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Critical Incident Stress Management (C.I.S.M.) A Basic Introduction

Critical Incident Stress Management (C.I.S.M.) A Basic Introduction. Montgomery County CISM Team. Montgomery County C ritical I ncident S tress M anagement. Who takes care of the caregivers?. Critical Incidents.

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Critical Incident Stress Management (C.I.S.M.) A Basic Introduction

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  1. Critical Incident Stress Management (C.I.S.M.)A Basic Introduction Montgomery County CISM Team

  2. Montgomery CountyCriticalIncidentStressManagement Who takes care of the caregivers?

  3. Critical Incidents Events that have the potential to create significant human distress and can overwhelm one’s usual coping mechanisms.

  4. What is a “Critical Incident?” • Death or injury of a coworker • Death or major injury to a child • Situations involving extensive media coverage • Prolonged situation with negative outcome • Mistakes, real or imagined • Victim previously known to person • Natural Disasters Unionville H.S.

  5. What is Critical Incident Stress? • Emotional, mental, and/or physical response which interferes with behavior, or the ability to function either on scene or after the incident is over. • As defined by Dr. Jeffrey T. Mitchell Ph.D.

  6. What DeterminesHow You Will React? • The type of stress you experience is dependant on 4 “P”s • Perception - How one views an event • Planning - Training and preparation • Preparedness - One’s expectations of the stimuli • Past- The baggage you carry from previous experiences

  7. Coping Mechanisms • Denial (“Things just don’t bother me”) • “Titanic Syndrome” – (I’m invincible and unsinkable) • “Image Armor” –(Admission of pain is seen as a sign of weakness) • Anger • Blame • Dark Humor

  8. Exposure Control • While working with a patient... • You may have gotten exposed to an infection • Would you seek treatment?

  9. Exposure Control • After an exposure, a physician may prescribe some prophylactic medication • CISM is the prescription following an exposure to stress C I S M

  10. The Goals of CISM are: • Early Recognition • Identifying a potentially stressful situation • Activation • Pagethe CISM Coordinator • Suppression • Set up an Intervention • Prevent burnout • Encourage the well being of personnel, careers, and families

  11. San Diego vs. Cerritos

  12. San Diego 125 killed-no survivors 16 homes destroyed 15 civilians killed on ground 300 EMS personnel > 10,000 body parts Cerritos 82 killed-no survivors 16 homes destroyed 15 civilians killed on ground 300 EMS personnel > 10,000 body parts The Tale of Two Plane Crashes

  13. San Diego No CISM Services provided Lost police - 5 in one yr. Lost fire - 5 in one yr. Lost paramedics - 15 in one yr. Increase in mental health services - 31% Cerritos 12 CISM Demobilizations Hotline Follow-up No loss of police or fire personnel 1 paramedic loss Increase in mental health services - 1% Impact of CISM

  14. What is Stress? • Your reaction to stimuli • Physical • Mental/Cognitive • Emotional • Stress comes in two forms • Eustress • Distress

  15. What is Distress? • A disruptive force that negatively impacts daily health -Mitchell & Bray • Physical- Change in eating patterns • Mental/Cognitive- Inability to recall simple information • Emotional- Hypersensitivity

  16. What is Eustress? • The positive, motivating reactions to situations • Driving force to do your best • Physical - Exercise • Mental - Academics • Emotional - Optimism

  17. Psychological Crisis An acute response to a trauma, disaster, or other critical incident wherein: 1) Psychological balance is disrupted 2) One’s usual coping mechanisms have failed 3) Evidence of significant distress, impairment, dysfunction

  18. Terrorism represents a form of psychological warfareThe war will ultimately be won or lost not on the battlefield, but in the mind

  19. Crisis Intervention was developed in response to the acute mental health needs of those in crisis

  20. Crisis Assessments

  21. Acute Mental Status Assessment • Orientation • Long-term Memory • Concentration • Emotion

  22. What is cumulative stress? • Chronic progressive culmination of small stressors • May result in P.T.S.D., if not managed. • Warning: Contents under extreme pressure!

