Critical Incident Stress Critical Incident Stress AwarenessAwareness

A Rescuer’s Silent InjuryA Rescuer’s Silent Injury

The members of Michigan USAR Task Force 1 The members of Michigan USAR Task Force 1 appreciate the use of this program. We thank appreciate the use of this program. We thank

our brothers and sisters from our brothers and sisters from Ohio Task Force Ohio Task Force 11 and the following course developers: and the following course developers:

Erik Scheiderer, RN, CEN, EMT-PErik Scheiderer, RN, CEN, EMT-PEMS & Preparedness CoordinatorEMS & Preparedness Coordinator

Community Mercy Health PartnersCommunity Mercy Health Partners

Medical SpecialistMedical SpecialistOhio Task Force OneOhio Task Force One

ObjectivesObjectives

Define the “critical incident.”Define the “critical incident.” Recognize the signs and symptoms of Recognize the signs and symptoms of

critical incident stress.critical incident stress. Define Critical Incident Stress Define Critical Incident Stress

Management, its utility and limitations.Management, its utility and limitations. Learn what to expect when attending a Learn what to expect when attending a

defusing or debriefing.defusing or debriefing. Learn internal mechanisms to survive Learn internal mechanisms to survive

an exposure to a critical incident.an exposure to a critical incident.

Some Background on CISMSome Background on CISM

During WWI, the medical During WWI, the medical community began to community began to recognize a link between recognize a link between the behavior of soldiers the behavior of soldiers and the psychological and the psychological trauma they encountered.trauma they encountered.

Sometimes called “shell Sometimes called “shell shocked”shocked”

Picture by Tom Lea – Life Picture by Tom Lea – Life Magazine Journalist Magazine Journalist accompanying Marines on accompanying Marines on Peleliu island in WWII – Peleliu island in WWII – The Two-Thousand Yard The Two-Thousand Yard Stare.Stare.

Some Background on CISMSome Background on CISM Formal CISM for Formal CISM for

emergency service emergency service workers has roots in workers has roots in the 1980’s.the 1980’s.

30% Emergency 30% Emergency Services workers will Services workers will burn out in less than 7 burn out in less than 7 years.years.

10% will commit 10% will commit suicide due to critical suicide due to critical incident stress.incident stress.

Steve Forbes & Robert Steve Forbes & Robert O’Donnell.O’Donnell.

Some Background on CISMSome Background on CISM In the days following In the days following

the Oklahoma City the Oklahoma City bombing, Robert bombing, Robert O’Donnell voiced the O’Donnell voiced the desire to assist with desire to assist with the rescue the rescue operations, but could operations, but could not go.not go.

He took his own life He took his own life due to post traumatic due to post traumatic stress events that stress events that returned to the returned to the surface following the surface following the OKC bombing.OKC bombing.

What is a “Critical What is a “Critical Incident?”Incident?”

Any event outside the usual realm of Any event outside the usual realm of human experience that is markedly human experience that is markedly distressing and exceeds normal distressing and exceeds normal coping mechanisms.coping mechanisms.

The individual defines what “their” The individual defines what “their” critical incident or event is. An critical incident or event is. An incident that you may be able to incident that you may be able to easily cope with, noticeably affects easily cope with, noticeably affects another individual.another individual.

Critical IncidentsCritical Incidents

Line of Duty Death.Line of Duty Death. Serious injury in the line of duty.Serious injury in the line of duty. Suicide of a peer.Suicide of a peer. Serious pediatric illness, injury, or Serious pediatric illness, injury, or

death.death. Multi-casualty event that has a high Multi-casualty event that has a high

profile in the media.profile in the media. Incidents with particularly gruesome Incidents with particularly gruesome

injuries or deaths.injuries or deaths.

Critical IncidentsCritical Incidents

Treating or extricating someone you Treating or extricating someone you know that is seriously ill or injured.know that is seriously ill or injured.

Terrorism.Terrorism. You name it.You name it.

Physical SymptomsPhysical Symptoms

ChillsChills ThirstThirst FatigueFatigue NauseaNausea VomitingVomiting FaintingFainting DizzinessDizziness WeaknessWeakness

HeadachesHeadaches Elevated B/PElevated B/P Rapid PulseRapid Pulse Visual DisturbancesVisual Disturbances Difficulty BreathingDifficulty Breathing Profuse SweatingProfuse Sweating

These may indicate These may indicate a serious medical a serious medical condition.condition.

Cognitive SymptomsCognitive Symptoms

ConfusionConfusion NightmaresNightmares UncertaintyUncertainty HypervigilanceHypervigilance SuspiciousnessSuspiciousness Blaming someoneBlaming someone Poor problem Poor problem

solvingsolving Poor attentionPoor attention

Poor concentrationPoor concentration DisorientationDisorientation Difficulty Difficulty

identifying objectsidentifying objects Heightened or Heightened or

lowered alertnesslowered alertness Intrusive imagesIntrusive images

Emotional SymptomsEmotional Symptoms

FearFear GuiltGuilt GriefGrief DenialDenial AnxietyAnxiety IrritabilityIrritability DepressionDepression Intense angerIntense anger

ApprehensionApprehension Emotional Emotional

outburstsoutbursts Feeling Feeling

overwhelmedoverwhelmed Inappropriate Inappropriate

emotional responseemotional response

Behavioral SymptomsBehavioral Symptoms

WithdrawalWithdrawal Anti-social actsAnti-social acts Inability to restInability to rest Erratic movementsErratic movements Change in social Change in social

activityactivity Loss or increase in Loss or increase in

appetiteappetite Increased use of Increased use of

alcoholalcohol

Hyper-alert to Hyper-alert to environmentenvironment

Change in usual Change in usual communicationscommunications

What is Critical Incident Stress What is Critical Incident Stress Management?Management?

