Title: Critical Incident Stress Management CISM
1Critical Incident StressManagement (CISM)
Headquarters Southwest Region Civil Air
Patrol/USAF-Auxiliary
2A
CISM PEP Talk
Pre-Exposure Preparation Talk
3Objectives of this presentation
To provide the participants with ...
- A review of the causes and effects of stress
- Some cues to identify stress and tools to manage
it - An overview of critical incident stress crisis
management and critical incident stress
management (CISM) - An orientation to CAPs CISM program
4CISM is a MandatedOperations Program!
It is not just a Chaplains program!
5Just What is Stress
A state of physical and emotional arousal.
6Where Does Stress Come From
Stimulus Stressor stimulus/demand
Response Stress Response
7Some Definitions ...
- Stressor -- a stimulus that causes evokes or is
otherwise strongly associated with the stress
response - Stress response -- Nonspecific response of the
body to a demand(s) - Target organ(s) -- The part of the body or mind
that is the recipient of the stress response and
which develops the signs symptoms of
over-arousal
8For example ...
- While flying the stressors of heat and G-forces
affect the body. - Next a stress response occurs in the inner ear
leading to a condition known as vertigo. - Then the target organ of the stomach is
over-aroused and decides to get rid of food!
airsickness
92 Varieties of Stress ...
Eustress equals Good Stress --- Positive
motivating stress Distress equals Bad
Stress --- Negative excessive debilitating
stress
10Some Generic Sources of Stress ...
- Biogenic
- Environmental
- Personality
11Some Biogenic Stressors ...
- Caffeine
- Nicotine
- Amphetamines
- Cold allergy medicines
- Theophylline
- Illness
- Lack of sleep
12Some Environmental Stressors ...
- Rain
- Temperature extremes
- Sounds --- screams
- Mud
- Smells
- G-forces
- Time of day
13Personality
The way people are hard-wired.
14Stress is Cumulative
- It builds up over time ...
15Cumulative Stress
Is stress that ...
- Piles up (snowballs).
- Increases with time.
- Deteriorates
- Performance
- Relationships
- Health
16We Used to Call it Burnout
- Increased cynicism.
- Increased physical lethargy.
- Procrastination.
- In the extreme even suicidal or homicidal
thoughts or ideations.
17Some Signs Symptoms of Cumulative Stress
- Tardiness
- Fatigue
- Detachment
- Depression
- Medication or drug use.
- Irritability
- Gallows humor
- Paranoia or irrational fears.
- Derogatory speech or labeling of others.
- Denial
- Increased workplace absences.
- Irresponsibility
18An Example of Cumulative Stress ...
The De Havilland Comet -- The Worlds First
Commercial Jet Airliner
19Like With The Airliner ...
- Stress is the wear and tear on our human coping
systems. Over time minor stresses can have major
and damaging effects. This is the cumulative
effect of stress.
and we can crash too!
20Critical Incident Stress
- Any event in which there is a stressful impact
sufficient enough to overwhelm the usually
effective coping skills of either an individual
or a group. - (Everly Mitchell 1999)
21Cumulative stress can exacerbate critical
incident stress.
22Critical Incidents
- are events that have the potential to create
significant human distress and can overwhelm the
usual coping mechanisms of individuals and/or
groups.
23How to Recognize Excessive Stress
24Manifestations of Distress Can Take a Number of
Forms...
- Physical
- Cognitive
- Emotional
- Behavioral
25Physical Manifestations
- Excessive sweating
- Nausea and/or vomiting
- Elevated pulse rate
- Elevated blood pressure
- Rapid breathing
- Dizziness
26Cognitive Signs
- Confusion. Mumbling of words
- Difficulty making decisions
- Decreased concentration
- Memory dysfunction
27Emotional Signs
- Emotional Shock
- Anger
- Grief
- Depression
- Feeling totally overwhelmed
28Behavioral Signs
- Changes in ordinary behavior
- Changes in eating habits
- Decreased personal hygiene
- Prolonged silences
- Withdrawal
29Stress Response Timelines
- Immediate -- up to 24 hours post event.
