Critical Incident Stress Management CISM


1
Critical Incident StressManagement (CISM)
Headquarters Southwest Region Civil Air
Patrol/USAF-Auxiliary
2
A
CISM PEP Talk
Pre-Exposure Preparation Talk
3
Objectives 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

4
CISM is a MandatedOperations Program!
It is not just a Chaplains program!
5
Just What is Stress
A state of physical and emotional arousal.
6
Where Does Stress Come From
Stimulus Stressor stimulus/demand
Response Stress Response
7
Some 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

8
For 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
9
2 Varieties of Stress ...
Eustress equals Good Stress --- Positive
motivating stress Distress equals Bad
Stress --- Negative excessive debilitating
stress
10
Some Generic Sources of Stress ...

• Biogenic
• Environmental
• Personality

11
Some Biogenic Stressors ...

• Caffeine
• Nicotine
• Amphetamines
• Cold allergy medicines
• Theophylline
• Illness
• Lack of sleep

12
Some Environmental Stressors ...

• Rain
• Temperature extremes
• Sounds --- screams
• Mud
• Smells
• G-forces
• Time of day

13
Personality
The way people are hard-wired.
14
Stress is Cumulative

• It builds up over time ...

15
Cumulative Stress
Is stress that ...

• Piles up (snowballs).
• Increases with time.
• Deteriorates
• Performance
• Relationships
• Health

16
We Used to Call it Burnout

• Increased cynicism.
• Increased physical lethargy.
• Procrastination.
• In the extreme even suicidal or homicidal
  thoughts or ideations.

17
Some 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

18
An Example of Cumulative Stress ...
The De Havilland Comet -- The Worlds First
Commercial Jet Airliner
19
Like 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!
20
Critical 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)

21
Cumulative stress can exacerbate critical
incident stress.
22
Critical Incidents

• are events that have the potential to create
  significant human distress and can overwhelm the
  usual coping mechanisms of individuals and/or
  groups.

23
How to Recognize Excessive Stress
24
Manifestations of Distress Can Take a Number of
Forms...

• Physical
• Cognitive
• Emotional
• Behavioral

25
Physical Manifestations

• Excessive sweating
• Nausea and/or vomiting
• Elevated pulse rate
• Elevated blood pressure
• Rapid breathing
• Dizziness

26
Cognitive Signs

• Confusion. Mumbling of words
• Difficulty making decisions
• Decreased concentration
• Memory dysfunction

27
Emotional Signs

• Emotional Shock
• Anger
• Grief
• Depression
• Feeling totally overwhelmed

28
Behavioral Signs

• Changes in ordinary behavior
• Changes in eating habits
• Decreased personal hygiene
• Prolonged silences
• Withdrawal

29
Stress Response Timelines

• Immediate -- up to 24 hours post event.
• Delayed -- 24 to 72 hours post event.
• Cumulative -- buildup of stress over time.

30
Post-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.
31
Examples 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

32
A 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.

33
Crisis Intervention
34
Crisis 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)

35
Crisis Intervention

• Is but one aspect of a continuum of care. It
  requires specialized and unique training.

36
Crisis InterventionPrinciples ...

• Spell B -I -S -E -P
• Brevity
• Immediacy
• Simplicity
• Expectancy
• Proximity

37
Critical Incident Stress Management (CISM)is

• one type of crisis intervention.
• It is a comprehensive systematic program for the
  mitigation of critical- incident related stress.

38
The 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

39
By 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

40
CISM is a comprehensive systematic maintenance
program for the overall well-being of our most
valuable assets
our members.
41
CISM involves many facets ...

• Pre-crisis preparation and education
• Demobilization (for large groups)
• Crisis management briefings (large groups also)
• Defusings
• Critical incident stress debriefing (CISD)

42
CISM also involves ...

• One-on-one individual crisis intervention
• Pastoral crisis intervention
• Family CISM
• Organizational crisis intervention /
  consultations
• Follow-up and referral mechanisms

43
CISM deals with the current circumstances the
current event or crisis NOT personal
histories.
It is First Aid not definitive care.
44
Some Key Elements of CISM ...
45
Pre-Incident Education

• General information stress trauma etc.
• Set expectations for actual
  experiences
• Teach stress management
  and coping skills

46
Demobilizations

• 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

47
Defusing

• 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

48
The Defusing 3-Step ...

• Introduction
• Exploration
• Information

49
The 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!

50
Objectives 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

51
CISDs consist of 7 stages ...
Mitchell 1991
52
Family 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

53
Referral ...

• 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.

54
Follow-up ...

• Essential element in all CISM interventions.
• Can be made by Phone calls
  Station / workplace visits Home visits

55
All CISM Interventions Are Strictly Confidential!
56
How well does CISM work

• Lets compare two airliner crashes to see ...

57
San 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
58
San 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
59
San 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
60
CISM Works!
61
CISM in the Civil Air Patrol
62
CAPs CISM Program

• Mandated by CAPR 60-5
• Not optional
• Specifically an operations program
• Implementation is assigned to Region Commanders
  by CAPR 60-5.

63
CAPs CISM Programcontd

• Wings are to assess the need for a CIST.
• All personnel are encouraged to receive CIS
  training.

64
CAPs 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

65
CAPs 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

66
A CAP CIST

• Consists of
• Mental Health Professionals (MHP)
• Peer Representatives
• CAPR 60-5 (3)a 2

67
Request 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.

68
Funding CISM

• CISM is not presently a specifically USAF
  funded mission (by itself).
• CAP CISM may be funded through an existing
  missions funding.

69
Funding 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.

70
For 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.

71
For More Information ...

• Call Chaplain Don Brown at [phone] or
  email him at lonecap_at_ev1.net.
• Sign up for the Basic Critical Incident Stress
  Management and other ICISF CISM courses.

72
Any Questions
73
(No Transcript)
74
Credits
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