It’s an organized approach directed It’s an organized approach directed at reducing and controlling the at reducing and controlling the harmful effects of stress involving harmful effects of stress involving emergent situations.emergent situations.

It’s based in psychology and crisis It’s based in psychology and crisis intervention theory.intervention theory.

It’s education in awareness training, It’s education in awareness training, demobilizations, defusings, demobilizations, defusings, debriefings, and support services.debriefings, and support services.

What is Critical Incident Stress What is Critical Incident Stress Management?Management?

It helps speed the recovery of It helps speed the recovery of normalnormal people with people with normalnormal reactions to reactions to abnormalabnormal events. events.

Layman’s terms – Keeps the Layman’s terms – Keeps the rescuer’s head in the game so they rescuer’s head in the game so they can come back to work tomorrow can come back to work tomorrow and continue to be a good rescuer.and continue to be a good rescuer.

Critical Incident Stress Critical Incident Stress Management – What It’s NotManagement – What It’s Not

For only those who “can’t take it.”For only those who “can’t take it.” A sign of weakness.A sign of weakness. Counseling.Counseling. Psychotherapy.Psychotherapy. A critique of the response to the A critique of the response to the

incident.incident.

Defusing and DebriefingDefusing and Debriefing

The “bandage” that stops the psyche The “bandage” that stops the psyche from bleeding.from bleeding.

The emotional first aid following a The emotional first aid following a traumatic event or a sequence of traumatic event or a sequence of traumatic events of a “smaller” traumatic events of a “smaller” scale.scale.

Defusing and DebriefingDefusing and Debriefing

Defusing – A process immediately post Defusing – A process immediately post event (12-24 hours), symptom driven, event (12-24 hours), symptom driven, that allows for symptom mitigations, that allows for symptom mitigations, possible closure, and identifying those possible closure, and identifying those needing further intervention.needing further intervention.

Debriefing – A process within a day to Debriefing – A process within a day to 4 weeks following an event, depending 4 weeks following an event, depending on the size, that facilitates on the size, that facilitates psychological closure, symptom psychological closure, symptom mitigation and identifying those mitigation and identifying those needing further intervention.needing further intervention.

Defusing and DebriefingDefusing and Debriefing

Utilizes peer counselors and mental Utilizes peer counselors and mental health specialists that have an health specialists that have an extensive CISM background and past extensive CISM background and past EMS/Fire/Rescue experience.EMS/Fire/Rescue experience.

People that understand where you People that understand where you are coming from.are coming from.

Defusing and DebriefingDefusing and Debriefing

Without exception, includes only Without exception, includes only those directly involved in the those directly involved in the incident.incident.

Confidential – no paper, recording Confidential – no paper, recording devices, etc.devices, etc.

Safe – allows rescuers to open up.Safe – allows rescuers to open up. Non-judgemental – not a critique of Non-judgemental – not a critique of

what occurred.what occurred.

Defusing and DebriefingDefusing and Debriefing

Provides the opportunity to vent the Provides the opportunity to vent the trauma and to learn ways to cope.trauma and to learn ways to cope.

Provides follow up and further help if Provides follow up and further help if needed.needed.

Helps to strengthen the bond of the Helps to strengthen the bond of the group and help each other.group and help each other.

Defusing and Debriefing – Defusing and Debriefing – Ground RulesGround Rules

Pagers, radios and phones off for the Pagers, radios and phones off for the duration of the session.duration of the session.

Those in the session are “off duty” to Those in the session are “off duty” to prevent disruption of the group.prevent disruption of the group.

No “rank” exists – everyone is on the No “rank” exists – everyone is on the same level.same level.

Participation is voluntary, but Participation is voluntary, but encouraged.encouraged.

Defusing lasts about 45 minutes.Defusing lasts about 45 minutes. Debriefings last about 90 minutes.Debriefings last about 90 minutes.

Surviving the Critical Surviving the Critical IncidentIncident

Do your best to keep work, play, and Do your best to keep work, play, and stress balanced and in control.stress balanced and in control.

Be aware of critical incident symptoms in Be aware of critical incident symptoms in yourself and your peers.yourself and your peers.

Maintain good nutrition and meal Maintain good nutrition and meal schedules, even when you don’t feel like it.schedules, even when you don’t feel like it.

ExerciseExercise RestRest Be good to yourself.Be good to yourself.

Surviving the Critical Surviving the Critical IncidentIncident

It is our responsibility to ourselves, It is our responsibility to ourselves, our family, and the victims we rescue our family, and the victims we rescue to remain in the game by staying to remain in the game by staying healthy.healthy.

Look out for your partner and other Look out for your partner and other team members. Ask them if you can team members. Ask them if you can help or if they’d like a CISM team.help or if they’d like a CISM team.