- Delayed -- 24 to 72 hours post event.
- Cumulative -- buildup of stress over time.
30Post-Traumatic Stress is ...
- a normal reaction in a normal person to an
abnormal event. - a survival mechanism whereas
Post-Traumatic Stress Disorder
(PTSD) is a pathogenic (unhealthy) variation of
that normal survival mechanism.
31Examples of Critical Incidents
- Line of duty death or death at workplace
- Serious line of duty injury or workplace injury
- Suicide of coworker friend family member
- Multiple casualty incidents (MCIs) disasters
- Significant events involving children
- Prolonged events especially with loss
- Any powerful event which overwhelms a persons
normal coping mechanisms
32A Crisis
A response to an event wherein ...
- Ones normal psychological balance (homeostasis)
has been disrupted - Ones usual coping mechanisms have failed to
reestablish the needed homeostasis or - There is evidence of functional impairment.
33Crisis Intervention
34Crisis Intervention is ...
The provision of timely emotional first aid
- An exercise in psychological damage control.
Stopping the bleeding! - Not a cure
- An opportunity for assessment and for follow-up
- Guided by a mental health professional (MHP)
35Crisis Intervention
- Is but one aspect of a continuum of care. It
requires specialized and unique training.
36Crisis InterventionPrinciples ...
- Spell B -I -S -E -P
- Brevity
- Immediacy
- Simplicity
- Expectancy
- Proximity
37Critical Incident Stress Management (CISM)is
- one type of crisis intervention.
- It is a comprehensive systematic program for the
mitigation of critical- incident related stress.
38The goals of CISM ...
- Prevent traumatic stress
- Mitigate traumatic stress
- Intervene to assist recovery from traumatic
stress - Accelerate recovery
- Restore function
- Maintain worker health and welfare
39By way of analogy ...
- According to the Wing Aircraft Maintenance
Officer HQ-TX Wing expects to spend
approximately 187000.00 - this year to maintain our fleet of airplanes.
- But
- how much are we spending to maintain our most
valuable assetOUR PEOPLE
40CISM is a comprehensive systematic maintenance
program for the overall well-being of our most
valuable assets
our members.
41CISM involves many facets ...
- Pre-crisis preparation and education
- Demobilization (for large groups)
- Crisis management briefings (large groups also)
- Defusings
- Critical incident stress debriefing (CISD)
42CISM also involves ...
- One-on-one individual crisis intervention
- Pastoral crisis intervention
- Family CISM
- Organizational crisis intervention /
consultations - Follow-up and referral mechanisms
43CISM deals with the current circumstances the
current event or crisis NOT personal
histories.
It is First Aid not definitive care.
44Some Key Elements of CISM ...
45Pre-Incident Education
- General information stress trauma etc.
- Set expectations for actual
experiences - Teach stress management
and coping skills
46Demobilizations
- Decompression
- Transition workers from disaster work
(large-scale incident) to routine duties or home - Used with large numbers of people
- A 10- to 30-minute session
- An opportunity for assessment of group needs
- Alert workers to possible stress effects
- Always followed by a CISD (debriefing usually
within one week
47Defusing
- A small group intervention conducted within hours
of the incident usually within 12 hours - Shortened version (20-45 mins) of the CIS-
Debriefing - May eliminate the need for or increase
effectiveness of CISD opportunity to assess the
need for CISD - Seeks to reduce intense reactions to a trauma
- Seeks to normalize the effects of the event
48The Defusing 3-Step ...
- Introduction
- Exploration
- Information
49The Critical Incident Stress Debriefing (CISD)
- A group discussion of a traumatic event
- Peer driven
- Clinician (MHP) guided
- Lasts 1-3 hours
- Closed circle format
- Held 1 - 10 days post event
- NOT psychotherapy!
50Objectives of the CISD
- Education
- Ventilation
- Reassurance and forewarning
- Positive contact with a MHP
- Improvement of interagency cooperation
- Increase group cohesiveness
- Restore self-confidence
- Facilitation of follow-up
51CISDs consist of 7 stages ...
