Critical incident stress Critical incident stress managementmanagement

Stress vs Critical Stress vs Critical IncidentIncident

Job Stress or Life StressJob Stress or Life Stress The harmful physical and The harmful physical and

emotional responses that occur emotional responses that occur when the requirement of the job when the requirement of the job do not match the capabilities, do not match the capabilities, resources, or needs of the workerresources, or needs of the worker

Critical IncidentCritical Incident

A Stressor event that appears to A Stressor event that appears to cause a crisis responsecause a crisis response

Critical incidentCritical incident

An event that has a powerful emotional An event that has a powerful emotional impact on a rescuer that can cause an acute impact on a rescuer that can cause an acute stress reactionstress reaction

Can effect a single crew or entire agencyCan effect a single crew or entire agency The event tends to generate rapid onset The event tends to generate rapid onset

stress responsesstress responses

Examples of critical Examples of critical incident eventsincident events Injury or death of:Injury or death of:

- an infant or child- an infant or child

- someone known to EMS personnel - someone known to EMS personnel

- an EMS worker - an EMS worker

- of a civilian caused by EMS operations- of a civilian caused by EMS operations Extreme threat to an EMS workerExtreme threat to an EMS worker Disasters or MCIDisasters or MCI Incidents that draw unusual media attentionIncidents that draw unusual media attention

Signs & symptoms of CISSigns & symptoms of CIS

Usually starts within 48 hours of the Usually starts within 48 hours of the eventevent

May feel excessive fatigue because of May feel excessive fatigue because of sleep disturbances (too much or too sleep disturbances (too much or too little, nightmares) and because the little, nightmares) and because the events is all consumingevents is all consuming

May experience flashbacksMay experience flashbacks May experience amnesia of the eventMay experience amnesia of the event Vague health issues such as Vague health issues such as

headaches or GI upsetheadaches or GI upset

CIS - CIS - REACTIONS

NormalNormal reaction reaction

By a ...By a ...NormalNormal person to person to

An...An...AbnormalAbnormal event event

CIS Physical - CIS Physical - ReactionsReactions

Hyper or hypoactivity or depressionHyper or hypoactivity or depression May be oversensitive and have ‘hair May be oversensitive and have ‘hair

trigger’ angertrigger’ anger May withdraw and seek isolationMay withdraw and seek isolation Strong feelings of guilt, fear and Strong feelings of guilt, fear and

helplessnesshelplessness Inability to concentrateInability to concentrate

What are some others?What are some others?

Self helpSelf help

Reach out and talk with others; family, Reach out and talk with others; family, colleagues colleagues

If no one available, ‘talk’ to a journalIf no one available, ‘talk’ to a journal ExerciseExercise Maintain a normal routineMaintain a normal routine Be careful to not ‘drown your sorrows’ Be careful to not ‘drown your sorrows’

in alcohol or drugsin alcohol or drugs

CIS managementCIS management

A system of related interventions usually A system of related interventions usually performed by regional, non-partisan, performed by regional, non-partisan, multidisciplinary teams comprised of EMS multidisciplinary teams comprised of EMS peers, police, fire & dispatchers and peers, police, fire & dispatchers and specially trained mental health specially trained mental health professionalsprofessionals

These interventions must These interventions must notnot be be implemented casually or improperlyimplemented casually or improperly

The most widely recognized model for The most widely recognized model for CSIM is the Mitchell Model, developed by CSIM is the Mitchell Model, developed by Jeffrey Mitchell in 1983Jeffrey Mitchell in 1983

CIS debriefing CIS debriefing

Designed specifically to address the Designed specifically to address the special personalities, jobs and family special personalities, jobs and family related stressors and the support needs related stressors and the support needs of emergency service workersof emergency service workers

Being a paramedic does not shield you. Being a paramedic does not shield you. You experience distress like anyone elseYou experience distress like anyone else

Important note: Important note: participation in any CIS participation in any CIS process is strictly voluntary! Personnel process is strictly voluntary! Personnel may be offered help but are not may be offered help but are not compelled to take it.compelled to take it.

