Chaplain Jim Crowley COPC 1 Welcome 1 Chaplain Jim Crowley COPC 2 Critical Incident Stress Management (CISM) Jim Crowley Mike Dismore Chaplains Central

Chaplain Jim Crowley COPC 1

Welcome

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Critical Incident StressManagement (CISM)

Jim CrowleyMike Dismore

Chaplains Central OregonPolice Chaplaincy

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Americans Say They:

Need More Fun 68% Need a Long Vacation 67% Often Feel Stressed 66% Feel Time Is Crunched 60% Want Less Work, More Play 51% Feel Pressure to Succeed 49% Feel Overwhelmed 48%

Some statistics from a survey by Hilton Generational Time Survey, Jan 2001

We Are a Stressed Out SocietyWe Are a Stressed Out Society

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Agenda

What Is Stress & Its CausesTypes of Critical IncidentsWho Is Susceptible?Symptoms of StressResourcesConfidentialityHelpful Ideas

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Objectives:

List elements of stress in the emergency services profession

Understand how a balanced lifestyle reduces critical incident stress reactions

Understand situations in which critical incident stress may develop and what may worsen them

List the CISM services available

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It is not my intention to bore you!

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What is stress and its causes?

Stress Is Caused When Our Sense of Order or Right Is Upset

Critical Incident Stress Defined: Normal Reactions of Normal People to

Abnormal Situations Any Incident Which Causes Us to

Experience Unusually Strong Emotional Reactions Which Interfere With Our Ability to Function, Either During the Event or Later.

Life Is Full Of Abnormal Events!

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STRESS: The Good The Bad

The Ugly Eustress (necessary stress) to keep us

motivated to accomplish things in our lives, i.e.: bills we need to pay motivates us to go to work, boredom motivates us to take up activities.

Distress (too much stress) can overload us and cause a variety of emotional, physical, cognitive and spiritual reactions, if left unresolved

Chronic Stress (burn-out) can disable us and in extreme cases cause and/or contribute to death.

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Stress Will Catch You Unaware

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Just When You Think you are OK

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Critical Incident Stress

Occurs when you experience an unusual or extreme emotional reaction after exposure to an event that is overwhelming to you. This is subjective based on each individual’s life experience and belief systems.

What is overwhelming to one person may not be overwhelming to another person.

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Cumulative Stress

Occurs when a person’s normal coping mechanism are continuously overwhelmed. It can also occur when you don’t build in daily self care activities that are regenerative and stress reducing.

Cumulative stress reactions are very debilitating. People begin to believe that frequent headaches, acid stomach, irritability, poor concentration, are normal. This produces further stress which can lead to serious physical and emotional illnesses.

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Delayed Stress

In some cases stress reactions to an overwhelming event do not occur until days, weeks, months or even years later. They are just as debilitating and impacting as a recent event.

Delayed stress can occur when people go into shock after an event, refuse to acknowledge the impact of the event, or when exposure to an event is prolonged.

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What Are Common Stressors?

Change in Family New Kids

Baby Blended Families

Teen Age Children Empty Nest Spousal Tension Divorce

Change in Your Society Loss of Family Member Strained Relationship

Family or Work Moving to New Digs

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Stressors (Work)

Administrative Decisions I May Not Agree With Fully

Operator Decisions That Might Find Conflict With Administration

Shift Changes Rotating shifts

Peer Relationships Health Problems

Those That Drain Us Lingering Colds, Etc

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A Small Example Of Stress

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Common Stress Triggers

Argument With Significant Other Argument With a Child Old Age Parent Care Traffic Congestion Travel by Air Traffic Ticket Job Change in Family Rebellious Child Extended Family Relationships Return To Work Report Writing - Paperwork

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Factors AffectingStress Responses

Duration

Multiplicity

Situational Importance

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Performance and Efficiency

Cumulative Stress Reaction

Critical Incident Stress Reaction

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Emergency Services Philosophy

We the Willing

Led by the Unknowing

Have Been Doing the Impossible

For the Ungrateful.

We Have Done So Much

For So Little,

We Are Now Qualified

To Do Anything With Nothing.

