Transcript Critical Incident Stress Management (CISM)

Headquarters Southwest Region
Civil Air Patrol/USAF-Auxiliary
Critical Incident Stress
Management (CISM)
7/20/2015
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A
CISM PEP Talk
Pre-Exposure
Preparation Talk
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Objectives of this presentation:
To provide the participants with ...
• A review of the causes and effects of stress
• Some cues to identify stress and tools to
manage it
• An overview of critical incident stress, crisis
management, and critical incident stress
management (CISM)
• An orientation to CAP’s CISM program
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CISM is a Mandated
Operations Program!
It is not just a Chaplain’s program!
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Just What is Stress?
“A state of physical and
emotional arousal.”
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Where Does Stress Come
From?
Stimulus
Response
Stressor
Stress Response
stimulus/demand
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Some Definitions ...
• Stressor -- a stimulus that causes, evokes, or
is otherwise strongly associated with the
stress response
• Stress response -- Nonspecific response of
the body to a demand(s)
• Target organ(s) -- The part of the body, or
mind, that is the recipient of the stress
response and which develops the signs &
symptoms of over-arousal
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For example ...
•While flying, the stressors of
heat and G-forces affect the body.
•Next a stress response occurs in
the inner ear leading to a
condition known as “vertigo.”
… airsickness
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•Then the target organ of the
stomach is over-aroused and
decides to “get rid of food!”
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2 “Varieties” of Stress ...
“Eustress”
equals
Good Stress
--- Positive, motivating stress
“Distress”
equals
Bad Stress
--- Negative, excessive, debilitating stress
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Some Generic
Sources of Stress ...
• Biogenic
• Environmental
• Personality
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Some Biogenic Stressors ...
• Caffeine
• Nicotine
• Amphetamines
• Cold & allergy medicines
• Theophylline
• Illness
• Lack of sleep
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Some
Environmental Stressors ...
• Rain
• Temperature extremes
• Sounds --- screams
• Mud
• Smells
• G-forces
• Time of day
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Personality
The way people are “hard-wired.”
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Stress is Cumulative
It builds up over time ...
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Cumulative Stress
Is stress that ...
• Piles up (snowballs).
• Increases with time.
• Deteriorates:
* Performance
* Relationships
* Health
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We Used to Call it
“Burnout”
•
•
•
•
Increased cynicism.
Increased physical lethargy.
Procrastination.
In the extreme … even …
suicidal or homicidal thoughts or
ideations.
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Some Signs & Symptoms of
Cumulative Stress
•
•
•
•
•
Tardiness
Fatigue
Detachment
Depression
Medication or drug
use.
• Irritability
• “Gallows” humor
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• Paranoia, or
irrational fears.
• Derogatory speech or
labeling of others.
• Denial
• Increased workplace
absences.
• Irresponsibility
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An Example of
Cumulative Stress ...
The De Havilland “Comet” -- The
World’s First Commercial Jet Airliner
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Like With The Airliner ...
Stress is the “wear and tear” on our
human coping systems. Over time minor
stresses can have major and damaging
effects. This is the cumulative effect of
stress.
… and we can crash too!
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Critical Incident
Stress
“Any event in which there is a stressful
impact sufficient enough to overwhelm
the usually effective coping skills of
either an individual or a group.”
(Everly & Mitchell, 1999)
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Cumulative stress can
exacerbate critical incident
stress.
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Critical Incidents
are events that have the potential to create
significant human distress and can
overwhelm the usual coping mechanisms of
individuals and/or groups.
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How to Recognize Excessive Stress?
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Manifestations of
Distress Can Take a Number of
Forms...
• Physical
• Cognitive
• Emotional
• Behavioral
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Physical Manifestations
• Excessive sweating
• Nausea and/or vomiting
• Elevated pulse rate
• Elevated blood pressure
• Rapid breathing
• Dizziness
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Cognitive Signs
• Confusion. Mumbling of words
• Difficulty making decisions
• Decreased concentration
• Memory dysfunction
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Emotional Signs
• Emotional Shock
• Anger
• Grief
• Depression
• Feeling totally
overwhelmed
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Behavioral Signs