  23. Cumulative and Long-Term Effects of Stress • Hindrance of performance • Decreased ability to make decisions • Memory problems • Interpersonal Conflicts • Morale problems • Accident prone • Absenteeism • Depression • Burnout and Attrition • Suicide

  24. P.T.S.D. (Post -Traumatic Stress Disorder) • This is a pathological reaction to an abnormal situation • Symptoms inhibit the person from functioning at his/her job • May have day or night terrors

  25. More P.T.S.D. • Hypersensitivity • May experience intrusive thoughts (flashbacks) • Symptoms MUST last for over 30 days • Early Recognition and intervention may prevent the domino effect

  26. Critical Incident Stress Management • “...is a comprehensive, organized approach for the reaction, and control of harmful aspects of stress.” • Jeffrey T. Mitchell Ph.D.Forms of intervention: • Pre-incident Education • On-Scene Support • Demobilization • Defusing • Debriefing (CISD) • Crisis Management Briefing (CMB) • Family Support • Assessment • Follow-up/Referral • Mutual Aid

  27. For Whom is C.I.S.M. Targeted? • Normal people experiencing normal reactions to abnormal situations

  28. C.I.S.M. is not for CRAZYPeople! • C.I.S.M. is not designed to be therapy or a replacement for therapy

  29. Critical Incident Stress Debriefing • “… is a method for mitigating the harmful effects of work-related trauma, and ultimately preventing P.T.S.D.” • Jeffrey T. Mitchell Ph.D.

  30. What is a Defusing? • A small group process which is initiated after any traumatic event that is powerful enough to overwhelm one’s usual coping mechanisms • Short version of a Debriefing

  31. What Does Defusing Mean? • Means to render something harmless before it can do damage • Overall objective is to reduce the potential for harm to those who were exposed to a critical incident

  32. Usual Effects of Defusings • May possibly eliminate need for formal Debriefing • It will enhance effectiveness of Debriefing process if one is needed

  33. Defusing Goals • Achieve a rapid reduction in the intense reactions to a traumatic event • Attempt to normalize the experience • Attempt to re-establish the social helping network of the group • Assess need for formal Debriefing process

  34. Additional Goals of Defusings • Information transfer between members • Re-focusing of thinking process; “getting your act together” • Education as to survival skills over next few days • Identifying support resources/personnel

  35. Debriefing - What is It? • A formal peer group discussion designed to help alleviate the effects of critical incident stress • A prevention program for “burn-out”

  36. What Happens at a Debriefing? • Team • Location • Phases • Introduction • Fact • Thought • Reaction • Symptom/teaching • Re-entry

  37. Introduction Phase • Introduce members • Establish ground rules • Explain process

  38. Fact Phase • Who are you and what was your job, or how were you involved in the incident? • What happened from your point of view?

  39. Thought Phase • What was your first or most prominent thought once you came off auto pilot?

  40. Symptom Phase • The group is asked to describe: • Any cognitive, physical, emotional or behavioral symptoms they experienced at the scene • Symptoms they experienced in the following days • Symptoms they continue to experience

  41. Teaching Phase • All team members teach about symptoms one may experience • Find a positive outcome, or gift that may have come out of tragedy • Utmost concern for group

  42. Re-entry Phase • Clarify issues • Answer questions • Team members make summary comments

  43. Follow-up and Referral • May return for another debriefing if group decides • May have an individual who may ask for further help

  44. Signs and Symptoms • Physical • Chest Pain • Elevated BP • Headaches • Muscle tremors • Cognitive • Confusion • Poor attention • Intrusive images • Nightmares Behavioral Physical Cognitive nal Emo

  45. Signs and Symptoms • Emotional • Guilt • Anxiety • Depression • Behavior • Withdraw • Loss of or increase in appetite • Changes in sleep patterns • Increased alcohol consumption

  46. The Keys to Unlocking a Successful Career After a Critical Incident: Helping a Peer • Listen carefully • Spend time with the traumatized person • Help with everyday tasks • Know your limitations as a peer supporter

  47. The Keys to Unlocking a Successful Career Helping yourself • Eat well-balanced and regular meals • Drink plenty of water • Get plenty of rest • Structure your time - Keep busy • Allow yourself to be emotional • Look to your peers and family for support

  48. Pre-Incident Strategies • Eat Properly • Exercise • Rest • Talk Must practice/do/engage in regularly

  49. Post-Incident Strategies • Eat Properly • Exercise • Rest • Talk

  50. Montgomery County Critical Incident Stress Management Team Department of Public Safety Division of EMS and the Office of Mental Health

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