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First Responders: Self Care, Wellness, Health, Resilience & Recovery Dealing with Stress: Personal, Department/Job, Home & Family in the Aftermath of Disasters – PowerPoint PPT presentation

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Title: First Responders: Self Care, Wellness, Health, Resilience


1
First RespondersSelf Care, Wellness, Health,
Resilience Recovery
  • Dealing with Stress
  • Personal, Department/Job, Home Family in the
    Aftermath of Disasters

Philip T. McCabe CSW, CAS, CDVC UMDNJ School
of Public Health- Office of Public Health
Practice Center for Public Health Preparedness
at UMDNJ Robert Wood Johnson Medical
School American Academy of Health Care Providers
in Addictive Disorders American Public Health
Association International Critical Incident
Stress Foundation
2
Objectives
  • Help first responders better understand stress
    and critical incidents
  • Increase awareness of self care and helpful
    resources
  • Recognize symptoms in ones self and in others
  • Is not intended to certify or credential anyone
    in clinical care, CISM, or other related activity

3
STRESS
  • Forty-three percent of all adults suffer adverse
    health effects from stress.
  • 75 to 90 percent of all physician office visits
    are for stress-related ailments and complaints.
  • Stress is linked to the six leading causes of
    death--heart disease, cancer, lung ailments,
    accidents, cirrhosis of the liver, and suicide.
  • The Occupational Safety and Health Administration
    has declared stress a hazard of the workplace.

4
Managing a mass casualty or bioterrorism
situation is no job for a single provider
organization.
5
This is, in fact, the responsibility of the
community a composite that, at a minimum,
includes
  • fire, police
  • emergency medical services
  • The public health system
  • local municipalities and government authorities
  • local hospitals and other health care
    organizations.

6
Disaster Response and the Publics Health
  • Public and Private
  • Outpatient/ Hospital

Medical Care System
Emergency Response System
Public Health System
  • EMS
  • Police/Fire
  • Water/Electric/ Communication Emerg.
    Response
  • Protection
  • Prevention
  • Promotion

7
Mental Health in Disaster and Terrorism
  • Change in Safety
  • Change in Travel

Distress Responses
Human Behavior in High Stress
Environments
Mental Health/ Illness
  • Smoking
  • Alcohol/Drugs
  • Violence
  • Over dedication
  • PTSD
  • Depression

8
Police/Fire/EMS/Rescue Workers
  • Individuals who traditionally work is stressful
    environments often develop various coping skills
    and strategies.
  • Resilience Recovery
  • Core Identity Development/Personality
  • learned behavior reactions
  • typical response to difficult situations

9
Police/Fire/EMS/Rescue Workers
  • Often these skills enable you to respond and
    maintain you level of function in performance of
    your duties, especially during difficult
    situations

10
Police/Fire/EMS/Rescue Workers
  • Some of the approaches can be considered healthy
    or positive
  • others may have a negative or unhealthy
    consequence.

11
Police/Fire/EMS/Rescue Workers
  • they can be appropriate for the individuals
    involved
  • they may seem unusual or strange to an outsider.

12
  • Who we are
  • What we do
  • Does what we do identifies who we are?
  • What else defines us?
  • List of characteristics
  • Personal
  • Professional

13
First Responders
  • Protectors
  • Helpers
  • Rescuers
  • Caretakers
  • Miracle Workers

14
Personality Traits
  • Obsessive Compulsive
  • Control Issues
  • Action orientated
  • Risk taker
  • High need for stimulation\
  • Highly dedicated
  • Easily bored
  • Need to be needed
  • Difficulty saying No
  • Caretakers
  • Family orientated
  • High tolerance for stress
  • Addiction to trauma

15
Critical Incident
  • Outside the range of normal coping skills
  • Normal reaction to an abnormal situation

16
What Is A Critical Incident?
  • Any situation that results in an overwhelming
    sense of vulnerability or loss of control.
  • Roger Solomon, Ph.D.
  • 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.
  • Jeff Mitchell, Ph.D.

17
Critical Incidents
  • Are sudden and unexpected!
  • Disrupt our sense of control!
  • Involve the perception of a life - damaging
    threat.
  • May involve emotional or physical loss!

