1. CISM Critical Incident Stress Management for Emergency Services Personnel

4. WHAT ARE CRITICAL INCIDENTS? Events which may cause strong emotional effect on an emergency worker

5. WHAT ARE CRITICAL INCIDENTS? Line of duty Death or Major Injury

6. WHAT ARE CRITICAL INCIDENTS? Death or Major Injury of a child

7. WHAT ARE CRITICAL INCIDENTS? Prolonged Search and Rescue Efforts

8. WHAT ARE CRITICAL INCIDENTS? Mass Casualty Incidents

9. WHAT ARE CRITICAL INCIDENTS? Operations involving extensive media coverage

10. CRITICAL INCIDENTS ARE….. Knowledge of the victim Long extrication Loss of a fellow Emergency Worker

11. OR…….. Any situation that causes stress to the Emergency Worker

12. ONE OF THE LEADING CAUSES OF DEATH IN EMERGENCY SERVICE WORKERS IS STRESS-RELATED CARDIAC ARREST Educational programs for dealing with stress on a daily basis are essential in reducing stress.

14. New Castle County CISM Team Member of Delaware Volunteer Firefighter’s Association - DVFA New Castle County Volunteer Firefighter’s Association - NCCVFA International Critical Incident Stress Foundation – ICISF Team #434-R Established 1989

15. NEW CASTLE COUNTY CISM TEAM Volunteer/Paid Personnel Fire Fighters Ladies Auxiliary Paramedics Police Nurses Clergy Mental Health Providers Disaster Workers

16. Delaware CISM Teams Coordinators in all three counties with one Clinical Director. Police CISM Teams established in New Castle County PD, Wilmington PD, Newark PD, Delaware Capital Police, Dover PD, Georgetown PD, Laurel PD, and Delaware State Police (stand alone). Protected by the Delaware CISM Law. www.NCCCISM.com Facebook.com/NCCCISM Twitter: @NCCCISM

17. GOAL Assist Emergency Service Workers who face a Critical Incident Provide pre-incident education and information on how to overcome stress reactions Prompt activation of the New Castle County CISM Team

19. SERVICES On-scene support Demobilization Services Defusing Formal debriefings

20. SERVICES On-scene support

21. ON SCENE SUPPORT One-on-one support for Emergency Personnel at the scene Provide advice and support incident commanders at the scene on topics of stress management Assist the victims and family members until other help arrives

22. SERVICES On-scene support Demobilization Services

23. DEMOBILIZATION SERVICES FOR LARGE SCALE EVENTS (highly intense or unusual) Establish a location away from the scene for out-of- service units Provide support and information on stress effects resulting from the incident Provide a place for command to issue incident updates Provide reassurance that help is only a phone call away

24. SERVICES On-scene support Demobilization Services Defusing

25. DEFUSING Initial session for releasing stress Performed 1-3 hours following an incident Provides information and support about managing stress for all personnel involved in the incident Lasts about 45-60 minutes TOTALLY CONFIDENTIAL

26. SERVICES On-scene support Demobilization Services Defusing Formal debriefings

27. FORMAL DEBRIEFINGS The next step in the Stress Management process for workers that have been involved in a critical incident Occurs as a result of follow-up requests Led by a mental health professional with the aid of peer support TOTALLY CONFIDENTIAL

28. THE EMOTIONAL RESPONSES TO CRITICAL INCIDENTS ARE…. NORMAL REACTIONS BY NORMAL PEOPLE TO ABNORMAL SITUATIONS.

29. Everyone has good days and bad days. Just because you don't see them, doesn't mean they aren't happening.

30. EMERGENCY SERVICES A very demanding profession - career or volunteer Daily emotional and physical demands leading to a strain on minds and bodies Continuous stress without resolution - lessens productivity and shortens careers

31. CISM INTERVENTION The required preventive maintenance of our minds and bodies

32. STRESSES FACED BY EMERGENCY SERVICE WORKERS Always on alert Dealing with tragedy Dealing with death

34. “Studies have found that between 7 and 19 percent of active duty police have PTSD, while MRIs of police officers’ brains have found a connection between experiencing trauma and a reduction in areas that play roles in emotional and cognitive decision-making, memory, fear, and stress regulation.”

35. PHYSICAL SIGNS OF STRESS Tension - chest pains, trembling, fidgeting, fumbling Jumpiness - easily startled Cold sweats, dry mouth, pale skin Pounding heart - lightheaded, dizzy Shortness of breath Nausea

36. PHYSICAL SIGNS OF STRESS Bowel or bladder disturbance Incontinence Fatigue Frequent Illness Day dreaming

37. EMOTIONAL SIGNS OF STRESS Changes in behavior Anxiety Irritability Lack of attention Lost train of thought Trouble sleeping Grief Crying

38. EMOTIONAL SIGNS OF STRESS Memory Problems Depression Anger Loss of confidence Rapid Mood Change Taking unnecessary chances Excessive use of Drugs or Alcohol

39. SIGNS/SYMPTOMS - A cry for help….. Watch for signs in yourself and co-workers Being aware enables you to help someone. KEEP AN EYE ON EACH OTHER, BECAUSE NO ONE ELSE CAN.

40. FEELING STRESSED? Keep calm and in control Focus on immediate assignment Talk to someone, anyone, everyone Take a deep breath Shrug your shoulders to reduce tension Keep a sense of humor Stay in touch with your colleagues

42. FEELING STRESSED? Exercise Eat properly Talk to friends and family, let them know what you are going through REMEMBER… STRESS REACTIONS ARE NORMAL

43. Keep in touch with loved ones.

44. WHEN A CRITICAL INCIDENT HAPPENS…. Contact your OIC Officer contacts the New Castle County CISM team via Fire board The CISM coordinator will set up a team and schedule a time for a defusing or debriefing

45. THINGS THE COORDINATOR NEEDS TO KNOW…. Why CISM is needed? What signs of stress are present? Who was involved? (# of persons) When session can take place? Where to meet and who to contact?

46. WHAT TO DO WHILE THE TEAM IS RESPONDING…. Support your co-workers

47. AN INCIDENT MAY TRIGGER REACTIONS FROM A PRIOR INCIDENT

48. STRESS CAN ACCUMULATE *Don’t let it build up* Talk Talk Talk!!!

49. STRESS IS EVERYWHERE Take care of Stress Before it takes care of YOU!!

50. Emergency Workers do not snore, burp, sweat or pass gas. There fore, they must “Bitch or they will BLOW UP!!

51. REMEMBER…. THE EMOTIONAL RESPONSES TO CRITICAL INCIDENTS ARE…. NORMAL REACTIONS BY NORMAL PEOPLE TO ABNORMAL SITUATIONS.