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CRISIS INTERVENTION Components of crisis intervention Guidelines Crisis at various stages of life Special challenges – PowerPoint PPT presentation

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  • Components of crisis intervention
  • Guidelines
  • Crisis at various stages of life
  • Special challenges

  • the helping response of a crisis worker to a
    victim in crisis. (Mitchell, Resnik)
  • An active but temporary entry into the life
    situation of a person, family or group during a
    period of stress
  • Paramedic needs to be alert, flexible,
    resourceful and willing to get involved
  • Intervention targets the response NOT the event
    per se.

Goals of crisis intervention
  • Earmarked by narrow goals of short duration
  • 1. Shield the person from additional stress
  • 2. Assist the person in organizing and mobilizing
    their resources
  • 3. Return the person, a much as possible, to a
    pre-crisis level of functioning

Five major components of crisis intervention
  • Intervention is flexible but structured not
    haphazard or sloppy
  • Consider the stages the individual is going
    through during your intervention
  • Assist you the paramedic to decide what to do

1. Assessment
  • First priority is safety is there any danger to
    you or others
  • What has happened?
  • Who is involved?
  • What was the cause?
  • How serious is the problem?

2. The plan
  • Preliminary plan of action based on assessment
  • Does not need to be detailed the crisis will not
  • Doing something positive is better than doing

3. Implementation of the plan
  • Act, intervene
  • What ever the plan, get going!

4. Reassessment
  • Once a plan has been implemented, it needs to be
    monitored for success
  • If the plan is working, keep going!
  • If not, formulate a new plan

5. Recapping
  • Victims of crisis have a difficult time following
    what is going on around them
  • The person may need someone to tell them what is
  • This may need to be done repeatedly

  • Most important tools are verbal and non verbal
    communication. Careful use of these skills will
  • Help the person reduce emotional reactions
  • Make sense out of what is happening
  • Find short term solutions to the problem

  • The DOs and DONTs of Intervention
  • Application
  • Crisis pt
  • Most incidents

1. Provide a reality base
  • Be calm
  • Identify yourself and your position
  • Explain the presence of others such as police and
    fire fighters
  • Use the persons name
  • Reassure the person of confidentiality
  • Give supportive and truthful information

  • Let the person know what you expect of them and
    what they can expect of you
  • Explain why you are doing or not doing something
  • Explain unusual equipment or procedures
  • Anticipate the concerns of the person and family
  • Be non judgmental
  • Be aware of your reactions

2. Provide verbal and non verbal support
  • Maintain a relaxed posture
  • Be near and at their level, if appropriate
  • Touch is important, if appropriate
  • Encourage communication
  • Realistic reassurance with reasonable
  • Stay with them if possible

3. Listen and respond
  • Effective listening
  • Attending
  • Paraphrasing
  • Reflection of feelings
  • Summarizing
  • Probing
  • Helper self disclosure

4. Ask clear, simple questions
  • Ask open ended questions
  • Questions should be understandable and focused
  • One at a time
  • A definite plan of questioning is helpful

Remember the Goal
  • Get the person to talk freely and frankly about
    the present situation
  • Obtain background info about the problem - detail
  • Help the person understand about the situation
  • Consider if time permits alternative to resolve
    problems...usually more the crisis

Precautionary Measures (the donts )
  • 1. Dont deny the possibility of violence when
    the early signs of agitation are first noticed.
  • 2. Dont dismiss warnings from records, family
    authorities or fellow workers (dispatch).
  • 3. Dont become isolated with potentially violent
  • 4. Dont engage in certain behaviors that may be
    interpreted as aggressive.

Precautionary Measures (donts) continued
  • 5. Dont allow a number of emergency personnel to
    interact simultaneously with the pt.
  • 6. Dont make promises that cant be kept !!
  • 7. Dont argue, give orders, or disagree unless
    absolutely necessary.
  • 8. Dont become condescending by using cynical,
    satirical or otherwise confrontational
  • 9. Dont attempt to reason with pts who are under
    the influence of a mind altering substance.

Precautionary Measures (donts) continued
  • 10. Dont attempt to gain compliance based upon
    the assumption that the patient is as reasonable
    about things as you are.
  • 11. Dont keep the pt waiting or leave a
    potentially violent pt alone with freedom to move
  • 12. Dont allow a crowd to congregate as
    spectators to an altercation.
  • 13. Dont use why and what questions that put the
    pt on the defensive.