18
Fight or Flight
  • Faced by a threat, your body responds with a
    complex cascade of chemicals.
  • The hypothalamus, alerted by the brain, pumps out
    a specialized hormone that ultimately prompts the
    two adrenal glands (perched atop the kidneys) to
    release the energizing hormone known as
    adrenaline.
  • The resultfaster pulse, higher blood pressure,
    sharpened awarenessis the "fight or flight"
    response to fear and anxiety.

19
Core Issues
  • Suicide
  • Substance Abuse
  • Stress
  • Burn-out/PTSD
  • Martial- Family
  • Violence
  • Shut down
  • Spirituality

20
Understanding the Blue Culture
  • Police Officers taught to take care of everyone
    else.
  • To Serve and Protect
  • Dont feel
  • Use police officer face/persona
  • Walking wounded
  • Us vs. Them
  • Law enforcement officers - all others

21
Types of CI for Law Enforcement
  • LODD
  • Serious injury
  • Suicide of co-worker
  • Multi-causality Incident
  • Police Shooting that ends with injury or death
  • Death or violence to a child
  • A prolonged event, with a negative results
  • Extensive media attention
  • Knowing the victim of the event

22
Sources of stress for individual officers can be
placed into five general categories
  • issues in the officer's personal life
  • the pressures of law enforcement work
  • the attitude of the general public toward police
    work and officers
  • the operation of the criminal justice system
  • the law enforcement organization itself.

23
Stress in Law Enforcement
  • Internal (department)
  • External (community)
  • Cumulative (career)
  • Critical Incident Stress
  • Family Stress

24
  • What we dont often
  • talk about

25
Police Suicide
  • Impulsive Suicide
  • Depressed Suicide
  • Suicide as an escape to suffering
  • Communication Suicide
  • Loss of a loved one

26
Risk Factors
  • Immediate Plan
  • Lethality
  • Family history
  • Alcohol
  • Access to weapon
  • History of Attempts
  • Family Problems

27
Suicide Components
  • Hopeless
  • Helpless
  • Worthless

28
Disturbing Legacy of Rescues Suicide
  • Bob Long, a surveyor credited with finding the
    nine trapped Pennsylvania coal miners, killed
    himself in June.
  • Terry Yeakey, an Oklahoma City police sergeant
    who rescued four bombing victims in 1995,
    committed suicide the following year.
  • Robert O'Donnell, a paramedic who played a
    crucial role in saving baby Jessica McClure from
    a Texas well shaft in 1987, took his life nearly
    eight years later.

29
Common factors in suicide by law enforcement
officers
  • Alcohol.
  • Coupled with an always-present firearm
  • drinking and depression are major causes of
    police officer suicides.

30
Common factors in suicide by law enforcement
officers
  • Breakup of a relationship or marriage.
  • Often, the only people outside law enforcement an
    officer trusts are his or her family.
  • When a relationship ends, an officer loses his or
    her emotional support base.
  • Stagnated career.
  • An officer under investigation.

31
Common police suicide warning signs
  • An officer who starts having a high number of
    off-duty accidents.
  • A rise in citizen complaints about
    aggressiveness.
  • A change in personality in which a sullen officer
    suddenly becomes talkative or an officer who is
    normally very vocal becomes silent and withdrawn.
  • The law enforcement official starts giving away
    prized possessions or telling friends they will
    be missed.
  • The officer suddenly writes a will.
  • Source The National P.O.L.I.C.E. Suicide
    Foundation

32
HEALTH WELLNESS
  • What is good health?
  • What is wellness?
  • What is comfort?

33
People can use rituals to find comfort
  • Family
  • Friends

34
People can use rituals to find comfort
  • Activity

35
People can use rituals to find comfort
  • Religion/Spirituality

36
  • Even the most experienced and skilled
    professional can be affected by their work.

37
Whats in a name ?
  • Unfortunate Incident
  • Urgent situation
  • Risky Business
  • Disturbance
  • Hazardous
  • Unsafe
  • Treacherous
  • Emergency
  • Dangerous
  • Tragedy
  • Distress
  • Crisis
  • Disaster
  • SNAFU
  • Critical
  • Trauma

38
Phases of a Crisis
  • Impact
  • Inventory
  • Rescue
  • Recovery

39
Topic 1 Psychological Phases of a Disaster
From Zunin Myers (2000)
40
Critical Incident
  • A critical (or traumatic) incident is any event
    outside the usual realm human experience that is
    markedly distressing
  • (e.g. evokes reactions of intense fear,
    helplessness, horror, etc.)

