Transcript CC's Brief on CISM/CRT

National Guard
Critical Incident
Stress Management (CISM)
Trained Crisis Responder Program
LTC Clarence Bowser
State Family Programs Director
Overview
TCR Briefing for Command
Military References…
 Trained Crisis Responder (TCR)…
 Crisis Intervention…
 Critical Incidents…
 Post-Traumatic Stress…
 TCR Services…
 Rationale…

References
TCR Briefing for Command



DoD:
 6490.5 – Combat Stress Control
Program
Air Force:
 AFI 44-153 – Critical Incident Stress
Management
 AFI 34-1101 Survivor Assistance
Army:
 Field Manual FM 16-1, Annex F-1
"Critical Event Debriefings"
Trained Crisis Responder
TCR Briefing for Command
The National Guard
TCR Program was
developed from Critical
Incident Stress
Management (CISM)
principles…
Crisis Intervention
TCR Briefing for Command
“CISM is a subset of the general field
of Crisis Intervention (CI) and may
be thought of as the application of
Crisis Intervention knowledge and
techniques to high risk groups, e.g.,
emergency services, military, etc.”
(J.T. Mitchell, G.S. Everly, 1995)
CISM Services
TCR Briefing for Command
Trained Crisis Responders are the
first line of defense in coping with
Post-Traumatic Stress Reactions to
Crisis events.
 CISM Services extend beyond the
training levels of Trained Crisis
Responders, therefore it is important
for the TCR’s to work in concert with
military and civilian CISM Teams…

CISM Core
Components
TCR Briefing for Command





Pre-Crisis
preparation
Demobilization
Crisis
Management
Briefing
Defusing
Critical Incident
Stress Debriefing





Individual crisis
intervention 1:1
Family CISM
Community
consultation
Pastoral Crisis
Intervention
Followup/Referral
Trained Crisis Responder
TCR Briefing for Command
Trained Crisis Responders
provide psychological
and emotional “Self-Aid
and Buddy-Care”
Spectrum Of Care
TCR Briefing for Command
Incident
Crisis
Intervention EAP
TCR’s
CISM
Legal
Chaplain
Mental Health
Psychotherapy
Hospitalization
Refer where needed…
Family Support
Rehab
Critical Incidents
TCR Briefing for Command

Major Accidents (Air Crashes, etc.)…

Line of Duty Death(s)…

Serious Line of Duty Injury(s)…

Suicide of a Co-Worker…

Disaster / Multi-Casualty Incident(s)…

Shooting(s)…
Critical Incidents
TCR Briefing for Command

Significant Events Involving Children…

Prolonged Incident(s) - Especially with
loss…

Excessive Community Media Interest…

Any Significant Traumatic Event…
Primary Goal
TCR Briefing for Command
CISM and the TCR Program are
forms of crisis intervention
designed to help reduce PostTraumatic Stress Reactions to
Critical Incidents…
Post-Traumatic Stress
TCR Briefing for Command
Post - traumatic stress
is a normal reaction,
in a normal person,
to an abnormal event.
Hallmarks of Crisis
Intervention
TCR Briefing for Command
 Immediacy
 Proximity
 Expectancy
 Brevity
 Practical
It’s learning how to toss a life raft, not a
course in ship building
Post traumatic stress
TCR Briefing for Command
Is everyone who experiences
traumatic distress suffering from
the disorder know as Post
Traumatic Stress Disorder?
NO.. NO ..NO
Post Traumatic Stress
Disorder
TCR Briefing for Command
PTSD represents a
contradiction to some
critically important
assumption or belief about
self and/or the world.
(G.S. Everly, 1995)
Post Traumatic Stress
Disorder
TCR Briefing for Command
A pathological and disabling
variant of a normal stress reaction
 Very clear criteria …symptoms
must be over 30 days and it is
impairing function

Important TCR
Concept
TCR Briefing for Command
The TCR Program is NOT a
stand alone process.
Rather it is meant to be one
part of a comprehensive
CISM intervention program.
TCR Services…
TCR Briefing for Command

TCR’s can be in any section (personnel,
security forces, fire, chaplain, medical,
family support, etc.)…

TCR’s are normally among your first
responders to an incident…

TCR’s can support official military and
civilian CISM Teams…
TCR Services…
TCR Briefing for Command

