Critical incident stress management Stress vs Critical Incident

Critical incident stress management

Stress vs Critical Incident Job Stress or Life Stress n 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

Critical Incident n A Stressor event that appears to cause a crisis response

Critical incident n n n 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

Examples of critical incident events n n 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

Signs & symptoms of CIS n n n 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

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

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

Self help n n n 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

CIS management n n n 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

CIS debriefing n n n 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.

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

CISD team members n n 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

On scene support services n n 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

Demobilization services n n 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

Defusing n n n 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 3045 minutes Involves the initial venting of feelings

Still Defusing n n n 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

Debriefing n n n 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

More on Debriefing n n n Emphasizes educational and informational elements to help understand 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

CISD may also include the following: n n 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

Emergency Response to Crisis n n 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