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National Guard. Critical Incident Stress Management (CISM). Trained Crisis Responder Program. LTC Clarence Bowser State Family Programs Director. Overview. Military References… Trained Crisis Responder (TCR)… Crisis Intervention… Critical Incidents… Post-Traumatic Stress… TCR Services…

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critical incident stress management cism

National Guard

Critical Incident Stress Management (CISM)

Trained Crisis Responder Program

LTC Clarence Bowser

State Family Programs Director

overview
Overview
  • Military References…
  • Trained Crisis Responder (TCR)…
  • Crisis Intervention…
  • Critical Incidents…
  • Post-Traumatic Stress…
  • TCR Services…
  • Rationale…
references
References
  • DoD:
    • 6490.5 – Combat Stress Control Program
  • Air Force:
    • AFI 44-153 – Critical Incident Stress Management
    • AFI 34-1101 Survivor Assistance
  • Army:
    • Field Manual FM 16-1, Annex F-1 "Critical Event Debriefings"
trained crisis responder
Trained Crisis Responder

The National Guard TCR Program was developed from Critical Incident Stress Management (CISM) principles…

crisis intervention
Crisis Intervention

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

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

cism services
CISM Services
  • Trained Crisis Responders are the first line of defense in coping with Post-Traumatic StressReactions to Crisis events.
  • CISM Services extend beyond the training levels of Trained Crisis Responders, therefore it is important for the TCR’s to work in concert with military and civilian CISM Teams…
cism core components
Pre-Crisis preparation

Demobilization

Crisis Management Briefing

Defusing

Critical Incident Stress Debriefing

Individual crisis intervention 1:1

Family CISM

Community consultation

Pastoral Crisis Intervention

Follow-up/Referral

CISM Core Components
trained crisis responder8
Trained Crisis Responder

Trained Crisis Responders provide psychological and emotional “Self-Aid and Buddy-Care”

slide9

Spectrum Of Care

Incident

Crisis

Intervention EAP

TCR’sLegal

Chaplain

CISM Mental Health

Psychotherapy

Hospitalization

Refer where needed… Family Support

Rehab

critical incidents
Critical Incidents
  • Major Accidents (Air Crashes, etc.)…
  • Line of Duty Death(s)…
  • Serious Line of Duty Injury(s)…
  • Suicide of a Co-Worker…
  • Disaster / Multi-Casualty Incident(s)…
  • Shooting(s)…
critical incidents11
Critical Incidents
  • Significant Events Involving Children…
  • Prolonged Incident(s) - Especially with loss…
  • Excessive Community Media Interest…
  • Any Significant Traumatic Event…
primary goal
Primary Goal

CISM and the TCRProgram are forms of crisis intervention designed to help reduce Post-Traumatic Stress Reactions to Critical Incidents…

post traumatic stress
Post-Traumatic Stress

Post - traumatic stress

is a normal reaction,

in a normal person,

to an abnormal event.

hallmarks of crisis intervention
Hallmarks of Crisis Intervention
  • Immediacy
  • Proximity
  • Expectancy
  • Brevity
  • Practical

It’s learning how to toss a life raft, not a course in ship building

post traumatic stress15
Post traumatic stress

Is everyone who experiences traumatic distress suffering from the disorder know as Post Traumatic Stress Disorder?

NO.. NO ..NO

post traumatic stress disorder
Post Traumatic Stress Disorder

PTSD represents a contradiction to some critically important assumption or belief about self and/or the world.

(G.S. Everly, 1995)

post traumatic stress disorder17
Post Traumatic Stress Disorder
  • A pathological and disabling variant of a normal stress reaction
  • Very clear criteria …symptoms must be over 30 days and it is impairing function
important tcr concept
Important TCR Concept

The TCR Program is NOT a stand alone process. Rather it is meant to be one part of a comprehensive CISM intervention program.

tcr services
TCR Services…
  • TCR’s can be in any section (personnel, security forces, fire, chaplain, medical, family support, etc.)…
  • TCR’s are normally among your first responders to an incident…
  • TCR’s can support official military and civilian CISM Teams…
tcr services20
TCR Services…
  • Pre-incident education, preparation…
  • One-on-one crisis intervention…
  • Demobilizations (large groups of public safety)…
  • Crisis Management Briefings [large groups of primary, secondary (emergency personnel), and tertiary (family, co-workers, etc.) victims]
tcr services21
TCR Services…
  • Family Support…
  • Organizational / Community intervention, consultation…
  • Follow-up and referral for TCR’s & CISM services and/or continued care…
slide22

Rationale

Why have TCR’s and CISM programs?

