Emergency Responder Culture
• Traits and Beliefs – What we believe about ourselves and why • Problem solvers
• Action Oriented • Can control ourselves and environments
• People are better off because we were there
• Why do we believe these things?
Cognitive Dissonance • In psychology, cognitive dissonance is the excessive mental stress and
discomfort[1] experienced by an individual who holds two or more contradictory beliefs, ideas, or values at the same time
I am a rescuer Belief
A rescuer saves people
Concept Incident
I was able to save that person
Reality
A rescuer saves people
Concept
I am a rescuer Belief
I was unable to save that person
Reality
Incident
The model breaks down
What is an example of a healthier model?
STRESS: good or bad? Low levels can Enhance memory and reaction Exhilaration Fight or flight Long term effects?
Categories of Incident Stress
Acute Stress (major incidents)
Cumulative stress
(combination of micro traumas)
Chronic stress (body can rarely relax)
Emergency responder exhaustion syndrome
Critical Incident Signs and Symptoms
Common signs and symptoms of critical incident stress show up in four main categories
Cognitive
Physical Emotional
Behavioral
Coping with Stress - Trauma • Give yourself time to heal, try to be patient with changes in your emotional state
• Ask for support from people who care about you and who will listen and empathize with your situation
• Participate in CISM and or find groups led by appropriately trained and experienced professionals
• Engage in healthy behaviors to enhance your ability to cope with excessive stress
• Eat well-balanced meals and get plenty of rest
• Avoid alcohol and drugs
• Establish or reestablish routines like eating meals at regular times and following an exercise program
• Take some time off from the demands of daily life by pursuing hobbies or other enjoyable activities
• Avoid major life decisions if possible because these activities tend to be highly stressful
Many experiences can be traumatic Some are traumatic to some, but not to all
Various factors may make some more vulnerable than others Traumas create reactions now and later Experiencing these reactions means the situation was serious for you Reactions sometimes get worse before they get better Sometimes they reappear later
Critical Incident Basics
An active, short-term, supportive, helping process.
Acute intervention designed to mitigate the crisis response.
NOT psychotherapy or a substitute for psychotherapy.
Crisis Intervention (CI)
Critical Incident Stress Management
Post disaster crisis intervention (CISM) was associated with reduced risk for: ▫ major depression (d=.81) ▫ anxiety disorder (d=.98) ▫ global impairment (.66) ▫ compared with comparable individuals who did not receive
this intervention (Boscarino, et al, IJEMH, 2005).
San Luis Obispo County Fire Chiefs Association CISM Team Services
Pre-crisis Preparation
Rest Information Transition Services (RITS)
Crisis Management Briefings (CMB)
Defusing
Critical Incident Stress Debriefing
Individual Crisis Intervention
Family Crisis Intervention
Follow-up and Referral
Civilian Assistance
Relative Intensity of Interventions
Demobilization
Defusing
5 Phase CISD
7 Phase CISD
Reaction
Introduction Information
Exploration
Reaction
Fact
Fact
Thought Symptoms
Reentry
Teaching
Teaching
Pre-crisis Preparation • Includes stress management education, stress resistance, and crisis
mitigation training for both individuals and organizations
Rest Information Transition Services (RITS)
• A brief intervention prior to release of employee(s) following a large-scale incident or disaster.
Crisis Management Briefing (CMB)
• A large group meeting to provide information about the incident.
• control rumors
• discuss potential symptoms of distress and the components
of stress management. • identify available resources for affected individuals who
may later elect to seek CISM support.
Defusing
A small group intervention applied within 12 hours of a critical incident, preferably during
the same shift. • A shorter, informal version of the debriefing process. • Most incidents that are defused do not need to be
debriefed.
Critical Incident Stress Debriefing
Structured 7 – phase group discussion conducted 2-10 days post incident with the support of mental
health care professional, trained peers and chaplains
• Designed to mitigate distress, facilitate
psychological closure, or facilitate access to continued care.
Individual Crisis Intervention
• One-on-one counseling or psychological support throughout the timeline of the critical incident.
Family Crisis Intervention
• Includes organizational consultation, as needed
Follow-up and Referral
• Intervention components for follow-up assessment and treatment, if necessary. This can include use of mental health providers, and other specialized programs
Civilian Assistance • Although assisting victims, survivors, and families is
not the primary function of the CISM Team, it may be necessary to provide interim support services to these individuals so that the emergency service crews may perform their duties without being hampered.
• CISM team will act as Liaison to gather local
resources for civilians. (Red Cross, County Mental Health, etc.)
Critical Incident Stress Management
• “There is now emerging evidence that prompt delivery of brief, acute phase services in the first weeks after an event can lead to sustained reduction in morbidity years later, reducing the burden of secondary functional impairment, presumed daily average life years lost (DALYS), and costs to both the individual and the public” (p. 15). Schreiber, M. (Summer, 2005). PsySTART rapid mental health triage and incident command system. The Dialogue: A Quarterly Technical Assistance Bulletin on Disaster Behavioral Health, 14-15.
Critical Incident Debriefing Literature suggests value in “debriefing” CISD (“debriefing”) should only use group format CISD should be offered as part of a larger integrated intervention
system (CISM) Participation is Voluntary and involves informed consent CISD contraindicated if basic physiological, shelter, & safety needs not
met Positive outcome may be other than prevention of PTSD (provides
information, support, may increase cohesion, positively viewed)
▫ Review for Canadian Armed Forces Ritchie, P. (2002)
Solutions
CISM 24-72 hrs :
Educate about stress and
stress reactions
Normalizes feelings Cathartic relief
Peer support
Referral
Medical care Medication
Counseling EMDR
Recovery
Remember
• CISM interventions are not substitutes for psychotherapy.
• Rather, they are elements within the emergency
mental health system.
• Designed to precede and complement psychotherapy, i.e., part of the full continuum of care.
San Luis Obispo County Fire Chiefs Association CISM Team Activation • Any responder can activate the request for assistance. • The incident commander, chief officer, or duty chief is responsible to determine
need for any of the following team services. • Initiate CISM services automatically for the Critical Incidents identified in the policy.
• All CISM Team members are to serve as lookout for peers and request CISM team
services when necessary. Contact CAL FIRE/San Luis Obispo County Fire Dispatch emergency line at 805-543-4242
Dispatch will contact CISM Team Coordinator
CISM Team Coordinator will contact Agency for details and determine need(s)
CISM team contacted via text message for deployment Critical Incident Services for emergency
responders, chaplains, clinicians.
Summary • There are many forms of stress, while natural,
critical incident stress can be detrimental.
• There is no one size fits all solution, CISM has many components that can be utilized to best fit the needs of the responders.
• The demands of our profession can tax us both physically and emotionally. We must understand what options are available to ensure we are doing our very best to support our most precious resource.