Critical Incident Stress Management

1. Critical Incident Stress Management How you can help during a crisis July 2014

2. USPS Critical Incidents • 1986: Edmond, OK • 2001: Anthrax Attacks • 2005: Hurricane Katrina • 2006: Goleta, CA • 2013: Oklahoma tornadoes

3. Introduction: Distinctions of Disasters • Human-Caused Disaster • Deliberate; human violence or human error • Preventable; sense of betrayal by another person • External anger and blame • Extended litigation that prolongs recovery • Natural Disaster • Beyond human control with no evil intent • World can be seen with an increased potential for random, uncontrolled disasters

4. Distinctions of a Disaster continued • Size/Scope of Disaster – as communities are destroyed, survivors become disoriented at the most basic level. If some part of community is left, there is a foundation from which recovery can occur. • Degree of Personal Impact – the higher degree of personal exposure one has, the greater post-disaster reaction • Visible Impact – prolonged impact without a clear end can impede recovery process • Probability of Recurrence – increased probability increases anxiety of being impacted again

5. How Do Individuals Function? • Research has indicated that when a disaster occurs, one’s primary focus is for the well-being of family and close friends

6. Common Reactions During a Disaster • Physical • Fatigue, headaches, rapid heartbeat, restlessness • Emotional • Anxiety, anger, grief, shock, irritability, fear, detachment, mood swings • Mental/Cognitive • Racing thoughts, confusion, lack of concentration, preoccupation with event • Behavioral • Pacing, crying, neglecting basic needs, blaming (self or others)

7. The Human Element of Disaster • Reaction of Reality • Shock, disbelief, confusion, sleep/appetite disturbance, fatigue, preoccupied with details of event • Adjustment • Assess loss and initiate recovery efforts; may display mood swings, frustration over lack of control, resentful, and constantly fatigued • Restabilization • Remaining problems are overcome and changes from disaster are accepted

8. Human Element Priorities in a Disaster • No one who sees a disaster is untouched • Most individuals will pull together and function during and following a disaster but their effectiveness is diminished • Many emotional reactions stem from problems of living caused by the disaster • Most individuals do not see themselves as requiring mental health services • Disaster mental health services tend to be more practical and must be tailored to meet the community • Interventions must be appropriate to the phase of disaster • Support must be genuine

9. Dave Yeager President, NALC Branch 204 Colorado Springs, CO  80917

10. Waldo Canyon Fire Colorado Springs, CO

11. Why is Comprehensive Disaster Response Important?

12. The Impact of Traumatic Events on Work • Lower morale • Increased absenteeism • Increased anxiety and anger • Lack of concentration • Increased fear • Under work or overwork • Difficulty in creative problem-solving • Possible job turnover

13. Continuous Improvement Event Optimism Individual Initiative Shock and Denial Cautious Optimism Anger Acceptance Guilt Bargaining Sense of Hope Pessimism Testing Despair Stages Following a Traumatic Event

14. Phases of Post Disaster Planning

15. Post Disaster Planning Phase I – Emergency Phase (immediate period after the disaster occurs) • Most people respond appropriately during the impact of a disaster • Some people respond in a way that is disorganized and stunned and thus may not be able to respond appropriately to protect themselves or their family • Several stressors may occur during the actual incident which could produce significant consequences for the person and should be taken into consideration regarding intervention

16. Post Disaster Planning – Phase I continued Phase I – Recommended Interventions • Protect: Shield individuals from additional harm or exposure to the traumatic incident. Guard individuals from on-looking spectators and media that may have gathered. • Direct: Kind but firm direction may be required. Individuals tend to be stunned, in shock, or experiencing some degree of dissociation and will need guidance. • Connect: The individuals have just lost connection to the world that was familiar. Connecting in a caring, concerned, and accommodating manner may help. Help individuals connect 1) to loved ones, 2) to accurate information and appropriate resources, and 3) to where they will be able to receive additional support. • Triage: The majority of those exposed to a traumatic incident experience normal stress reactions. However, some may require immediate crisis intervention to help manage intense feelings of panic or grief. Attempt to quickly establish a relationship, ensure the individual’s safety, acknowledge and validate the survivor’s experience, offer empathy, and seek additional immediate resources as needed.

