Critical incident stress management

1. Critical incident stress management Text pages 47-52 - Bledsoe

2. Stress vs Critical Incident Job Stress or Life Stress • The harmful physical and emotional responses that occur when the requirement of the job do not match the capabilities, resources, or needs of the worker

3. Critical Incident • A Stressor event that appears to cause a crisis response

4. Critical incident • An event that has a powerful emotional impact on a rescuer that can cause an acute stress reaction • Can effect a single crew or entire agency • The event tends to generate rapid onset stress responses

5. Examples of critical incident events • Injury or death of: - an infant or child - someone known to EMS personnel - an EMS worker - of a civilian caused by EMS operations • Extreme threat to an EMS worker • Disasters or MCI • Incidents that draw unusual media attention

6. Signs & symptoms of CIS • Usually starts within 48 hours of the event • May feel excessive fatigue because of sleep disturbances (too much or too little, nightmares) and because the events is all consuming • May experience flashbacks • May experience amnesia of the event • Vague health issues such as headaches or GI upset

7. CIS - REACTIONS Normal reaction By a ...Normal person to An...Abnormal event

8. CIS Physical - Reactions • Hyper or hypoactivity or depression • May be oversensitive and have ‘hair trigger’ anger • May withdraw and seek isolation • Strong feelings of guilt, fear and helplessness • Inability to concentrate What are some others?

9. Self help • Reach out and talk with others; family, colleagues • If no one available, ‘talk’ to a journal • Exercise • Maintain a normal routine • Be careful to not ‘drown your sorrows’ in alcohol or drugs

10. CIS management • A system of related interventions usually performed by regional, non-partisan, multidisciplinary teams comprised of EMS peers, police, fire & dispatchers and specially trained mental health professionals • These interventions must not be implemented casually or improperly • The most widely recognized model for CSIM is the Mitchell Model, developed by Jeffrey Mitchell in 1983

11. CIS debriefing • Designed specifically to address the special personalities, jobs and family related stressors and the support needs of emergency service workers • Being a paramedic does not shield you. You experience distress like anyone else • Important note: participation in any CIS process is strictly voluntary! Personnel may be offered help but are not compelled to take it.

12. CISD team members • Mental health professionals • Peer support personnel – may include police, fire, paramedics, nursing, dispatch, disaster management and other emergency oriented organizations • May include clergy

13. CISD team members • CISD team may have between 20-40 members. 1/3 mental health professionals and 2/3 peer support personnel • A response team usually consists of 4 members. One mental health care professional and 3 peer support personnel

14. On scene support services • Peer support personnel briefly assist obviously distressed co-workers usually by moving them away from the scene and notifying supervisory personnel • May also assist victims, family members and bystanders to reduce interference with operations

15. Demobilization services • Usually reserved for large scale events • EMS personnel go to a separate area before leaving the scene • The process takes about 30 minutes. About 10 minutes is information about stress and about 20 minutes is for feeding and resting of crews • May include some venting of feelings

16. Defusing • Usually occurs within 1-4 hours of the event • Lead by peer support personnel • Goal – to stabilize the crew(s) so they can return to normal service or go home at the end of the shift • A small group process that usually takes 30-45 minutes • Involves the initial venting of feelings

17. Still Defusing • Involves an educations component about stress and stress related reactions to the event • Concentrates on the most seriously affected personnel • Either eliminates the need for a formal debriefing or enhances the debriefing process

18. Debriefing • Structured, confidential group meetings • Best when offered 24-72 hours post event • Last about 3 hours • Includes all 4 members of the CISD team • Goal – to reduce the impact of the critical event and to accelerate the normal recovery process • Emphasizes ventilation of emotions and other reactions to the event

19. More on Debriefing • Emphasizes educational and informational elements to help understand and deal with the stress generated from the event • Provides an opportunity for: stress reduction, education, emotional reassurance, enhancement of group cohesiveness and interagency co-operation • Provides referral for individuals to other services

20. CISD may also include the following: • Follow-up services with additional meetings • Special debriefings for non-emergency community groups • Special debriefings for the spouses and family members of EMS workers • Individual consultations

21. Emergency Response to Crisis • CISD teams also provide ongoing educations about stress and how it affects EMS personnel • These may be separate education sessions or subsequent training sessions after a critical incident