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Application of the U.S. Military Combat Stress Control to Civilian Emergency Teams in Catastrophic Events. Philip Gruzalski, LCSW Commander, IL-2. Objectives. To describe: The likely stressors and their affects in a catastrophic event. 2. The key components of the U.S. Military’s CSC.

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Application of the U.S. Military Combat Stress Control to Civilian Emergency Teams in Catastrophic Events

Philip Gruzalski, LCSW

Commander, IL-2

objectives
Objectives

To describe:

  • The likely stressors and their affects in a catastrophic event.

2. The key components of the U.S. Military’s CSC.

3. The application of CSC to civilian responders.

anticipate high stress from wmd
Anticipate High Stress from WMD
  • Technical and unfamiliar: “Uncontrollable”
    • Tendency to overestimate and overreact
    • Tendency to deny and ignore
  • Agents and deliveries are AMBIGUOUS
    • Many FALSE ALARMS
    • High ambiguity and bad consequences lead to high stress reactions.

James Stokes, MD

wmd terrorism
WMD & Terrorism
  • Sense of Wrongfulness: Immoral, unfair
    • Indiscriminate
    • Attacks the innocent and defenseless
    • Hooks in the sense of victimhood.
  • James Stokes, MD
wmd terrorism6
WMD & Terrorism
  • Will be catastrophic.
  • Will produce extreme stress and trauma.
  • Will require a critical need for stress control.
stressors
Stressors

“ Events or conditions that may cause physiological and behavioral reactions and present coping difficulties for the individual experiencing them”

Mental health and Mass Violence, 2002

stress reaction
Stress Reaction

“ The physiological and behavioral response to stressors, such as fatigue, high blood pressure, anger, and psychological distress.”

Mental health and Mass Violence, 2002

a traumatic event
A Traumatic Event

An event or events that involve:

  • Actual or threatened death or
  • Serious injury or
  • A threat to the physical integrity of self or other

DSM IV

immediate common signs of extreme stress
Immediate Common Signs of Extreme Stress
  • 1. Anxiety
  • 2. Irritability
  • 3. Attention
  • 4. Thinking
  • 5. Sleep
  • 6. Sadness
  • 7. Anger
  • 8. Lost Confidence
some early warning signs of severe stress
Some Early Warning Signs of Severe Stress
  • 1. Hyperactivity
  • 2. Trembling or cowering
  • 3. Spaced-out appearance
  • 4. Rapid speech
  • 5. Irritable or angry outbursts
  • 6. Memory loss
  • 7. Exaggerated startle response
stress
Stress

Stress can be a silent enemy having adverse effects on an emergency program’s mission and performance.

types of post mobilization stress reaction
Types of Post-Mobilization Stress Reaction
  • Sub-clinical Stress Disorders
    • Boredom, sensation seeking and recklessness,
    • Burnout, job change,
    • Alcohol/drug misuse (self-medication)
    • Family disturbance, abuse, break-up,
    • Chronic medical complaints, problems.

James Stokes, MD

dual effect of extreme stress
Dual Effect of Extreme Stress
  • Effects response performance.
  • Has long-term consequences.
some objective factors affecting the victim
Some Objective Factors Affecting the Victim
  • 1. Proximity to the event.
  • 2. Duration of the Stressor.
  • 3. Degree of physical harm.
  • 4. Intentionality of the injury.
  • 5. Exposure to grotesque, mutilating death of others.
  • 6. Suddenness of the event.
  • 7. Death and injury to children

(Meichenbaum, 94)

moderators
MODERATORS

Antecedent variables such as prior trauma, demographics, intelligence, temperament, situational stress at home, religious beliefs: these can be negative in terms of increasing vulnerability or positive in that they enhance resilience.

Gal and Jones, ‘95

mediators
MEDIATORS

These are present items that seem to be more changeable and can be both good or bad: unit cohesion, leadership, peer support all which affect the individual’s appraisal of the situation and the individual’s coping with the realities of the situation.