41
Critical Incident
  • Such critical incidents usually involve the
    perceived threat to one's physical integrity or
    the physical integrity of someone else.

42
Critical Incident
  • Most importantly, critical incidents are
    determined by how they undermine a person's sense
    of safety, security and competency in the world.

43
Critical Incident
  • This results in a form of psychiatric injury,
    also called traumatic impact or traumatic stress.

44
What is a Traumatic Incident?
  • A situation that is extraordinary and may
    overwhelm coping mechanisms
  • Causes the worker to experience a stress reaction
  • Unusually strong emotional reactions at any time
    during or after the incident

45
Symptoms of a Stress Reaction
  • Can last
  • a few days
  • a few weeks
  • a few months
  • and occasionally longer
  • Support and understanding of loved ones needed

46
Symptoms of a Stress Reaction
  • difficulty feeling love and intimacy
  • difficulty taking interest and pleasure in
    day-to-day activities

47
Symptoms of a Stress Reaction
  • Professional assistance may be necessary

48
Can be broken down into 4 categories
  • Emotional
  • Cognitive
  • Behavioral
  • Physical

49
Emotional
  • feelings of shock
  • Anxiety
  • Guilt
  • Grief
  • Severe panic
  • Fear
  • Uncertainty
  • Depression
  • Apprehension
  • Intense Anger
  • Irritability
  • Agitation
  • Resentment
  • Shame
  • helplessness
  • hopelessness
  • emotional numbness
  • Feeling overwhelmed

50
Cognitive
  • Blaming someone
  • Confusion
  • Heightened or lowered awareness
  • Indecisiveness
  • Worry
  • Shortened attention span
  • Self-blame
  • Poor concentration
  • Memory problems
  • Hypervigilence
  • Poor problem solving
  • Nightmares
  • Intrusive images
  • Loss of time, place, or person orientation

51
Behavioral
  • Change in activity
  • Change in speech patterns
  • Withdrawal
  • Emotional outbursts
  • Increase or decrease in appetite
  • Startle reflex intensified
  • Change in sexual functioning
  • Erratic movement
  • Antisocial acts
  • Suspiciousness/
  • paranoia
  • Pacing
  • Alcohol and/or drug consumption

52
Physical
  • Fatigue
  • Nausea
  • Muscle cramps
  • Twitches
  • Chest pain
  • Difficult breathing
  • Grinding of teeth
  • Elevated blood pressure
  • Rapid heartbeat
  • Thirst
  • Headaches
  • Visual difficulties
  • Profuse sweating

53
TRAUMATIC STRESS
  • Years ago, PTSD was commonly called "combat
    fatigue soldiers heart or "shell shock."

Many people believed that only soldiers or other
people who had been in a war could get PTSD.
54
Traumatic Stress
  • Trauma is considered an event outside the normal
    range of experience.

55
Learning from Our Past Experience
  • The mental fallout from the Oklahoma City
    bombings in 1995 didnt peak until 12 to 18
    months after the event.

56
Learning from Our Past Experience
  • One year after the bombing, three times as many
    residents of Oklahoma City reported increased
    drinking as those in a control community
    (Indianapolis). Rescue workers in Oklahoma City
    experienced elevated rates of substance abuse,
    depression and suicide.

57

58
Beyond the range of normal experience
59
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60
Stress-Related Illnesses During the 11 Months
After the Attacks (September 11, 2001--August
22, 2002)
  • During the 11 months after the attacks, 1,277
    stress-related incidents were observed among FDNY
    rescue workers, a 17-fold increase compared with
    the 75 stress-related incidents reported during
    the 11 months preceding the attacks.

61
  • As of August 28, 2002, a total of 250 FDNY rescue
    workers remain on leave with service-connected,
    stress-related problems. Of these, 37 also have
    respiratory problems

62
  • As of August 28, 2002, a total of 358
    firefighters and five EMS workers remained on
    medical leave or light duty assignment because of
    respiratory illness that occurred after WTC
    exposure.

63
  • The number of New York City firefighters and
    emergency medical service workers being treated
    for alcohol and drug abuse in 2004 is more than
    50 percent higher than it was the year previous.

