Title: Critical Incident Stress Management
1(No Transcript)
2SNOWY RANGE ASSIST CISM TEAM
3SNOWY RANGE ASSIST CISM TEAM
MISSION STATEMENT To minimize the potentially
harmful stress- related symptoms associated with
critical incidents affecting emergency service
personnel and their families through timely
confidential crisis intervention that is
empathic and respectful toward all involved.
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- TEAM MISSION - Expanded
- The mission of the team is not to debrief the
public or victims - of disasters. However, the mental health members
may make appropriate referrals. Exceptions will
be discussed with the clinical or program
coordinator. - CISM Teams provide debriefing following
critical - incidents to any emergency response agency
requesting - assistance. The focus of this service is to
minimize the - harmful effects of job stress, particularly
in crisis or - emergency situations.
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THE CONCERN Emergency services personnel have
become increasingly aware of the toll that
unique occupation- related stressors may have on
their quality of life. The very nature of
emergency service jobs may expose these
individuals routinely, or periodically, to
stressful events which they may or may not be
able to work through satisfactorily on their
own. Factors which cause stress to one
individual may not be stressful for another.
worker or group of emergency workers.
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THE CONCERN (Continued) It has been
demonstrated that certain events, such as the
death of a child, the death of a co-worker, high
rise fires or multiple casualty incidents, are
particularly stressful for emergency workers. It
has been demonstrated that certain events, such
as the death of a child, the death of a
co-worker, high rise fires or multiple casualty
incidents, are particularly stressful for
emergency workers. Any of these events, plus a
host of others may cause or contribute to a
critical incident for an emergency worker or
group of emergency workers.
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THE CONCERN (Continued) Research has shown that
a very small percentage of emergency service
personnel are not actually affected by stress. Of
those who do demonstrate symptoms related to
stress, one-half can resolve these alone, while
the other half continue to be affected.
Responses to stress may be immediate and
incident specific, may be delayed for a period of
time after an incident, or may be cumulative,
building up after a long period of time and may
include many incidents.
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THE CONCERN (Continued) Multiple factors
affect an individual's response to stress and
include factors specific to the stressor, such as
the individual's personal qualities, past
experiences and the resources available to him
or her.
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A CRITICAL INCIDENT A critical incident is a
traumatic event, in an institution or in the
community, that is outside the range of usual
human experience and that may cause unusual
psychological distress and has sufficient
emotional power to affect a person's ability to
cope with the consequences of the event.
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A CRITICAL INCIDENT Jeffrey Mitchell, founder
of the International Critical Incident Stress
Foundation (ICISF), has defined a critical
incident as "any situation faced by emergency
service personnel that causes them to experience
unusually strong emotional reactions which have
the potential to interfere with their ability to
function either at the scene or later. All that
is necessary is that the incident, regardless of
the type, generates unusually strong feelings in
the emergency workers."
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- CRITICAL INCIDENT EXAMPLES
- Death of an emergency services worker, i.e.
law - enforcement, fire fighter or other emergency
- personnel in the line of duty, including
during the - incident, enroute to or following the scene,
or - during a training exercise.
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- CRITICAL INCIDENT EXAMPLES (Continued)
- Serious line of duty injury.
- Suicide of a crew member or other unexpected
death. - Mass casualty incidents.
- Serious injury or death of a civilian
resulting from - emergency services operations, i.e. auto
accident, etc.
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- CRITICAL INCIDENT EXAMPLES (Continued)
- Police shooting.
- Events that seriously threaten the lives of
responders. - Death of a child or violence to a child.
- Loss of life of a patient following
extraordinary and - prolonged expenditure of physical and
emotional - energy during rescue efforts by emergency
services - personnel.
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- CRITICAL INCIDENT EXAMPLES (Continued)
- Incidents that attract excessive media
coverage. -
- Personal identification with the victim or the
- circumstances.
- Events where the victims are relatives or
friends of - emergency personnel.
- Any incident that is charged with profound
emotion. -
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- CRITICAL INCIDENT EXAMPLES (Continued)
- Any incident in which the circumstances were
so - unusual or the sights and sounds so
distressing as - to produce a high level of immediate or
delayed - emotional reaction.
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A SOLUTION The Snowy Range ASSIST CISM Team
has been established to provide a form of crisis
intervention specifically designed to assist
emergency workers to reduce the number of
psychological casualties among their ranks.
Through critical incident stress debriefing,
emergency personnel are provided a tool to
potentially alleviate overwhelming emotional
feelings and physical symptoms.
