Critical IncidentStress Management Command Officer CourseLearning from the Past, . . . Progressing into the Future Developed by Lt. Col. Sam D. Bernard, Ph.D.CAP CISM National Team Leader Partial content from Chevron Publishing
Welcome Thank you for attending this session concerning CAP Command Officers
Rationale • To provide Command Staff & Incident Commanders with basic knowledge to: • Recognize the need for CISM, • Implament the CISM program, • Understand basic CISM principles, • Identify distressed personnel under their supervision, • Access CISM services.
Goals To provide the knowledge to: • Mitigate critical incident stress, • Prepare for critical incident stress, • Identify critical incident stress, • Support interventions for active critical incident stress intervention, • Recover from a critical incident while supporting members & the organization in CAP members while performing CAP duties.
Agenda • Stress & Types of Stress • Management of Cumulative Stress • Recognizing Critical Incident Stress (CIS) • Preventing Critical Incident Stress (CIS) • Mitigating Op Stress • After Action Support • Indicators of CIS vs. Disciplinary Problems or Character Disorders • CISM Resources • General Functions of CISM Teams • Follow-Up Services • P.A.S.S. • CAPR 60-5 & Updates • Liability • Charge • Contact Information Jeffrey T. Mitchell, Ph.D., CTS & George S. Everly, Jr., Ph.D., CTS
Stress • Stress is a state of: • Physical • Cognitive • Behavioral • Emotional and • Spiritual arousal. Take Home Message
Once physical, cognitive, emotional and spiritual arousal occurs, behaviors change. Chevron Publishing, 2002
Primary Types of Stress • General Stress • Cumulative Stress • Critical Incident Stress • Stress Related Disorder Take Home Message Normal Pathological
Having stress is not bad, in itself.What is bad is experiencing excessive or prolonged stress. Chevron Publishing, 2002
Resistance If the stressor continues, the body mobilizes to withstand the stress and return to normal. Exhaustion Ongoing, extreme stressors eventually deplete the body’s resources so we function at less than normal. Alarm The body initially responds to a stressor with changes that lower resistance. Return to homeostasis Homeostasis The body systems maintain a stable and consistent (balanced) state. Stressor The stressor may be threatening or exhilarating. Illness Illness and Death The body’s resources are not replenished and/or additional stressors occur; the body suffers breakdowns. Death
The brain becomes more alert. Stress can contribute to headaches, anxiety, and depression. Sleep can be disrupted. Stress hormones can damage the brain’s ability to remember and cause neurons to atrophy and die. Baseline anxiety level can increase. Heart rate increases. Persistently increased blood pressure and heart rate can lead to potential for blood clotting and increase the risk of stroke and heart attack. Adrenal glands produce stress hormones. Cortisol and other stress hormones can increase appetite and thus body fat. Stress can contribute to menstrual disorders in women. Stress can contribute to impotence and premature ejaculation in men. Red = immediate response to stress Muscles tense. Blue = effects of chronic of prolonged stress Muscular twitches or “nervous tics” can result.
Mouth ulcers or “cold sores” can crop up. Breathing quickens. The lungs can become more susceptible to colds and infections. Immune system is suppressed. Skin problems such as eczema and psoriasis can appear. Cortisol increases glucose production in the liver, causing renal hypertension. Digestive system slows down. Stress can cause upset stomachs. Red = immediate response to stress Blue = effects of chronic of prolonged stress
Stress Curve Maximum adaptive arousal Health & Performance Stress arousal
Cumulative Stress • Destructive pathway of stress • Piled up, unresolved general stress • Takes time • Produces negative changes in: • Mental & physical health • Performance • Relationships • Personality Chevron Publishing, 2002
Cumulative Stress • A chronic state of disturbing stress which can cause physical & changes in personality over time. • Takes months or years to develop. • May be a combination of work or home life. • Often referred to as “burnout”. • Often needs professional help for recovery especially if in late stages. continued...
Cumulative Stress - continued • Develops in four stages: • Early Warning • Mild Symptoms • Entrenched • Severe Symptoms • Characterized by gradually declining performance, increasing problem in job.continued...
Cumulative Stress - continued • Early Symptoms: • Vague anxiety • Boredom • General fatigue • Mild Symptoms: • All of the Early Symptoms • Irritability • Chronic tension • Depression continued...
Cumulative Stress - continued Mild Symptoms • Frustration • Frequent sighs • Sleep disturbance • Chronic worry • Loss of interest in work • More frequent colds • Mild rashes • Headaches • Withdrawal from others • etc..
Entrenched Symptoms • Chronic depression • Loss of joy of life • Chronic anger • Increased drinking / drugging • Thoughts of suicide • Emotional outbursts • Marital or relationship discord • Conflict with fellow workers • Conflict with supervisors • Increasing discipline problemscontinued...
Entrenched symptoms - continued • Increased self destructive behaviors (i.e.?) • Withdrawal from loved ones Continued... Loss of trust in others • Increasing paranoia • Loss of ambition • Tendency to blame others • Inability to take responsibility for one’s own actions • Minor property destruction • Acting out behaviors • etc.. (?)
