critical incident stress management (cism)
DESCRIPTION
Headquarters Southwest Region Civil Air Patrol/USAF-Auxiliary. Critical Incident Stress Management (CISM). A. CISM PEP Talk. Pre-Exposure Preparation Talk. Objectives of this presentation:. To provide the participants with . A review of the causes and effects of stress - PowerPoint PPT PresentationTRANSCRIPT
04/22/23 Southwest Region CAP CISM PEP Talk 1
Critical Incident StressCritical Incident StressManagement (CISM)Management (CISM)
Headquarters Southwest Headquarters Southwest Region Region
Civil Air Patrol/USAF-AuxiliaryCivil Air Patrol/USAF-Auxiliary
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CISM PEP CISM PEP TalkTalkPre-Exposure Pre-Exposure
Preparation TalkPreparation Talk
AA
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Objectives of this Objectives of this presentation:presentation:
• 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
To provide the participants with ...
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CISM is a MandatedCISM is a MandatedOperations Program!Operations Program!
It is not just a Chaplain’s program!
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Just What is Stress?Just What is Stress?
“A state of physical and emotional
arousalarousal.”
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Where Does Stress Where Does Stress Come From?Come From?
Stimulus
Stressorstimulus/demand
Response
Stress Response
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Some Some Definitions ...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
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For example ...For example ...•While flying, the stressorsstressors of heat and G-forces affect the body. •Next a stress responsestress response occurs in the inner ear leading to a condition known as “vertigo.”•Then the target organtarget organ of the stomach is over-aroused and decides to “get rid of food!”
… … airsickneairsicknessss
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2 “Varieties” of Stress ...2 “Varieties” of Stress ...
“Eustress” equals GoodGood Stress--- Positive, motivating stress
“Distress” equals BadBad Stress--- Negative, excessive, debilitating stress
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Some Generic Some Generic Sources of Stress ...Sources of Stress ...
• Biogenic• Environmental
• Personality
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Some Biogenic Some Biogenic Stressors ...Stressors ...
• Caffeine • Nicotine
• Amphetamines• Cold & allergy medicines
• Theophylline• Illness
• Lack of sleep
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Some Some Environmental Environmental
Stressors ...Stressors ...• Rain
• Temperature extremes• Sounds --- screams
• Mud• Smells
• G-forces• Time of day
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PersonalityPersonality
The way people are “hard-wired.”
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Stress is Stress is CumulativeCumulative
It builds up over time ...
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Cumulative StressCumulative Stress
• Piles up (snowballs).• Increases with time.• Deteriorates:
* Performance * Relationships * Health
Is stress that ...
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We Used to Call it We Used to Call it “Burnout”“Burnout”
• Increased cynicism.• Increased physical lethargy.• Procrastination.• In the extreme … even … suicidal
or homicidal thoughts or ideations.
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Some Signs Some Signs && Symptoms Symptoms of Cumulative Stressof Cumulative Stress
• 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
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An Example of An Example of Cumulative Stress ...Cumulative Stress ...
The De Havilland “Comet” -- The World’s First Commercial
Jet Airliner
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Like With The Airliner ...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 and we can crash too!crash too!
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Critical Incident Critical Incident StressStress
“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)
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Cumulative stress cancan exacerbate critical incident
stress.
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Critical IncidentsCritical Incidentsare events that have the potential
to create significant human distress and can overwhelm the usual coping
mechanisms of individuals and/or groups.
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How to Recognize Excessive How to Recognize Excessive Stress?Stress?
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Manifestations of Manifestations of Distress Can Take a Distress Can Take a Number of Forms...Number of Forms...
• Physical• Cognitive• Emotional• Behavioral
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Physical ManifestationsPhysical Manifestations• Excessive sweating
• Nausea and/or vomiting• Elevated pulse rate
• Elevated blood pressure• Rapid breathing
• Dizziness
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Cognitive SignsCognitive Signs
• Confusion. Mumbling of words• Difficulty making decisions
• Decreased concentration• Memory dysfunction
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Emotional SignsEmotional Signs• Emotional Shock
• Anger• Grief
• Depression• Feeling totally
overwhelmed
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Behavioral SignsBehavioral Signs• Changes in ordinary behavior
• Changes in eating habits• Decreased personal hygiene
• Prolonged silences• Withdrawal
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Stress Response TimelinesStress Response Timelines
• Immediate -- up to 24 hours post event.• Delayed -- 24 to 72 hours post event.• Cumulative -- buildup of stress over time.