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- THE TEAM
- The Snowy Range team consists of a
multidisciplinary group of certified
ICISF-trained professionals. Debriefers are
volunteers who are familiar with emergency
services. They are carefully selected from the
following groups - Mental health professionals
- Fire service personnel
- Chaplains
- Law enforcement
- Emergency Medical Services
- Field personnel from various agencies
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- THE TEAM (Continued)
- The highest priorities of the team are to
maintain - confidentiality and to respect the feelings
of the individuals - involved.
- It is not the function of a team to replace
on-going - professional counseling, but to provide
immediate crisis - intervention. Through the CISM process, a
team provides - emergency personnel tools to potentially
alleviate stress - related symptoms.
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- THE TEAM (Continued)
-
- CISM Teams also provide education regarding
critical - incident stress to emergency services
workers. CISM - Teams provide services to emergency/first
responder - personnel, hospital personnel, and spouses.
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- GROUPS SERVED BY THE
- SNOWY RANGE CISM TEAM
- Fire services - paid or volunteer
- EMS service - paid or volunteer
- Law enforcement personnel
- Search and rescue personnel
- Ski patrol organizations
- Hospital personnel
- Others
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TYPES OF INTERVENTIONS Several types of
interventions may be conducted depending upon
the circumstances of a particular incident.
Intervention may be on an individual one-on-one
basis or, ideally, in small groups. The following
types of interventions, singularly or in
combination, are most commonly utilized
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- TYPES OF INTERVENTIONS
- Pre-Incident Education
- On-scene support services
- Demobilization/de-escalation/decompression
- Defusing
- Formal debriefing
- Individual consults
- Significant other support
- Specialty debriefing
- Informal discussion
- Follow-up services
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- Pre-Incident Education
- Pre-incident education regarding stress,
stress recognition - and stress reduction strategies is an
essential part of the - CISM process.
- Educational programs for line and command
staff also - include information on critical incident
stress debriefings, - how to contact a team, and on-scene
considerations. - Programs should be provided for recruits,
refresher training, - and veteran personnel.
-
- Programs for spouses and significant others
may also include - stress recognition and management.
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- On-Scene Support Services
- Three types of services for prolonged or large
scale - incidents may be provided
- One-on-one sessions with rescuers exhibiting
signs of - obvious distress
- Consultation to the Incident Commander or
command - officers
- Assistance to victims of the incident as
needed
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- Demobilization/De-escalation/Decompression
- Utilized during or following a large scale
incident as units are released from the scene to
determine if all personnel are accounted for,
make announcements, etc. - A mental health professional or experienced peer
takes 15 minutes to provide information on the
signs and symptoms - of stress reactions that may occur. Lasts a
maximum of 30 minutes. - Unit may be released from duty or return to the
station in - service. Incident Commander may require
that all personnel - go through a demobilization session before
they are released - from the scene.
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- Defusing
- Defusing is a shortened version of the
debriefing. - Defusings take place immediately or relatively
- soon after the critical incident is finished
and - typically last less than one hour.
- The leader of a defusing may be a peer support
- person or one of the mental health support
people - on the critical incident stress management
team. - Defusings are designed to either eliminate
the - need to provide a formal debriefing or to
enhance - the debriefing if it is still necessary to
provide one.
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- Defusing
-
- A mini-debriefing for a small core or working
group - (such as an engine company) conducted at the
station - shortly after the incident, usually within
3-4 hours. - Provides information about the incident and
general - information and advice on stress reactions.
In some - circumstances a defusing may involve a more
in-depth - discussion of participants feelings and
reactions. - May be led by an experienced peer debriefer. A
- defusing may eliminate the need for a formal
debriefing.
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- DEBRIEFING
- A debriefing is a group meeting or discussion
about a - distressing critical incident.
- Based upon the core principles of education
and crisis - intervention, the critical incident stress
debriefing is - designed to mitigate the impact of a
psychologically - traumatic event (a critical incident) and to
assist personnel - in recovering as quickly as possible from
the stress - associated with the event.
- The formal critical incident stress debriefing
is a structured - group meeting using a seven-stage
intervention process.
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- Formal Debriefing
-
- Ideally conducted within 24-72 hours of the
incident. - Confidential non-evaluative discussion of the
- involvement, thoughts, and feelings
resulting from the - incident.
- Also provides discussion and education
regarding - possible stress-related symptoms.
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- Individual Consults
-
- One-on-one counseling for concerns related to
the - incident.
- May require a mental health professional.
Providing - individual counseling is not a function of
the CISM - Team. However, team clinicians may be
utilized for - referrals.
