Cism new hire_rev_03-16-2010


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  • At any time during this power pt. it can be stop and questions answered. It is encouraged to have discussion.
  • Play Introduction Video
  • Introduce yourself… The goal of this program is to enhance the awareness level regarding CISM to help acknowledge the emotions experienced during an event as normal to guide those involved in a critical incident through a process designed to help deal with those emotions and the effects that can have on our self’s, our families and our co-workers.
  • Should not be considering group counseling.
  • Get peoples opinions on what they think it is or means to them. Do they know how to activate it? For what or when is it used? Who is involved in it?
  • C omprehensive I ntegrated S ystematic M ulti-Component Approach to managing a traumatic event
  • For new hires, only read one historical event per slide.
  • There is no policy in place for Marion County Fire Rescue. This provision is widely accepted and used when needed.
  • Your peers need to recognize event, what might not affect one may affect another and vice versa. Don’t let pride hurt you or others. Can they think of any other situations that may qualify?
  • If considered small scale event group discussion or one on one within crew members may be preformed. Anyone can call CSIM team if they think it is needed. Members that are on shift may be able to meet up with crew to debrief situation.
  • Might be important to remember?!!
  • Might be important to remember?!!
  • Who is included in the team? What do they do or are their qualifications? Where do you meet? This model is for debriefing. Mental health is not present during information gathering and defusing. All is done by peers. Mental health is present during debriefings to assist with keeping the focus on debriefing by peers, to observe, and to be available if requested.
  • Explain this is not a critique or investigation, not psychotherapy, no disciplinary actions can come out of this in meeting, this is included in confidentiality. There is no rank in meeting, all are peers.
  • Might be important to remember?!!
  • Have everyone try to recall an incident they believe may have been beneficial for them to have had CISM on scene.
  • Inform first responders that this number is available by calling either county or city dispatch at 352-732-9111 or 352-369-7000.
  • Cism new hire_rev_03-16-2010

    1. 1. Critical Incident Stress Management How It Affects Us As Responders CISM: What's it all about?
    2. 2. Course Contents (1/2) <ul><li>Introduction & Goals </li></ul><ul><li>Lesson 1: What is CISM? </li></ul><ul><li>Lesson 2: History </li></ul><ul><li>Lesson 3: How It Works </li></ul>CISM: What's it all about?
    3. 3. Course Contents (2/2) <ul><li>Lesson 4: How Your Actions Can Assist/Affect Others </li></ul><ul><li>Lesson 5: What Is Involved During an Intervention </li></ul><ul><li>Lesson 6: Desired Results </li></ul><ul><li>Closing Remarks </li></ul>CISM: What's it all about?
    4. 4. Introduction Video <ul><li>Arms of Angels </li></ul>CISM: What's it all about?
    5. 5. Course Goals and Objectives <ul><li>Enhance the awareness level regarding CISM. </li></ul><ul><li>Help individuals involved in a critical incident to acknowledge the feelings experienced during an event as normal. </li></ul><ul><li>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. </li></ul><ul><li>Learn the steps involved in activating the CISM team. </li></ul>CISM: What's it all about?
    6. 6. Terminology (1/3) <ul><li>Critical Incidents </li></ul><ul><ul><li>Powerful traumatic events that initiate the crisis response. </li></ul></ul><ul><li>Crisis </li></ul><ul><ul><li>An acute emotional reaction to a powerful stimulus or demand. </li></ul></ul><ul><li>Critical Incident Stress </li></ul><ul><ul><li>A state of cognitive, physical, emotional and behavioral impact that accompanies the crisis reaction. </li></ul></ul>CISM: What's it all about?
    7. 7. Terminology (2/3) <ul><li>Critical Incident Stress Management </li></ul><ul><ul><li>A comprehensive, integrated, systematic and multi-tactic crisis intervention approach to manage critical incident stress after traumatic events. </li></ul></ul>CISM: What's it all about?
    8. 8. Terminology (3/3) <ul><li>Critical Incident Stress Debriefing </li></ul><ul><ul><li>A group crisis intervention tool designed to assist a group of people after an exposure to the same significant traumatic event. </li></ul></ul><ul><ul><li>Not a stand alone process </li></ul></ul><ul><ul><li>Should not be considered psychotherapy, a substitute for psychotherapy, or professional counseling </li></ul></ul><ul><ul><li>Should not be considered a cure for PTSD or any mental or physical disease or disorder </li></ul></ul>CISM: What's it all about?
    9. 9. 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. CISM: What's it all about?
    10. 10. PERSONAL EXPERIENCE SLIDE CISM: What's it all about?
    11. 11. Symptoms of Distress (1/3) <ul><li>Cognitive (Thinking) </li></ul><ul><li>Confusion </li></ul><ul><li>Inability to concentrate </li></ul><ul><li>Difficulty in decision making </li></ul><ul><li>Guilt </li></ul><ul><li>Obsession with event </li></ul><ul><li>Suicidal/homicidal ideation </li></ul><ul><li>Psychosis </li></ul><ul><li>Emotional </li></ul><ul><li>Anxiety </li></ul><ul><li>Irritability </li></ul><ul><li>Anger </li></ul><ul><li>Panic </li></ul><ul><li>Fear, Phobia </li></ul><ul><li>Grief </li></ul>CISM: What's it all about?
