1. Critical Incident Stress Management Kelly Burkholder-Allen Churton Budd Paul Rega

2. The responder is often a victim as well

4. Critical Incidents  Are events which have significant power to overwhelm an individual’s normally effective ability to cope  Individuals who experience a critical incident are faced with the demand to respond  They often respond in ways which require exceptional physical or heroic effort

5. Critical Incidents  Critical Incident Stress affects nearly 90% of all emergency personnel  Are emotionally charged events  The effects of critical incident stress can be intensified, influenced, or mitigated by our personal, family, and developmental issues  Symptoms usually subside within a few weeks

6. Critical Incident Stress  No one is immune from responding to the stress of a critical incident  Critical incident stress may occur hours, days, or even months after a critical event  You may experience symptoms of stress and not even know it  Suffering the stress effects following a critical incident stress is NORMAL

7. In the days immediately after a critical event  Maintain your schedule, alternate physical activity with relaxation  Remember that you are having normal reactions to an abnormal event  Reach out and spend time with others---they care  It is ok that you bad and talk about your feelings

8. After a critical event  Do things that feel good to you or provide you with comfort  Avoid drugs and alcohol to numb your emotions  Keep a journal  Don’t make life-altering changes at this time  Do make daily decisions and assume control over your life  Get plenty of rest, eat nutritiously, and take care of yourself

9. Normal signs and symptoms of stress  Physical Symptoms: –Nausea –Tremors –Chills –Diarrhea –Rapid heart rate –Muscle aches –Dry mouth –Shaking –Visual problems –Fatigue  Emotional Symptoms: –Anxiety –Denial –Fear –Survivor guilt –Uncertainty of feelings –Depression –Grief –Hopelessness –Feeling overwhelmed, lost, or abandoned –Wishing to hide or die –Anger –Feeling numb

10. Normal signs and symptoms of stress  Behavioral: –Change in activity –Withdrawal –Suspiciousness –Change in communication patterns –Changes in interpersonal interactions –Variations in food consumption –Excessive humor –Excessive silence –Unusual behavior –Increased smoking or alcohol consumption  Cognitive: –Confusion –Inability to pay attention –Difficulty calculating –Memory problems –Inability to concentrate –Repeated flashbacks –Nightmares –Blaming others –Disrupted logical thought process

11. Critical Incident Stress can be MANAGED!

12. CISM  Critical Incident Stress Management was first recognized and techniques to respond were developed in the 1980’s  The first team was in Virginia, today there are hundreds of teams worldwide

13. A seven phase process developed to:  Minimize the emotional and physical impact of an event  Prevent burn-out  Educate participants regarding normal stress reactions  Mitigate stress responses  Help to keep careers, relationships, and physical/mental health intact with little residual damage  Can be delivered in a 6 hour course

14. A formal debriefing:  Ideal debriefing time is between 24 and 72 hours post event  Generally lasts for 2-3 hours  Is a seven stage process

15. The seven phases of a formal debriefing: 1.Introduction 2.Fact phase 3.Thought phase 4.Reaction phase 5.Symptom phase 6.Teaching phase 7.Re-entry phase

16. Defusing  Defusing: –An abbreviated version of a debriefing in a small group process –Helpful when a full debriefing cannot be organized –Is held very soon after the event—ideal time within first 3 hours post event –Three main segments:  Introduction  Exploration  information –Four main goals:  Rapid reduction in the intensity to reactions  A normalizing experience  Re-establishment of the social network of the group  To assess whether a full debriefing will be necessary

17. Demobilization  Demobilization: –A very brief intervention that takes place immediately following the event –Primary stress prevention and intervention technique –Two main segments:  Brief period where personnel are given information to assist them with management of stress reactions  A rest and nutrition/rehydration period prior to return to duties –Goals of demobilization:  To provide a transition from the traumatic event or critical incident to the routine  To reduce the intensity of immediate stress-related reactions  Assessment of group for additional needs  To educate the group about potential stress reactions  To provide information about additional support  To establish positive expectations about outcome

18. What makes defusings and debriefings effective?  Early intervention  Opportunity for catharsis  Opportunity to verbalize about the trauma with those who experienced it  Behavioral structure  Psychological structure  Group support  Peer support  Promotes follow-up

19. CISM  Was designed to assist in the prevention, management, and recovery from a significant stress  Include pre-incident education, defusing, debriefings, support services, follow-up services, individual consults, peer counseling, and disaster management  CISM interventions are provided be especially trained individuals

20. CISM increases the rate of normal recovery, in normal people, who are having normal reactions to abnormal events

21. Professionals trained in CISM can provide: Defusing Demobilization Debriefing Recommendations for follow-up

22. Know your community’s resources! Find out who provides CISM services and make contact, if you or some one that you care about has experienced a critical incident