Critical Incident Stress Management (CISM) Program This presentation has two main goals: Increase awareness of Critical Incident Stress (preventive education) Increase awareness of CISM procedures EAP Coordinators HSWL Base Seattle Ms. Kristin Cox – Seattle Ms. Karen Collins - Astoria

Presentation Objectives Define a critical incident Review stress response Explore normal reactions Review policy Understand CISM goals and interventions Understand CISM protocol The objectives for this presentation are to: Define a critical incident Review stress response Explore normal reactions to stressful incidents Review policy Understand CISM goals and interventions Understand CISM protocol

A critical incident is . . . First responders will typically encounter many of these situations during the course of their career, which can have an emotional impact. The definition of a “critical incident” is: Any event with sufficient impact to produce signficant emotional reactions now or later. It is generally considered extremely unusual in the range of ordinary human experiences. https://www.uscg.mil/hq/cg1/cg111/critical_incident_stress.asp sudden disruption short duration coping may fail emotional turmoil disrupted thought Any event with sufficient impact to produce significant emotional reactions now or later.

Stress reaction categories Fight Flight Freeze Most of you are familiar with the “fight or flight” reactions that spur our actions geared toward survival. Some of you may also know about the less common “freeze” response under high stress situations. These are ways our brain and body attempts to maximize our ability to survive what it perceives as a high-level threat. The “fallout” from the body’s stress reaction can have impacts that last hours, days or even months depending on a variety of factors.

You can think of common Critical Incident Stress reactions as fitting into 5 general categories: Cognitive symptoms may include: Confusion Inability to concentrate Poor attention span Difficulties in problem solving Memory disruptions Inability to calculate Impaired decision making Time distortions Cognitive (thinking) 5

Emotional Emotional symptoms may include: Crying Withdrawing/isolating Anger Depression Sadness Emotional

Behavioral Behavioral symptoms may include: Changes in ordinary behavior Changes in eating Decreased personal hygiene Withdrawal Prolonged silences

Physical Physical symptoms may include: Thirst Fatigue Headaches Racing heart Gastro-intestinal distress Sweating

Spiritual Spiritual symptoms may include: Anger at God Loss of meaning and purpose Questioning of basic beliefs Importantly, remember that stress symptoms after a critical incident are normal and usually fade in time. 9

The Stress Continuum Another way to view the impact of stress and critical incidents is from the Navy’s OSC program: the stress continuum. This chart is a clear and easy way to identify the impact of stressful events and what is helpful to recover and “get back in the green.”

Another possibility: Growth! Some people actually experience GROWTH & enhanced functioning after an incident – they gain experience, learn new coping strategies, grow their support networks and gain confidence in their abilities. Kelly McGonigal, Stanford University Health Psychologist, has a great Ted Talk: How to Make Stress Your Friend.

Coast Guard Policy COMDTINST 1754.3 Standard of Care Designed to prevent/mitigate adverse psychological reactions experienced by some people following traumatic events International Critical Incident Stress Foundation (ICISF) model So, what is the CG’s policy regarding CISM? The current Commandant Instruction is 1754.3 and designates Critical Incident Stress Management as the standard of care for the organization, using the International Critical Incident Stress Foundation model.

Coast Guard Policy – cont. Work-Life EAPCs primary POC for CISM inquiries/response EAPCs are Team Coordinators and provide training, support and peer oversight for the Pacific Northwest Commands request CISM consultations and services from Work-Life EAPCs provides CISM, stress and resiliency training for units The Base Health Safety Work Life Regional Practice Employee Assistance Program Coordinators (or EAPCs) are the primary POC for the program within the region. We provide training and oversight for trained peers, support for units that have experienced a critical incident as well as unit training on stress and resiliency. To access team services, contact the EAPCs.

CISM Team Team Leader/Mental Health Professional Chaplains Peer Facilitators diverse operational backgrounds credibility in the field geographically considered command recommended Referral Resources

CISM Goals Mitigate impact on personnel Normalize stress symptoms/reaction Restore functioning CISM operates on the assumption that most responders will cope very well with even extremely stressful events. The goals of interventions are to minimize the impact, normalize reactions and restore folks to readiness. The CISM team has various tools used for various situations. All interventions are based on principles of Crisis Intervention/Psychological First Aid (either individual or group) Goals: 1. Stabilization 2. Symptom reduction 3. Return to adaptive functioning, or 4. Facilitation of access to continued care

Types of interventions 1 to 1 contacts CISM interventions include 1 to 1 contacts,

Types of interventions Defusing Types of interventions Defusing Defusings are less formal and shorter group meetings, usually held immediately after an incident (within 12-24 hours) used to prevent impact of an event. The focus of a defusing is to validate the groups’ experience, normalize reactions, check in to see how responders are doing and remind them of good coping skills.

Types of interventions Debriefings Group Debriefings are done when a fairly significant incident has impacted a work group. Debriefings are confidential group meetings, typically held 2-3 days after the incident is over, led by a CISM team of peers and leader/mental health professional. Sometimes a chaplain is included. Some of the indicators that a debriefing may be helpful are . . . Many individuals appear distressed There is evidence of significant distress, impairment, and/or dysfunction One’s usual coping mechanisms have failed The event is extraordinary Personnel are requesting help

Types of interventions Crisis Management Briefings Crisis Management Briefings (or CMBs) are more educational in nature. CMBs are structured organizational “all hands” type meetings designed to: provide information control rumors symptoms of distress basic stress management identify resources Photo – CMB provided for USCG and community in Kodiak, AK after murders at Communication Station Kodiak 2012 Types of interventions Crisis Management Briefings

Types of interventions Family Interventions Although CISM does not often provide Family interventions, in certain circumstances such as disasters, line-of-duty death or other situations that impact CG family members, we encourage commands to work with the CISM team to provide an opportunity for family members to hear from the command, learn about stress reactions, coping skills and referral resources. Photo: Port Security Unit 311 holds a Family Day as preparation for extended deployment.

Procedure If you are part of an incident & think CISM would be helpful, please request it through your chain of command! Chances are, if you are experiencing a reaction, someone else is too.

Procedure Crew notify OOD OOD notify OPS, XO, or CO Command notify Work-Life EAP Coordinator (Primary) HSWL Regional Manager (Secondary) *After hours contact Duty Work-Life Phone 206-595-6435

What then? Command consults with Work-Life EAPC Team Coordinator in determining appropriate response Work-Life EAPC engages CISM peer team members If you are interested in becoming a CISM peer, please review the Commandant Instruction, then schedule a conversation with an EAPC for more information on the application process.

EAP Coordinators HSWL Seattle CISM Program EAP Coordinators HSWL Seattle Ms. Karen Collins 503-861-6327 Ms. Kristin Cox 206-217-6607