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Critical Incident Stress Management (CISM) - PowerPoint PPT Presentation

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Northeast Region Civil Air Patrol/USAF-Auxiliary. Critical Incident Stress Management (CISM). Objectives of this Presentation. To provide the participants with. An introduction to NER CISM.

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Northeast Region

Civil Air Patrol/USAF-Auxiliary

Critical Incident StressManagement (CISM)

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Objectives of this Presentation

To provide the participants with

  • An introduction to NER CISM

  • An overview of critical incident stress, crisis management and critical incident stress management (CISM)

  • An orientation to CAP’s CISM program

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Part IEverything you ever wantedto know aboutCritical Incident Stressand CISM

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A Crisis

A response to an event wherein

  • One’s normal psychological balance (homeostasis) has been disrupted,

  • One’s usual coping mechanisms have failed to reestablish the needed homeostasis, or

  • There is evidence of functional impairment.

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Critical Incident Stress

“Any event in which there is a stressful impact

sufficient enough to overwhelm

the usually effective coping skills

of either an individual or a group.”

(Everly & Mitchell, 1999)

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Examples of Critical Incidents

  • Line of duty death or death at workplace

  • Serious line of duty injury or workplace injury

  • Suicide of coworker, friend, family member

  • Multiple casualty incidents (MCI’s), disasters

  • Significant events involving children

  • Prolonged events especially with loss

  • Any powerful event which overwhelms a person’s normal coping mechanisms

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Crisis Intervention

The provision of timely “emotional first aid”

  • An exercise in psychological damage control…stopping the bleeding!

  • Not a cure

  • An opportunity for assessment and

    for follow-up

  • Guided by a mental health professional (MHP)

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Crisis Intervention

Is one aspect of

a continuum of care

It requires

specialized &uniquetraining

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Crisis InterventionPrinciples

Spell B -I -S -E -P

  • Brevity- few minutes up to 1 hour

  • Immediacy – Rapid Intervention

  • Simplicity – KIS – Keep it Simple

  • Expectancy – A reasonable positive outcome

  • Proximity – Close to operational zone is most effective

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Post-Traumatic Stress


Stress Disorder

A normal reaction

in a normal person

to an abnormal event

It is a

survival mechanism

(PTSD) is a pathogenic (unhealthy) variation

of that normal survival mechanism

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Stress Response Timelines

  • Immediate – up to 24 hours post event.

  • Delayed – 24 to 72 hours post event.

  • Cumulative – buildup of stress over time.

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Critical Incident Stress Management (CISM)is

One type of crisis intervention

It is a comprehensive,

systematic program

for the mitigation of

critical- incident related stress.

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The goals of CISM

  • Preventtraumatic stress

  • Mitigate traumatic stress

  • Intervene to assist recovery from traumatic stress

  • Accelerate recovery

  • Restore function

  • Maintain worker health and welfare

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CISM involves many facets

  • Pre-crisis preparation and education

  • Demobilization (for large groups)

  • Crisis management briefings (large groups also)

  • Defusings

  • Critical incident stress debriefing (CISD)

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CISM also involves

  • One-on-one, individual crisis intervention

  • Pastoral crisis intervention

  • Family CISM

  • Organizational crisis intervention/consultations

  • Follow-up and referral mechanisms

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CISMdeals with the current circumstancesthe current event or crisis NOT personal histories

It is First Aid, not definitive care.

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Pre-Incident Education“PEP Talks”

  • General information: stress, trauma, etc.

  • Set expectations for actual experiences

  • Teach stress management and coping skills

  • Appropriate for ALL members

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  • Provide decompression

  • Transition workers from disaster work (large-scale incident) to routine duties or home

  • Used with large numbers of people

  • A 10- to 30-minute session

  • An opportunity for assessment of group needs

  • Alert workers to possible stress effects

  • Always followed by a CISD (debriefing, usually within one week

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  • A small group intervention conducted within hours of the incident, usually within 12 hours

  • Shortened version (20-45 mins) of the CIS- Debriefing

  • May eliminate the need for, or increase effectiveness of, CISD – opportunity to assess the need for CISD

  • Seeks to reduce intense reactions to a trauma

  • Seeks to “normalize” the effects of the event

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The Defusing 3-Step




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The Critical IncidentStress Debriefing (CISD)

  • A group discussion of a traumatic event

  • Peer driven

  • Clinician (MHP) guided

  • Lasts 1-3 hours

  • Closed circle format

  • Held 1-10 days post event

  • NOT psychotherapy!

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Objectives of the CISD

  • Education

  • Ventilation

  • Reassurance and forewarning

  • Positive contact with an MHP

  • Improvement of interagency cooperation

  • Increase group cohesiveness

  • Restore self-confidence

  • Facilitation of follow-up

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  • Is made for those requiring a more thorough process of assessment and evaluation

  • The mental health provider should understand the “culture” of the agency in which the person is employed, and

  • Should have specialized training/experience in post-traumatic stress.

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Family Support

  • An essential component of a comprehensive CISM program

  • Consists of

    - Educational programs

    - CISD for significant others

    - Bereavement support/grief & crisis counseling

  • Provided by peers, MHP, clergy, trained spouses

  • Includes children and elderly as well

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  • Essential element in all CISM interventions

  • Can be made by - Phone calls - Station/workplace visits - Home visits

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Part TwoEverything you always wantedto know aboutthe CAP CISM Program

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CISMa comprehensive,systematic maintenance program for the overall well-beingof our most valuable assets

our members

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The CIS Team consists of:

  • Mental Health Professionals (MHP)

  • Peer Representatives

    CAPR 60-5 (3)a 2

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CAP’s CISM Program

“The use of qualified, local, non-CAP teams to respond to incident stress-affected CAP members is highly encouraged … The use of local non-CAP teams will somewhat limit the need to dispatch a trained CAP CIS [Team]”

--CAPR 60-5 (2)e

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CISM is a MandatedOperations Program!

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CAP’s CISM Program

  • Mandated by CAPR 60-5

  • Not optional

  • Specifically an operations program

  • Implementation is assigned to Region Commanders by CAPR 60-5

  • Wings are to “assess the need for a CIST”

  • All personnel are encouraged to receive CIS training.

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Funding CISM

  • CISM is not, presently, a specifically USAF funded mission (by itself).

  • CAP CISM may be funded through an existing mission’s funding.

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Funding CISM

  • CAP National HQ has approved limited funding to support CISM missions.

    • Housing and feeding of a team will normally NOT be reimbursed.

    • The “use of host families” is encouraged to mitigate housing costs.

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Compare these...

According to the Wing Aircraft Maintenance Officer, HQ-TX Wing expects to spend approximately $187,000.00

this year to maintain our fleet of airplanes.

But …

How much are we spending

to maintain our most valuable asset


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Everythingyou ever wanted to know about CAP CISMin Northeast Region

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Request & Deployment

  • After a SAR or DR mission “… a review of the need for CIS intervention should be made for all personnel ...”

  • The Incident Commander or Unit Commander will pass a request to Wing Commander.

  • In consultation with staff, the Wing CC will coordinate use of a local non-CAP team or request one of the Region Teams.

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For More Information ...

  • Visit the website of the International Critical Incident Stress Foundation (ICISF) at

  • Join the ICISF.

  • Review CAPR 60-5.

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For More Information

Contact the NER CIS Staff

- Jack Arena, NER CIS

631-645-7912 (cell), mission

- Paul Mondoux, NER Deputy CIS

603-424-3019 (home) or 603-759-0178 (cell),





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All CISM InterventionsAre Strictly Confidential!