64
  • The counseling unit of the Fire Department has
    seen an increase in every diagnostic category
    since Jan. 1. 2004
  • After Sept. 11, the department's caseload went
    from an annual average of 600 cases over all to
    3,600.
  • Most of those cases are for anxiety and
    bereavement after the terrorist attack.
  • The alcohol and drug treatment cases represent 4
    percent of the counseling unit's total caseload.

65
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66
Police Organization ProvidingPeer Assistance
(POPPA)
  • POPPA is a confidential, voluntary,
  • independent, no departmental assistance program
    for the NYPD that uses trained volunteer NYPD
    officers as peer support officers.

67
Police Organization ProvidingPeer Assistance
(POPPA)
  • In the first year, there were about 250 calls to
    the help line.
  • Since 2001, the number of calls has increased to
    between 900 and 1,200 per year.
  • The proportion of callers who accept a referral
    for professional assistance has also increased,
    from about 30 percent to 45 percent of callers.

68
However, the primary reasons for calls over the
years 2003 and 2004 were in the areas of
  • stress or anxiety (34 percent)
  • alcohol problem (26 percent)
  • marital problem (24 percent)
  • Traumatic stress (18 percent)
  • depression (14 percent)
  • bereavement issues (7percent).
  • Because of confidentiality issues, detailed
    information is unavailable.

69
New Jersey Cop 2 Cop
  • Cop 2 Cop which began in November of 2000 saw an
    immediate increase of 300 in calls following
    9/11.
  • Since that time Cop 2 Cop has received over
    15,000 calls and have become a model for other
    programs.

70
NJ Cop2Cop
  • There were over 550 Critical Incident Stress
    Management Response Services within the first two
    years including at the closing of Ground Zero.
  • a specialized large group crisis CMB's called
    "reentry" for the Port Authority Police Dept.
  • had Direct Contact with over 1,900 rescuers
    directly involved with the rescue and recovery at
    the WTC Site and have supported and created
    supplemental programs and hotlines.

71
On The Front Line The Work of First Responders
in a Post 9/11 World.
  • 9/11 attacks on the World Trade Center put
    firefighters and officers, especially those who
    were on the site of the disaster during the month
    of September, at an increased risk of developing
    emotional health problems.
  • Samuel B. Bacharach, Ph.D.
  • Institute for Workplace Studies School of
  • Industrial Labor Relations Cornell University

72
  • Also highlighted in the report is a unique
    strength of FDNY firefighters and officers they
    work in highly supportive self-managed teams,
    which enable them to operate as highly effective
    work units in fighting fires and confronting
    other emergencies.

73
The New York State Office of Alcoholism and
Substance Abuse Services
  • reports that demand for alcohol and drug
    treatment in New York City increased immediately
    after the World Trade Center attacks.

74
Who is at greatest risk for severe stress
symptoms?
75
Groups Potentially Vulnerable to  Terror-Related
Issues  Demartino 2001
  • Rescue Workers
  • Medical Personnel
  • Leaders
  • Hero
  • Persons deemed responsible
  • Media representatives 
  • Elderly
  • Children
  • Single Parents
  • Injured
  • Bereaved  

76
Who is at greatest risk for severe stress
symptoms?
  • Rescue workers who directly experience or witness
    any of the following during or after the disaster
    are at greatest risk for severe stress symptoms
    and lasting readjustment problems

77
Who is at greatest risk for severe stress
symptoms?
  • Life threatening danger or physical harm
    (especially to children)

78
Who is at greatest risk for severe stress
symptoms?
  • Exposure to gruesome death, bodily injury, or
    dead or maimed bodies

79
Who is at greatest risk for severe stress
symptoms?
  • Extreme environmental or human violence or
    destruction

80
Who is at greatest risk for severe stress
symptoms?
  • Loss of home/family
  • valued possessions
  • neighborhood
  • community

81
Who is at greatest risk for severe stress
symptoms?
  • Workers who experience
  • Loss of communication with or support from close
    relations

82
Who is at greatest risk for severe stress
symptoms?
  • Workers who experience
  • Extreme fatigue
  • weather exposure
  • Hunger
  • sleep deprivation

83
Who is at greatest risk for severe stress
symptoms?
  • Workers who experience
  • Intense emotional demands (such as searching for
    possibly dying survivors or interacting with
    bereaved family members)

84
Who is at greatest risk for severe stress
symptoms?
  • Extended exposure to danger, loss,
    emotional/physical strain