Jones and Gal, 95

resilience
Resilience

An adaptive, good mix of moderators and mediators that helps a person to adapt and recover.

combat and operational stress control cosc
Combat and Operational Stress Control (COSC)
  • Became U.S. Army doctrine in 1986.
  • DoD Directive 6490.5 (1999) directed all services to design and implement a CSC program to preserve mission effectiveness and …
directive 6490 5
Directive 6490.5

“…to minimize the short and long-run adverse effects of combat on the physical , psychological, intellectual and social health of the service members.”

triservice csoc units mh teams
TRISERVICE CSOC UNITS & MH TEAMS
  • USAF: “COSC” includes:
    • Mental Health Rapid Response Team (MHRRT),
    • Mental Health Augmentation Team (MHAT) - - Aeromed Evacuation Squadron
  • NAVY / USMC: “COSC” includes:
    • --Special Psych Rapid Intervention Team –Marine Div, Med Battalion Tm
other uniformed services programs
Other Uniformed Services Programs
  • Royal Marines: Fleet Risk Management Program (TRIM).
  • Royal Netherlands Marines Corp: Stress Program.
positive aspects of cosc for civilian teams preparing for catastrophic events
Positive Aspects of COSC for Civilian Teams Preparing for Catastrophic Events
  • Designed to mitigate stress throughout a deployment: from the beginning to the end.
  • Designed to be implemented in highly stressful situations, i.e. Combat.
  • Designed to have high rates of RTD.
  • May mitigate long-term effects of extreme stress.
il 2 cosc training
Il-2 COSC Training
  • Ft. Gordon, with the 785th COSC, 2000
  • Camp Bullis, 2003
  • Ft. Snelling, 88th RRC, 2003
  • Ft. McCoy, 88th RRC, 2004
cosc measures and activities primary prevention
COSC Measures and Activities Primary Prevention

Surveillance and Mitigation activities: to reduce or avoid stressors, and increase workers/victims tolerance and resilience to stress

cosc measures and activities secondary prevention
COSC Measures and Activities:Secondary Prevention

Surveillance and Mitigation activities: 1:1’s with individuals identified as having possible warning signs of stress reactions with the goal of returning them to work ASAP.

cosc measures and activities tertiary prevention
COSC Measures and Activities:Tertiary Prevention

Mitigation/stabilization activities to reduce long term effects in workers/victims with pre-existing mental health conditions with the goal of returning them to work ASAP.

cosc measures and activities forward tx
COSC Measures and Activities: Forward Tx
  • Proximity
  • Immediacy
  • Expectancy
  • Simplicity
cosc measures and activities the 5 r s
COSC Measures and Activities: The 5 R’s

Reassure (of normality).

Rest (respite).

Replenish physiologic needs.

Restore confidence (work, talk).

Return (reunite) to duty & team.

application of cosc wtc
Application of COSC: WTC

Preventive Measures included:

  • Education on stress
  • Secondary and Tertiary

prevention.

deployments since 9 11
Deployments since 9/11
  • Hurricane Isabel
  • Hurricane Charley
  • Hurricane Ivan
stress control general plan
Consultation

Introductions

Briefings on Stress

TBWA

Consultation

Briefings on Stress

Secondary and Tertiary Prevention

Stress Control General Plan
points of distribution
Points of Distribution
  • Staff may not show up.
  • Greater risks.
  • Stigmatization issues.
  • Problems at the home front.
  • Reinforcements from the Outside?
controlling worker stress
Controlling Worker Stress
  • Limit exposure to traumatic stimuli
  • Ensure reasonable hours
  • Provide reasonable rest, sleep, diet, exercise
  • Allow private time
  • Make counseling available
  • Provide an identifiable end for involvement
stress programs ought to be organic
Stress Programs ought to be Organic
  • To enhance positive identification & cohesions,
  • To understand the teams they are helping.
stress control is the second business of
Stress Control is the Second Business of …
  • Every nurse.
  • Every police officer.
  • Every firefighter.
  • Every leader.
  • Every environmental health worker.
  • Every public affairs officer.
  • Every support staff.
second business cont
Second Business (cont.)
  • Everyone’s Second Business is no-one’s business when First Business must be done.
  • Stress control throughout the event, both response and recovery, is mental health’s First Business.