For 9-1-1 Dispatchers Managing Cumulative and Critical Incident Stress Tools for Survival

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For 9-1-1 DispatchersManaging Cumulative and
Critical Incident Stress Tools for Survival

• Janet Childs
• Bay Area CISM Team
• Training for Safety

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Perspectives onStress Change
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Joy vs. Stress, They are just emotions

• Joy Upbeat EmotionsEasy to share with
  othersPeople are willing to hear stories
  Laughter Good/positive
• Stress Loss Difficult EmotionsCan be
  isolatingPeople may be uncomfortable or
  unwilling to hear storiesDepressed, sad
  Bad/negative
• Public Safety/ Emergency Response Culture

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Change creates trauma/stress

• Stress is the natural response to any change or
  loss
• Emotional trauma is similar to physical injury
  Stress creates an Emotional Imprint a
  Physical Imprint sight, sound, touch,
  smell, taste

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Stress

• The stress response is individual and unique
• A normal universal human experience
• Natural response to any loss or change Even
  positive change can cause stress
• Unpredictable waves of emotions
• The body remembers in ways we may not expect
• There is no timetable for stress management

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Stress CISM Team

• Proactive response to critical incident stress
  Any incident that impacts you.
• Team is present to listen and support, we dont
  make it better or take away the pain.
• Empower affected personnel to support themselves
  and each other in a positive way.
• Everything is confidential a safe environment
  is created to address the difficult issues of
  stress.
• All emergency personnel are vulnerable to stress
  Its an occupational hazard.

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Types of Stress/Grief

• Acute Immediate reactions, laced with disbelief
  numbness. First responders do not have the
  luxury of having a stress response.
• Delayed Feelings/Reactions can surface weeks or
  months later. Responders will have a delayed
  response.
• Cumulative Multiple incidents can build over
  time, creating a backpack of stressors that can
  get triggered.
• Occupational Especially for responders, needs
  not validated or responded to in a positive
  fashion.

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Organizational Betrayal

• Dealing with the workplace Supervisors,
  co-workers, second guessing.
• Coping with external influences that create
  secondary trauma such as the media, family
  members loved ones
• Internal self talk.

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Dispatchers Whats stress

• Work the incident the longest.
• Are often the first responder to know about
  incident.
• Have the least opportunity to know outcome of
  incident or to respond with action step.
• Are the hub of the wheel of response.

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Stress and Change

• Magnitude of change

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Stress Dynamic
Crash Wall Tired/Wired
Stress Baseline for Responders
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Stress and Change

• Spiral of Reactions

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Backpack
Present Stress
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Stress and Change

• 3 types of landminesTriggered by Senses, Time or
  Memory

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Stress and Change

• Loss of Lifes Meaning/PurposeRebuild a new
  normal

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Stress, Change and Loss

• Heart Hotel

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Dynamics of Stress
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Signs of Stress

• Out of control (OOC)
• Anger, fear, guilt, loneliness, sadness,
  depression
• Physical symptoms
• Relationship issues
• Loss of life purpose
• Suicidal feelings/thoughts
• Substance abuse
• Sleep disturbance
• Eating changes/disorders
• Loss of belief

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Family Dynamics

• Expectations for behaviors vs. feelings behind
  the behavior
• Each person has a specific roleCan be
  overwhelming or isolating depending on the
  stereotype (Feminine/Macho, Cultural)
• Conflict because each person reacts differently
  to loss
• Focus on individual experience and needs

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Social/Work Dynamics

• Support can be difficult to findStress is not
  talked about
• IsolationPeople are uncomfortable with Stress
  responses
• Expectations of society and public safety
  environmentDepending on the loss or stress,
  social rules change spouse, child, parents work
  roles change

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Whats difficult about dealing with change and
stress

• Might make it worse by talking about it
• What do I do?
• Might be painful for me
• Might bring up past incidents
• And . . .

