Line of Duty Death Line of Duty Death & &

Critical Incident StressCritical Incident Stress

Critical Incident StressCritical Incident Stress

Life Changing Experiences

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

Emotional

Thoughts of suicide/homicide

Inappropriate emotional responses/outbursts

Intense anger

•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

Where to find help

Your employer

Employee Assistance Program (EAP)

Health care insurance plan

Local health systems

Local or community hospital

County health services

Local EMS system

Friends, family and others

Church

Survivor networks