Transcript Slide 1

EMERGENCY
RESPONSE
TEAMS
AND THE MILITARY
ARE NOT
THE ONLY ONES
AFFECTED BY
TRAUMATIC EVENTS…
Do you remember where you were
on September 11th 2001 at 8:45 AM (EDT)?
American Airlines Flight 11 & United Airlines Flight 175…
9:40AM (EDT)?
American Airlines Flight 77…
How about 10:07 AM (EDT)?
United Airlines Flight 93…
What emotion does this image
invoke in you?
Who did this one
single event affect?
You, me, everyone…
THE WORLD!
Got your
attention?
HOW DID YOU COPE?
When you are involved, either directly or indirectly (even watching TV or radio
news, and seeing the headlines in your newspaper may cause trauma too) with
trauma it places stress on your mental health. How do you cope or deal with
these feelings? How do you “chase away the demons”?
Keeping “it” inside can be the cause of loss of attention, anxiety, thoughts of
hurting yourself or others, chemical abuse, depression and
many other clinically diagnosed psychosis similar to that of
combat stress and even PTSD.
Carrying your feelings inside ultimately festers and becomes
a severe burden on you, your family and your friends.
Do you know where to go to reach out for help?
There are many programs which are available but in all cases help is best offered
while the events are “fresh” in your mind. You can call your local Law
Enforcement Center for contact information of your local area CISM team.
WHAT CAUSITIVE REACTIONS DO
CRITICAL INCIDENTS PRODUCE?
A Critical Incident is any event that generates such intense
emotional energy that it overwhelms an individual’s or group’s
ability to cope and causes impairment
in work or personal activities
A crisis is an acute emotional reaction to a critical incident
Critical Incident Stress is the cognitive physical, and emotional
state of arousal that is part of the crisis response
Critical Incident Stress (CIS) is also known as
“Post Traumatic Stress”.
This is NOT the same as PTSD.
CIS is a normal response of normal People to an abnormal event
Domestic
Violence
Riots and Terror
There are many everyday events which may cause
personal psychological stress, it’s not just war &
violence that professionals deal with, we
are all vulnerable…
Accidental Tragedy
WHAT CONSTITUTES MENTAL TRAUMA?
Line of duty deaths
Suicide of a colleague
Defusing
Debriefing
Follow-Up
Serious work related injury
Multi-casualty / disaster / terrorism incidents
Events with a high degree of threat to the personnel
Significant events involving children
Events in which the victim is known to the personnel
Events with excessive media interest
Events that are prolonged and end with a negative outcome
Any significantly powerful, overwhelming distressing event
How do you react normally to an abnormal event?
HELP IS AVAILABLE!
C
I
S
M
Hope
Critical
Incident
Stress
Management
Psychological P
First F
Aid A
Compassion Fatigue Therapy
WHAT KIND OF HELP IS AVAILABLE?
Incidents come and go but their memories may linger forever…
Military members are apt to see/experience atrocities, older
Veterans just kept the memories to themselves. Perhaps they
were too painful to talk about or it was just the “manly” thing
to do because it was a sign of “weakness”.
Left untreated these memories can manifest into more sever
clinically diagnosed issues such as depression and Post Traumatic
Stress Disorder (PTSD).
These issues have been recognized in many more than just the
military and counseling is routinely performed
following traumatic incidents for Emergency
Responders, Health Care Workers, Family,
and Law Enforcement. These sessions are
referred to as Critical Incident Stress
Management (CISM) & Psychological
First Aid (PFA). There is help for the
caregiver too, Compassion Fatigue Therapy.
CISM:
Definition
“Critical incident stress management (CISM) is an
adaptive short term helping process that focuses solely
on an immediate and identifiable problem. It spans
pre-incident preparedness to acute crisis to post-crisis
follow up. Its purpose is to enable people to return to
their daily routine more quickly and with less likelihood
of experiencing Post Traumatic Stress Disorder (PTSD).“
http://en.wikipedia.org/wiki/Critical_incident_stress_management
What is Critical Incident Stress Management and how does it work?