Danger signs to watch out for
  • Living in a fantasy world, has difficulty
    separating fact from fiction
  • Wont accept or ask for help
  • Uses extreme withdrawal, retreat, avoidance
  • Turns to drugs/alcohol
  • Consumed with rage
  • Acts on impulse after the stage of emotional
    shock has passed

Danger continued
  • Becomes hopeless and gives up
  • Very dependent on others
  • Comes across as a rock may be denying or
    suppressing emotions
  • Usual patterns are disrupted to the extreme

Can apply to the patient, family member or the
paramedic watch out for them
Dos and Donts use the
  • Dual Action Approach
  • In approaching the situation
  • A Assess
  • C control
  • T treat
  • I Inform
  • O Okay
  • N - Notate

Check personal Action
  • A Attitudes
  • C Concern
  • T Thinking ability
  • I Interactions
  • O Objectivity
  • N - Needs

Crisis at various stages of life
  • Beyond the expected
  • Consider a Normal cycle of events

  • Children in various age groups have specific
    needs and respond to crisis in different ways
  • May regress or return to behaviour of another age

Assessment and Intervention
  • Consider the childs age, past experience with
    injury, what they were doing when the event
    occurred and their developmental level
  • Look at the childs relationship with adults if
    his physical, social and emotional needs are
    being met, his response to you will be different
    than if they are not being met

Children under six years old
  • Greatest anxiety is separation from a parent or
    caregiver include the parent in care provided
  • Fear pain and disapproval
  • Allow them to keep a favorite toy or blanket

Children between 6 and 12
  • Often fear retaliation or punishment from a
  • Let the parent know that although they may be
    angry, they need to give support and comfort

All children
  • Remember children listen to everything that is
  • Escort away from the scene
  • Give brief explanation of what is happening
  • Always tell the child if you will be doing
    something painful before hand and tell them when
    you are finished

  • Leave a child alone
  • Threaten a child with punishment if they are
  • Lie or frighten
  • Talk about the childs family or living
  • Criticize the parents

Student 17-?
  • Not doing well at school
  • Lost scholarship
  • School complete NOW WHAT
  • Job search
  • Interview...

Adult beyond school
  • Job loss
  • 2nd career forced on them
  • Marriage
  • May have more conflict
  • Sexual difficulties often increase due to health
    problems or fear of health problems

Retirement the mature adult
  • May have a sense of worthlessness
  • Possibly forced to retire due to age
  • Some become depressed

Sensory loss not age dependent
  • Decrease in sight, hearing and smell
  • May increase anxiety
  • Does not mean they are intellectually inferior

Physical appearance
  • Accept the changes of aging
  • Never joke about or unnecessarily discuss these

Emotional changes
  • Slowed thinking, forgetfulness, rigid thought
    patterns, irritability
  • May be anxious about security
  • Depressed and feel a loss of social status
  • Grief is common due to loss of loved ones,
    friends, health status and activity level
  • Suicide risk increases in the elderly

Illness or death of a spouse
  • Linked to decline in the health and functioning
    of the survivor
  • Often the most serious loss the person faced

Crisis intervention with the elderly
  • Often find it difficult to ask for help because
    of sense of privacy and pride
  • May have a sense of immediacy may become
  • Reassurance is important
  • Use touch if appropriate
  • Be patient

Sudden Infant Death Syndrome
  • Make every attempt to resuscitate the baby
  • Do not give false hope
  • Do not be overly silent
  • Do not accuse the parent
  • Gather information from the parents
  • Listen
  • Provide supportive care to the family
  • Only provide the information you can

The silent patient
  • Depression, organic brain condition, muscular
    impairment, stroke, lack of trust, quiet person
  • Observe for non verbal clues
  • Encourage speech
  • Are your actions contributing to the silence
    talking too fast, have you frightened or offended
  • Always keep safety in mind - yours

Language barriers
  • Try to locate an interpreter (verbal)
  • The interpreter may paraphrase what is being
    said. The true meaning may not be conveyed
  • Dont try to interpret yourself unless you are

Most Common Interpreter Errors Glenn Flores, MD,
FAAP, Medical College of Wisconsin
  • Omission (52), in which the interpreter left out
    an important piece of information.
  • False fluency (16), in which the interpreter
    used words or phrases that didnt exist in a
    specific language.
  • Substitution (13), in which a word or phrase is
    replaced with another word or phrase of a
    different meaning.
  • Editorialization (10), in which the
    interpreters opinion is added to the
  • Addition (8), in which a word or phrase is added
    by the interpreter.

  • Identify yourself
  • Explain who you are and what you are doing
  • Touch is important
  • Remember your voice is your only means of
  • Guide dogs are working dogs. Do not touch or feed

Cultural differences
  • Both you and the patient bring cultural
    stereotypes to the situation
  • Some are more comfortable with different
    distances and may or may not be receptive to
  • It is important to be aware of various cultures

  • Remember you may encounter the pt at any point
    during their critical event
  • Emotional shock
  • Denial
  • Anger
  • Remorse
  • Grief
  • Reconciliation

Crisis Intervention
  • A short term helping process
  • Acute intervention designed to mitigate the
    crisis response
  • Not psychotherapy

Crisis Intervention
  • Goal To foster natural resiliency through...
  • Stabilization
  • Symptom reduction
  • Return to adaptive function or
  • Facilitation of access to continued care