A Life Changing Experience
Anyone can experience a critical incident
The death of a parent, spouse, child, significant family member or friend
Conventional wisdom, law enforcement, fire service and emergency medical services personnel are at greater risk
• We often find comfort with other responders
• Tend to believe our families/friends will not understand (those not involved in public safety)
• We use humor as a defense mechanism
• “Self medicate” with alcohol or drugs/medications
• As emergency responders, we portray ourselves as “tough” professional unemotional about our work
Statistically….
• Less than 5% of emergency services personnel will develop long-term PTSD
• That percentage increases when responders endure a line of duty death
Critical incidents: Traumatic events which those who are exposed to it have powerful, emotional reactions
Every profession can list their own scenarios that can be categorized as critical incidents
The Terrible Ten of public safety
1. Line of duty deaths
2. Suicide of a colleague
3. Serious work related injury
4. Multi-casualty / disaster / terrorism incidents
5. Events with a high degree of threat to the personnel
6. Significant events involving children
7. Events in which the victim is known to the personnel
8. Events with excessive media interest
9. Events that are prolonged and end with a negative outcome
10. Any significantly powerful, overwhelming distressing event
It is not a question of IF …
It is a questions of when
When you, your agency or coworker(s) will experience
• An event that will have a profound affect
• An impact so great that it will change behavior
Signs and Symptoms
When your colleague, coworker, friend or you may need help
Reactions vary, depending on the incident and the person
Symptoms are what is felt, what you feel or told
Signs are what you, or others, see
The stress reaction can manifest in the following ways;
physically behavioral
emotional psychological
Any of these symptoms may require medical attention
Physical
Grinding of teeth Visual difficulties Vomiting
Profuse sweating Dizziness Headaches
Weakness Chest pain Difficulty breathing
Elevated BP Rapid heart rate Muscle tremors
Chills Thirst Fatigue
•Fear
•Guilt
•Grief
•Panic
•Agitation
•Anxiety
•Irritability
•Depression
•Apprehension
•Feeling overwhelmed
•Denial
Psychological
• Uncertainty & Suspiciousness
• Hyper-vigilance, watchful
• Intrusive images / Nightmares
• Blaming someone
• Poor problem solving, concentration & memory
• Difficulty identifying objects or person
• Increased or decreased awareness of surrounding
Behavioral
Withdrawal/Change in social activity
Increased alcohol use/substances abuse
Inability to rest/Change in sleep pattern
Pacing / Erratic movements
Change in speech patterns
Loss or increase of appetite
Hyper-alert or sensitive to environment
Change in usual communications
The purpose of the intervention process
• Identify those in trouble
• Provide them the assistance they need
• Establish or set the new normal stress levels as low as possible
Critical Incident Stress Intervention
Types of intervention
The type of intervention used varies, depending on
The situation
Number of people involved
Their proximity to the event
The Approach
Addressing the various stages of progression
Grief Counseling
Defusing
Debriefing
Individual follow-up care
Grief Counseling
Designed to:
Provide the individual an understanding of
their reaction to the event
their grief
help them move along in their grieving
Goal
Promote a healthy atmosphere of openness and dialogue
• Can be presented in a structured group form or individually
• Should occur within 3 days of the event
• Effective in coping with the lost of a co-worker or fellow employee
• Helpful in assisting staff with a personal loss of a friend or family member
Defusing
•Allows the involved an opportunity to vent
•Share their emotions and address immediate needs
•Defusing is limited to the individuals directly involved
•Should be conducted by persons trained in CISM/CISD
•Done informally, same day, sometimes at the scene or 1 to 4 hours after
•Short in duration, a few informal questions and a great deal of listening
Defusing (continued)
•Designed to assure the those involved that their feelings are normal
•Provides information on what signs & symptoms to look for
•Provides information of where they can reach someone they can talk to
Debriefing
• Formal approach to stress intervention
• Usually the second level of intervention for those directly affected by the incident
• Often the first for those not directly involved
• Done within 72 hours of the incident
• Conducted by a trained CISD/CISM professional
• Can be in a group format or individual bases
A Debriefing session is
Designed to mitigate the impact of potential stress Allows participates to;
Talk about their experience How it has affected them
Understand coping mechanismsIdentifies individuals at risk Provides inform about services available
A follow up is performed within 7 days of the debriefing
To ensure they’re safety and are coping well Refer for professional counseling
Critical incident stress management (CISM)
The purpose of CISM is to:
•Enable people to return to their daily routine more quickly •Decrease the likelihood of post-traumatic stress
Critical Incident Stress Management
The goal: Help people deal with their trauma one incident at a time Allowing them to talk about the incident when it happens
Without judgment Without criticism
All interventions are strictly confidential
If it is determined the person being helped is a danger to them self or to others, appropriate action is taken.
The emphasis is ensuring
their safety &
returning them to a normal level of functioning
Peer-driven
Most are first responders or mental health professionals
Normal is different for everyone
• It’s not easy to quantify
• Critical incidents raise stress levels dramatically in a short period of time • After treatment a new normal is established
• However it is always higher than the old level