• Assist people to deal with their trauma one incident at a time
• Allows conversation about the incident when it happens without judgment or
criticism
• CISM is peer driven and those providing CISD may be from all walks of life
• All interventions are strictly confidential
• Caveat: If person is deemed to be a danger to themselves or others
• Emphasis: Keeping people safe and returning them to more normal
levels of functioning as quickly as possible
WHAT IS “NORMAL”? “Normal” is different for everyone, and it is difficult to quantify.
Any critical incident causes a dramatic raise in stress levels in a short amount of time.
Although “normal” may vary between individuals trauma establishes a new normal
that is always higher than the previous level.
PURPOSE: The purpose of the CISM intervention process is to establish or set the
new normal stress levels as low as possible.
TYPES OF INTERVENTION: It depends upon the situation, the number
of people involved and their proximity to the event. The optimum
is a three-step approach that addresses the trauma at various
stages of progression: defusing, debriefing, and follow-up.
SYMPTOMS
• A person has been exposed to a catastrophic event involving actual
or perceived death or injury. This event is characterized by intense
fear.
• The duration of the PTSD symptoms last at least a month but may
last a lifetime.
• The person experiences significant occupational, social or other
distresses.
• The person starts to avoid anything that will cause them to reexperience the event. He/she also experiences a numbing effect
that interferes with his/her personal relationships.
• The person tends to be in a state of hyper arousal that results in
being startled very easily and a heightened vigilance to the point
of paranoia.
• The traumatic event persists as a dominating psychological
experience, typically causing a person to experience flashbacks of
the event from other stimuli.
RECOGNITION & TREATMENT
Many hospitals, corporations, law enforcement and EMS have recognized the importance
of CISM. In many cases they have incorporated training and a response team within their
organization. If not, they know the LOCAL resources that are available.
Left untreated, traumatic stress will culminate into far greater mental health issues such as
PTSD. However, we have come a long way, especially in the Military! We now recognize
symptoms of Combat Stress and a focus on its treatment before it evolves into PTSD.
Throughout the years there have been many names for it to include:
• Battle Fatigue or Gross Stress Reaction for soldiers who came down with PTSD after World
War II
• Combat Fatigue or Shell Shock for soldiers who experienced PTSD symptoms after World
War I
• Soldier's Heart for soldiers who developed the symptoms of PTSD after the Civil War.
Worst of all, it was often mistakably considered to be COWARDICE…
Click Here
to watch short
take from
“Patton”
Kyle Housmann-Stokes:
”Now, After”
The producer, Kyle Housmann-Stokes, was an OIF Veteran who was preceded in military
service by his grandfather who is a Lieutenant Colonel serving two tours in Viet Nam and
one in Iraq. This film depicts the plight of stress and trauma that many returning service
men and women suffer. It’s poignant and it’s direct… Please be aware that there are
some parts which are graphic representations but allows you a better understanding, if
you are not military or a Vet, of what is war means to those returning.
Regardless of the era, conflict or war, the technologies may change
but the carnage and after effects remain much the same, as does the
camaraderie among Veterans, young and old. You can see from this
film how Veterans are not strangers and regardless of era rally to his side.
Let’s watch the film… (or via Internet: Watch Film)
For Kyle’s latest filmography you can go to: www.kylehs.com
For a background on Kyle and how this came about you can log on to the following:
http://vantagepointmag.com/2009/07/14/the-back-story-on-kyle-hausmannstokes-film-career-to-date.aspx
Kyle Housmann-Stokes:
”Now, After”
Personal observations about the film:
•
•
•
•
Pride in his military service and accomplishments
He possesses hyper-vigilance
Flashbacks (both good & bad, human carnage and the Iraqi people)
Indications of Obsessive Compulsive Disorder (O.C.D.) (preparing for his school
day as if it were for a patrol)
• Anxiety
• Sweating
• Apprehensive about leaving the safety of his home
• Inability to “disconnect” himself from the Military
• Hyper-vigilance and flashbacks while driving (speeding up and driving the
middle of the road to avoid possible “IED’s”)
• Avoiding others, loner
• Uncontrolled outburst of anger, anger management issues
Once at the VA:
• Reverence when at the VA parking garage
• Realization that he’s not alone…
GUIDELINES FOR STRESS MANAGEMENT
Diet
• Mind what you eat…
– Focus on the following:
• High Protein, raw fruits, vegetables
– Stay away from:
• Carbohydrates, low sugar, low fat and low salt
– Why?
