pre incident education v

7/31/2019 Pre Incident Education V

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CriticalConceptsCon

sulting

Basic Critical Incident

Stress Management

International Critical Incident

Stress Foundation

Daniel W. Clark, Ph.D.


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What is Stress?

"The nonspecific response of the body to anydemand made upon it" (Selye)

"Demands on the person which tax or exceedhis adjustive resources" (Lazarus)

"A particular relationship between the personand the environment that is appraised by the

person as taxing or exceeding his/her resourcesand endangering his/her well-being"


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Components of Stress

necessary for life

subjective

positive and negative

anything that threatens us

pushes usscares us

worries usthrills us


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Prolonged StressPhysical Effects

muscle tension

headaches

lack of energy

stomach problems

immune system

high blood pressure

strokes

sexual problems


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Prolonged Stress...Psychological effects

depression

anxiety

anger

confusion

irritability

impatience

fear

negativism

memory problems

helpless/hopeless


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Prolonged Stress...Behavioral effects

Alcohol and drug use

Change in usualbehavior

Withdrawal

Acting out

Silence / talkative

Under / Overeating Hypervigilance

Impulsive


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What are your stressors?

Home

Work

Environment

Biogenic

Military


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HomeStressors

Spouse

Children

Family demands

Finances

Role in the home

Family illness

Shift changes

Relatives


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Work Stressors

Supervisor/subordinates

Time demands

Personal safety

Role at work

Environment

Shift work

Work pace


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Environmental Stressors

Pollution

Crowding

Temperature

Noise


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Biogenic Stressors

Stimulants which cause stress by virtueof the biochemical actions they exert on

the body.

Caffeine

Nicotine

Amphetamines


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Military Stressors

Irregular work schedule

Danger of job/injury

Frequent relocations

Inadequate rewards

Frequent deployments

Field time

Human suffering/death


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Real Life

Home

Job

Family Personal

NutritionFinances

Security

HealthEnvironment


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Coping Techniques

for Managing Stress


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Steps in stress management

that you are constantly under stress

areas causing negative stress

effective stress management


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Time Management

Decide what's important

and worth worrying

about

Get organized

Schedule time for

relaxation andexercise

Write it down!


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Positive Attitude

Know yourself and your "automatic thoughts"

Communicate and express your feelings

Rally your support system

Adopt a problem-solving approach


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Relaxation

Do something you enjoy, whether indoors

or out, alone or with others

Do what is satisfying for you

Set aside time for yourself


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Exercise

Exercise is a great way to relieve

physical and mental tension

Improves physical resistance to stress

Choose an activity that appeals to you


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Don't accept substitutes

for stress management


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Post-Traumatic Stress

Post - traumatic stress

is a normal reaction,

in a normal person,

to an abnormal event.


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Post-Traumatic Stress

Post-traumatic stress is a

survival mechanism, Post

Traumatic Stress Disorder is a

pathogenic version of thatsurvival mechanism.


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Post Traumatic Stress DisorderBrief History

First Named in DSM - III, 1980

Military awareness

Civil War - nostalgiaWWI - war neurosis, shellshock

WWII - combat fatigue/exhaustion

Post Vietnam - PTSD

Prevalence

General population: 1-2%

Emergency Services: 16-20%


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Critical Incident

In a career where day to day you respond

to the abnormal events in other peoples

lives;

A critical incident is theonethat, forwhatever reason, is abnormal even for

experiencedpersonnel.


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Critical IncidentsThe Terrible 10

Line of Duty Death

Serious Line of Duty

Injury Suicide of a Co-Worker

Disaster / Multi-

Casualty Incident Law Enforcement

Shooting

OKC, 19 APR 1995


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Critical IncidentsThe Terrible 10

Events Involving Children

Relatives of Known

Victims Prolonged Incident -

Especially with loss

Excessive Media Interest

Any Significant Event

Baby Jessica Rescue - 16 OCT 1987


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Intensity of Impact

Personal Relevance *

Duration

Sense of Loss

Previous History

Guilt

Social Support

Coping Skills


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Comprehensive CISMProgram

Why have a critical incident stress

management program?

We can learn from past experience.


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ComparisonTwin disasters

Total Killed 125 82

Plane Survivors 0 0

Homes Destroyed 16 16

Killed On Ground 15 15

Emergency Personnel 300 300Body Parts Found 10,000 10,000

San Diego Cerritos


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ComparisonTwin disasters

San Diego

Sporadic One on One

Cerritos

On Scene One on One

Demobilizations

12 Debriefings

Hot Line Number One on One Follow Up

Support Services Provided


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ComparisonPersonnel Lost in 1 Year

Police 5 0

Fire 7 0

Paramedics 17 1

Increase in

Mental Health Use 31% 1%

San Diego Cerritos


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Pre-Incident Education

Heart of Successful CISM Program

Discuss Stress/Human Stress

Response

Describe CISM Services

Explain What CISM Is NotProvides Outline for CISM Access

Generates Positive Contacts


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Individual Crisis Intervention

Positives

Been there, done

that

Credibility

Rapport

Negatives

May be too close

Very vulnerable tocounter-transference

May over-identify


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1:1 Crisis Intervention

Communication Skills

Awareness of Acute Stress Symptoms

Intervention Protocol

Referral Options


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Demobilization

Provided by trained CISM personnel.

10 minute informational talk.

Describe stress reactions.List signs and symptoms.Outline stress survival strategies.

20 minute rest after talk is completed.

Low fat, low sugar, low salt foodsNon-caffeinated drinks


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Crisis Management Briefing

a group psychological crisis intervention

designed to mitigate the levels of felt crisis

and traumatic stress in the wake ofterrorism, mass disasters, violence, andother large scale crises.

IJEMH v2(1) p. 53-57 (2000)


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Crisis Management BriefingGoals

Inform and consult

Allow psychological decompression

Stress management

Similar to Demobilization but for

non-operational personnel


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Defusing

Defusing means to render somethingharmless before it can do damage.


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Defusing

A small group intervention applied within

hours of a critical incident.


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Defusing

Introduction

Exploration

Information


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Critical Incident StressDebriefing

The goal of a

Critical Incident Stress Debriefingis psychological closure.


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DebriefingConsiderations

Large scale incident.

Prolonged incident.

Circumstances out of the ordinary.

CISD is not therapy

CISD is not a substitute for therapy.


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DebriefingPhases

Introduction (C)

Fact (C)

Thought (C E) Reaction (E)

Symptom (E C)

Teaching (C)

Re-Entry (C)


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Daniel W. Clark, Ph.D.

2103 Harrison Avenue NW

2183

Olympia, WA 98502-2607

(360)-786-0292

[email protected]

Washington State Patrol

1405 Harrison Avenue NW

Suite 205

Olympia, WA 98502

(360)-586-8492

[email protected]

Web site:

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