychological balance (homeostasis) has been disrupted, One’s usual coping mechanisms have failed to reestablish the needed homeostasis, or There is evidence of functional impairment. A response to an event wherein...

11/26/2018Southwest Region CAP CISM PEP Talk33 Crisis Intervention

11/26/2018Southwest Region CAP CISM PEP Talk34 Crisis Intervention is... An exercise in psychological damage control. Stopping the bleeding! Not a cure An opportunity for assessment and for follow-up Guided by a mental health professional (MHP) The provision of timely “emotional first aid:”

11/26/2018Southwest Region CAP CISM PEP Talk35 Crisis Intervention specializedunique training Is but one aspect of a continuum of care. It requires specialized and unique training.

11/26/2018Southwest Region CAP CISM PEP Talk36 Crisis Intervention Principles... BISEP Spell B -I -S -E -P Brevity Immediacy Simplicity Expectancy Proximity BISEPBISEP

11/26/2018Southwest Region CAP CISM PEP Talk37 Critical Incident Stress Management (CISM) is one type of crisis intervention. It is a comprehensive, systematic program for the mitigation of critical- incident related stress.

11/26/2018Southwest Region CAP CISM PEP Talk38 The goals of CISM... Prevent Prevent traumatic stress Mitigate Mitigate traumatic stress Intervene Intervene to assist recovery from traumatic stress Accelerate Accelerate recovery Restore Restore function Maintain Maintain worker health and welfare

11/26/2018Southwest Region CAP CISM PEP Talk39 By way of analogy... $187, According to the Wing Aircraft Maintenance Officer, HQ-TX Wing expects to spend approximately $187, this year to maintain our fleet of airplanes. But … OUR PEOPLE? how much are we spending to maintain our most valuable asset… OUR PEOPLE?

11/26/2018Southwest Region CAP CISM PEP Talk40 CISM is a comprehensive, systematic maintenance program for the overall well-being of our most valuable assets … our members.

11/26/2018Southwest Region CAP CISM PEP Talk41 CISM involves many facets... Pre-crisis preparation and education Demobilization (for large groups) Crisis management briefings (large groups also) Defusings Critical incident stress debriefing (CISD)

11/26/2018Southwest Region CAP CISM PEP Talk42 CISM also involves... One-on-one, individual crisis intervention Pastoral crisis intervention Family CISM Organizational crisis intervention / consultations Follow-up and referral mechanisms

11/26/2018Southwest Region CAP CISM PEP Talk43 CISM deals with the current circumstances, the current event or crisis … NOT … personal histories. It is First Aid, not definitive care.

11/26/2018Southwest Region CAP CISM PEP Talk44 Some Key Elements of CISM...

11/26/2018Southwest Region CAP CISM PEP Talk45 Pre-Incident Education General information: stress, trauma, etc. Set expectations for actual experiences Teach stress management and coping skills

11/26/2018Southwest Region CAP CISM PEP Talk46 Demobilizations Decompression Transition workers from disaster work (large- scale incident) to routine duties or home Used with large numbers of people A 10- to 30-minute session An opportunity for assessment of group needs Alert workers to possible stress effects Always followed by a CISD (debriefing, usually within one week

11/26/2018Southwest Region CAP CISM PEP Talk47 Defusing A small group intervention conducted within hours of the incident, usually within 12 hours Shortened version (20-45 mins) of the CIS- Debriefing May eliminate the need for, or increase effectiveness of, CISD; opportunity to assess the need for CISD Seeks to reduce intense reactions to a trauma Seeks to “normalize” the effects of the event

11/26/2018Southwest Region CAP CISM PEP Talk48 The Defusing 3-Step... *Introduction *Exploration *Information

11/26/2018Southwest Region CAP CISM PEP Talk49 The Critical Incident Stress Debriefing (CISD) A group discussion of a traumatic event Peer driven Clinician (MHP) guided Lasts 1-3 hours Closed circle format Held days post event NOTNOT psychotherapy! C I S D

11/26/2018Southwest Region CAP CISM PEP Talk50 Objectives of the CISD  Education  Ventilation  Reassurance and forewarning  Positive contact with a MHP  Improvement of interagency cooperation  Increase group cohesiveness  Restore self-confidence  Facilitation of follow-up

11/26/2018Southwest Region CAP CISM PEP Talk51 CISDs consist of 7 stages... Mitchell, 1991

11/26/2018Southwest Region CAP CISM PEP Talk52 Family Support  An essential component of a comprehensive CISM program  Consists of: * Educational programs * CISD for significant others * Bereavement support -- grief and crisis counseling  Provided by peers, MHP, clergy, trained spouses  Includes children and elderly as well

11/26/2018Southwest Region CAP CISM PEP Talk53 Referral... Is made to obtain a more thorough a process of assessment and evaluation, The mental health provider should understand the “culture” of the agency in which the person is employed, and should have specialized training/experience in post-traumatic stress.