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Some Facts

80% of All Non-trauma Deaths Are Caused by STRESS

Chaplains Typically Live Longer (Joke)

Law Enforcement & Emergency Services Personnel Under Extreme Traumatic Stress Will Manifest the Same Symptoms As a DRUNK

X

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More To Think About

Police Stats:

140-170 Officers Killed in Line of Duty Each Year

Police Suicides are a reality

There IS a Need for Stress Management Within the Emergency Service Community

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Personality Profile of Law Enforcement & Emergency

Services Personnel

Obsessive/compulsive Very Controlling Action Oriented Detail Oriented High Need for

Stimulation Easily Bored Dedicated Risk Taker Needs to Be Needed Can’t Say NO

Rescue Personality Driven by Internal

Motives Good Guy Vs Bad Guy High Tolerance for

Stress Ambiguity Toward

Stress Goal Oriented Family Oriented Others

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Comprehensive CISM Program

Why have a critical incident stress management program?

We can learn from past experience.

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ComparisonBoth Airliners Collided with Small Planes

Total Killed From Planes 137 67

Plane Survivors 0 0

Homes Destroyed or Damaged 22 12

Killed On Ground 7 15

Emergency Personnel +/-300 +/-300

Body Parts Found +/-10,000 +/-10,000

San DiegoSeptember 25, 1978

CerritosAugust 31, 1986

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Comparison“Twin” disasters

San Diego

Sporadic One on One

Cerritos

On Scene One on One Demobilizations 12 Debriefings Hot Line Number One on One Follow Up

Support Services Provided

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ComparisonPersonnel Lost in 1 Year

Police 5 0

Fire 7 0

Paramedics 17 1

Dispatch ? ?

Increase inMental Health Use 31% 1%

San DiegoSan Diego Cerritos

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Critical Incident Stress Management Core Components

Pre-incident preparation

Demobilizations

Crisis Management Briefings

Defusings

Critical Incident Stress Debriefing

Individual crisis intervention

Family/organizational CISM

Follow-up/Referral

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Critical Incident Stress Management (CISM)

Pre-incident Traumatic Stress Education Before It Happens – TRAINING

CISM Is Managing Stressors of Life On scene Support Support for Dispatchers (New Concept?) Significant Other Family Peer Team work - IMPORTANT Professional Counseling Specialty Defusing and Debriefing

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Critical Incident Stress Management

CISM Is a Comprehensive, Multi-component Crisis Intervention Program

A Useful Stress Management Concept Is to Reduce or Eliminate the Use of Self Medication During Periods of Increased Work-related or Personal Distress

To Prevent Being “Crippled By Stress” Law Enforcement Wellness Association Inc

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Forms of Self Medication

Coffee - TeaSoda (With Caffeine) Drugs (Both Legal and Illegal)Tobacco Products AlcoholEating DisordersSweets (Chocolate)Diet Pills

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Self Medication - Emotions Anger Affairs – Pornography Addiction Shopping – Malls or Internet Complaining – Grumbling Abuse – Physical, Verbal, Sexual Self harm Gambling Others

Refuse to give stressstress permission to shape your reactive emotional response

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Notice the Teamwork Emphasis

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Team Work

“We’re Not Just Building A Plane Here, We’re Building A Dream”

Our Goal as Chaplains is to Build on Their Teamwork to promote wellness in each life.

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Team Management

The team concept of stress management involves each member to support and encourage those who may be experiencing adverse emotional or physical symptoms due to a stressful incident(s)

Discussion of incidents among members

is often enough to avert serious problems if if used on a regular basis

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Team Cooperation

Avoid put-down comments

Realize some incidents can be extremely stressful for some while routine for others – Allow for it!

Talk over everyevery incident

Post Incident - Ask questions like – How did this incident affect you? Did this one bother you? What are you thinking?

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Team Confidence

Keep comments positive Avoid terms like

“You can handle it” “Buck-up wimp” “Get a grip” “Greenhorn”

Be supportive and listen, listen, listen Never Never share a co-worker’s stress

reaction with others as gossip If a co-worker displays symptoms of

stress overload, go with them to get help

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Defusing

Defusing means to render something harmless before it can do damage.

A small group intervention applied within hours of a critical incident.