• Cortisone levels rise when you are stressed
• Immune system depletes
• Brain tells our body that it’s starving to death
GUIDELINES FOR STRESS MANAGEMENT
Exercise
• Sweat out the chemicals!
– 132 chemicals mix together when your body goes into the stress response
– Sweat is the only way to remove these quickly
– Recommend physical therapy massage to ease the pains in the body
• Chemistry of survival:
– Catecholamine
•
•
•
Excites the System
Triggers increased nervous system
“Flight or Fight” response
– Cortico-Steroids
•
•
Moderates and controls extremes of catecholamine
Keeps “Flight or Fight” response in check
– Endogenous Opioids
•
•
•
•
Creates Heightened threshold of pain
Causes dissociative reactions
Causes blunting of emotions with catecholamine’s, causes amnesiac reactions
Causes feelings o f euphoria
GUIDELINES FOR STRESS MANAGEMENT
Let It Run
• Your unconscious has to find a “fit”
– Your mind must find a “fit” for the event in your memory so
your memory can accept it
– It will “run” at your request or when it feels it is necessary
– Let it run when YOU control it
– If it is overwhelming now, “set it up” to run at another day
or time
GUIDELINES FOR STRESS MANAGEMENT
Breathing
• Deep Breathing
– Generally you only use 1/3 of your lung capacity
– Deep Breathing, using more than 2/3 of your lung capacity:
• Increases oxygen flow to your brain
• Dumps the Carbon Monoxide in our lungs
– This allows us to breath better
• Allows us to think with more clarity
– Deep Breathing also increases the serotonin levels in our body
• Practice deep breathing techniques
CISM:
Timeline
• Defusing – Immediately
– On-site
– Group or One-on-One
• Debriefing – Within 72 hours of the incident
– Formal setting for group
– Formal/informal setting for one-on-one
• Follow-up – Within approximately 30 days
– Comfortable setting
– Preferably in person
CISM: Defusing
•
•
WHO: Individuals who were directly involved in the incident
HOW: These are generally informal and often performed at the scene
–
•
WHEN: The day of the event before the person gets to sleep
–
–
•
Steps used in this process are:
• Introduction; Exploration; Information
Initial Defusing: Initial informal defusing sessions should be held within 8-12 hours after the
incident. A defusing session is a brief, spontaneous, non-evaluative discussion coordinated and
conducted by a minimum of two peer supporters and held immediately following a critical incident.
The defusing may be considered an emotional “triage”, in which a person can begin to talk about and
explore their thoughts concerning the incident - a chance to “vent” feelings - in an informal, positive
and supportive atmosphere.
It is NOT to serve as a critique of the situation
WHAT: Designed to assure those involved that their feelings are normal:
–
–
–
It’s a process of “talking it out “
Explanation of what symptoms to watch for over the short term
Offering a lifeline (phone number where they can reach someone with
whom they can talk)
CISM:
•
•
WHO: Those who were directly affected by the incident and often the first for
those not directly involved
HOW: Formal, in a group setting
–
–
–
•
“Seven Step Process” is generally used in this setting
• Introduction; Facts; Thoughts; Reactions; Symptoms; Teaching; Re-Entry
No notes taken or paper/pen allowed
Facilitator and intervenor are the only two in the room besides those participating
WHEN: Within 72 hours of the incident
–
–
•
Group Debriefing
A chance to “vent” feelings - in an informal, positive and supportive atmosphere.
It is NOT to serve as a critique of the situation
WHAT: Structured to allow participants to “talk it out” and “reflect” on the
event(s) to help them identify with how one another reacts to an abnormal event,
everyone’s normal reactions are different
–
–
–
–
Group debriefing provides the group the opportunity to talk about their experience, how it has
affected them, brainstorm coping mechanisms, identify individuals at risk
It also serves to inform the group about services available to them in their community
Provides an explanation of what symptoms to watch for over the short term
The “intervenor” is always on watch for individuals who are not coping
well and additional assistance is offered at the conclusion of the process
CISM:
•
•
WHO: An individual who was directly, or possibly indirectly, affected by the
incident
HOW: In a quiet & comfortable setting
–
–
–
•
“Seven Step Process” is generally used in this setting
• Introduction; Facts; Thoughts; Reactions; Symptoms; Teaching; Re-Entry
No notes taken or paper/pen allowed
Facilitator and intervenor are the only two in the room besides the participant
WHEN: Within 72 hours of the incident
–
–
•
One-on-One Debriefing
A chance to “vent” feelings - in an informal, positive and supportive atmosphere.