17. Post Disaster Planning Phase II – Early Post-Traumatic Phase • Emotional reactions will be inconsistent and depend on the individual’s perceptions and experience • Reactions may include: • numbness, denial, or shock • flashbacks and nightmares • grief reactions to loss • anger, despair • sadness, hopelessness

18. Post Disaster Planning – Phase II continued Phase II – Recommended Interventions • Provide user-friendly educational materials and presentations (ex. Choose material with plain language, preferably not above the 5th grade reading level). • Provide group and individual interventions including stress-management education as environmental conditions allow. • Coach managers on what to expect and how to assist team members as they recover from the incident exposure. • Help individuals cope with “normal” stress reactions by providing low profile, practical, and emotional support. Emotional support in crises reduces helplessness and enhances recovery. • Continue to identify individuals and families at risk for longer-term psychological problems. This identification may be done by stewards or union representatives, managers or supervisors, self-assessment, or by a professional. Make sure that individuals, union leaders and managers know about EAP services and how to access.

19. Post Disaster Planning Phase III – Restoration Phase • The prolonged period of return to community and individual adjustment or stability • Phase begins as rescue is completed and individuals and communities face the task of bringing their lives and activities back to a new normal • Disillusionment phase may soon follow when a disaster is off the front pages, organized support starts to be withdrawn, and the realities of losses, bureaucratic constraints, and the changes wrought by the disaster must now be faced and resolved • Particularly important to remember that emotional needs may be very significant, especially for those who have been severely affected; they may only start to appear at this time

20. Post Disaster Planning – Phase III continued Phase III – Recommended Interventions • Ongoing practical and emotional support to normalize reactions and promote hope and resiliency • Follow-up with individuals and managers to address emotional needs, work performance • Use of individual and/or group counseling to address symptoms • Referral for psychiatric evaluation should symptoms warrant

21. David Miller President, Branch 458 Oklahoma City, OK

22. Moore, OK May 2013

23. Moore, OK May 2013

24. Moore, OK May 2013

25. Psychological First Aid

26. What is Psychological First Aid? • Designed to reduce initial distress • Foster short-/long-term adaptive functioning and coping skills • Does not assume that all survivors will develop long-term issues • Based on understanding that those impacted will experience broad-range of early reactions • Recovery is aided by caring, compassionate responders

27. Objectives of Psychological First Aid • Establish compassionate, human connections • Calm emotionally overwhelmed survivors • Assess for immediate and ongoing safety • Assist impacted to identify immediate needs • Connect to resources • Provide education related to coping with psychological impact

28. Psychological First Aid – Core Actions • Contact and Engagement • Safety and Comfort • Stabilization • Current Needs/Concerns • Practical Assistance • Connection with Social Supports • Information on Coping • Linkage to Collaborative Services

29. How to Be Present • Keep communication simple, brief, and direct • Speak in a steady, controlled, and confident manner • Avoid statements that may devalue an individual’s experiences or feelings • Respect cultural and social diversity • Know when to refer an individual for additional help • Respect confidentiality

30. What to Do • Make connection with eye contact and mild touch (if appropriate) • Lower stimuli as soon as possible, which may involve leaving the area • Body positioning – encourage sitting/ standing in response to agitation/pacing and standing or walking with those who are emotionally blunted/shocked

31. What can I do? • Normalize symptoms • Provide practical information on ways to cope and decrease/control symptom intensity • Encourage group support for each other • Remind that recovery is a process

32. Resiliency

33. What is Resiliency? Individual Personality Trait + Interpersonal Supports = Resilient Management of Stressful Event

34. Stressful Event Opportunities to: • Change • Realign priorities • Hone talents • Find hidden talents • Strengthen relationships • Develop new relationships

35. Components of Resiliency • Self efficacy • Realistic appraisal of the environment • Social problem-solving skills • Sense of direction or mission • Empathy • Humor • Adaptive distancing • Coping strategies unlimited by gender-role stereotypes • Positive, empathic relationships Resiliency Enhancement by Norman, Columbia University Press, NY 2000

36. What Encourages Resiliency • Find a sense of purpose • Have a positive outlook • Take pleasure in small joys • Take an active approach to solve problems • Build relationships • Keep learning • Expect change • Be a doer • Care for yourself

37. How a critical incident can impact you?

38. Your reactions • Burnout • Stress • Anxiety • Fatigue • Leading during a crisis • Overwhelmed • How to I balance everything?

39. How to stay afloat • Be aware of your reactions – they are normal • Prioritize • Take care of yourself – eating, sleeping • Maintain your regular schedule • Stay connected to friends and family • Call the EAP

40. Response Scenarios

41. Thank You • To reach EAP: 800.327.4968 • EAP4YOU.com • Bob McCullough, National Consultant • 314.387.4727 • rmmccullough@magellanhealth.com