Mitchell 1991
52Family Support
- An essential component of a comprehensive CISM
program - Consists of Educational programs
CISD for significant others Bereavement
support -- grief and crisis counseling - Provided by peers MHP clergy trained spouses
- Includes children and elderly as well
53Referral ...
- Is made to obtain a more thorough a process of
assessment and evaluation - The mental health provider should understand the
culture of the agency in which the person is
employed and - should have specialized training/experience in
post-traumatic stress.
54Follow-up ...
- Essential element in all CISM interventions.
- Can be made by Phone calls
Station / workplace visits Home visits
55All CISM Interventions Are Strictly Confidential!
56How well does CISM work
- Lets compare two airliner crashes to see ...
57San Diego 1978 v. Cerritos 1986
San Diego Cerritos
Total Killed 125 82 Aircraft
Survivors 0 0 Homes
Destroyed 16
16 Killed on Ground 15
15 ESP used 300 300 Body Parts
Recovered 10000 10000
San Diego PSA-182 9/25/1978 Cerritos
Aeromexico 8/31/1986
58San Diego v. Cerritoscontd
Types of Critical Incident Interventions Provided
San Diego 1978 Cerritos 1986 Sporadic 1 on
1 12 CISDs Crisis Interventions
Demobilizations Crisis hotline Follow-ups
with MHPs
59San Diego v. Cerritos
Personnel losses among responders within 1 year
of event
SD CER Ranking PD 5
0 FD Personnel 7 1 EMS Personnel 17 0
Increase in MH utilization within community
within 1 year
31 1
60CISM Works!
61CISM in the Civil Air Patrol
62CAPs CISM Program
- Mandated by CAPR 60-5
- Not optional
- Specifically an operations program
- Implementation is assigned to Region Commanders
by CAPR 60-5.
63CAPs CISM Programcontd
- Wings are to assess the need for a CIST.
- All personnel are encouraged to receive CIS
training.
64CAPs CISM Program ...
- The use of qualified local non-CAP teams to
respond to incident stress-affected CAP members
is highly encouraged The use of local non-CAP
teams will somewhat limit the need to dispatch a
trained CAP - CIS Team
- --CAPR 60-5 (2)e
65CAPs CISM Program ...
- Each active duty Air Force base is required to
have a CIST which with prior coordination may
be able to support CAP - --CAPR 60-5 (2)e
66A CAP CIST
- Consists of
- Mental Health Professionals (MHP)
- Peer Representatives
- CAPR 60-5 (3)a 2
67Request Deployment
- After a SAR or DR mission a review of the
need for CIS intervention should be made for all
personnel ... - The incident commander or unit commander will
pass a request to wing commander. - In consultation with staff the wing CC will
coordinate use of a local non-CAP team or request
one of the Region teams.
68Funding CISM
- CISM is not presently a specifically USAF
funded mission (by itself). - CAP CISM may be funded through an existing
missions funding.
69Funding CISM
- The CAP Natl HQ has approved limited funding to
support CISM missions nationally. - Housing and feeding of a team will normally NOT
be reimbursed. - The use of host families is encouraged to
mitigate housing costs.
70For More Information ...
- Visit the web site of the International Critical
Incident Stress Foundation (ICISF) at
http//www.icisf.org. - Join the ICISF.
- Review CAPR 60-5.
71For More Information ...
- Call Chaplain Don Brown at (936) 394-3310 or
email him at lonecap_at_ev1.net. - Sign up for the Basic Critical Incident Stress
Management and other ICISF CISM courses.
72Any Questions
73(No Transcript)
74Credits
Ch Lt Col DONALD R. BROWN II CAP SWR Deputy
Chaplain and CISM Director
Lt Col Sherry Jones RN CAP Special Advisor to
the National Commander for CISM
1st Lt Penny Herndon-Finuf RN CAP SWR/TXWNG
CISM Educational Officer