Critical Incident Stress Management (CISM) LTC Clarence Bowser State Family Programs Director National Guard Trained Crisis Responder Program

Critical Incident Critical Incident Stress Management (CISM)Stress Management (CISM)

LTC Clarence BowserLTC Clarence BowserState Family Programs DirectorState Family Programs Director

National GuardNational Guard

Trained Crisis Responder ProgramTrained Crisis Responder Program

TCR Briefing for Command

Military References…Military References… Trained Crisis Responder Trained Crisis Responder

(TCR)…(TCR)… Crisis Intervention…Crisis Intervention… Critical Incidents…Critical Incidents… Post-Traumatic Stress…Post-Traumatic Stress… TCR Services…TCR Services… Rationale…Rationale…

OverviewOverview


DoD:DoD: 6490.5 – Combat Stress Control 6490.5 – Combat Stress Control

ProgramProgram Air Force:Air Force:

AFI 44-153 – Critical Incident AFI 44-153 – Critical Incident Stress ManagementStress Management

AFI 34-1101 Survivor Assistance AFI 34-1101 Survivor Assistance Army:Army:

Field Manual Field Manual FM 16-1, Annex F-1 FM 16-1, Annex F-1 "Critical Event Debriefings""Critical Event Debriefings"

ReferencesReferences


The National Guard The National Guard TCR ProgramTCR Program was was

developed from Critical developed from Critical Incident Stress Incident Stress

Management Management (CISM)(CISM) principles…principles…

Trained Crisis Trained Crisis ResponderResponder


Crisis InterventionCrisis Intervention

““CISMCISM is a subset of the general is a subset of the general field of field of Crisis Intervention (CI)Crisis Intervention (CI) and may be thought of as the and may be thought of as the application of Crisis Intervention application of Crisis Intervention knowledge and techniques to knowledge and techniques to high risk groups, e.g., high risk groups, e.g., emergency services, military, emergency services, military, etc.”etc.”

(J.T. Mitchell, G.S. Everly, 1995)(J.T. Mitchell, G.S. Everly, 1995)


CISM ServicesCISM Services

Trained Crisis Responders Trained Crisis Responders are are the first line of defense in coping the first line of defense in coping with Post-Traumatic Stresswith Post-Traumatic Stress Reactions to Crisis events. Reactions to Crisis events. CISM ServicesCISM Services extend beyond extend beyond the training levels of Trained the training levels of Trained Crisis Responders, therefore it is Crisis Responders, therefore it is important for the TCR’s to work in important for the TCR’s to work in concert with military and civilian concert with military and civilian CISM Teams…CISM Teams…


CISM CISM Core Core ComponentsComponents

Pre-Crisis Pre-Crisis preparationpreparation

Demobilization Demobilization Crisis Crisis

Management Management BriefingBriefing

Defusing Defusing Critical Incident Critical Incident

Stress DebriefingStress Debriefing

Individual crisis Individual crisis intervention 1:1intervention 1:1

Family CISMFamily CISM Community Community

consultationconsultation Pastoral Crisis Pastoral Crisis

InterventionIntervention Follow-up/Follow-up/

ReferralReferral


Trained Crisis Trained Crisis ResponderResponder

Trained Crisis Trained Crisis

Responders provide Responders provide

psychological and psychological and

emotional emotional “Self-Aid “Self-Aid

and Buddy-Care”and Buddy-Care”


IncidentIncident

Crisis Intervention EAP

TCR’s Legal

Chaplain

CISM Mental Health

Psychotherapy

Hospitalization

Refer where needed… Family Support

Rehab

Spectrum Of CareSpectrum Of Care


Critical IncidentsCritical Incidents

Major Accidents (Air Crashes, etc.)…Major Accidents (Air Crashes, etc.)…

Line of Duty Death(s)…Line of Duty Death(s)…

Serious Line of Duty Injury(s)…Serious Line of Duty Injury(s)…

Suicide of a Co-Worker…Suicide of a Co-Worker…

Disaster / Multi-Casualty Incident(s)…Disaster / Multi-Casualty Incident(s)…

Shooting(s)…Shooting(s)…


Critical IncidentsCritical Incidents

Significant Events Involving Children…Significant Events Involving Children…

Prolonged Incident(s) - Especially with Prolonged Incident(s) - Especially with

loss…loss…

Excessive Community Media Interest…Excessive Community Media Interest…

Any Significant Traumatic Event…Any Significant Traumatic Event…


Primary GoalPrimary Goal

CISMCISM and the and the TCRTCR ProgramProgram are are forms of crisis intervention forms of crisis intervention

designed to help reduce Post-designed to help reduce Post-Traumatic Stress Reactions to Traumatic Stress Reactions to

Critical Incidents…Critical Incidents…


Post-Traumatic Post-Traumatic StressStress

Post - traumatic stress Post - traumatic stress

is a is a normal reactionnormal reaction, ,

in a in a normal personnormal person, ,

to an to an abnormal eventabnormal event..


