CrisisCrisis

SituationsSituations

ManifestationsManifestations

Intervention strategiesIntervention strategies

Crisis Crisis

•What does the term crisis What does the term crisis mean for you?mean for you?

CrisisCrisis

• State of emotional turmoilState of emotional turmoil• Serious interruption in equilibriumSerious interruption in equilibrium• Emotion overcomes thoughtsEmotion overcomes thoughts• Emotional pressure becomes too Emotional pressure becomes too

great great • Can happen to anyone, at any stage Can happen to anyone, at any stage

of lifeof life

Brady: Emergency Response to Crisis Mitchell/Resnik pp3Brady: Emergency Response to Crisis Mitchell/Resnik pp3

WikipediaWikipedia on Crisis on Crisis

• crises are "specific, unexpected, crises are "specific, unexpected, and non-routine events or series of and non-routine events or series of events that [create] high levels of events that [create] high levels of uncertainty and threat or uncertainty and threat or perceived threat to a persons or perceived threat to a persons or organization's high priority goals." organization's high priority goals."

Delicate BalanceDelicate Balance

• Most of the time we live in a steady state.Most of the time we live in a steady state.• We fluctuate between thoughts and We fluctuate between thoughts and

emotions. One normally fluctuates emotions. One normally fluctuates around the baseline of equilibrium. around the baseline of equilibrium. When one’s own balancing system When one’s own balancing system fails and one’s equilibrium fails and one’s equilibrium disrupted, disrupted, Crisis can occurCrisis can occur. When . When that equilibrium is shifted far that equilibrium is shifted far enough or rapidly enough a problem enough or rapidly enough a problem occursoccurs..

““The breaking point”The breaking point”

• Everyone has a “breaking point”Everyone has a “breaking point”• We are all unique, therefore our We are all unique, therefore our

breaking point is unique and differentbreaking point is unique and different• Remember; anyone can reach the Remember; anyone can reach the

breaking point – even you!breaking point – even you!• A person in crisis is a person who has A person in crisis is a person who has

reached their breaking pointreached their breaking point

• OMAHA, Neb.–The gunman who OMAHA, Neb.–The gunman who

killed eight people in a mall killed eight people in a mall shooting "just snapped," he wrote shooting "just snapped," he wrote in a suicide note that combines in a suicide note that combines love for his friends and family with love for his friends and family with contempt for his random victims.contempt for his random victims.

Toronto Star, Dec. 8/07, Sophia Tareen, Associated PressToronto Star, Dec. 8/07, Sophia Tareen, Associated Press

Four Characteristics of Four Characteristics of crisiscrisis

1.1. Crisis is suddenCrisis is sudden

2.2. Normal coping mechanisms failNormal coping mechanisms fail

3.3. Crisis short in durationCrisis short in duration

4.4. Result in dangerous, Result in dangerous, unacceptable or self destructive unacceptable or self destructive behaviourbehaviour

Brady: Emergency Response to Crisis Mitchell/Resnik Brady: Emergency Response to Crisis Mitchell/Resnik

1. Crisis is sudden1. Crisis is sudden

• The breakdown in equilibrium is an The breakdown in equilibrium is an isolated incident, not a usual isolated incident, not a usual pattern of lifepattern of life

• It is unforeseen and unexpectedIt is unforeseen and unexpected

2. Normal coping methods 2. Normal coping methods have failedhave failed

• The person tries to cope but is The person tries to cope but is unsuccessfulunsuccessful

• The person is unable to draw The person is unable to draw on his emotional resources, his on his emotional resources, his self motivation, his internal self motivation, his internal strengths or outside supportstrengths or outside support

3. The crisis is short in 3. The crisis is short in durationduration

• A true crisis rarely lasts more A true crisis rarely lasts more then six weeksthen six weeks

• Most are resolved in 36 hoursMost are resolved in 36 hours• Why? People find it unbearable Why? People find it unbearable

to be in a crisis state for very to be in a crisis state for very longlong

• A person will do something to A person will do something to end the pain and sufferingend the pain and suffering

4. Crisis may result in 4. Crisis may result in dangerous, unacceptable dangerous, unacceptable

or self destructive or self destructive behaviourbehaviour

• Crisis can bring with it feelings Crisis can bring with it feelings of panic or defeatof panic or defeat

• If not resolved, may lead to If not resolved, may lead to suicide or homicidesuicide or homicide

From a different From a different perspectiveperspective

Crisis has four defining characteristics.Crisis has four defining characteristics.

1. event is unexpected (i.e., a surprise)1. event is unexpected (i.e., a surprise)

2. creates uncertainty2. creates uncertainty

3. is seen as a threat to important goals. 3. is seen as a threat to important goals. "crisis is a process of transformation "crisis is a process of transformation where the old system can no longer be where the old system can no longer be maintained." maintained."

4. There is a need for change, if change is 4. There is a need for change, if change is not needed, the event could more not needed, the event could more accurately be described as a failure.accurately be described as a failure.