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- Significant Other Support
-
- Includes the following services
- Educational programs for significant others,
-
- Debriefings for significant others,
-
- Bereavement support,
- Grief and crisis counseling, and
- Family support
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- Specialty Debriefing
- Providing debriefing interventions for groups
not - directly involved in emergency services or
otherwise - outside the realm of the CISM Team.
- May be requested if services are not available
in the - mental health community.
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- Informal Discussion
- An informal leaderless discussion of the event
by - individual crews following return to
quarters. - Initial discussion occurs spontaneously in
many - groups and is not structured.
- It may be facilitated by a team peer member
who is - present.
- The focus of the discussion should be the
groups - reaction to the event rather than a
critique.
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- Follow-up Services
-
- Conducted following individual consults,
defusings, - debriefings, demobilizations, and
significant other - support in the weeks or months after an
incident. - May include an informal debriefing session,
phone - or personal follow-up.
- Concern with detecting delayed or prolonged
stress - syndrome.
- May also be used to evaluate debriefing
services - offered.
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- THE DEBRIEFING PROCESS
- Emergency services personnel, command staff,
- emergency management, medical control
authorities - (e.g., Public Health, Hospital, Nursing,
etc.) are - responsible for identifying and recognizing
significant - incidents that may require debriefing.
- When an occurrence is identified as a
critical - incident, a request for debriefing should
be made as - soon as possible.
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- THE DEBRIEFING PROCESS (Continued)
- The team is activated by a call to the
dispatch center in - the Sheriffs Office.
- Appropriate call information is obtained and
relayed to - the Snowy Range CISM Team.
- CISM interventions are coordinated by a
designated - team member to promote the quality of the
services - and to ensure appropriate procedures are
followed. - The team member also schedules requests for
- education/in-service presentations.
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- THE DEBRIEFING PROCESS (Continued)
- A team member contacts the agency requesting
services to - Assess the need for a formal debriefing, a
- defusing, or a referral.
- Determine the nature of the incident.
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- THE DEBRIEFING PROCESS (Continued)
- Team members should coordinate a time and
- location to meet prior to and following the
- debriefing to discuss the incident, available
- resource information, and the approach to be
- used during and after the debriefing.
- At times, they may wish to visit the incident
site before - the debriefing.
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- THE DEBRIEFING PROCESS (Continued)
- Arrange a time and location if a formal
debriefing - is indicated.
- Debriefings are optimally conducted within
24-72 hours of - the incident, and should not generally extend
beyond one - week.
- A 24 hour normalizing period following the
incident is - recommended.
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- THE DEBRIEFING PROCESS (Continued)
- If large numbers of personnel are involved,
debriefing - begins with those most involved with the
incident. - A defusing may be appropriate within 24 hours
of the - incident.
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- Debriefing Process Considerations
- The location selected for the debriefing
should be - free of distractions.
- Other potential sites include schools,
churches or - other meeting facilities. Crew quarters or
station - may also be utilized if appropriate to the
circumstances.
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- Debriefing Process Considerations (Continued)
- All emergency personnel involved in the
incident - should be invited to the debriefing and
encouraged - to attend. This includes, but is not limited
to fire, law - enforcement, dispatch, EMS personnel, and
hospital - emergency department personnel.
-
- A time for the debriefing should be selected
that is - most convenient for as many responders as
possible - and for the team members.
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- Debriefing Process Considerations (Continued)
- Agency management or command officers
- should be encouraged to relieve personnel
from - duty during the debriefing.
- The environment should be free of
interruptions, - phone calls, radios, and pagers. Turn off
pagers, - cell phones, radios, and other communication
- devices.
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- Debriefing Process Considerations (Continued)
- The team member contacted selects a debriefing
- team from available members.
- To assure the quality of the process, the team
- must consist of at least one mental health
- professional and two to three team members.
- The average team consists of 3 members.
- The mental health professional is the
designated - team leader.
- Team members who have responded to the
- incident should not be debriefers.
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- Guidelines For Debriefings
- Strict confidentiality must be maintained. All
- information regarding agencies involved,
- situation debriefed, and issues discussed
shall - not be divulged before or after a debriefing
- except with team members or as part of the
team - continuing education process.
- No mechanical recordings or written notes will
be - made during a debriefing. It is up to the
team to - enforce this rule during the debriefing.
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- Guidelines For Debriefings (Continued)
- No media personnel (TV, radio or newspapers)
- will be allowed to attend a debriefing.
- In the event that these individuals are
present - without team knowledge, phrases such as
- Everything said here is off the record may
be - helpful.
- This does not guarantee, however, that
- information will not be reported.
