Yesterday Today & Tomorrow CISM Yesterday Today & Tomorrow

Civil War Nostalgia Illness observed most often among the youngest soldiers who frequently had no combat experience Symptoms Signs Causes Treatment Taken from War Syndromes and Their Evaluation by Kenneth C Hyams, MD MPH

Civil War Irritable Heart/Da Costa Syndrome Postulated cardiac condition evaluated among 300 patients in a specialized referral center Symptoms Signs Causes Treatment Taken from War Syndromes and Their Evaluation by Kenneth C Hyams, MD MPH

World War I Shell Shock Considered psychological Illness after initial evaluation of victims. Symptoms Signs Cause Treatment Taken from War Syndromes and Their Evaluation by Kenneth C Hyams, MD MPH

World War II Battle Fatigue (acute combat stress reaction) Symptoms Signs Cause Treatment Taken from War Syndromes and Their Evaluation by Kenneth C Hyams, MD MPH

COCOANUT GROVE HOTEL November 28th 1942 492 killed Event involved 187 firefighters, 26 engine companies, 5 ladder companies and 1 water tower 13 days before 6 firemen had been killed and 43 injured in a building collaspe

Pictures of Cocoanut Grove Fire The following pictures were from the Boston Globe Online Archives

Eric Lindeman 1944 Symptomatology and Management of Acute Grief American Journal of Psychiatry 101, pp141-148. Conducted interviews with 101 people. His work along with that of Caplan from Harvard University formed the basis of the development of the theory and practice of Crisis Intervention.

According to Lindemann persons experiencing acute grief may show one or more of: Somatic Distress Preocupation with the image of the deceased Guilt Hostile Reactions Loss of Patterns of condust

Crisis Intervention Crisis Intervention is emergency psychological care aimed at assisting individuals in a crisis situation to restore equilibrium to their biopsychosocial functioning and to minimise the potential for psychological trauma. Crisis can be defined as one’s perception or experiencing of an event or situation as an intolerable difficulty that exceeds the person’s current resources and coping mechanisms. The priority of crisis intervention and counseling is to increase stabilization. Crisis interventions occur at the spur of the moment and in a variety of settings, as trauma can arise instantaneously. Crises are temporary, usually with short span, no longer than a month, although the effects may become long-lasting. Taken from Wikipedia

A PRIMER ON CRITICAL INCIDENT STRESS MANAGEMENT (CISM) George S. Everly, Jr., Ph.D., C.T.S. and Jeffrey T. Mitchell, Ph.D., C.T.S. The International Critical Incident Stress Foundation As crises and disasters become epidemic, the need for effective crisis response capabilities becomes obvious. Crisis intervention programs are recommended and even mandated in a wide variety of community and occupational settings (Everly and Mitchell, 1997). Critical Incident Stress Management (CISM) represents a powerful, yet cost- effective approach to crisis response (Everly, Flannery, & Mitchell, in press; Flannery, 1998; Everly & Mitchell, 1997) which unfortunately is often misrepresented and misunderstood

Critical Incident Stress Management by Jeffrey T Critical Incident Stress Management by Jeffrey T. Mitchell taken from www.info-trauma.org What is CISM? Critical Incident Stress Management (CISM) iscomprehensive, integrated, systematic and multicomponent crisis intervention program. It was developed to help manage traumatic experiences within organizations and communities organizations and communities. CISM is a “package” of crisis intervention tactics that are strategically woven together to: Mitigate the impact of a traumatic event; Facilitate normal recovery processes in normal people, who are having normal reactions to traumatic events; 3) Restore individuals, groups and organizations to adaptive function; 4) Identify people within an organization or a community who would benefit from additional support services or a referral for further evaluation and, possibly, psychological treatment.

Critical Incident Stress Management by Jeffrey T Critical Incident Stress Management by Jeffrey T. Mitchell taken from www.info-trauma.org (continued) CISM is neither a form of psychotherapy, nor is it a substitute for psychotherapy. Instead, CISM is a broad collection of support services that can be selected and applied to assist people who are experiencing a strong reaction to a traumatic event. In other words, it is “psychological first aid” or “emotional first aid”. Similar to a toolbox with many tools for different purposes, CISM contains many crisis intervention “tools”. Some of those tools are useful before a traumatic event occurs. Others are useful while an event is ongoing. Still others are available for when the event is over.

Critical Incident Stress Management by Jeffrey T Critical Incident Stress Management by Jeffrey T. Mitchell taken from www.info-trauma.org (continued) Main Components of a CISM Program (include by are not limited to) • Pre-incident planning, policy development, education, training • Crisis assessment • Strategic planning • Individual crisis intervention • Large group interventions (Demobilization, Crisis Management Briefing) • Small group crisis interventions (Defusing, Critical Incident Stress Debriefing {CISD}) • Pastoral crisis intervention • Family support services • Significant other support services • Follow-up services • Referral services • Follow-up meetings • Post-incident education • Links to pre-incident planning and preparation for the next crisis

Critical Incident Stress Debriefing developed by Jeffrey T. Mitchell Ph.D.