Hallmarks of Crisis Hallmarks of Crisis InterventionIntervention

Immediacy Immediacy ProximityProximityExpectancyExpectancyBrevityBrevityPracticalPractical It’s learning how to toss a life raft, not a course It’s learning how to toss a life raft, not a course

in ship buildingin ship building


Post traumatic Post traumatic stressstress

Is everyone who experiences Is everyone who experiences traumatic distress suffering traumatic distress suffering

from the disorder know as Post from the disorder know as Post Traumatic Stress Disorder?Traumatic Stress Disorder?

NO.. NO ..NONO.. NO ..NO


Post Traumatic Post Traumatic Stress DisorderStress Disorder

PTSDPTSD represents a represents a contradiction to some contradiction to some

critically important critically important assumption or belief about assumption or belief about

self and/or the world.self and/or the world.

(G.S. Everly, 1995)(G.S. Everly, 1995)


Post Traumatic Post Traumatic Stress DisorderStress Disorder

A A pathological and disablingpathological and disabling variant of a normal stress variant of a normal stress reactionreaction

Very clear criteria …symptoms Very clear criteria …symptoms must be must be over 30 daysover 30 days and it is and it is impairingimpairing function function


Important TCR Important TCR ConceptConcept

The TCR Program is The TCR Program is NOTNOT a a

stand alone process. stand alone process.

Rather it is meant to be Rather it is meant to be

one part of a one part of a

comprehensive CISM comprehensive CISM

intervention program.intervention program.


TCR Services…TCR Services…

TCR’s can be in TCR’s can be in any sectionany section (personnel, security forces, fire, (personnel, security forces, fire, chaplain, medical, family support, chaplain, medical, family support, etc.)…etc.)…

TCR’s are normally among your TCR’s are normally among your first first respondersresponders to an incident… to an incident…

TCR’s can support official military TCR’s can support official military and civilian and civilian CISM TeamsCISM Teams……



Pre-incident educationPre-incident education, , preparation…preparation…

One-on-one crisis interventionOne-on-one crisis intervention……

DemobilizationsDemobilizations (large groups of (large groups of public safety)…public safety)…

Crisis Management BriefingsCrisis Management Briefings [large [large groups of primary, secondary groups of primary, secondary (emergency personnel), and tertiary (emergency personnel), and tertiary (family, co-workers, etc.) victims](family, co-workers, etc.) victims]



Family SupportFamily Support……

Organizational / Community Organizational / Community intervention, consultationintervention, consultation……

Follow-up and referralFollow-up and referral for TCR’s & for TCR’s & CISM services and/or continued CISM services and/or continued care…care…


Why have TCR’s and CISM programs?

We can learn from past experience.

RationaleRationale


141 ARW Suicide141 ARW Suicide

December 1998 - Fairchild AFB December 1998 - Fairchild AFB WAWA

Just-retired Wing CommanderJust-retired Wing Commander Prior incidents in unitPrior incidents in unit Impact on unitImpact on unit Chaplains from outside called in Chaplains from outside called in

for first UTA following incidentfor first UTA following incident Ministered to entire wingMinistered to entire wing


141 ARW CRASH141 ARW CRASH

Six weeks after suicide of Six weeks after suicide of commandercommander

Four members killed in GermanyFour members killed in Germany Chaplains called from outside; Chaplains called from outside;

some had just been theresome had just been there Assigned to each family to assist Assigned to each family to assist

local clergy and chaplainslocal clergy and chaplains Memorial Service and FuneralsMemorial Service and Funerals


Red Horse CrashRed Horse Crash

March 2001March 2001 Army NG Sherpa crashed over Army NG Sherpa crashed over

Ga.Ga. 18 ANG and 3 ARNG members 18 ANG and 3 ARNG members

killedkilled Chaplains called in for ministryChaplains called in for ministry Memorial Service and FuneralsMemorial Service and Funerals Continuing care for familiesContinuing care for families


