Transcript Critical Incident Stress Management

Critical Incident Stress
Management
Kelly Burkholder-Allen
Churton Budd
Paul Rega
The responder is often a victim as
well
Critical Incidents
 Are events which have significant power to
overwhelm an individual’s normally effective
ability to cope
 Individuals who experience a critical incident
are faced with the demand to respond
 They often respond in ways which require
exceptional physical or heroic effort
Critical Incidents
 Critical Incident Stress
affects nearly 90% of all
emergency personnel
 Are emotionally charged
events
 The effects of critical incident
stress can be intensified, influenced, or mitigated by our
personal, family, and developmental issues
 Symptoms usually subside within a few weeks
Critical Incident Stress
 No one is immune from responding to the
stress of a critical incident
 Critical incident stress may occur hours,
days, or even months after a critical event
 You may experience symptoms of stress
and not even know it
 Suffering the stress effects following a
critical incident stress is NORMAL
In the days immediately after a
critical event
 Maintain your schedule, alternate physical
activity with relaxation
 Remember that you are having normal
reactions to an abnormal event
 Reach out and spend time with others---they
care
 It is ok that you bad and talk about your
feelings
After a critical event
 Do things that feel good to you or provide you with
comfort
 Avoid drugs and alcohol to numb your emotions
 Keep a journal
 Don’t make life-altering changes at this time
 Do make daily decisions and assume control over
your life
 Get plenty of rest, eat nutritiously, and take care of
yourself
Normal signs and symptoms of
stress
 Physical Symptoms:
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Nausea
Tremors
Chills
Diarrhea
Rapid heart rate
Muscle aches
Dry mouth
Shaking
Visual problems
Fatigue
 Emotional Symptoms:
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Anxiety
Denial
Fear
Survivor guilt
Uncertainty of feelings
Depression
Grief
Hopelessness
Feeling overwhelmed, lost,
or abandoned
– Wishing to hide or die
– Anger
– Feeling numb
Normal signs and symptoms of
stress
 Behavioral:
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Change in activity
Withdrawal
Suspiciousness
Change in communication
patterns
Changes in interpersonal
interactions
Variations in food
consumption
Excessive humor
Excessive silence
Unusual behavior
Increased smoking or
alcohol consumption
 Cognitive:
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Confusion
Inability to pay attention
Difficulty calculating
Memory problems
Inability to concentrate
Repeated flashbacks
Nightmares
Blaming others
Disrupted logical thought
process
Critical Incident Stress can be
MANAGED!
CISM
 Critical Incident Stress Management was
first recognized and techniques to respond
were developed in the 1980’s
 The first team was in Virginia, today there
are hundreds of teams worldwide
A seven phase process developed
to:
 Minimize the emotional and physical impact of an
event
 Prevent burn-out
 Educate participants regarding normal stress
reactions
 Mitigate stress responses
 Help to keep careers, relationships, and
physical/mental health intact with little residual
damage
 Can be delivered in a 6 hour course
A formal debriefing:
 Ideal debriefing time is between 24 and 72
hours post event
 Generally lasts for 2-3 hours
 Is a seven stage process
The seven phases of a formal
debriefing:
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Introduction
Fact phase
Thought phase
Reaction phase
Symptom phase
Teaching phase
Re-entry phase
Defusing
 Defusing:
– An abbreviated version of a debriefing in a small group process
– Helpful when a full debriefing cannot be organized
– Is held very soon after the event—ideal time within first 3 hours post
event
– Three main segments:
 Introduction
 Exploration
 information
– Four main goals:
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Rapid reduction in the intensity to reactions
A normalizing experience
Re-establishment of the social network of the group
To assess whether a full debriefing will be necessary
Demobilization
 Demobilization:
– A very brief intervention that takes place immediately following the event
– Primary stress prevention and intervention technique
– Two main segments:
 Brief period where personnel are given information to assist them with
management of stress reactions
 A rest and nutrition/rehydration period prior to return to duties
– Goals of demobilization:
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To provide a transition from the traumatic event or critical incident to the routine
To reduce the intensity of immediate stress-related reactions
Assessment of group for additional needs
To educate the group about potential stress reactions
To provide information about additional support
To establish positive expectations about outcome
What makes defusings and
debriefings effective?
 Early intervention
 Opportunity for catharsis
 Opportunity to verbalize about the trauma with
those who experienced it
 Behavioral structure
 Psychological structure
 Group support
 Peer support
 Promotes follow-up
CISM
 Was designed to assist in the prevention,
management, and recovery from a
significant stress
 Include pre-incident education, defusing,
debriefings, support services, follow-up
services, individual consults, peer
counseling, and disaster management
 CISM interventions are provided be
especially trained individuals
CISM increases the rate of normal
recovery, in normal people, who are
having normal reactions to abnormal
events
Professionals trained in CISM can
provide:
Defusing
Demobilization
Debriefing
Recommendations for follow-up
Know your community’s resources!
Find out who provides CISM
services and make contact, if you or
some one that you care about has
experienced a critical incident