    12. 12. Symptoms of Distress (2/3) <ul><li>Behavioral </li></ul><ul><li>Impulsiveness </li></ul><ul><li>Risk taking </li></ul><ul><li>Excessive eating </li></ul><ul><li>Alcohol/Drug use </li></ul><ul><li>Compensatory sexuality/shopping </li></ul><ul><li>Sleep disorder </li></ul><ul><li>Withdrawal </li></ul><ul><li>Family discord </li></ul><ul><li>Crying spells </li></ul><ul><li>1000 yard stare </li></ul><ul><li>Violence </li></ul><ul><li>Antisocial behavior </li></ul><ul><li>Physical </li></ul><ul><li>Tachycardia </li></ul><ul><li>Headaches </li></ul><ul><li>Hyperventilation </li></ul><ul><li>Muscle spasms </li></ul><ul><li>Psychogenic sweating </li></ul><ul><li>Fatigue/exhaustion </li></ul><ul><li>Indigestion, nausea, vomiting </li></ul><ul><li>Blood in stool, sputum, vomit </li></ul><ul><li>Chest pain </li></ul><ul><li>Loss of consciousness </li></ul>CISM: What's it all about?
    13. 13. Symptoms of Distress (3/3) <ul><li>Spiritual </li></ul><ul><li>Anger at God </li></ul><ul><li>Withdrawal from faith </li></ul>CISM: What's it all about?
    14. 14. Lesson 1 What is CISM? CISM: What's it all about?
    15. 15. What is CISM? <ul><li>A comprehensive integrated, systematic and multi-component approach to managing traumatic events </li></ul><ul><ul><ul><li>C ritical </li></ul></ul></ul><ul><ul><ul><li>I ncident </li></ul></ul></ul><ul><ul><ul><li>S tress </li></ul></ul></ul><ul><ul><ul><li>M anagement </li></ul></ul></ul><ul><li>“ Psychological” or “Emotional” First Aid </li></ul><ul><li>Designed to help an individual or group of individuals to recognize, manage and recover from a traumatic or stressful event. </li></ul>CISM: What's it all about?
    16. 16. History of CISM (1/3) <ul><li>1944 </li></ul><ul><ul><li>Erik Linderemann’s observations of grief reactions to the Coconut Grove fire begins “Modern era” of crisis intervention </li></ul></ul><ul><li>1974 </li></ul><ul><ul><li>Early work on crisis and stress in emergency personnel </li></ul></ul><ul><li>1980 </li></ul><ul><ul><li>Formal recognition of PTSD </li></ul></ul><ul><li>1982 </li></ul><ul><ul><li>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) </li></ul></ul>CISM: What's it all about?
    17. 17. History of CISM (2/3) <ul><li>1992 </li></ul><ul><ul><li>Formal training initiated by red cross </li></ul></ul><ul><li>1993 </li></ul><ul><ul><li>First World Trade Center bombing </li></ul></ul><ul><li>1995 </li></ul><ul><ul><li>Bombing of the Federal Building of Oklahoma City underscores need for crisis intervention for rescue personnel as well as civilians </li></ul></ul><ul><li>1996 </li></ul><ul><ul><li>OSHA recommends comprehensive violence/crisis intervention programs in healthcare and social services agencies </li></ul></ul>CISM: What's it all about?
    18. 18. History of CISM (3/3) <ul><li>1999 </li></ul><ul><ul><li>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 </li></ul></ul><ul><li>2001 </li></ul><ul><ul><li>World Trade Center in NYC, Pennsylvania and the Pentagon. Approx. 1 ½ yrs. Crisis intervention to victims, families, businesses, communities, and emergency personnel </li></ul></ul>CISM: What's it all about?
    19. 19. Prevalence of Stress (1/2) <ul><li>31% of urban firefighters report symptoms of PTSD </li></ul><ul><li>10-15% of law enforcement personnel exhibited signs of PTSD </li></ul><ul><li>Police are 8.6 x greater at risk of suicide than accidental death </li></ul>CISM: What's it all about?
    20. 20. Prevalence of Stress (2/2) <ul><li>When crisis or tragedy touch the workplace, organizations and the individuals that comprise them are impacted </li></ul><ul><ul><li>Use of increased sick time </li></ul></ul><ul><ul><li>Loss of productivity </li></ul></ul><ul><ul><li>Increased human error </li></ul></ul><ul><li>In addition, both NIOSH and OSHA recommend the implementation of a crisis program </li></ul>CISM: What's it all about?
    21. 21. PERSONAL EXPERIENCE SLIDE CISM: What's it all about?
    22. 22. Lesson 3 How it Works CISM: What's it all about?