• Changes in ordinary behavior
• Changes in eating habits
• Decreased personal hygiene
• Prolonged silences
• Withdrawal
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Stress Response Timelines
• Immediate -- up to 24 hours post event.
• Delayed -- 24 to 72 hours post event.
• Cumulative -- buildup of stress over time.
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Post-Traumatic Stress is ...
“… a normal reaction in a normal
person, to an abnormal event.”
“… a survival mechanism, whereas
Post-Traumatic Stress Disorder
(PTSD) is a pathogenic (unhealthy)
variation of that normal survival
mechanism.”
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Examples of Critical Incidents
• Line of duty death or death at workplace
• Serious line of duty injury or workplace injury
• Suicide of coworker, friend, family member
• Multiple casualty incidents (MCI’s), disasters
• Significant events involving children
• Prolonged events especially with loss
• Any powerful event which overwhelms a
person’s normal coping mechanisms
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A Crisis
A response to an event wherein ...
• One’s normal psychological balance
(homeostasis) has been disrupted,
• One’s usual coping mechanisms have failed to
reestablish the needed homeostasis, or
• There is evidence of functional impairment.
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Crisis Intervention
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Crisis Intervention is ...
The provision of timely “emotional first aid:”
• An exercise in psychological damage
control. Stopping the bleeding!
• Not a cure
• An opportunity for assessment and for
follow-up
• Guided by a mental health professional
(MHP)
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Crisis Intervention
Is but one aspect of a
continuum of care. It requires
specialized and unique
training.
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Crisis Intervention
Principles ...
• Spell B -I -S -E -P
•Brevity
•Immediacy
•Simplicity
•Expectancy
•Proximity
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B
I
S
E
P
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Critical Incident Stress
Management (CISM)
is
one type of crisis intervention.
It is a comprehensive, systematic
program for the mitigation of criticalincident related stress.
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The goals of CISM ...
•
•
•
•
•
•
Prevent traumatic stress
Mitigate traumatic stress
Intervene to assist recovery from traumatic stress
Accelerate recovery
Restore function
Maintain worker health and welfare
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By way of analogy ...
According to the Wing Aircraft
Maintenance Officer, HQ-TX Wing expects
to spend approximately $187,000.00
this year to maintain our fleet of airplanes.
But …
how much are we spending to maintain our
most valuable asset…OUR
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PEOPLE?
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CISM is
a comprehensive, systematic
maintenance program for the
overall well-being of our most
valuable assets
… our members.
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CISM involves many facets ...
•
•
•
•
•
Pre-crisis preparation and education
Demobilization (for large groups)
Crisis management briefings (large groups
also)
Defusings
Critical incident stress debriefing (CISD)
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CISM also involves ...
•
•
•
•
•
One-on-one, individual crisis intervention
Pastoral crisis intervention
Family CISM
Organizational crisis intervention / consultations
Follow-up and referral mechanisms
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CISM deals with
the current circumstances, the
current event or crisis …
NOT
… personal histories.
It is First Aid, not definitive care.
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Some Key
Elements of CISM ...
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Pre-Incident Education
• General information: stress, trauma, etc.
• Set expectations for actual
experiences
• Teach stress management
and coping skills
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Demobilizations
• Decompression
• Transition workers from disaster work (largescale incident) to routine duties or home
• Used with large numbers of people
• A 10- to 30-minute session
• An opportunity for assessment of group needs
• Alert workers to possible stress effects
• Always followed by a CISD (debriefing, usually
within one week
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Defusing
• A small group intervention conducted within
hours of the incident, usually within 12 hours
• Shortened version (20-45 mins) of the CISDebriefing
• May eliminate the need for, or increase
effectiveness of, CISD; opportunity to assess the
need for CISD
• Seeks to reduce intense reactions to a trauma
• Seeks to “normalize” the effects of the event
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The Defusing 3-Step ...
*Introduction
*Exploration
*Information
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The Critical Incident Stress
Debriefing (CISD)
•
•
•
•
•
•
•
A group discussion of a traumatic event
Peer driven
CISD
Clinician (MHP) guided
Lasts 1-3 hours
Closed circle format
Held 1 - 10 days post event
NOT psychotherapy!
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Objectives of the CISD