Severe Symptoms • Rage reactions • Homicidal thinking • Suicidal thinking / acts • Easily angered • Verbally violent outbursts • Acts of violence • Threats to others • Excessive drinking / drugging • Severe depression • Severe paranoia continued...
Severe Symptoms - continued • Break up of relationships over minor issues • Compulsive thinking about bothersome topics • Easily frustrated • Sense of hopelessness • Sense of helplessness • Seriously declining performance • Most symptoms from previous levels • etc..
Burnout • Changes attitudes • Avoids work • Or, becomes totally immersed • Develops negative outlook
Flame-out • Exhaustion, hyperactivity • Overwhelming negative emotions • Denial of symptoms • Loss of objectivity
Stress Reactions Physiological not Characteriological Take Home Message
Management of Cumulative Stress Reactions • Stress management education • Balance in life - work - home, etc.. • Recreation • Vacation • Limiting overtime • Emphasis on home life • Professional counseling when neededcontinued...
Management - continued • Exercise • Proper food • Clear job expectations • Reduction of one worker performing two jobs • Effective leadership • Administrative support • Stress reduction techniques • Healthy living • Effective training
Critical Incident An event that has the power to overwhelm the coping abilities of an individual or group. Take Home Message Chevron Publishing, 2002
The Terrible 10 for CAP 1. 6. 2. 7. 3. 8. 4. 9. 5. 10. . . . not limited to missions! Take Home Message
Crisis Noun vs Verb Both Take Home Message An acute reaction to a critical incident. A name of a particular critical incident.
Crisis Characteristics • The relative balance between thought processes and emotional processes is disturbed, • The usual coping methods do not work effectively, • There is evidence of mild to severe impairment in individuals or groups exposed to the critical incident, Chevron Publishing, 2002
Post CRISIS Pre-CRISIS FEELINGS THOUGHTS FEELINGS THOUGHTS CRISIS
Assessing the Need forCrisis Intervention (CISM) • Is this one of the CAP “Terrible 10”? • Are coping mechanisms working effectively for EVERYONE? • Is there evidence of mild to severe impairment in individuals or groups exposed to the critical incident? Take Home Message
Critical Incident Stress (CIS) • Also called “traumatic stress” • Not caused by general stress or cumulative stress, but produced by a specific terrible event • All people are vulnerable • Emergency personnel may be more vulnerable because of exposure to traumatic events continued...
C I S - continued • Some may react more strongly than others • Usually resolves in a reasonable period of time • May need some form of brief support service • Can turn into a serious problem for a few people if it is not resolved • Supervisors are able to recognize the problem continued...
C I S - continued • Some people have several Critical Incident Stress reactions during their careers • Reactions can be reduced by early intervention • Critical Incident Stress can be an opportunity for positive change and growth Chevron Publishing, 2002
Reactions to Stress • Physical • Cognitive • Emotional • Behavioral • Spiritual Chevron Publishing, 2002
PhysicalSigns and Symptoms of Critical Incident Stress • Thirst • Fatigue • Nausea • Twitches • Vomiting • Dizziness • Elevated B/P • Muscle tremors • Grinding teeth • Visual difficulties • Profuse sweating • Difficulty breathing • Fainting / LoC • Weakness/numbess • Chest pain • Headaches • Rapid heart rate Chevron Publishing, 2002
CognitiveSigns and Symptoms of Critical Incident Stress • Confusion • Nightmares • Uncertainty • Hypervigilence • Suspiciousness • Intrusive images • Blaming someone • Poor problem solving • Poor abstract thinking • Change in attention/decision • Poor concentration or memory • Disorientation • Change in alertness • Suicide/homicide • Hallucinations/delusions • Paranoid ideas • Disabling guilt • Hopelessness • Helplessness Chevron Publishing, 2002
BehavioralSigns and Symptoms of Critical Incident Stress • Withdrawal • Inability to rest • Intensified pacing • Erratic movements • Changes in social activity • Changes in speech • Changes in appetite • Hyper-alertness • Changes in alcohol or drug consumption • Antisocial acts • Abuse of others • Diminished personal hygiene • Immobility • Self medication • Violence Chevron Publishing, 2002
EmotionalSigns and Symptoms of Critical Incident Stress • Guilt • Grief • Denial • Anxiety • Agitation • Irritability • Depression • Anger • Apprehension • Emotional shock • Emotional outburst • Feeling overwhelmed • Loss of emotional control • Inappropriate emotional responses • Infantile emotions • Panic attacks Chevron Publishing, 2002
SpiritualSigns and Symptoms of Critical Incident Stress • Angry at “God” • Asking “why” questions • Cessation of practice of faith • Faith rituals fail to have meaning • Religious hallucinations or delusions Chevron Publishing, 2002
Cumulative CIS • High frequency of activation • Long duration of service • High intensity of service provision
Cumulative CIS • Loss of purpose • Loss of connection • Loss of autonomy • Loss of integrity • Spiritual depletion Kendall Johnson, 1993
Factors Effecting Crisis Reactions • Suddenness • Intensity • Duration • Level of loss • Age • Injury or death to relatives or friends • Availability of resources • Level of education / training • Availability of coping mechanisms Chevron Publishing, 2002