85
Who is at greatest risk for severe stress
symptoms?
  • Workers who experience
  • Exposure to toxic contamination
  • gas or fumes
  • Chemicals
  • radioactivity

86
Risk Factors
  • Life threatening danger/physical harm
  • Exposure to gruesome death or bodily injury
  • Extreme environmental/human violence or
    destruction
  • Loss of home, possessions, community
  • Loss of communication with, or support from,
    close relations
  • Extreme fatigue, weather exposure, hunger or
    sleep deprivation
  • Extended exposure to danger, loss, or
    emotional/physical strain
  • Exposure to toxic contamination

87
The psychological problems that may result from
disaster experiences include Physical reactions
  • Tension
  • Fatigue
  • Edginess
  • difficulty sleeping
  • bodily aches or pain
  • startling easily
  • racing heartbeat
  • Nausea
  • change in appetite
  • change in sex drive

88
The psychological problems that may result from
disaster experiences include
  • Interpersonal reactions in relationships at
    school, work, in friendships, in marriage, or as
    a parent
  • feeling rejected or abandoned
  • being distant
  • Judgmental
  • over-controlling
  • Distrust
  • Irritability
  • Conflict
  • Withdrawal
  • Isolation

89
What severe stress symptoms can result from
disasters?
  • Most responders only experience mild, normal
    stress reactions, and disaster experiences may
    even promote personal growth and strengthen
    relationships.

90
Severe Stress Symptoms
  • However, as many as one out of every three rescue
    workers experience some or all of the following
    severe stress symptoms, which may lead to lasting
    Post Traumatic Stress Disorder (PTSD), anxiety
    disorders, or depression.

91
Severe stress symptoms
  • Dissociation (feeling completely unreal or
    outside yourself, like in a dream having "blank"
    periods of time you cannot remember)

92
Severe stress symptoms
  • Intrusive re-experiencing
  • terrifying memories
  • Nightmares
  • Flashbacks

93
Severe stress symptoms
  • Extreme attempts to avoid disturbing memories
    (such as through substance use)

94
Severe stress symptoms
  • Extreme emotional numbing (completely unable to
    feel emotion, as if empty)

95
Hyper-arousal
  • panic attacks
  • rage
  • extreme irritability
  • intense agitation

96
Severe anxiety
  • paralyzing worry
  • extreme helplessness
  • compulsions or obsessions

97
Severe depression
  • complete loss of hope
  • self-worth
  • motivation
  • purpose in life

98
TERRORISM
Crisis Stress Trauma Terror
99
The ultimate tool of the terrorist
  • is not chemical, biological, nuclear or
    radiological.

It is psychological. Terror is fear.
100
How is Terrorism Different? 
  • Terrorism wins only if you respond to it in the
    way the terrorist wants you to 
  • You can control the fate of the terrorist act in
    terms of your response to it.
  • Psychologically speaking, the impact is up to you
    and not to the terrorist. 
  • Adopted from DeMartino 11/15/01 and his
    interpretation of Franklin 1975 

101
Traumatic Crisis
  • An event in which people experience or witness
  • Actual or potential death or injury to self or
    others.
  • Serious injury.
  • Destruction of homes, neighborhood, or valued
    possessions.
  • Loss of contact with family/close relationships.

102
Mediating Factors
  • Prior experience with a similar event
  • The intensity of the disruption in the survivors
    lives
  • Individual feelings that there is no escape,
    which sets the stage for panic
  • The emotional strength of the individual
  • The length of time that has elapsed between the
    event occurrence and the present

103
  • On Site
  • Trauma
  • Response

104
Stabilizing Individual
  • Assess the survivors for injury and shock.
  • Get uninjured people involved in helping.
  • Provide support by
  • Listening.
  • Empathizing.
  • Help survivors connect with natural support
    systems.

105
Avoid Saying . . .
  • I understand.
  • Dont feel bad.
  • Youre strong/Youll get through this.
  • Dont cry.
  • Its Gods will.
  • It could be worse or At least you still have .
    . .

106
Managing the Death Scene
  • Cover the body treat it with respect.
  • Have one family member look at the body and
    decide if the rest of the family should see it.
  • Allow family members to hold or spend time with
    the deceased.
  • Let the family grieve.