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Post-Traumatic Stress Post-Traumatic Stress is ...is ...“… a normal reaction in a
normal person, to an abnormal eventabnormal event.”
“… a survival mechanism, whereas
(PTSD)(PTSD) is a pathogenicpathogenic (unhealthy) variation of that normal survival
mechanism.”
Post-Traumatic Stress Post-Traumatic Stress DisorderDisorder
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Examples of Critical IncidentsExamples 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
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A CrisisA Crisis
• 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.
A response to an event wherein ...
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Crisis Crisis InterventionIntervention
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Crisis Intervention is ...Crisis Intervention is ...
• 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)
The provision of timely “emotional first aid:”
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Crisis InterventionCrisis Intervention
Is but one aspect of a continuum of care. It
requires specializedspecialized and uniqueunique trainingtraining.
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Crisis InterventionCrisis InterventionPrinciples ...Principles ...
• Spell BB -II -SS -EE -PP
•Brevity•Immediacy•Simplicity•Expectancy•Proximity
BISEP
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Critical Incident Critical Incident Stress Management Stress Management
(CISM)(CISM)isis
one type of crisis intervention. It is a comprehensive, systematic
program for the mitigation of critical- incident related stress.
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The goals of CISM ...The goals of CISM ...• PreventPrevent traumatic stress• MitigateMitigate traumatic stress• InterveneIntervene to assist recovery from traumatic stress• AccelerateAccelerate recovery• RestoreRestore function• MaintainMaintain worker health and welfare
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By way of analogy ...By way of analogy ...According to the Wing Aircraft
Maintenance Officer, HQ-TX Wing expects to spend approximately
$187,000.00$187,000.00 this year to maintain our fleet of airplanes.
But …
how much are we spending to maintain our
most valuable asset…OUR OUR PEOPLEPEOPLE??
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CISM is CISM is a comprehensive, a comprehensive,
systematic maintenance systematic maintenance program for the overall program for the overall well-being of our most well-being of our most
valuable assetsvaluable assets… … our our
membersmembers..
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CISM involves many facets 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)
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CISM CISM alsoalso involves ... involves ...
• One-on-one, individual crisis intervention• Pastoral crisis intervention• Family CISM• Organizational crisis intervention / consultations• Follow-up and referral mechanisms
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CISM deals with CISM deals with the current circumstances, the current circumstances, the current event or crisis the current event or crisis
… … NOT NOT
… personal histories.… personal histories.It is First Aid, not definitive care.
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Some Key Some Key Elements of Elements of
CISM ...CISM ...
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Pre-Incident EducationPre-Incident Education• General information: stress, trauma, etc.• Set expectations for actual
experiences• Teach stress management
and coping skills
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DemobilizationsDemobilizations• 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
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DefusingDefusing• 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
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The Defusing 3-Step ... The Defusing 3-Step ...
*Introduction*Exploration*Information
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The Critical Incident Stress The Critical Incident Stress Debriefing (CISD)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• NOTNOT psychotherapy!
C I S D
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Objectives of the CISDObjectives 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
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CISDs consist of 7 CISDs consist of 7 stages ...stages ...
Mitchell, 1991
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Family SupportFamily Support An essential component of a comprehensive CISM
program Consists of: * Educational programs * CISD
for significant others* Bereavement support -- grief and crisis counseling
Provided by peers, MHP, clergy, trained spouses Includes children and elderly as well
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Referral ...Referral ...• Is made to obtain a more thorough a process of
assessment and evaluation,• The mental health provider should understand
the “culture” of the agency in which the person is employed, and
• should have specialized training/experience in post-traumatic stress.
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Follow-up ...Follow-up ...• Essential element in all CISM
interventions.• Can be made by: * Phone calls * Station /
workplace visits * Home visits
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All CISM Interventions All CISM Interventions Are Strictly Are Strictly
Confidential!Confidential!
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How well does CISM work?How well does CISM work?Let’s compare two airliner crashes to
see ...