CISD team membersCISD team members

Mental health professionalsMental health professionals Peer support personnel – may include Peer support personnel – may include

police, fire, paramedics, nursing, police, fire, paramedics, nursing, dispatch, disaster management and dispatch, disaster management and other emergency oriented other emergency oriented organizationsorganizations

May include clergyMay include clergy

CISD team membersCISD team members

CISD team may have between 20-40 CISD team may have between 20-40 members. members.

1/3 mental health professionals and 1/3 mental health professionals and 2/3 peer support personnel 2/3 peer support personnel

A response team usually consists of 4 A response team usually consists of 4 members. One mental health care members. One mental health care professional and 3 peer support professional and 3 peer support personnelpersonnel

On scene support On scene support servicesservices

Peer support personnel briefly assist Peer support personnel briefly assist obviously distressed co-workers obviously distressed co-workers usually by moving them away from the usually by moving them away from the scene and notifying supervisory scene and notifying supervisory personnelpersonnel

May also assist victims, family May also assist victims, family members and bystanders to reduce members and bystanders to reduce interference with operationsinterference with operations

Demobilization servicesDemobilization services

Usually reserved for large scale eventsUsually reserved for large scale events EMS personnel go to a separate area EMS personnel go to a separate area

before leaving the scenebefore leaving the scene The process takes about 30 minutes. The process takes about 30 minutes.

About 10 minutes is information about About 10 minutes is information about stress and about 20 minutes is for stress and about 20 minutes is for feeding and resting of crewsfeeding and resting of crews

May include some venting of feelingsMay include some venting of feelings

Defusing Defusing

Usually occurs within 1-4 hours of the Usually occurs within 1-4 hours of the eventevent

Lead by peer support personnelLead by peer support personnel Goal – to stabilize the crew(s) so they Goal – to stabilize the crew(s) so they

can return to normal service or go can return to normal service or go home at the end of the shifthome at the end of the shift

A small group process that usually A small group process that usually takes 30-45 minutestakes 30-45 minutes

Involves the initial venting of feelingsInvolves the initial venting of feelings

Still DefusingStill Defusing

Involves an educations component Involves an educations component about stress and stress related about stress and stress related reactions to the eventreactions to the event

Concentrates on the most seriously Concentrates on the most seriously affected personnelaffected personnel

Either eliminates the need for a formal Either eliminates the need for a formal debriefing or enhances the debriefing debriefing or enhances the debriefing processprocess

Debriefing Debriefing

Structured, confidential group meetingsStructured, confidential group meetings Best when offered 24-72 hours post Best when offered 24-72 hours post

eventevent Last about 3 hoursLast about 3 hours Includes all 4 members of the CISD teamIncludes all 4 members of the CISD team Goal – to reduce the impact of the Goal – to reduce the impact of the

critical event and to accelerate the critical event and to accelerate the normal recovery processnormal recovery process

Emphasizes ventilation of emotions and Emphasizes ventilation of emotions and other reactions to the eventother reactions to the event

More on DebriefingMore on Debriefing

Emphasizes educational and informational Emphasizes educational and informational elements to help understand and deal with elements to help understand and deal with the stress generated from the eventthe stress generated from the event

Provides an opportunity for: stress Provides an opportunity for: stress reduction, education, emotional reduction, education, emotional reassurance, enhancement of group reassurance, enhancement of group cohesiveness and interagency co-operationcohesiveness and interagency co-operation

Provides referral for individuals to other Provides referral for individuals to other servicesservices

CISD may also include CISD may also include the following:the following:

Follow-up services with additional Follow-up services with additional meetingsmeetings

Special debriefings for non-emergency Special debriefings for non-emergency community groupscommunity groups

Special debriefings for the spouses and Special debriefings for the spouses and family members of EMS workersfamily members of EMS workers

Individual consultationsIndividual consultations

Emergency Response Emergency Response to Crisisto Crisis

CISD teams also provide ongoing CISD teams also provide ongoing educations about stress and how it educations about stress and how it affects EMS personnelaffects EMS personnel

These may be separate education These may be separate education sessions or subsequent training sessions or subsequent training sessions after a critical incidentsessions after a critical incident