107
Informing Family of a Death
  • Separate the family members from others in a
    quiet, private place.
  • Have the person(s) sit down, if possible.
  • Make eye contact and use a calm, kind voice.
  • Use the following words to tell the family
    members about the death Im sorry, but your
    family member has died. I am so sorry.

108
Emergency Mental Health and Traumatic Stress
  • Disasters, whether natural or terrorist-related,
    may result in human trauma that requires special
    attention.
  • Following such events, the need for crisis
    counseling is just as important as the need to
    clean up debris and reconstruct property.

109
Emergency Mental Health and Traumatic Stress
  • Most people who are coping with the aftermath of
    a disaster have normal reactions as they struggle
    with the disruption and loss caused by the
    disaster.

110
Emergency Mental Health and Traumatic Stress
  • They do not see themselves as needing mental
    health services and are unlikely to request them.
  • Community outreach may be necessary to seek out
    and provide mental health services to individuals
    who may be affected by a disaster.

111
Individual Stress Management Training
  • Primary Stress Prevention
  • How we think,
  • how we live,
  • how we work

112
Traditional Mental Health Practice
Crisis Counseling
  • Is primarily home and community based.
  • Focuses on assessment of strengths, adaptation of
    existing coping skills and development of new
    ones.
  • Seeks to restore people to pre-disaster levels of
    functioning.
  • Accepts content at face value.
  • Validates the appropriateness of reactions to the
    event and its aftermath and normalizes the
    experience.
  • Has a psycho-educational focus.
  • Is often office based.
  • Focuses on diagnosis and treatment of a mental
    illness.
  • Attempts to impact the baseline of personality
    and functioning.
  • Examines content.
  • Encourages insight into past life experiences and
    their influence
  • on current problems.
  • Has a psycho-therapeutic focus.

113
COMMON CRISIS COUNSELING SERVICES
  • Information
  • Education
  • Outreach
  • Counseling
  • Supportive listening
  • Referrals
  • Training
  • Collaboration with other programs

114
Individual Stress Management Training
  • Secondary Stress Prevention Relaxation
    exercises, physical fitness, spirituality and
    faith, emotional outlets.

115
Individual Stress Management Training
  • Tertiary Stress Prevention Psychological
    counseling/therapy, medical care for
    stress-related physical or psychological
    illnesses.

116
Disaster Stress Interventions
  • Individual stress management training
  • Social support and creating a supportive
    organization
  • Traumatic incident stress management techniques

117
Disaster Stress Interventions
  • Social support is one of the most important and
    powerful stress reducers.

118
Disaster Stress Interventions
  • Two powerful ways of healing from disaster
  • For the individual, creating and telling the
    story of the disaster
  • Rituals and memorials, which bring the community
    of responders, victims and public together

119
Traumatic Incident Stress Management Techniques
  • An intervention specifically for dealing with
    traumatic events
  • Helps those involved in a traumatic incident to
    share their experiences, vent emotions, learn
    about stress reactions and symptoms
  • Confidential, voluntary and educative process
  • NOT psychotherapy

120
Types of Traumatic/ Critical Incident Stress
Management
  • Emergency Preparedness
  • Crisis Management Briefing
  • Defusing
  • Debriefing
  • Critical Incident Stress Debriefing
  • FEMA/CMHS
  • Red Cross Crisis Response Team
  • NOVA
  • Grief and Loss
  • Individual Crisis Intervention
  • Family CISM
  • Organizational Consultation
  • Follow-up/ Referral

121
Types of Traumatic Incident Stress Management
Debriefing
  • Proactive intervention involving a group
    meeting/discussion about a particularly
    distressing event

122
Debriefing
  • Designed to mitigate the impact of the event and
    assist those in recovery from the associated
    stress

123
Debriefing
  • Facilitated by a specially trained team
  • Ideal to have it conducted between 24 and 72
    hours after the incident

124
Critical Incident Stress Debriefing
  • CONDUCTED BY TRAINED PROFESSIONALS

125
Types of Traumatic Incident Stress Management
Defusing
  • Shorter, less formal version of a debriefing
  • Best conducted within 1 to 4 hours after an
    incident

126
Defusing
  • Confidential and voluntary
  • Sharing of reactions to an incident and venting
    emotions
  • Main purpose stabilize people affected by the
    incident so that they can return to their normal
    routines