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Offering Support
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How to support others Need
Dont Need

• Honesty
• Acknowledgement
• Listen
• Presence
• Choice
• Space
• Validation
• Empowerment

• Pity
• Advise
• Judgment/critique
• War stories
• Platitudes/cliches
• Ignored
• Fix-it
• Personal Power taken away

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Support Tips

• Stay in the present moment
• Reassure stress response is normal
• Focus on most difficult issue RIGHT NOW
• Assess what is needed RIGHT NOW
• No easy way over stress, but moment by moment, we
  get through and build the NEW NORMAL

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Ways to Respond to Occupational Stress

• Control vs. Out of control
• Where your mind goes, your emotions will follow.
• Develop and maintain friends, activities and
  support systems outside of your occupation
• Do an action step.

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Personal Perspectives
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Circle of Meaning
People, activities, dreams, beliefs, possessions
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Loss Affects Everything
Are you spending quality time with people
you care about? Are you participating in
activities that are meaningful for you? Is
there anybody that you have unfinished business
with?
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Building the New Normal

• What gives me joy?
• Who and what are my support systems?
• With whom and what do I have unfinished business?
  
• What action steps do I need to do?
• Are there any unspoken appreciations, or I love
  yous?

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Adapted Maslows Needs Hierarchy

• Survival
• Safety
• Emotional Needs/ Relationships
• Building the New Normal
• Creating Meaning from the Trauma/ Life
  Transformation

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Tools for Survival

• Acknowledge the loss the impact of the grief
  process
• Express your feelings issues
• Act take steps to create as much meaning as you
  can to bring completion to the stressful event
• Acknowledge your progress Reconnect to whats
  good in your life

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CISM Interventions

• Demobilization
• Defusing
• Debriefing
• Follow up
• Landmine
• Debrief Debriefers

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CISM Groundrules

• Confidentiality
• No critique of operations or personnel
• Automatic attendance/ No mandatory participation
• No rank or hierarchy
• Only involved personnel
• Puts puzzle pieces of the incident together
• Normalizes stress reactions and gives tools for
  coping

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Phases of a Debriefing

• Introduction
• Fact
• Thought
• Reaction
• Signs

• Landmine
• Education
• Meaningful Aspects
• Closure
• Re-entry

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CISM for Dispatchers

• Validate impact of incident. This sucks!
• Get food, comfort items to Comm center.
• Do NOT interrupt dispatcher who is actively
  working.
• Have brief CIS Defusing before shift ends.
• Include dispatcher in CIS Response.
• Ask dispatcher what is needed and give choice
  when possible.

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Info Whats the 411?

• International Critical Incident Stress Foundation
  ICISF.org
• Bay Area CISM Team website criticalincident.net
• Training for Safety trainingforsafety.com
• Great trainings on a variety of subjects
• California Peer Support Network A network of
  peer support teams
• WCPR West Coast Post Trauma Retreat

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What is the Bay Area CISM Team/Centre for Living
with Dying?

• Provides support, intervention and education for
  the life issues of grief, loss, serious illness,
  trauma and change
• Bay Area CISM Team
• Non profit program of Bill Wilson Center for
  Silicon Valley and surrounding areas
• Group, individual, children, family and community
  support and intervention
• For over 30 years, over one million people served

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Triage whats important

• Breathe
• Drink plenty of water
• Move
• Give yourself a break
• Ground Get in the present moment
• Identify what is the most difficult
  and what do I need to get through it right now.

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How to work with loss . . .

• Take care of youYou are not responsible for any
  one elses experience

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Stress and the Holidays

• If it takes more energy than it gives,
• Let it go..

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Tools for Responders/Caregivers

• Critical Incident Stress Management
• Education of Family and Loved ones
• Comfort Anchors, Comfort tasks
• Grounding tools
• Daily Log
• Positive Imprinting

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Positive Imprinting

• Imagine . . .

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Locking it in . . .
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Remember

• Be easy with your own process.
• We have today. Savor whats good in your life
  now.
• What you do does make a difference in peoples
  lives and their ability to survive the loss.
• Do something decadent to spoil yourself in the
  next 24 hours.

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