    23. 23. How it Works <ul><li>Recognition of a critical incident </li></ul><ul><ul><li>Critical incident is any event that may overwhelm the coping ability of an individual or crew exposed to a traumatic event </li></ul></ul><ul><ul><li>Events that have the potential to create significant human distress and may overwhelm one’s usual coping mechanisms </li></ul></ul><ul><ul><li>Ex: LODD, multiple casualty incidents, events involving children, personally threatening situations, prolonged incidents with negative results, incident with extensive media coverage. </li></ul></ul>CISM: What's it all about?
    24. 24. How it Works <ul><li>HOW IS CISM TEAM ACTIVATED? </li></ul><ul><ul><li>Team activation </li></ul></ul><ul><ul><ul><li>Team notified by peers or officers </li></ul></ul></ul><ul><ul><ul><li>On shift team members notified for meeting </li></ul></ul></ul><ul><ul><ul><li>Team notified by phone for assembly and intervention when needed </li></ul></ul></ul><ul><ul><ul><li>OR </li></ul></ul></ul><ul><ul><li>Intervention can occur amongst yourselves </li></ul></ul><ul><ul><ul><li>Talking among the crew is sometimes all it takes, however this should not take the place of utilizing the CISM team </li></ul></ul></ul>CISM: What's it all about?
    25. 25. WHAT’S THE NUMBER? 352-898-8483 CISM: What's it all about?
    26. 26. Lesson 4 Participation And How It Affects The Entire Crew CISM: What's it all about?
    27. 27. How Peers Participate <ul><li>Always be aware of yourself and your crew members. </li></ul><ul><li>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. </li></ul>CISM: What's it all about?
    28. 28. How Peers Participate <ul><li>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. </li></ul>CISM: What's it all about?
    29. 29. How Peers Participate <ul><li>Keep in mind that stress is Cumulative </li></ul><ul><li>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? </li></ul>CISM: What's it all about?
    30. 30. PERSONAL EXPERIENCE SLIDE CISM: What's it all about?
    31. 31. WHAT’S THE NUMBER? 352-898-8483 CISM: What's it all about?
    32. 32. Lesson 5 What is Involved During an Intervention CISM: What's it all about?
    33. 33. What is Involved During an Intervention? <ul><li>Team members consist of various volunteers </li></ul><ul><li>Depending on the size and complexity of the incident those individuals may come from your own agency or from an outside agency. </li></ul><ul><li>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). </li></ul><ul><li>In addition there will be one member from the mental health community and / or clergy. </li></ul><ul><li>After notification team members assemble and meet with those who responded to the scene. </li></ul>CISM: What's it all about?
    34. 34. What is Involved During an Intervention? <ul><li>Team Meets </li></ul><ul><li>Introduction and Rules </li></ul><ul><li>Facts </li></ul><ul><li>Thoughts </li></ul><ul><li>Follow-up </li></ul>CISM: What's it all about?
    35. 35. What is Involved After an Intervention? <ul><li>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. </li></ul><ul><li>Team members will also be available via pager 24/7 </li></ul>CISM: What's it all about?
    36. 36. WHAT’S THE NUMBER? 352-898-8483 CISM: What's it all about?
    37. 37. Lesson 6 Desired Results CISM: What's it all about?
    38. 38. Goals of CISM <ul><li>Mitigate impact of event (lower tension) </li></ul><ul><li>Facilitate normal recovery processes. </li></ul><ul><li>Restoration to adaptive function. </li></ul>CISM: What's it all about?
    39. 39. Closing Remarks / Credits Mitchell, Jeffery T., Ph.D., C.T.S. Critical Incident Stress Management (CISM): Group Crisis Intervention, 4th Edition CISM: What's it all about?
    40. 40. WHAT’S THE NUMBER? 352-898-8483 CISM: What's it all about?
    41. 41. Contributing Editors <ul><li>Rodney Mascho </li></ul><ul><li>Andrea Rascovich </li></ul><ul><li>Aaron Taylor </li></ul><ul><li>Joseph Taddeo </li></ul><ul><li>George Robinson </li></ul><ul><li>Teresa Fletcher </li></ul><ul><li>Debbie Pando </li></ul><ul><li>Ken Devilling </li></ul><ul><li>Dottie Rispoli </li></ul><ul><li>Kimberla Hawkins </li></ul><ul><li>Victoria Barreras </li></ul><ul><li>Dwight Leon </li></ul>CISM: What's it all about? <ul><li>Alina Stoothoff </li></ul><ul><li>Robin Robarge </li></ul><ul><li>Brian Stoothoff </li></ul><ul><li>Carl Thompson </li></ul><ul><li>Anthony Palmese </li></ul><ul><li>Michael Saxe </li></ul><ul><li>Anna Saxe </li></ul><ul><li>Josh Wilson </li></ul><ul><li>Vicki Long </li></ul><ul><li>Charles Etheredge </li></ul><ul><li>Kris Wuenstel </li></ul>
    42. 42. PERSONAL EXPERIENCE SLIDE CISM: What's it all about?
    43. 43. Any Questions? CISM: What's it all about?
    44. 44. THE END CISM: What's it all about?