Critical Incident Stress Management (CISM)

1. Headquarters Southwest Region Civil Air Patrol/USAF-Auxiliary Critical Incident StressManagement (CISM) Southwest Region CAP CISM PEP Talk

2. A CISM PEP Talk Pre-Exposure Preparation Talk Southwest Region CAP CISM PEP Talk

3. Objectives of this presentation: To provide the participants with ... • A review of the causes and effects of stress • Some cues to identify stress and tools to manage it • An overview of critical incident stress, crisis management, and critical incident stress management (CISM) • An orientation to CAP’s CISM program Southwest Region CAP CISM PEP Talk

4. CISM is a MandatedOperations Program! It is not just a Chaplain’s program! Southwest Region CAP CISM PEP Talk

5. Just What is Stress? “A state of physical and emotional arousal.” Southwest Region CAP CISM PEP Talk

6. Where Does Stress Come From? Stimulus Stressor stimulus/demand Response Stress Response Southwest Region CAP CISM PEP Talk

7. Some Definitions ... • Stressor-- a stimulus that causes, evokes, or is otherwise strongly associated with the stress response • Stress response-- Nonspecific response of the body to a demand(s) • Target organ(s)-- The part of the body, or mind, that is the recipient of the stress response and which develops the signs & symptoms of over-arousal Southwest Region CAP CISM PEP Talk

8. For example ... • While flying, the stressors of heat and G-forces affect the body. • Next a stress response occurs in the inner ear leading to a condition known as “vertigo.” • Then the target organ of the stomach is over-aroused and decides to “get rid of food!” … airsickness Southwest Region CAP CISM PEP Talk

9. 2 “Varieties” of Stress ... “Eustress” equalsGood Stress --- Positive, motivating stress “Distress” equalsBad Stress --- Negative, excessive, debilitating stress Southwest Region CAP CISM PEP Talk

10. Some Generic Sources of Stress ... • Biogenic • Environmental • Personality Southwest Region CAP CISM PEP Talk

11. Some Biogenic Stressors ... • Caffeine • Nicotine • Amphetamines • Cold & allergy medicines • Theophylline • Illness • Lack of sleep Southwest Region CAP CISM PEP Talk

12. Some Environmental Stressors ... • Rain • Temperature extremes • Sounds --- screams • Mud • Smells • G-forces • Time of day Southwest Region CAP CISM PEP Talk

13. Personality The way people are “hard-wired.” Southwest Region CAP CISM PEP Talk

14. Stress is Cumulative It builds up over time ... Southwest Region CAP CISM PEP Talk

15. Cumulative Stress Is stress that ... • Piles up (snowballs). • Increases with time. • Deteriorates: * Performance * Relationships * Health Southwest Region CAP CISM PEP Talk

16. We Used to Call it “Burnout” • Increased cynicism. • Increased physical lethargy. • Procrastination. • In the extreme … even … suicidal or homicidal thoughts or ideations. Southwest Region CAP CISM PEP Talk

17. Tardiness Fatigue Detachment Depression Medication or drug use. Irritability “Gallows” humor Paranoia, or irrational fears. Derogatory speech or labeling of others. Denial Increased workplace absences. Irresponsibility Some Signs & Symptoms of Cumulative Stress Southwest Region CAP CISM PEP Talk

18. An Example of Cumulative Stress ... The De Havilland “Comet” -- The World’s First Commercial Jet Airliner Southwest Region CAP CISM PEP Talk

19. Like With The Airliner ... Stress is the “wear and tear” on our human coping systems. Over time minor stresses can have major and damaging effects. This is the cumulative effect of stress. … and we can crash too! Southwest Region CAP CISM PEP Talk

20. Critical Incident Stress “Any event in which there is a stressful impact sufficient enough to overwhelm the usually effective coping skills of either an individual or a group.” (Everly & Mitchell, 1999) Southwest Region CAP CISM PEP Talk

21. Cumulative stress can exacerbate critical incident stress. Southwest Region CAP CISM PEP Talk

22. Critical Incidents are events that have the potential to create significant human distress and can overwhelm the usual coping mechanisms of individuals and/or groups. Southwest Region CAP CISM PEP Talk

23. How to Recognize Excessive Stress? Southwest Region CAP CISM PEP Talk

24. Manifestations of Distress Can Take a Number of Forms... • Physical • Cognitive • Emotional • Behavioral Southwest Region CAP CISM PEP Talk

25. Physical Manifestations • Excessive sweating • Nausea and/or vomiting • Elevated pulse rate • Elevated blood pressure • Rapid breathing • Dizziness Southwest Region CAP CISM PEP Talk

26. Cognitive Signs • Confusion. Mumbling of words • Difficulty making decisions • Decreased concentration • Memory dysfunction Southwest Region CAP CISM PEP Talk

27. Emotional Signs • Emotional Shock • Anger • Grief • Depression • Feeling totally overwhelmed Southwest Region CAP CISM PEP Talk

28. Behavioral Signs • Changes in ordinary behavior • Changes in eating habits • Decreased personal hygiene • Prolonged silences • Withdrawal Southwest Region CAP CISM PEP Talk

