CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

2. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

3. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • MISSION STATEMENT • To minimize the potentially harmful stress- • related symptoms associated with critical incidents affecting emergency service personnel and their • families through timely confidential crisis intervention • that is empathic and respectful toward all involved.

4. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • TEAM MISSION - Expanded • The mission of the team is not to debrief the public or victims • of disasters. However, the mental health members may make appropriate referrals. Exceptions will be discussed with the clinical or program coordinator. • CISM Teams provide debriefing following critical • incidents to any emergency response agency requesting • assistance. The focus of this service is to minimize the • harmful effects of job stress, particularly in crisis or • emergency situations.

5. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • THE CONCERN • Emergency services personnel have become • increasingly aware of the toll that unique occupation- related stressors may have on their quality of life. • The very nature of emergency service jobs may • expose these individuals routinely, or periodically, • to stressful events which they may or may not be • able to work through satisfactorily on their own. • Factors which cause stress to one individual may • not be stressful for another. worker or group of emergency workers.

6. CRITICAL INCIDENT STRESS MANAGEMENT TEAM (CISM) TEAM • THE CONCERN (Continued) • It has been demonstrated that certain events, such as the death of a child, the death of a co-worker, high rise fires or multiple casualty incidents, are particularly stressful for emergency workers. It has been demonstrated that certain events, such as the death of a child, the death of a co-worker, high rise fires or multiple casualty incidents, are particularly stressful for emergency workers. Any of these events, plus a host of others may cause or contribute to a critical incident for an emergency worker or group of emergency workers.

7. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • THE CONCERN (Continued) • Research has shown that a very small percentage of emergency service personnel are not actually affected by stress. Of those who do demonstrate symptoms related to stress, one-half can resolve these alone, while the other half continue to be affected. • Responses to stress may be immediate and incident specific, may be delayed for a period of time after an incident, or may be cumulative, building up after a long period of time and may include many incidents.

8. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • THE CONCERN (Continued) • Multiple factors affect an individual's response to stress and include factors specific to the stressor, such as the individual's personal qualities, past experiences and the resources available to him • or her.

9. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • A CRITICAL INCIDENT • A critical incident is a traumatic event, in an institution or in the community, that is outside • the range of usual human experience and • that may cause unusual psychological distress • and has sufficient emotional power to affect a person's ability to cope with the consequences • of the event.

10. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • A CRITICAL INCIDENT • Jeffrey Mitchell, founder of the International Critical Incident Stress Foundation (ICISF), has defined a • critical incident as "any situation faced by emergency service personnel that causes them to experience unusually strong emotional reactions which have the potential to interfere with their ability to function either • at the scene or later. All that is necessary is that the incident, regardless of the type, generates unusually strong feelings in the emergency workers."

11. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • CRITICAL INCIDENT EXAMPLES • Death of an emergency services worker, i.e. law • enforcement, fire fighter or other emergency • personnel in the line of duty, including during the • incident, enroute to or following the scene, or • during a training exercise.

12. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • CRITICAL INCIDENT EXAMPLES (Continued) • Serious line of duty injury. • Suicide of a crew member or other unexpected death. • Mass casualty incidents. • Serious injury or death of a civilian resulting from • emergency services operations, i.e. auto accident, etc.

13. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • CRITICAL INCIDENT EXAMPLES (Continued) • Police shooting. • Events that seriously threaten the lives of responders. • Death of a child or violence to a child. • Loss of life of a patient following extraordinary and • prolonged expenditure of physical and emotional • energy during rescue efforts by emergency services • personnel.

14. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • CRITICAL INCIDENT EXAMPLES (Continued) • Incidents that attract excessive media coverage. • Personal identification with the victim or the • circumstances. • Events where the victims are relatives or friends of • emergency personnel. • Any incident that is charged with profound emotion.

15. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • CRITICAL INCIDENT EXAMPLES (Continued) • Any incident in which the circumstances were so • unusual or the sights and sounds so distressing as • to produce a high level of immediate or delayed • emotional reaction.

16. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • A SOLUTION • The CISM Team has been established to provide a form of crisis intervention specifically designed to assist emergency workers to reduce the number of psychological casualties among their ranks. Through critical incident stress debriefing, emergency personnel are provided a tool to potentially alleviate overwhelming emotional feelings and physical symptoms.

17. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • THE TEAM • The CISM Team consists of a multidisciplinary group of certified ICISF-trained professionals. Debriefers are volunteers who are familiar with emergency services. They are carefully selected from the following groups: • Mental health professionals • Fire service personnel • Chaplains • Law enforcement • Emergency Medical Services • Field personnel from various agencies

18. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • THE TEAM (Continued) • The highest priorities of the team are to maintain • confidentiality and to respect the feelings of the individuals • involved. • It is not the function of a team to replace on-going • professional counseling, but to provide immediate crisis • intervention. Through the CISM process, a team provides • emergency personnel tools to potentially alleviate stress • related symptoms.

19. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • THE TEAM (Continued) • CISM Teams also provide education regarding critical • incident stress to emergency services workers. CISM • Teams provide services to emergency/first responder • personnel, hospital personnel, and spouses.

20. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • GROUPS SERVED BY THE CISM TEAM • Fire services - paid or volunteer • EMS service - paid or volunteer • Law enforcement personnel • Search and rescue personnel • Ski patrol organizations • Hospital personnel • Others

21. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • TYPES OF INTERVENTIONS • Several types of interventions may be conducted depending • upon the circumstances of a particular incident. Intervention • may be on an individual one-on-one basis or, ideally, in small groups. The following types of interventions, singularly or in combination, are most commonly utilized:

22. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • TYPES OF INTERVENTIONS • Pre-Incident Education • On-scene support services • Demobilization/de-escalation/decompression • Defusing • Formal debriefing • Individual consults • Significant other support • Specialty debriefing • Informal discussion • Follow-up services

23. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Pre-Incident Education • Pre-incident education regarding stress, stress recognition • and stress reduction strategies is an essential part of the • CISM process. • Educational programs for line and command staff also • include information on critical incident stress debriefings, • how to contact a team, and on-scene considerations. • Programs should be provided for recruits, refresher training, • and veteran personnel. • Programs for spouses and significant others may also include • stress recognition and management.

24. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • On-Scene Support Services • Three types of services for prolonged or large scale • incidents may be provided: • One-on-one sessions with rescuers exhibiting signs of • obvious distress • Consultation to the Incident Commander or command • officers • Assistance to victims of the incident as needed

25. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Demobilization/De-escalation/Decompression • Utilized during or following a large scale incident as units are released from the scene to determine if all personnel are accounted for, make announcements, etc. • A mental health professional or experienced peer takes 15 minutes to provide information on the signs and symptoms • of stress reactions that may occur. Lasts a maximum of 30 minutes. • Unit may be released from duty or return to the station in • service. Incident Commander may require that all personnel • go through a demobilization session before they are released • from the scene.

26. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Defusing • Defusing is a shortened version of the debriefing. • Defusings take place immediately or relatively • soon after the critical incident is finished and • typically last less than one hour. • The leader of a defusing may be a peer support • person or one of the mental health support people • on the critical incident stress management team. • Defusings are designed to either eliminate the • need to provide a formal debriefing or to enhance • the debriefing if it is still necessary to provide one.

27. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Defusing • A mini-debriefing for a small core or working group • (such as an engine company) conducted at the station • shortly after the incident, usually within 3-4 hours. • Provides information about the incident and general • information and advice on stress reactions. In some • circumstances a defusing may involve a more in-depth • discussion of participants’ feelings and reactions. • May be led by an experienced peer debriefer. A • defusing may eliminate the need for a formal debriefing.

28. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • DEBRIEFING • A debriefingis a group meeting or discussion about a • distressing critical incident. • Based upon the core principles of education and crisis • intervention, the critical incident stress debriefing is • designed to mitigate the impact of a psychologically • traumatic event (a critical incident) and to assist personnel • in recovering as quickly as possible from the stress • associated with the event. • The formal critical incident stress debriefing is a structured • group meeting using a seven-stage intervention process.

29. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Formal Debriefing • Ideally conducted within 24-72 hours of the incident. • Confidential non-evaluative discussion of the • involvement, thoughts, and feelings resulting from the • incident. • Also provides discussion and education regarding • possible stress-related symptoms.

30. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Individual Consults • One-on-one counseling for concerns related to the • incident. • May require a mental health professional. Providing • individual counseling is not a function of the CISM • Team. However, team clinicians may be utilized for • referrals.

31. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Significant Other Support • Includes the following services: • Educational programs for significant others, • Debriefings for significant others, • Bereavement support, • Grief and crisis counseling, and • Family support

32. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Specialty Debriefing • Providing debriefing interventions for groups not • directly involved in emergency services or otherwise • outside the realm of the CISM Team. • May be requested if services are not available in the • mental health community.

33. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Informal Discussion • An informal leaderless discussion of the event by • individual crews following return to quarters. • Initial discussion occurs spontaneously in many • groups and is not structured. • It may be facilitated by a team peer member who is • present. • The focus of the discussion should be the group’s • reaction to the event rather than a critique.

34. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Follow-up Services • Conducted following individual consults, defusings, • debriefings, demobilizations, and significant other • support in the weeks or months after an incident. • May include an informal debriefing session, phone • or personal follow-up. • Concern with detecting delayed or prolonged stress • syndrome. • May also be used to evaluate debriefing services • offered.

35. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • THE DEBRIEFING PROCESS • Emergency services personnel, command staff, • emergency management, medical control authorities • (e.g., Public Health, Hospital, Nursing, etc.) are • responsible for identifying and recognizing significant • incidents that may require debriefing. • When an occurrence is identified as a “critical • incident”, a request for debriefing should be made as • soon as possible.

36. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • THE DEBRIEFING PROCESS (Continued) • The team is activated by a call to the dispatch center in • the Sheriff’s Office. • Appropriate call information is obtained and relayed to • the CISM Team. • CISM interventions are coordinated by a designated • team member to promote the quality of the services • and to ensure appropriate procedures are followed. • The team member also schedules requests for • education/in-service presentations.

37. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • THE DEBRIEFING PROCESS (Continued) • A team member contacts the agency requesting services to: • Assess the need for a formal debriefing, a • defusing, or a referral. • Determine the nature of the incident.

38. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • THE DEBRIEFING PROCESS (Continued) • Team members should coordinate a time and • location to meet prior to and following the • debriefing to discuss the incident, available • resource information, and the approach to be • used during and after the debriefing. • At times, they may wish to visit the incident site before • the debriefing.

39. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • THE DEBRIEFING PROCESS (Continued) • Arrange a time and location if a formal debriefing • is indicated. • Debriefings are optimally conducted within 24-72 hours of • the incident, and should not generally extend beyond one • week. • A 24 hour normalizing period following the incident is • recommended.

40. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • THE DEBRIEFING PROCESS (Continued) • If large numbers of personnel are involved, debriefing • begins with those most involved with the incident. • A defusing may be appropriate within 24 hours of the • incident.

41. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Debriefing Process Considerations • The location selected for the debriefing should be • free of distractions. • Other potential sites include schools, churches or • other meeting facilities. Crew quarters or station • may also be utilized if appropriate to the circumstances.

42. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Debriefing Process Considerations (Continued) • All emergency personnel involved in the incident • should be invited to the debriefing and encouraged • to attend. This includes, but is not limited to fire, law • enforcement, dispatch, EMS personnel, and hospital • emergency department personnel. • A time for the debriefing should be selected that is • most convenient for as many responders as possible • and for the team members.

43. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Debriefing Process Considerations (Continued) • Agency management or command officers • should be encouraged to relieve personnel from • duty during the debriefing. • The environment should be free of interruptions, • phone calls, radios, and pagers. Turn off pagers, • cell phones, radios, and other communication • devices.

44. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Debriefing Process Considerations (Continued) • The team member contacted selects a debriefing • team from available members. • To assure the quality of the process, the team • must consist of at least one mental health • professional and two to three team members. • The average team consists of 3 members. • The mental health professional is the designated • team leader. • Team members who have responded to the • incident should not be debriefers.

45. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Guidelines For Debriefings • Strict confidentiality must be maintained. All • information regarding agencies involved, • situation debriefed, and issues discussed shall • not be divulged before or after a debriefing • except with team members or as part of the team • continuing education process. • No mechanical recordings or written notes will be • made during a debriefing. It is up to the team to • enforce this rule during the debriefing.

46. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Guidelines For Debriefings (Continued) • Nomedia personnel (TV, radio or newspapers) • will be allowed to attend a debriefing. • In the event that these individuals are present • without team knowledge, phrases such as • “Everything said here is off the record” may be • helpful. • This does not guarantee, however, that • information will not be reported.

47. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Guidelines For Debriefings (Continued) • Participants in the debriefing may speak to the • media either before or after the debriefing. It is • important for team members to explain that • individuals speak only for themselves and NOT • for anyone else in the debriefing. • Debriefers may speak to the media, but only to • educate about the process of CISM and to • discuss the effects of stress. All other inquiries • should be referred to a Team Coordinator or other • designated individual.

48. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • Guidelines For Debriefings (Continued) • Debriefings are not a critique of the incident. The • team has no evaluation function of tactical • procedures. • The debriefing process provides a format in • which personnel can discuss their feelings and • reactions and thus reduce the stress resulting • from exposure to critical incidents.

49. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • CISD GOAL • The goal of the CISD is to encourage ventilation of • emotions and a re-balancing of the individual and • the group, and to educate group members regarding • normal stress reactions.

50. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM • General Format For Formal CISD • Introductory Phase • Introduction of the CISM Team, description of • the debriefing process, establish ground rules.