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


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Education
Ventilation
Reassurance and forewarning
Positive contact with a MHP
Improvement of interagency cooperation
Increase group cohesiveness
Restore self-confidence
Facilitation of follow-up
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CISDs consist of 7 stages ...
Mitchell, 1991
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Family Support




An essential component of a comprehensive
CISM program
Consists of:
* Educational programs
* CISD for significant others
* Bereavement support -- grief and crisis
counseling
Provided by peers, MHP, clergy, trained spouses
Includes children and elderly as well
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Referral ...
• Is made to obtain a more thorough a process of
assessment and evaluation,
• The mental health provider should understand
the “culture” of the agency in which the person
is employed, and
• should have specialized training/experience in
post-traumatic stress.
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Follow-up ...
• Essential element in all CISM
interventions.
• Can be made by:
* Phone calls
* Station / workplace visits
* Home visits
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All CISM Interventions Are
Strictly Confidential!
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How well does CISM work?
Let’s compare two airliner crashes to
see ...
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San Diego 1978 v. Cerritos 1986
San Diego Cerritos
Total Killed
125
Aircraft Survivors
0
Homes Destroyed
16
Killed on Ground
15
ESP used
300
Body Parts Recovered 10,000+
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82 San Diego,
0 PSA-182:
9/25/1978
16
Cerritos,
15 Aeromexico:
300 8/31/1986
10,000+
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San Diego v. Cerritos
cont’d …
Types of Critical Incident Interventions Provided
San Diego 1978
Sporadic 1 on 1
Crisis Interventions
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Cerritos 1986
12 CISDs
Demobilizations
Crisis hotline
Follow-ups with MHP’s
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San Diego v. Cerritos
Personnel losses, among responders,
within 1 year of event:
SD
CER
Ranking PD
5
0
FD Personnel
7
1
EMS Personnel
17
0
Increase in MH utilization within community within 1 year:
31%
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1%
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CISM Works!
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CISM
in the
Civil Air Patrol
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CAP’s CISM Program
Mandated by CAPR 60-5
 Not optional
 Specifically an operations program
 Implementation is assigned to Region
Commanders by CAPR 60-5.

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CAP’s CISM Program
cont’d
Wings are to “… assess the need for a
CIST.”
 All personnel are encouraged to receive
CIS training.

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CAP’s CISM Program ...
“The use of qualified, local, non-CAP
teams to respond to incident stressaffected CAP members is highly
encouraged … The use of local nonCAP teams will somewhat limit the
need to dispatch a trained CAP
CIS [Team]”
--CAPR 60-5 (2)e
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CAP’s CISM Program ...
“… Each active duty Air Force base is
required to have a CIST, which, with
prior coordination, may be able to
support CAP”
--CAPR 60-5 (2)e
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A CAP CIST
Consists of:
Mental Health Professionals
(MHP)
Peer Representatives

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CAPR 60-5 (3)a 2
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Request & Deployment
After a SAR or DR mission “ … a review of the
need for CIS intervention should be made for all
personnel ...”
 The incident commander or unit commander will
pass a request to wing commander.
 In consultation with staff, the wing CC will
coordinate use of a local non-CAP team or request
one of the Region teams.

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Funding CISM
 CISM
is not, presently, a specifically
USAF funded mission (by itself).
 CAP CISM
may be funded through an
existing mission’s funding.
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Funding CISM
• The CAP Natl HQ has approved limited
funding to support CISM missions
nationally.
 Housing and feeding of a team will
normally NOT be reimbursed.
 The “… use of host families…” is
encouraged to mitigate housing costs.
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For More Information ...
 Visit
the web site of the International Critical
Incident Stress Foundation (ICISF) at
http://www.icisf.org.
 Join
the ICISF.
 Review
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CAPR 60-5.
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For More Information ...
 Call
Chaplain Don Brown at (936) 394-3310 or
email him at [email protected].
 Sign
up for the “Basic Critical Incident Stress
Management” and other ICISF CISM courses.
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Any Questions?
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Credits
Ch, Lt Col DONALD R. BROWN II, CAP
SWR Deputy Chaplain and CISM Director
Lt Col Sherry Jones, RN, CAP
Special Advisor to the National
Commander for CISM
1st Lt Penny Herndon-Finuf, RN, CAP
SWR/TXWNG CISM Educational Officer
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