It is NOT to serve as a critique of the situation
WHAT: Structured to allow participants to “talk it out” and “reflect” on the
event(s) to help them identify with how one another reacts to an abnormal event,
everyone’s normal reactions are different
–
–
–
–
Group debriefing provides the group the opportunity to talk about their experience, how it has
affected them, brainstorm coping mechanisms, identify individuals at risk
It also serves to inform the group about services available to them in their community
Provides an explanation of what symptoms to watch for over the short term
The “intervenor” is always on watch for individuals who are not coping
well and additional assistance is offered at the conclusion of the process
CISM:
Follow-up
• Follow-up is the most important final step to the process
• Follow-up is generally done within the week (or up to 30 days)
following the debriefing
• Follow-up is for participants as well as CISM team members as
a check-in to make sure they are OK too
During a follow-up additional intervention or a referral may be provided to the
original participant. It may also be provided for the caregiver(s) to ensure the
Caregiver(s) does not demonstrate the symptoms of Compassion Fatigue.
CISM:
Referral
Referrals are recommended any time that it is obvious that one or more persons
needs are beyond the scope of the CISM program. The referral action is
considered an essential component of CISM that supports and enhances the care
provided for these people.
There are many links in the chain of concern
that are dedicated to assist you…
Compassion Fatigue
• Compassion Fatigue is the cost of caring…
– You must care for yourself and allow others to help you care for yourself
– Use your Compassion Fatigue Therapist
• It is care for the caregiver…
Compassion fatigue plagues caregivers worldwide. When providing care to others
without incorporating authentic, sustainable self-care practices into our daily lives,
destructive symptoms surface. Isolation, emotional outbursts, substance abuse and
reoccurring nightmares are just a few of the symptoms that can distress the life of a
caregiver. With awareness and knowledge, compassion fatigue can be
recognized and managed.
For more information about Compassion Fatigue please visit:
www.compassionfatigue.org
Psychological First Aid
•
•
•
•
WHO:
HOW:
WHEN:
WHAT:
Discovering you’re OK…
PRICELESS!
CONFIDENTIALITY
CISD’s are like visiting Las Vegas…
What is said, what is heard & what is seen during a CISD will remain
at the CISD! Everything is CONFIDENTIAL.
Don’t “monkey around” with another person’s life…
•
•
•
•
•
•
Critical Incident Stress Management (CISM): Group Crisis Intervention (4th Edition)
Jeffery T. Mitchell, Ph.D., C.T.S. International Critical Incident Stress Foundation,
www.icisf.org
JEC Counseling, Dr. Dan Casey, Traumatologist www.jec-counseling.com
“Green Cross Academy of Traumatology”, Charles R. Figley, Ph.D.,
www.greencross.org
http://en.wikipedia.org/wiki/Critical_incident_stress_management
Green Cross Academy of Traumatology, www.greencross.org
International Red Cross, www.redcross.org
Thank You!
SPREAD THE WORD…
THE WORD IS “FAC”!
(FAC = “Family Assistance Center”)
Your Presenter: Jeff Gay
Minnesota Military Family Assistance Center
500 Timmerman Drive
Marshall, MN 56258
Office 651.268.8475 or Cellular 320.295.3741
[email protected]
You make the call;
We’ll make the difference!
8 Locations! To locate your nearest FAC go to:
www.BeyondTheYellowRibbon.org
IN REVIEW
Question, Comments, Observations, Conversation,
Constructive Criticism, Blasphemous Comments
about the Presenter, Praise, Adoration, Accolades…
To locate your local CISM team, contact your local
Law Enforcement Center or EMS
Do You wish to become a CISM Volunteer?
If you wish to become involved in volunteering in the area of CISM
locally or, becoming Green Cross certified and travel to disaster
areas worldwide, please contact Dr. Dan Casey at 320.743.3639
or on-line at www.jec-counseling.com for upcoming classes in
your area.
It feels good to help and the best feeling you can have
is knowing that you “made a difference” in someone’s life…
Catch that feeling! Become a peer volunteer!