127
Types of Traumatic Incident Stress Management
Grief and Loss Session
  • Structured group or individual session following
    a death
  • Assists people in understanding their own grief
    reactions
  • Creates a healthy atmosphere of openness and
    dialogue around the circumstances of the death

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Types of Traumatic Incident Stress Management
Crisis Management Briefing
  • A large homogeneous group intervention used
    before, during and after crisis
  • Present facts, facilitate a brief controlled
    discussion, Q A and information on stress
    survival skills and/
  • or other available support services
  • May be repeated as situation changes

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Managing Stress During Disaster
  • On scene briefings for incoming responders
  • Develop a buddy system
  • Watch out for each other

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Managing Stress During Disaster
  • Take care of yourself physically
  • Take frequent rest breaks
  • Drink plenty of fluids
  • Eat healthy foods

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Managing Stress During Disaster
  • Take breaks away from the work area
  • Give yourself permission to feel rotten

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Fatigue as a Health HazardThe Health Effects of
Working Long Hours
  • Stress
  • Causes a lack of concentration, memory loss and
    errors in judgment
  • Depression
  • May be caused by extended periods of stress
  • Can be caused when workers experience high
    demands and low levels of control over their work
  • Burnout (Work Exhaustion)
  • When workers undergo extended periods of high
    demanding high stress situations coupled with
    long hours work overload

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  • Psychological First Aid

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Psychological First Aid
  • Recognizing that some phases of disasters, such
    as the impact phase, and some type of disasters,
    such as bioterrorism and other public health
    emergencies, are characterized more by acute fear
    and anxiety than by classic traumatic stress
    reactions, the Institute of Medicine and other
    leading mental health authorities are
    increasingly promoting the use of "Psychological
    First Aid"  as means of addressing the intense
    physiological and emotional arousal that
    accompanies certain crisis events.

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Psychological First Aid
  • (PFA) is quickly becoming another necessary tool
    in the disaster mental health responder's tool
    kit, and training in for New Jersey's disaster
    mental health responders will soon be offered in
    several counties.

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Psychological First Aid
  • This research is beginning to suggest that
    waiting several hours, or days, before providing
    basic psycho-social support may miss an important
    window of opportunity in helping people
    emotionally recover from the aftershock of a
    traumatic event.
  • Psychological first aid may be best applied
    during a critical incident and in the minutes and
    hours immediately following the event.

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Psychological First Aid is not new
  • Long established principle of buddy-care in
    U.S. military
  • Growing body of empirical evidence demonstrating
    relationship between physiological arousal and
    PTSD development following crises
  • Recommended by the National Academy of
    Sciences-Institute of Medicine and National
    Center for PTSD

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Working Definition
  • Psychological first aid (PFA) refers to a set of
    skills identified to limit the distress and
    negative behaviors that can increase fear and
    arousal.
  • (National Academy of Sciences, 2003)

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Psychological First Aid is
  • Psychological first aid (PFA) is as natural,
    necessary and accessible as medical first aid.
  • Psychological first aid means nothing more
    complicated than assisting people with emotional
    distress resulting from an accident, injury or
    sudden shocking event.

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Psychological First Aid
  • Like medical first aid skills, you don't need to
    be a doctor, nurse or highly trained
    professional to provide immediate care to those
    in need.

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General Principles of Psychological First Aid
  • The most urgent tasks for the Psychological
    First Responder is to focus on restoring
    emotional equilibrium.

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Psychological First Aid responders should
  • Present a calm, reassuring demeanor
  • Be direct, informative, authoritative, nurturing,
    and problem-solving oriented

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Psychological First Aid
  • Counter denial, by encouraging 
  • individuals to deal with the facts of the event
  • give accurate information and explanations of
    what happened and what to expect
  • never offer false or unrealistic assurances

144
Psychological First Aid
  • Talk to individuals about their emotional
    reactions and encourage them to deal with such
    reactions as another facet of countering denial
    and other defenses that interfere with restoring
    equilibrium

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Psychological First Aid
  • Convey a sense of hope and positive
    expectation--that a crisis changes things, there
    are ways to deal with the impact
  • Normalize the individual's emotional reaction as
    much as feasible

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Psychological First Aid
  • Facilitate emotional expression (e.g., through
    use of empathy, warmth, and genuine concern)
  • Explain what can and will be done to assist the
    individual, their family and community