11/26/2018Southwest Region CAP CISM PEP Talk54 Follow-up... Essential element in all CISM interventions. Can be made by: * Phone calls * Station / workplace visits * Home visits

11/26/2018Southwest Region CAP CISM PEP Talk55 All CISM Interventions Are Strictly Confidential!

11/26/2018Southwest Region CAP CISM PEP Talk56 How well does CISM work? Let’s compare two airliner crashes to see...

11/26/2018Southwest Region CAP CISM PEP Talk57 San Diego 1978 v. Cerritos 1986 San Diego, PSA-182: 9/25/1978 Cerritos, Aeromexico: 8/31/1986 San Diego, PSA-182: 9/25/1978 Cerritos, Aeromexico: 8/31/1986 San DiegoCerritos San Diego Cerritos Total Killed Aircraft Survivors 0 0 Homes Destroyed Killed on Ground ESP used Body Parts Recovered 10, ,000+

11/26/2018Southwest Region CAP CISM PEP Talk58 San Diego v. Cerritos cont’d … Types of Critical Incident Interventions Provided San Diego 1978Cerritos 1986 Sporadic 1 on 112 CISDs Crisis Interventions Demobilizations Crisis hotline Follow-ups with MHP’s

11/26/2018Southwest Region CAP CISM PEP Talk59 San Diego v. Cerritos Personnel losses, among responders, within 1 year of event: Increase in MH utilization within community within 1 year: 31% 1% SD CER Ranking PD 5 0 FD Personnel 7 1 EMS Personnel17 0

11/26/2018Southwest Region CAP CISM PEP Talk60 CISM Works!

11/26/2018Southwest Region CAP CISM PEP Talk61 CISM in the Civil Air Patrol

11/26/2018Southwest Region CAP CISM PEP Talk62 CAP’s CISM Program  Mandated by CAPR 60-5  Not optional  Specifically an operations program  Implementation is assigned to Region Commanders by CAPR 60-5.

11/26/2018Southwest Region CAP CISM PEP Talk63 CAP’s CISM Program cont’d  Wings are to “… assess the need for a CIST.”  All personnel are encouraged to receive CIS training.

11/26/2018Southwest Region CAP CISM PEP Talk64 CAP’s CISM Program... “The use of qualified, local, non-CAP teams to respond to incident stress- affected CAP members is highly encouraged … The use of local non- CAP teams will somewhat limit the need to dispatch a trained CAP CIS [Team]” --CAPR 60-5 (2)e

11/26/2018Southwest Region CAP CISM PEP Talk65 CAP’s CISM Program... “… Each active duty Air Force base is required to have a CIST, which, with prior coordination, may be able to support CAP” --CAPR 60-5 (2)e

11/26/2018Southwest Region CAP CISM PEP Talk66 A CAP CIST Consists of:  Mental Health Professionals (MHP)  Peer Representatives  CAPR 60-5 (3)a 2

11/26/2018Southwest Region CAP CISM PEP Talk67 Request & Deployment  After a SAR or DR mission “ … a review of the need for CIS intervention should be made for all personnel...”  The incident commander or unit commander will pass a request to wing commander.  In consultation with staff, the wing CC will coordinate use of a local non-CAP team or request one of the Region teams.

11/26/2018Southwest Region CAP CISM PEP Talk68 Funding CISM  CISM is not, presently, a specifically USAF funded mission (by itself).  CAP CISM may be funded through an existing mission’s funding.

11/26/2018Southwest Region CAP CISM PEP Talk69 Funding CISM The CAP Natl HQ has approved limited funding to support CISM missions nationally.  Housing and feeding of a team will normally NOT be reimbursed.  The “… use of host families…” is encouraged to mitigate housing costs.

11/26/2018Southwest Region CAP CISM PEP Talk70 For More Information...  Visit the web site of the International Critical Incident Stress Foundation (ICISF) at  Join the ICISF.  Review CAPR 60-5.

11/26/2018Southwest Region CAP CISM PEP Talk71 For More Information...  Call Chaplain Don Brown at (936) or him at  Sign up for the “Basic Critical Incident Stress Management” and other ICISF CISM courses.

11/26/2018Southwest Region CAP CISM PEP Talk72 Any Questions?

11/26/2018Southwest Region CAP CISM PEP Talk73

11/26/2018Southwest Region CAP CISM PEP Talk74 Credits Lt Col Sherry Jones, RN, CAP Special Advisor to the National Commander for CISM Ch, Lt Col DONALD R. BROWN II, CAP SWR Deputy Chaplain and CISM Director 1st Lt Penny Herndon-Finuf, RN, CAP SWR/TXWNG CISM Educational Officer