Red Horse, cont’dRed Horse, cont’d

Late July - Early August reportLate July - Early August report Some possible questionsSome possible questions Chaplains and Line Colonels Chaplains and Line Colonels

formed teams for each familyformed teams for each family Trained at Langley then deployedTrained at Langley then deployed There to walk families through There to walk families through

report and to offer pastoral carereport and to offer pastoral care


ComparisonComparison

Total KilledTotal Killed 125125 8282

Plane SurvivorsPlane Survivors 00 00

Homes DestroyedHomes Destroyed 1616 1616

Killed On GroundKilled On Ground 1515 1515

Emergency PersonnelEmergency Personnel 300300 300300

Body Parts FoundBody Parts Found 10,00010,000 10,00010,000

San Diego, CASan Diego, CAAir Crash - 1978Air Crash - 1978

Cerritos, CACerritos, CAAir Crash - 1986Air Crash - 1986


ComparisonComparison


On Scene One on On Scene One on OneOne

DemobilizationsDemobilizations 12 Debriefings12 Debriefings Hot Line NumberHot Line Number One on One One on One

Follow UpFollow Up

Support Services ProvidedSupport Services ProvidedSan Diego, CASan Diego, CAAir Crash - 1978Air Crash - 1978

Sporadic One on Sporadic One on OneOne


ComparisonComparisonPersonnel Lost in 1 Personnel Lost in 1

YearYear

Police 5 -Fire 7 -

1Paramedics 17 -Increase inMental HealthServices increase of 31% increase

of 1%

San Diego, CASan Diego, CAAir Crash - 1978Air Crash - 1978



RationaleRationale

Trauma and stress-related disorders Trauma and stress-related disorders are sometimes disabling and costly are sometimes disabling and costly to treat…to treat…

Interventions are designed to assist Interventions are designed to assist in preventing “burnout” and PTSD…in preventing “burnout” and PTSD…

Healthy employees are more Healthy employees are more productive and effective on the job…productive and effective on the job…


Example 1…Example 1…

100 trauma victims100 trauma victims Intervention began Intervention began afterafter 6 6

monthsmonths Average cost = Average cost = $46,000.00 ea.$46,000.00 ea. 94%94% filed civil litigation filed civil litigation

Friedman, et al, EAP Digest, 1988


Example 2…Example 2…

100 trauma victims100 trauma victims Intervention began Intervention began withinwithin 6 6

monthsmonths Average cost = Average cost = $8,300.00 ea.$8,300.00 ea. 13%13% filed civil litigation filed civil litigation

Friedman, et al, EAP Digest, 1988


RationaleRationale

On any given trauma/disaster, On any given trauma/disaster, 4%-97%4%-97% of the individuals of the individuals exposed will develop exposed will develop Symptoms similar to PTSD.Symptoms similar to PTSD.

16-30%16-30% of emergency of emergency responders are at risk of responders are at risk of developing PTSD symptoms.developing PTSD symptoms.


RationaleRationale

Disaster / Trauma planning Disaster / Trauma planning (including CISM protocols) is (including CISM protocols) is

appropriate for not only appropriate for not only emergency response emergency response

personnel and institutions, but personnel and institutions, but for all business and industrial for all business and industrial (and military) settings as well.(and military) settings as well.

Yandrick, EAPA Exchange, 1990Yandrick, EAPA Exchange, 1990


Main GoalMain Goal

Trained Crisis Trained Crisis Responders helpResponders help

keep your teamkeep your team

on the job!on the job!


WHERE YOU CAN WHERE YOU CAN LEARN THIS STUFF!LEARN THIS STUFF!

Ch, LtCol Charles E. WoodsCh, LtCol Charles E. Woods

Chief, Crisis InterventionChief, Crisis Intervention

McGhee Tyson ANG Base, TNMcGhee Tyson ANG Base, TN

Academy for Academy for Innovative MinistryInnovative Ministry


AIM COURSESAIM COURSES

AIM course offerings available on-line:

https.//tys.tnknox.ang.af.mil/AAIM/AAIM.HTM

This web site is accessible from a ".mil" computer only!


CHAPLAIN SERVICE CHAPLAIN SERVICE AND FAMILY AND FAMILY

SUPPORTSUPPORT

WHY DO CHAPLAINS EXIST?WHY DO CHAPLAINS EXIST?

- First Amendment- First Amendment

- ‘Provision without - ‘Provision without establishment’establishment’

RequirementsRequirements SkillsSkills ‘‘neutral zone’neutral zone’ 100 % Confidentiality100 % Confidentiality


Chaplain Service Chaplain Service and Family Supportand Family Support

LET’S TALK!LET’S TALK!

Documents

Critical Incident Stress Management (CISM) LTC Clarence Bowser State Family Programs Director National Guard Trained Crisis Responder Program