Cism new hire_rev_03-16-2010

Critical Incident Stress Management

How It Affects Us As Responders

1CISM: What's it all about?

Course Contents (1/2)

• Introduction & Goals• Lesson 1: What is CISM?• Lesson 2: History• Lesson 3: How It Works

CISM: What's it all about? 2

Course Contents (2/2)

• Lesson 4: How Your Actions Can Assist/Affect Others

• Lesson 5: What Is Involved During an Intervention

• Lesson 6: Desired Results• Closing Remarks


Introduction VideoArms of Angels


Course Goals and Objectives

• Enhance the awareness level regarding CISM.• Help individuals involved in a critical incident

to acknowledge the feelings experienced during an event as normal.

• Guide those involved through a process designed to help deal with those feelings and the effects that they can have on themselves, their families and their co-workers.

• Learn the steps involved in activating the CISM team.


Terminology (1/3)

• Critical Incidents– Powerful traumatic events that initiate the

crisis response.• Crisis

– An acute emotional reaction to a powerful stimulus or demand.

• Critical Incident Stress– A state of cognitive, physical, emotional and

behavioral impact that accompanies the crisis reaction.


Terminology (2/3)

• Critical Incident Stress Management– A comprehensive, integrated, systematic

and multi-tactic crisis intervention approach to manage critical incident stress after traumatic events.


Terminology (3/3)

• Critical Incident Stress Debriefing– A group crisis intervention tool designed to

assist a group of people after an exposure to the same significant traumatic event.

– Not a stand alone process– Should not be considered psychotherapy, a

substitute for psychotherapy, or professional counseling

– Should not be considered a cure for PTSD or any mental or physical disease or disorder


There is now emerging evidence that prompt delivery of these

services in the first weeks after an event can lead to a reduction

in problems years later, and decreases the cost to both the

individual and the public.


PERSONAL EXPERIENCE SLIDE


Symptoms of Distress (1/3)

Cognitive (Thinking)• Confusion• Inability to concentrate• Difficulty in decision

making• Guilt• Obsession with event• Suicidal/homicidal

ideation• Psychosis

Emotional• Anxiety• Irritability• Anger• Panic• Fear, Phobia• Grief



Behavioral• Impulsiveness• Risk taking• Excessive eating• Alcohol/Drug use• Compensatory

sexuality/shopping• Sleep disorder• Withdrawal• Family discord• Crying spells• 1000 yard stare• Violence• Antisocial behavior

Physical• Tachycardia• Headaches• Hyperventilation• Muscle spasms• Psychogenic sweating• Fatigue/exhaustion• Indigestion, nausea,

vomiting• Blood in stool, sputum,

vomit• Chest pain• Loss of consciousness



Spiritual• Anger at God• Withdrawal from faith


Lesson 1

What is CISM?


What is CISM? • A comprehensive integrated, systematic and multi-

component approach to managing traumatic events

CriticalIncident StressManagement

• “Psychological” or “Emotional” First Aid• Designed to help an individual or group of individuals to

recognize, manage and recover from a traumatic or stressful event.


History of CISM (1/3)

• 1944– Erik Linderemann’s observations of grief reactions to

the Coconut Grove fire begins “Modern era” of crisis intervention

• 1974– Early work on crisis and stress in emergency

personnel• 1980

– Formal recognition of PTSD• 1982

– Air Florida air disaster in Washington D.C. prompts reexamination of psychological support for emergency response personnel. FIRST LARGE SCALE DISASTER USE OF CISD (currently known as CISM)



• 1992– Formal training initiated by red cross

• 1993– First World Trade Center bombing

• 1995– Bombing of the Federal Building of Oklahoma

City underscores need for crisis intervention for rescue personnel as well as civilians

• 1996– OSHA recommends comprehensive

violence/crisis intervention programs in healthcare and social services agencies



• 1999– Mass shooting in Colorado high school leads

to a reexamination of youth and school violence issues and an increase in the establishment of school crisis response programs

