1. Yesterday Today & Tomorrow
CISM
Yesterday Today & Tomorrow

2. 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

3. 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

4. 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

5. 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

6. COCOANUT GROVE HOTEL
November 28th 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

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

13. Eric Lindeman 1944
Symptomatology and Management of Acute Grief American Journal of Psychiatry 101, pp
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.

14. 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

15. 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

16. 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

17. Critical Incident Stress Management by Jeffrey T
Critical Incident Stress Management by Jeffrey T. Mitchell taken from
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.

18. Critical Incident Stress Management by Jeffrey T
Critical Incident Stress Management by Jeffrey T. Mitchell taken from (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.

19. Critical Incident Stress Management by Jeffrey T
Critical Incident Stress Management by Jeffrey T. Mitchell taken from (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

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