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Defusing

Shortened Version of CIS Debriefing 20 Min to 1 Hour Intervention and

Teaching - Often During Same Shift Factual in Nature What Did You Feel Not Fact Finding Not an Investigation Strictly Confidential Allows Impact to Be Dealt With

Quickly

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Debriefing

1 ½ to 3 Hours Group Meeting to Reduce the Impact of an Event and Accelerate Recovery of Personnel

Deals With a Serious Incident to Assess Personnel Impact

To Promote Re-entry to Normalized Work

Strictly ConfidentialDone With CISM Team

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Some are Oblivious – Others Not

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Types of Critical Incidents

Not Limited to These: Line of Duty Death or Injury Serious Threat to Significant Others or Self Suicide of Co-worker or Family Multiple Casualties Injury or Death of a Child Personally Known Victims Prolonged Incident Excessive Media Coverage (reminders) Community Wide Disasters

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Burnout Defined

A state of mental,

physical and emotional

exhaustion

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Burnout or Cumulative Stress

Mix of Home and Work Stress I.E. Divorce Rate For Law

Enforcement and Dispatch Builds up Over Time Erodes Personal Resources

Normal Coping Mechanisms Often Is Cause of Depression

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Burnout - First StageArousal

Leading To: Anxiety, Panic, Difficulty Concentrating, and Feeling Out of Control

Physical Symptoms: Tachycardia – Fast Heart Arrhythmias – Irregular Heart Gastrointestinal Distress – Stomach Rashes (Shingles) Acute Elevation in BP Muscle Tensions and Spasms Headaches+ Diaphramatic - Respiration

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Burnout - Second Stage Energy Conservation

Displays Procrastination

Lateness

Absenteeism

Increased Stimulant Usage

Withdrawal, Avoidance

Personality Shift “That’s Not Like You”

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Every Day Is a Monday

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Burnout - Third StageExhaustion

Feeling Hopeless / Helpless Fully Developed Depression Serious Consideration of Job Change Serious Consideration of Changes of

Personal Living Situations (I.E. Divorce) Desire to Withdraw / Take a “Geographic

Cure” Substance Abuse Contemplation of Self Destructive Actions

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Who’s Susceptible to CIS?

Any Person Who Is Traumatized by a Bad Scenario Hearing, But Not Able to See the Incident Family Members in Tragedy Close Friend – Resident Child Death by Abuse or SIDS, Etc Multi Fatality Incident Mass Casualty No Closure After an Incident (Dispatch?) Basically Everyone Is Susceptible

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Post Traumatic Stress Disorder

PTSD – Problem Identified After Viet Nam Not New – Problem Has Always Existed Seen in People With Extensive Trauma From

Incidents (Think of Viet Nam) Flight Home Versus Ship Ride Home Lack of Time to Process

90% US Adults exposed to major trauma in a lifetime

1-3% General Population End Up with PTSD 10-15% of Law Enforcement end up with

PTSD Dispatch, EMS and Fire, and SAR are

similar

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Symptoms of stress physical

Muscle Tremors Fatigue Chills Nausea Sweating Gastro-intestinal

Distress Dizzy Spells Hunger Sleep Disorder

Chest Pain Difficulty Breathing Elevated Blood

Pressure Rapid Heart Rate Weakness Headaches Visual Problems Sensitivity to Noise Hic-cups

May require medical attention by physician

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Symptoms of StressThinking

Confusion Poor Attention Poor Decision Making Altered Alertness Poor Concentration Hyper Vigilance Poor Problem Solving Nightmares Sleep Irregularities Intrusive Images (Flashbacks) -

Recurring Sounds Regrets – Woulda Coulda Shoulda

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Symptoms of Stress Relational

Isolated Resentful Lonely Lack of Intimacy Lashing Out Social Withdrawal Intolerant of Others Nagging Assaultive

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Symptoms of Stress Emotional

Emotional Numbness Withdrawal, Lack of

Enjoyment Emotional Shock Feeling

Overwhelmed Hopeless & Helpless Panic Feelings Loss of Emotional

Control Loss of Confidence

in Future

Anxiety Guilt Grief Denial Fear Uncertainty Depression Intense

Anger Irritability Apathy

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Symptoms of Stress Behavioral

Clues To Stress Overload Overly Protective of Self

& Family (Over Jealous, Restrictive)

Overly Alert, Easily Startled (Jumpy)

Sleep Habit Changes Avoidance Behaviors Increased Conflicts at

Home & Work Changes in Association

With Fellow Workers

Suspicious Appetite Changes Increased Self

Medication Tearful Changes in Personal

Hygiene Prolonged Silences Loss of Interest Withdrawal Abusive

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We need to take care of ourselves!