Pre-incident education, preparation…

One-on-one crisis intervention…

Demobilizations (large groups of
public safety)…

Crisis Management Briefings [large
groups of primary, secondary
(emergency personnel), and tertiary
(family, co-workers, etc.) victims]
TCR Services…
TCR Briefing for Command

Family Support…

Organizational / Community
intervention, consultation…

Follow-up and referral for TCR’s &
CISM services and/or continued care…
Rationale
TCR Briefing for Command
Why have TCR’s and CISM
programs?
We can learn from past
experience.
141 ARW Suicide
TCR Briefing for Command
December 1998 - Fairchild AFB WA
 Just-retired Wing Commander
 Prior incidents in unit
 Impact on unit
 Chaplains from outside called in for
first UTA following incident
 Ministered to entire wing

141 ARW CRASH
TCR Briefing for Command
Six weeks after suicide of
commander
 Four members killed in Germany
 Chaplains called from outside;
some had just been there
 Assigned to each family to assist
local clergy and chaplains
 Memorial Service and Funerals

Red Horse Crash
TCR Briefing for Command
March 2001
 Army NG Sherpa crashed over Ga.
 18 ANG and 3 ARNG members
killed
 Chaplains called in for ministry
 Memorial Service and Funerals
 Continuing care for families

Red Horse, cont’d
TCR Briefing for Command
Late July - Early August report
 Some possible questions
 Chaplains and Line Colonels
formed teams for each family
 Trained at Langley then deployed
 There to walk families through
report and to offer pastoral care

Comparison
TCR Briefing for Command
San Diego, CA
Air Crash - 1978
Total Killed
125
Plane Survivors
0
Homes Destroyed
16
Killed On Ground
15
Emergency Personnel 300
Body Parts Found
10,000
Cerritos, CA
Air Crash - 1986
82
0
16
15
300
10,000
Comparison
TCR Briefing for Command
Support Services Provided
San Diego, CA
Cerritos, CA
Air Crash - 1978

Sporadic One on
One
Air Crash - 1986





On Scene One on
One
Demobilizations
12 Debriefings
Hot Line Number
One on One Follow
Up
Comparison
Personnel Lost in 1 Year
TCR Briefing for Command
San Diego, CA
Air Crash - 1978
Police
Fire
Paramedics
Increase in
Mental Health
Services
5
7
17
increase of
31%
Cerritos, CA
Air Crash - 1986
- 1
1%
increase of
Rationale
TCR Briefing for Command

Trauma and stress-related disorders
are sometimes disabling and costly to
treat…

Interventions are designed to assist in
preventing “burnout” and PTSD…

Healthy employees are more
productive and effective on the job…
Example 1…
TCR Briefing for Command
 100
trauma victims
 Intervention began after 6
months
 Average cost = $46,000.00 ea.
 94% filed civil litigation
Friedman, et al, EAP Digest, 1988
Example 2…
TCR Briefing for Command
 100
trauma victims
 Intervention began within 6
months
 Average cost = $8,300.00 ea.
 13% filed civil litigation
Friedman, et al, EAP Digest, 1988
Rationale
TCR Briefing for Command

On any given trauma/disaster,
4%-97% of the individuals
exposed will develop Symptoms
similar to PTSD.

16-30% of emergency responders
are at risk of developing PTSD
symptoms.
Rationale
TCR Briefing for Command
Disaster / Trauma planning
(including CISM protocols) is
appropriate for not only
emergency response personnel
and institutions, but for all
business and industrial (and
military) settings as well.
Yandrick, EAPA Exchange, 1990
Main Goal
TCR Briefing for Command
Trained Crisis
Responders help
keep your team
on the job!
Academy for Innovative
Ministry
TCR Briefing for Command
WHERE YOU CAN
LEARN THIS STUFF!
Ch, LtCol Charles E. Woods
Chief, Crisis Intervention
McGhee Tyson ANG Base, TN
AIM COURSES
TCR Briefing for Command
AIM course offerings available on-line:
https.//tys.tnknox.ang.af.mil/AAIM/AAIM.HTM
This web site is accessible from a ".mil" computer
only!
CHAPLAIN SERVICE
AND FAMILY SUPPORT
TCR Briefing for Command
WHY DO CHAPLAINS EXIST?
- First Amendment
- ‘Provision without establishment’
 Requirements
 Skills
 ‘neutral zone’
 100 % Confidentiality

Chaplain Service and
Family Support
TCR Briefing for Command
LET’S TALK!