29. Stress Response Timelines • Immediate -- up to 24 hours post event. • Delayed -- 24 to 72 hours post event. • Cumulative -- buildup of stress over time. Southwest Region CAP CISM PEP Talk

30. Post-Traumatic Stress is ... “… a normal reaction in a normal person, to an abnormal event.” “… a survival mechanism, whereas Post-Traumatic Stress Disorder (PTSD) is a pathogenic (unhealthy) variation of that normal survival mechanism.” Southwest Region CAP CISM PEP Talk

31. Examples of Critical Incidents • Line of duty death or death at workplace • Serious line of duty injury or workplace injury • Suicide of coworker, friend, family member • Multiple casualty incidents (MCI’s), disasters • Significant events involving children • Prolonged events especially with loss • Any powerful event which overwhelms a person’s normal coping mechanisms Southwest Region CAP CISM PEP Talk

32. A Crisis A response to an event wherein ... • One’s normal psychological balance (homeostasis) has been disrupted, • One’s usual coping mechanisms have failed to reestablish the needed homeostasis, or • There is evidence of functional impairment. Southwest Region CAP CISM PEP Talk

33. Crisis Intervention Southwest Region CAP CISM PEP Talk

34. Crisis Intervention is ... The provision of timely “emotional first aid:” • An exercise in psychological damage control. Stopping the bleeding! • Not a cure • An opportunity for assessment and for follow-up • Guided by a mental health professional (MHP) Southwest Region CAP CISM PEP Talk

35. Crisis Intervention Is but one aspect of a continuum of care. It requiresspecializedanduniquetraining. Southwest Region CAP CISM PEP Talk

36. B I S E P Crisis InterventionPrinciples ... • Spell B -I -S -E -P • Brevity • Immediacy • Simplicity • Expectancy • Proximity Southwest Region CAP CISM PEP Talk

37. Critical Incident Stress Management (CISM)is one type of crisis intervention. It is a comprehensive, systematic program for the mitigation of critical- incident related stress. Southwest Region CAP CISM PEP Talk

38. The goals of CISM ... • Preventtraumatic stress • Mitigate traumatic stress • Intervene to assist recovery from traumatic stress • Accelerate recovery • Restore function • Maintain worker health and welfare Southwest Region CAP CISM PEP Talk

39. By way of analogy ... According to the Wing Aircraft Maintenance Officer, HQ-TX Wing expects to spend approximately $187,000.00 this year to maintain our fleet of airplanes. But … how much are we spending to maintain our most valuable asset…OUR PEOPLE? Southwest Region CAP CISM PEP Talk

40. CISM is a comprehensive, systematic maintenance program for the overall well-being of our most valuable assets … our members. Southwest Region CAP CISM PEP Talk

41. CISM involves many facets ... • Pre-crisis preparation and education • Demobilization (for large groups) • Crisis management briefings (large groups also) • Defusings • Critical incident stress debriefing (CISD) Southwest Region CAP CISM PEP Talk

42. CISM also involves ... • One-on-one, individual crisis intervention • Pastoral crisis intervention • Family CISM • Organizational crisis intervention / consultations • Follow-up and referral mechanisms Southwest Region CAP CISM PEP Talk

43. CISM deals with the current circumstances, the current event or crisis … NOT … personal histories. It is First Aid, not definitive care. Southwest Region CAP CISM PEP Talk

44. Some Key Elements of CISM ... Southwest Region CAP CISM PEP Talk

45. Pre-Incident Education • General information: stress, trauma, etc. • Set expectations for actual experiences • Teach stress management and coping skills Southwest Region CAP CISM PEP Talk

46. Demobilizations • Decompression • Transition workers from disaster work (large-scale incident) to routine duties or home • Used with large numbers of people • A 10- to 30-minute session • An opportunity for assessment of group needs • Alert workers to possible stress effects • Always followed by a CISD (debriefing, usually within one week Southwest Region CAP CISM PEP Talk

47. Defusing • A small group intervention conducted within hours of the incident, usually within 12 hours • Shortened version (20-45 mins) of the CIS- Debriefing • May eliminate the need for, or increase effectiveness of, CISD; opportunity to assess the need for CISD • Seeks to reduce intense reactions to a trauma • Seeks to “normalize” the effects of the event Southwest Region CAP CISM PEP Talk

48. The Defusing 3-Step ... *Introduction *Exploration *Information Southwest Region CAP CISM PEP Talk

49. C I S D The Critical Incident Stress Debriefing (CISD) • A group discussion of a traumatic event • Peer driven • Clinician (MHP) guided • Lasts 1-3 hours • Closed circle format • Held 1 - 10 days post event • NOT psychotherapy! Southwest Region CAP CISM PEP Talk

50. Objectives of the CISD • Education • Ventilation • Reassurance and forewarning • Positive contact with a MHP • Improvement of interagency cooperation • Increase group cohesiveness • Restore self-confidence • Facilitation of follow-up Southwest Region CAP CISM PEP Talk