Seeger, Sellnow and Ulmer – Communication organization and crisisSeeger, Sellnow and Ulmer – Communication organization and crisis

Three classifications of Three classifications of crisiscrisis

types of crisistypes of crisis1.1. PredictablePredictable

2. Maturational2. Maturational

3. Unpredictable3. Unpredictable

1. Predictable1. Predictable

• Part of the natural order of lifePart of the natural order of life• Result from normal and Result from normal and

expected life experiencesexpected life experiences• Any change can be stressful Any change can be stressful

(positively or negatively) and (positively or negatively) and may lead to a crisismay lead to a crisis

2. Maturational2. Maturational

• PubertyPuberty• AdolescenceAdolescence• Old ageOld age

3. Unpredictable3. Unpredictable

• SuddenSudden• Completely unexpectedCompletely unexpected

Stages of crisisStages of crisis

1.1. ImpactImpact

2.2. CrisisCrisis

3.3. ResolutionResolution

4.4. ReconstructionReconstruction

1. Impact1. Impact

• The occurrence of the crisis The occurrence of the crisis /stressful event /stressful event

• Equilibrium is destroyedEquilibrium is destroyed• Body prepares for the traditional Body prepares for the traditional

‘fight or flight’‘fight or flight’• All of the person’s energy is All of the person’s energy is

concentrated on the present and on concentrated on the present and on the stressful eventthe stressful event

• Person may be disoriented and Person may be disoriented and distracted or may be full of energy – distracted or may be full of energy – why?why?

2. Crisis2. Crisis

• Crisis occurs within minutes to Crisis occurs within minutes to hours of the eventhours of the event

• You are concerned with the You are concerned with the person’s reaction to the eventperson’s reaction to the event

• There may be a range of There may be a range of emotions from hostility to emotions from hostility to uncertainty and uncertainty and detachmentdetachment

3. Resolution3. Resolution

• As the crisis period passes, the period As the crisis period passes, the period of resolution or adjustment beginsof resolution or adjustment begins

• The person regains control and begins The person regains control and begins to think more clearly, explores to think more clearly, explores alternatives, makes plans and sets alternatives, makes plans and sets goalsgoals

• Motivated to make changeMotivated to make change• May take weeks to monthsMay take weeks to months

4. Reconstruction/Post 4. Reconstruction/Post crisiscrisis

• Once the resolution is complete, Once the resolution is complete, the person resumes normal the person resumes normal activityactivity

• There may be some lasting effects, There may be some lasting effects, however, most of the signs and however, most of the signs and effects of the crisis are over and effects of the crisis are over and may even be forgottenmay even be forgotten

• Some suffer permanent emotional Some suffer permanent emotional injury injury

Recognizing a person in Recognizing a person in crisiscrisis

• Remember; each person is uniqueRemember; each person is unique• There is no ‘checklist’ for There is no ‘checklist’ for

psychological crisispsychological crisis

BUT do not underestimate your roleBUT do not underestimate your role• Assistance provided by EMS has Assistance provided by EMS has

deep and lasting effects upon deep and lasting effects upon victimsvictims

Consider the following Consider the following when trying to determine if when trying to determine if

a person is in crisisa person is in crisis

• The person may have lost some The person may have lost some or all contact with realityor all contact with reality

• May not be acting normally May not be acting normally • When talking to them, you may When talking to them, you may

feel you are talking to a brick wallfeel you are talking to a brick wall• Unable to work at a normal levelUnable to work at a normal level

More…More…• May seem withdrawnMay seem withdrawn• Avoid sensory overloadAvoid sensory overload• Extraordinary fear and/or angerExtraordinary fear and/or anger• Extreme anxietyExtreme anxiety• ConfusionConfusion• DepressionDepression• May become impulsiveMay become impulsive• Overly dependent on othersOverly dependent on others• May reject offers of helpMay reject offers of help

YOU MAY SEE ALL, SOME OR YOU MAY SEE ALL, SOME OR NONE OF THESE SYMPTOMSNONE OF THESE SYMPTOMS

When things were out of When things were out of “whack” how have you felt?“whack” how have you felt?

What was your What was your response to the crisis response to the crisis

??

Emotional reactions to Emotional reactions to crisiscrisis

As we explore the following As we explore the following behaviour consider what kinds behaviour consider what kinds of calls would elicit the of calls would elicit the responseresponse

1. Emotional shock1. Emotional shock“high anxiety”“high anxiety”

• May be hysterical or stunnedMay be hysterical or stunned• CombativeCombative• PanicPanic• Agitated, out of controlAgitated, out of control• Tend to act irrationallyTend to act irrationally• Can be dangerousCan be dangerous

2. Denial2. Denial

• The person is trying to protect The person is trying to protect themselvesthemselves

• Trying to limit what is Trying to limit what is happening to them, so they happening to them, so they deny the crisis is happeningdeny the crisis is happening

• Management?Management?

3. Anger3. Anger

• Once the person has passed Once the person has passed through the denial stage and through the denial stage and admits that the crisis is admits that the crisis is happening they will often happening they will often become angrybecome angry

• May direct the anger May direct the anger inappropriately – often at you!inappropriately – often at you!

Management?Management?

4. Remorse4. Remorse

• May become overwhelmed with May become overwhelmed with guilt and sorrowguilt and sorrow

• Twist events out of proportionTwist events out of proportion• Place the burden of events onto Place the burden of events onto

them selfthem self• ““if only statement”if only statement”

Management ??Management ??

5. Grief5. Grief

• Begins the first stage of Begins the first stage of healinghealing

Usually happens much later – Usually happens much later – not generally seen by not generally seen by paramedicsparamedics

6. Reconciliation6. Reconciliation

• The person passed through the The person passed through the crisiscrisis

• Resumes his normal lifestyleResumes his normal lifestyle• No longer preoccupied by the No longer preoccupied by the

crisiscrisis

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• Intervene in the Crisis Intervene in the Crisis • Could be at any of the aforementioned Could be at any of the aforementioned

stagesstages• Earmarked by narrow goals of short Earmarked by narrow goals of short

durationduration• Aimed at helping a person regain equilibrium Aimed at helping a person regain equilibrium

and return to normal functioningand return to normal functioning

To be continued…To be continued…

Our RoleOur Role