Rapid Trauma Intervention By Mark Lessard, PhD

Introduction u The goal of this class is to familiarize people with the effects of trauma and interventions to minimize its long-term consequences.

Traumatic Stress u Exposure to a crisis u Turning Point u Sudden u Unexpected u Dangerous u Immediacy u Unusual

Crises/personal u Rape u Assault u Auto Accident u Burglary

Crises/group u Natural Disasters u Plane Crashes u Terrorism u Operational Deaths

Victims u Primary u Secondary u Tertiary

Crises/Professional u Firefighters u Police u Paramedics u Physicians u Witnesses

Stress Response u Environmental Stimulus u Cognitive Interpretation u Affective Integration u Psychobiological Response

Effects of Stress/Cognitive u Confusion u Poor Concentration u Impaired ability to make decisions u Memory

Effects/Physical u Diaphoresis u Dizziness u Increased Heart Rate u Elevated Blood Pressure u Headaches u Gastrointestinal Upset

Effects /Emotional u Shock/Numbing u Anger u Grief/Sadness u Helplessness

Effects/Behavioral u CHANGE u Appetite u Sleep u Hygiene u Social

Acute Stress Disorder u Exposure to Trauma u Dissociation u Re-experiencing u Avoidance u Hyperarousal u Two days-- four weeks

Posttraumatic Stress Disorder u Exposure u Re-experiencing u Avoidance u Hyperarousal u Greater than one month

Who Will Be Most Affected? u Personal Factors: u Neurologic Predisposition u Background u Internal Locus of Control u Traumatic Factors: u Duration u Intensity

Intervention/Prevention u Education/ Stress Management u Trauma Immunization u Standard Processing With Peers

Intervention/On Scene/SAFE-R u Stimulation Reduction u Acknowledgment of Crisis u Facilitation of Understanding u Encourage Effective Coping u Restoration of Independent Functioning

Intervention/Debriefing u Introduction u Fact u Thought u Reactions u Symptom u Teaching u Re-entry

Intervention/Defusing u Abbreviated version of the debriefing u Introduction u Exploration u Information

Intervention/Demobilization u For Massive, ongoing, operations u Information regarding effects of stress and referral possibilities u Hot-line

Mechanism of Action u “Trauma Membrane” u Structuring the event u Group Support u Stress Education

A Case Example u Cerritos u Total Killed 82 u Survivors 0 u Homes 16 u Civilians 15 u Res Pers 300 u Body Parts u San Diego u Total Killed 125 u Survivors 0 u Homes 16 u Civilians 15 u Res Pers 300 u Body parts 10000

A Case Example u Cerritos u 12 Debriefings u Many Demobilizations u Hot-line u Follow-up u San Diego u Sporadic on-scene intervention

A Case Example u Cerritos u One Loss u Increase in MH 01% u San Diego u Loss of Police 5 u Loss of Fire 7 u Loss of Paras 17 u Increase in MH 31%

SPRINT u Special Psychiatric Rapid Intervention Team u Official Sites: San Diego, Portsmouth, Bethesda, Oakland u West Coast u East Coast u BUMED CODE-311

What to do u Acknowledge the Problem u Assess Magnitude, personal, group u Assess Local Assets/ Chaplains etc... u Sell to command u QUICKLY, organize CISD with local assets or Activate Sprint u Follow-up