Critical Incident Stress. San Luis Obispo County Fire Chiefs Association CISM Team

Transcription

1 Critical Incident Stress San Luis Obispo County Fire Chiefs Association CISM Team

2 Overview Responder Culture Stress CIS Symptoms Intervention Resources for responders

3 Emergency Responder Culture Traits and Beliefs What we believe about ourselves and why Problem solvers Action Oriented Can control ourselves and environments People are better off because we were there Why do we believe these things?

4 Cognitive Dissonance In psychology, cognitive dissonance is the excessive mental stress and discomfort [1] experienced by an individual who holds two or more contradictory beliefs, ideas, or values at the same time I am a rescuer Belief Incident I was able to save that person Reality A rescuer saves people Concept What is an example of a healthier model? The model breaks down I am a rescuer Belief Incident I was unable to save that person Reality A rescuer saves people Concept

5 STRESS: good or bad? Low levels can Enhance memory and reaction Exhilaration Fight or flight Long term effects?

6 Critical Incident Stress / PTSD Distress overwhelms ability to cope

7 Categories of Incident Stress Acute Stress (major incidents) Emergency responder exhaustion syndrome Cumulative stress (combination of micro traumas) Chronic stress (body can rarely relax)

8 Critical Incident Signs and Symptoms Common signs and symptoms of critical incident stress show up in four main categories Cognitive Physical Emotional Behavioral

9 Coping with Stress - Trauma Give yourself time to heal, try to be patient with changes in your emotional state Ask for support from people who care about you and who will listen and empathize with your situation Participate in CISM and or find groups led by appropriately trained and experienced professionals Engage in healthy behaviors to enhance your ability to cope with excessive stress Eat well-balanced meals and get plenty of rest Avoid alcohol and drugs Establish or reestablish routines like eating meals at regular times and following an exercise program Take some time off from the demands of daily life by pursuing hobbies or other enjoyable activities Avoid major life decisions if possible because these activities tend to be highly stressful

10 Critical Incident Basics Many experiences can be traumatic Some are traumatic to some, but not to all Various factors may make some more vulnerable than others Traumas create reactions now and later Experiencing these reactions means the situation was serious for you Reactions sometimes get worse before they get better Sometimes they reappear later

11 Crisis Intervention (CI) An active, short-term, supportive, helping process. Acute intervention designed to mitigate the crisis response. NOT psychotherapy or a substitute for psychotherapy.

12 Critical Incident Stress Management Post disaster crisis intervention (CISM) was associated with reduced risk for: major depression (d=.81) anxiety disorder (d=.98) global impairment (.66) compared with comparable individuals who did not receive this intervention (Boscarino, et al, IJEMH, 2005).

13 San Luis Obispo County Fire Chiefs Association CISM Team Services Pre-crisis Preparation Rest Information Transition Services (RITS) Crisis Management Briefings (CMB) Defusing Critical Incident Stress Debriefing Individual Crisis Intervention Family Crisis Intervention Follow-up and Referral Civilian Assistance

14 Relative Intensity of Interventions Introduction Demobilization Information Fact Defusing Exploration Teaching Fact 5 Phase CISD Reaction Teaching Reentry Thought 7 Phase CISD Symptoms Reaction

15 Pre-crisis Preparation Includes stress management education, stress resistance, and crisis mitigation training for both individuals and organizations Rest Information Transition Services (RITS) A brief intervention prior to release of employee(s) following a large-scale incident or disaster.

16 Crisis Management Briefing (CMB) A large group meeting to provide information about the incident. control rumors discuss potential symptoms of distress and the components of stress management. identify available resources for affected individuals who may later elect to seek CISM support.

17 Defusing A small group intervention applied within 12 hours of a critical incident, preferably during the same shift. A shorter, informal version of the debriefing process. Most incidents that are defused do not need to be debriefed.

18 Critical Incident Stress Debriefing Structured 7 phase group discussion conducted 2-10 days post incident with the support of mental health care professional, trained peers and chaplains Designed to mitigate distress, facilitate psychological closure, or facilitate access to continued care.

19 Individual Crisis Intervention One-on-one counseling or psychological support throughout the timeline of the critical incident. Family Crisis Intervention Includes organizational consultation, as needed

20 Follow-up and Referral Intervention components for follow-up assessment and treatment, if necessary. This can include use of mental health providers, and other specialized programs

21 Civilian Assistance Although assisting victims, survivors, and families is not the primary function of the CISM Team, it may be necessary to provide interim support services to these individuals so that the emergency service crews may perform their duties without being hampered. CISM team will act as Liaison to gather local resources for civilians. (Red Cross, County Mental Health, etc.)

22 Critical Incident Stress Management There is now emerging evidence that prompt delivery of brief, acute phase services in the first weeks after an event can lead to sustained reduction in morbidity years later, reducing the burden of secondary functional impairment, presumed daily average life years lost (DALYS), and costs to both the individual and the public (p. 15). Schreiber, M. (Summer, 2005). PsySTART rapid mental health triage and incident command system. The Dialogue: A Quarterly Technical Assistance Bulletin on Disaster Behavioral Health,

23 Critical Incident Debriefing Literature suggests value in debriefing CISD ( debriefing ) should only use group format CISD should be offered as part of a larger integrated intervention system (CISM) Participation is Voluntary and involves informed consent CISD contraindicated if basic physiological, shelter, & safety needs not met Positive outcome may be other than prevention of PTSD (provides information, support, may increase cohesion, positively viewed) Review for Canadian Armed Forces Ritchie, P. (2002)

24 Solutions CISM hrs : Referral Counseling EMDR Educate about stress and stress reactions Peer support Medical care Medication Normalizes feelings Cathartic relief Recovery

25 Remember CISM interventions are not substitutes for psychotherapy. Rather, they are elements within the emergency mental health system. Designed to precede and complement psychotherapy, i.e., part of the full continuum of care.

26 San Luis Obispo County Fire Chiefs Association CISM Team Activation Any responder can activate the request for assistance. The incident commander, chief officer, or duty chief is responsible to determine need for any of the following team services. Initiate CISM services automatically for the Critical Incidents identified in the policy. All CISM Team members are to serve as lookout for peers and request CISM team services when necessary. Contact CAL FIRE/San Luis Obispo County Fire Dispatch emergency line at Dispatch will contact CISM Team Coordinator CISM Team Coordinator will contact Agency for details and determine need(s) CISM team contacted via text message for deployment Critical Incident Services for emergency responders, chaplains, clinicians.

27 Summary There are many forms of stress, while natural, critical incident stress can be detrimental. There is no one size fits all solution, CISM has many components that can be utilized to best fit the needs of the responders. The demands of our profession can tax us both physically and emotionally. We must understand what options are available to ensure we are doing our very best to support our most precious resource.

28 Questions? Additional information regarding the San Luis Obispo County Interagency Critical Incident Stress Management Team Can be found at :