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San Diego 1978 v. Cerritos San Diego 1978 v. Cerritos 19861986
San Diego, PSA-182: 9/25/1978
Cerritos, Aeromexico: 8/31/1986
San DiegoSan Diego CerritosCerritosTotal KilledTotal Killed 125125 8282Aircraft SurvivorsAircraft Survivors 00 00Homes DestroyedHomes Destroyed 1616 1616Killed on GroundKilled on Ground 1515 1515ESP usedESP used 300300 300300Body Parts RecoveredBody Parts Recovered 10,000+10,000+ 10,000+10,000+
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San Diego v. San Diego v. CerritosCerritos
cont’d …cont’d …Types of Critical Incident Interventions ProvidedTypes of Critical Incident Interventions Provided
San Diego 1978San Diego 1978 Cerritos 1986Cerritos 1986Sporadic 1 on 1 12 CISDsCrisis Interventions Demobilizations
Crisis hotlineFollow-ups with
MHP’s
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San Diego v. San Diego v. CerritosCerritos
Personnel losses, among responders, within 1 year of event:
Increase in MH utilization within community within 1 year:
31%31% 1% 1%
SDSD CERCERRanking PDRanking PD 55 0 0FD PersonnelFD Personnel 77 1 1EMS PersonnelEMS Personnel 1717 0 0
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CISM Works!CISM Works!
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CISM CISM in the in the
Civil Air PatrolCivil Air Patrol
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CAP’s CISM ProgramCAP’s CISM Program Mandated by CAPR 60-5 Not optional Specifically an operations program Implementation is assigned to Region
Commanders by CAPR 60-5.
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CAP’s CISM CAP’s CISM ProgramProgram
cont’dcont’d Wings are to “… assess the need for a
CIST.” All personnel are encouraged to receive
CIS training.
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CAP’s CISM Program ...CAP’s CISM Program ...“The use of qualified, local, non-CAP teams to respond to incident stress-
affected CAP members is highly encouraged … The use of local non-CAP teams will somewhat limit the
need to dispatch a trained CAP CIS [Team]”
--CAPR 60-5 (2)e
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CAP’s CISM Program ...CAP’s CISM Program ...
“… Each active duty Air Force base is required to have a CIST, which, with
prior coordination, may be able to support CAP”
--CAPR 60-5 (2)e
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A CAP CISTA CAP CIST
Consists of:Mental Health Professionals (MHP)Peer Representatives
CAPR 60-5 (3)a 2
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Request & DeploymentRequest & Deployment After a SAR or DR mission “ … a review of the
need for CIS intervention should be made for all personnel ...”
The incident commander or unit commander will pass a request to wing commander.
In consultation with staff, the wing CC will coordinate use of a local non-CAP team or request one of the Region teams.
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Funding CISMFunding CISM CISM is not, presently, a specifically
USAF funded mission (by itself).
CAP CISM may be funded through an existing mission’s funding.
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Funding CISMFunding CISM• The CAP Natl HQ has approved limited
funding to support CISM missions nationally.
Housing and feeding of a team will normally NOT be reimbursed.
The “… use of host families…” is encouraged to mitigate housing costs.
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For More For More Information ...Information ...
Visit the web site of the International Critical Incident Stress Foundation (ICISF) at http://www.icisf.org.
Join the ICISF.
Review CAPR 60-5.
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For More For More Information ...Information ...
Call Chaplain Don Brown at (936) 394-3310 or email him at [email protected].
Sign up for the “Basic Critical Incident Stress Management” and other ICISF CISM courses.
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Any Questions?Any Questions?
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CreditsCredits
Lt Col Sherry Jones, Lt Col Sherry Jones, RN, CAPRN, CAPSpecial Advisor to Special Advisor to the National the National Commander for CISMCommander for CISM
Ch, Lt Col DONALD R. BROWN Ch, Lt Col DONALD R. BROWN II, CAPII, CAPSWR Deputy Chaplain and SWR Deputy Chaplain and CISM DirectorCISM Director
1st Lt Penny Herndon-1st Lt Penny Herndon-Finuf, RN, CAPFinuf, RN, CAP SWR/TXWNG CISM SWR/TXWNG CISM Educational OfficerEducational Officer