• 2001– World Trade Center in NYC, Pennsylvania and

the Pentagon. Approx. 1 ½ yrs. Crisis intervention to victims, families, businesses, communities, and emergency personnel


Prevalence of Stress (1/2)

• 31% of urban firefighters report symptoms of PTSD

• 10-15% of law enforcement personnel exhibited signs of PTSD

• Police are 8.6 x greater at risk of suicide than accidental death


Prevalence of Stress (2/2)

• When crisis or tragedy touch the workplace, organizations and the individuals that comprise them are impacted– Use of increased sick time– Loss of productivity– Increased human error

• In addition, both NIOSH and OSHA recommend the implementation of a crisis program


Lesson 3

How it Works


How it Works • Recognition of a critical incident

– Critical incident is any event that may overwhelm the coping ability of an individual or crew exposed to a traumatic event

– Events that have the potential to create significant human distress and may overwhelm one’s usual coping mechanisms

– Ex: LODD, multiple casualty incidents, events involving children, personally threatening situations, prolonged incidents with negative results, incident with extensive media coverage.


How it Works

• HOW IS CISM TEAM ACTIVATED?– Team activation

1. Team notified by peers or officers2. On shift team members notified for meeting3. Team notified by phone for assembly and

intervention when neededOR

– Intervention can occur amongst yourselves• Talking among the crew is sometimes all it

takes, however this should not take the place of utilizing the CISM team


WHAT’S THE NUMBER?

352-898-8483


Lesson 4

Participation And How It Affects The Entire Crew


How Peers Participate

• Always be aware of yourself and your crew members.

• Experience has shown have found that people that talk about a traumatic incident eat better, sleep better, remain healthier, stay on the job longer, and do not have as much disruption in their home lives.



• After a traumatic event you may feel like you can handle it on your own, and that may true. But experience demonstrates that people who try to handle everything alone can actually make the situation worse.



• Keep in mind that stress is Cumulative

• There is always one person in every group that feels more comfortable than most with talking in public. That person may be able to draw out the others. Are you that person?



352-898-8483


Lesson 5

What is Involved During an Intervention


What is Involved During an Intervention?

• Team members consist of various volunteers• Depending on the size and complexity of the incident

those individuals may come from your own agency or from an outside agency.

• The general concept is to try and gather individuals from the same type of services that were involved in the incident (i.e. EMS, Fire, Law, Dispatch, Victim Advocates).

• In addition there will be one member from the mental health community and / or clergy.

• After notification team members assemble and meet with those who responded to the scene.


What is Involved During an Intervention?

• Team Meets• Introduction and Rules• Facts• Thoughts• Follow-up


What is Involved After an Intervention?

• After the meeting if any one wants to talk more or address any individual issues, the team members will remain available until the last person has left the room.

• Team members will also be available via pager 24/7



352-898-8483


Lesson 6

Desired Results


Goals of CISM

• Mitigate impact of event (lower tension)

• Facilitate normal recovery processes.• Restoration to adaptive function.


Closing Remarks / Credits

Mitchell, Jeffery T., Ph.D., C.T.S. Critical Incident Stress Management

(CISM): Group Crisis Intervention, 4th Edition



352-898-8483


Contributing Editors• Rodney Mascho• Andrea Rascovich• Aaron Taylor• Joseph Taddeo• George Robinson• Teresa Fletcher• Debbie Pando• Ken Devilling• Dottie Rispoli• Kimberla Hawkins• Victoria Barreras• Dwight Leon


• Alina Stoothoff• Robin Robarge• Brian Stoothoff• Carl Thompson• Anthony Palmese• Michael Saxe• Anna Saxe• Josh Wilson• Vicki Long• Charles Etheredge• Kris Wuenstel

Any Questions?


THE END


Cism new hire_rev_03-16-2010

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