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Protect
  • Individuals from further physical or emotional
    harm, including gruesome or graphic sights and
    sounds
  • Individuals' dignity and privacy following a
    crisis
  • Individuals from media intrusion or curious
    well-wishers
  • Individuals from danger to self or others

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Direct
  • Individuals toward quiet, safe areas
  • With calm, compassionate but authoritative tone
  • Any available personnel to appropriate tasks and
    to offer support to co-workers

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Connect
  • Individuals with mental health and social service
    resources
  • Individuals and their families with available
    printed and online resources for coping with the
    emotional consequences of crises
  • Friends, family, co-workers and other sources of
    emotional support
  • Individuals to information about the event or any
    relevant news pertaining to the situation

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Psychological First Aid is not
  • Debriefing
  • Counseling
  • Psychotherapy
  • Mental health treatment

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Managing Stress after a Disaster
  • Attend end of shift briefing
  • Reach out
  • Reconnect
  • No big life decisions
  • Rest
  • Eat well
  • Mood swings
  • Slow down
  • Dont overwhelm children
  • Stress relief
  • Recall what is important
  • Avoid use of drugs or alcohol

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Workers Families
  • Workers have valid concerns for their families.
  • Families worry about workers health and safety.

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Helping Children Feel Better
  • Carry out daily routines and outings
  • (when possible)

154
Helping Children Feel Better
  • Encourage children to talk and ask questions

155
Helping Children Feel Better
  • Reassure children they are safe

156
Helping Children Feel Better
  • Screen TV

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Self Care for Critical Incidents
  • Alternate strenuous exercise and relaxation for
    the first 24-48 hours after the incident.
  • Keep busy.  Structure your time.  Be with people,
    especially those who have "been there."
  • Remember that your reactions are normal and
    expected.  Don't label yourself as "crazy" or
    "weak."
  • Keep your life as routine as possible.  Avoid
    making any big life changing decisions. However,
    you should make a lot of small choices about your
    daily life this will return a sense of being
    back in control to you.

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Self Care for Critical Incidents
  • Avoid alcohol and drug usage.  Any relief that is
    felt will be short lived and your feelings
    afterwards will be more extreme than before.
  • Give yourself permission to feel rotten.
  • Watch your diet.  You should avoid sugars and
    caffeine.  Eat regular, balanced meals.  Increase
    your intake of fruits and vegetables.
  • Realize that others have gone through this before
    and have felt the same way you are feeling now.
  • Don't hesitate to call a trusted and experienced
    peer anytime you need to talk.

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A day at the Jersey Shore
Small Group Exercise
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SUMMARY of CISM
  • When implemented as prescribed, CISM appears to
    be an effective crisis intervention, capable of
    reducing signs and symptoms of distress
    associated with an acute psychological crisis.
  • When providers are not properly trained and
    experienced and when the debriefing is provided
    as a stand-alone intervention, it is likely to
    ineffectual and perhaps harmful.
  • When providers apply CISM tactics to individuals
    for whom it was never intended under
    circumstances for which it was never designed and
    with a complete disregard for standardization and
    quality assurance the interventions may be
    ineffective and possibly harmful.

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KISS Keep it Simple Silly
  • Remember you are dealing with a very stressful
    situation and its aftermath
  • TALK- especially to other who relate to your
    situation
  • DONT make major decisions alone
  • LIMIT Expectations on self and others

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HALT
  • Avoid Being
  • Hungry
  • Angry
  • Lonely
  • Tired

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REMEMBER
  • Take care of yourself.
  • Take care of family.

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Available Resources
  • Mental health benefits may be available
  • Local and national organizations
  • Community services and hotlines
  • Mental health resources
  • Financial resources
  • Legal resources

165
Acknowledgments
  • Dr. George Everly, International Critical
    Incident Stress Foundation
  • Jamie F. Becker of the Laborers Health and
    Safety Fund of North America.
  • Steven M. Crimando MA, BCETS
  • Deborah J DeWolfe PHD, MSPH Training Manual for
    Mental Health and Human Service Workers in Major
    Disaster. SAMHSA Publication
  • National Centers for Posttraumatic Stress
    Disorders
  • Dept of Veterans Affairs
  • American Psychological Association
  • American Psychiatric Association
  • American Public Health Association
  • The American Academy of Experts in Traumatic
    Stress
  • FEMA
  • CDC
  • NIDA, NIH, NIAAA

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