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- Guidelines For Debriefings (Continued)
- Participants in the debriefing may speak to
the - media either before or after the debriefing.
It is - important for team members to explain that
- individuals speak only for themselves and NOT
- for anyone else in the debriefing.
- Debriefers may speak to the media, but only to
- educate about the process of CISM and to
- discuss the effects of stress. All other
inquiries - should be referred to a Team Coordinator or
other - designated individual.
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- Guidelines For Debriefings (Continued)
- Debriefings are not a critique of the
incident. The - team has no evaluation function of tactical
- procedures.
- The debriefing process provides a format in
- which personnel can discuss their feelings
and - reactions and thus reduce the stress
resulting - from exposure to critical incidents.
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- CISD GOAL
- The goal of the CISD is to encourage
ventilation of - emotions and a re-balancing of the
individual and - the group, and to educate group members
regarding - normal stress reactions.
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- General Format For Formal CISD
- Introductory Phase
- Introduction of the CISM Team, description
of - the debriefing process, establish ground
rules.
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- Fact Phase
- Self introduction of participants, description of
- what the participants heard, saw, and did during
- the incident. Each participant is included in
turn - by completing the circle.
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- Thought Phase
- At what point did the participants realize this
was - an unusual situation? Content question What
- did you think at the time?
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- Reaction Phase
- Sharing of feelings at the scene, now, and in
past situations, if applicable. Content question
What - was the worst part for you?
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- Symptom Phase
- Perceived unusual experiences at the time of
- and/or since the incident. Expression of
participants - stress response syndromes. Content questions
- What symptoms let you know that this was
- different from other situations? What was your
- most intense reaction at the scene? What were
- your reactions later? Whats not going away?
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- Teaching Phase
- Team discusses stress response syndrome and
- normal signs, symptoms, and emotional reactions.
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- Re-entry Phase
- Wrap up loose ends, answer additional questions,
provide - final reassurances, establish a plan of action.
Content - questions What was your moment of strength?
What - did you feel good about in yourself? What was
positive - about your response? What will be valuable in
the future?
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- REMINDERS
- Referrals are made at the discretion of the
- debriefing team clinician.
- The CISM Team should follow-up with the
- debriefed agency in an appropriate period
- of time. The team leader and peer members
- may also provide appropriate follow-up.
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- REMINDERS (Continued)
- The potential need to debrief the debriefers
must - be considered by the debriefing team.
- Following the death of an emergency services
- worker in the line of duty, two debriefings
are - indicated. The first should ideally occur on
the - day of the death if possible. The second
should - occur as soon as possible after the funeral.
- Postponing the second debriefing for a week
is - probably too long.
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- ACCESSING THE TEAM
- Snowy Range ASSIST is available to any emergency
service requesting the team services. Any agency
requiring assistance may contact Snowy Range
ASSIST by calling 1-800-821-3711, 24 hours a day,
seven days a week. Be prepared to give
information to the following questions -
- Your agency's name, address and chief officer
- The nature and location of the incident
- Date and time of the incident
- The urgency of the situation
- The number of persons expected to attend the
debriefing - Your name and telephone number
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- ACCESSING THE TEAM (Continued)
- For optimal effectiveness, a formal debriefing
should be - conducted 24 to 72 hours following an
incident. It should - generally not be postponed for longer than
one week. - Because of Wyoming's rural population, special
circumstances - are often encountered, and debriefings must
be contoured to - each individual situation.
- All information during the debriefing is
strictly confidential and - will not be discussed with those not at the
session. Only - general information will be released.
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- AGENCY RESPONSIBILITIES
- Your agency will be asked to cover the
debriefers' - expenses such as travel, meals, and lodging,
if needed. -
- At the present time, all the services of the
debriefing - sessions are on a volunteer basis.
- Your agency should strongly encourage
attendance at - the debriefing session by all personnel
involved in the - incident from your agency as well as others
affected by - the incident.
-
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- Training
- All Teams shall follow the training outlines and
schedules. - All teams must receive training from an ICISF
approved trainer. New/additional members must
also - receive training from an ICISF approved
trainer.
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- Training (Continued)
- New member team training shall be a 16-hour
- basic training program plus field ride-along
time - for clinicians.
- New team members must complete the training
- session before being scheduled as active
- debriefing team members.
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- Training (Continued)
- Instructors in the training programs shall be
- experienced CISM Team members and approved
- by ICISF as basic trainers.
- Team training will be scheduled annually to
- provide new member training.
- The Network members will provide or assist
- Member Teams in providing continuing
education - offerings
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1-800-821-3711 Available 24/7