We can learn from past experience.

141 arw suicide
141 ARW Suicide
  • December 1998 - Fairchild AFB WA
  • Just-retired Wing Commander
  • Prior incidents in unit
  • Impact on unit
  • Chaplains from outside called in for first UTA following incident
  • Ministered to entire wing
141 arw crash
141 ARW CRASH
  • Six weeks after suicide of commander
  • Four members killed in Germany
  • Chaplains called from outside; some had just been there
  • Assigned to each family to assist local clergy and chaplains
  • Memorial Service and Funerals
red horse crash
Red Horse Crash
  • March 2001
  • Army NG Sherpa crashed over Ga.
  • 18 ANG and 3 ARNG members killed
  • Chaplains called in for ministry
  • Memorial Service and Funerals
  • Continuing care for families
red horse cont d
Red Horse, cont’d
  • Late July - Early August report
  • Some possible questions
  • Chaplains and Line Colonels formed teams for each family
  • Trained at Langley then deployed
  • There to walk families through report and to offer pastoral care
comparison
Comparison

Total Killed 12582

Plane Survivors 00

Homes Destroyed 1616

Killed On Ground 1515

Emergency Personnel 300300

Body Parts Found 10,00010,000

San Diego, CA

Air Crash - 1978

Cerritos, CA

Air Crash - 1986

comparison31
Cerritos, CA

Air Crash - 1986

On Scene One on One

Demobilizations

12 Debriefings

Hot Line Number

One on One Follow Up

Comparison

Support Services Provided

San Diego, CA

Air Crash - 1978

  • Sporadic One on One
comparison personnel lost in 1 year
ComparisonPersonnel Lost in 1 Year

Police 5 -

Fire 7 - 1

Paramedics 17 -

Increase in

Mental Health

Services increase of 31% increase of 1%

San Diego, CA

Air Crash - 1978

Cerritos, CA

Air Crash - 1986

rationale
Rationale
  • Trauma and stress-related disorders are sometimes disabling and costly to treat…
  • Interventions are designed to assist in preventing “burnout” and PTSD…
  • Healthy employees are more productive and effective on the job…
example 1
Example 1…
  • 100 trauma victims
  • Intervention began after 6 months
  • Average cost = $46,000.00 ea.
  • 94% filed civil litigation

Friedman, et al, EAP Digest, 1988

example 2
Example 2…
  • 100 trauma victims
  • Intervention began within 6 months
  • Average cost = $8,300.00 ea.
  • 13% filed civil litigation

Friedman, et al, EAP Digest, 1988

rationale36
Rationale
  • On any given trauma/disaster, 4%-97% of the individuals exposed will develop Symptoms similar to PTSD.
  • 16-30% of emergency responders are at risk of developing PTSD symptoms.
rationale37
Rationale

Disaster / Trauma planning (including CISM protocols) is appropriate for not only emergency response personnel and institutions, but for all business and industrial (and military) settings as well.

Yandrick, EAPA Exchange, 1990

main goal
Main Goal

Trained Crisis Responders help

keep your team

on the job!

academy for innovative ministry
Academy for Innovative Ministry

WHERE YOU CAN LEARN THIS STUFF!

Ch, LtCol Charles E. Woods

Chief, Crisis Intervention

McGhee Tyson ANG Base, TN

aim courses
AIM 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 and family support
CHAPLAIN SERVICE AND FAMILY SUPPORT
  • WHY DO CHAPLAINS EXIST?

- First Amendment

- ‘Provision without establishment’

  • Requirements
  • Skills
  • ‘neutral zone’
  • 100 % Confidentiality