Who We Are...

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Spiritual Stress Symptoms

Religious Reappraisal Questions About Reality/meaning/justice/fairness Asking Core Questions “Why Me” – “Why Did God” Needing Reassurance of God’s Presence & Power Question the Power of Prayer Feelings of Hopelessness and Fatalism Questioning Core Faith and Spiritual Values Guilt, Shame Changing Assumptions About Life and Afterlife Feeling Need to Be Punished Needing Acts/rituals of Purification

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Often Overlooked Help

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Results of trying to do too much

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Things to Try When Stressed Out

Talk to People – Talking Is HealingReach Out – People Do CareMaintain As Normal a Schedule As

Possible (Maintain Goals)Do Things You Enjoy DoingAvoid Self Medication

Alcohol, Caffeine Tobacco, Diet Pills, Drugs, Etc

Don’t Let Pride Keep You From Help!

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Find A Way To Laugh

A cheerful heart is a good medicine, but a downcast spirit dries up the bones.

Medical Science is proving this is true

A Good Sense of Humor Adds To Life

Be Creative – Find What Makes You Laugh

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Good Back Massage Helps

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When Stressed Out . . .

Avoid Making Major Decisions Get Plenty of Rest Eat Well-balanced and Regular Meals Exercise to Reduce Physical Stress Share This Information With Significant

Others Seek out a trusted Spiritual Counselor World Wide Web Resources

StressStress, ICISF

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CISM And Family Systems

Within a law enforcement career, families are affected by situations outside of their control.

Police (for example) are trained in crisis situations …

. . . Families are NOT! What happens at work affects the

family, just as events at home affect you while on duty.

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When your spouse is a First Responder

Listen Carefully

Spend Time With the Person Affected

Offer Your Attention and Listening Ear

Reassure Them That They Are Safe

Give Them Opportunities for Private Time

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For Family Members & Friends

Don’t Take Their Anger or Feelings PersonallyPersonally

Familiarize Yourself With What Affects Families

Signs & Symptoms of Stress and Emotional Trauma

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Social Life

Expand Your Life Outside of The Agency

FriendsFaith CommunityCommunity ServicesRecreational OutletEnjoy a Hobby Find a Balance of Work and Outside ActivitiesFind a Balance of Work and Outside Activities

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Enjoy a Hobby

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Or try a new hobby

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Resources

Chaplain – Talk to One They Will Maintain Confidentiality

Peers – Talk Over the Incident Leadership

They Likely Have Been There

Massage Therapy Mental Health Providers

Trained in Stress Management

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Confidentiality

What You Discuss Is to Remain Confidential Defusing – for Exploring Emotional Reactions

Not Hashing Over Facts Defusing Should Be SOP for Stressful

Incidents Debriefing – for in Depth Look Into the Impact

of a Critical Incident on the Emotional Morale of the Emergency Workers Present, Including Multiple Agencies and Dispatch

Debriefing Should Be Used, But With Discretion

Discussion Stays Within the Room

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Wheel of Success

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Diet - Fueling your body for Peak Performance Some bodies do better with meats, poultry, fish,

some do better with a vegetarian diet.

Food’s Negative Effects: Chronic Illness Physical Complaints Sleep disruption Emotional Response Allergies Energy Depletion Inability to Concentrate

DietDiet

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Cardiac Fitness ~ Muscle Strength ~ Flexibility

Exercise is critical for the development of certain neurotransmitters in the brain, called endorphins. Endorphins help us develop a sense of well being

Aerobic activity after a stressful event will help release the stress response from the muscle.

Exercise can conflict with the immune system during times of illness. You might need to rest while it is regenerating.

ExerciseExercise

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SleepSleep

Research shows that having a stable sleep schedule and enough sleep every day is essential to physical and psychological health.

It takes 30 days for your body to readjust every time you change your sleep schedule or get less sleep than your body needs. You cannot “make-up” sleep you can only get back into balance.

Workers who are subjected to chronic changes in sleep schedule have a higher risk for cardiovascular disease, neurotic disorders and depression; poor diet: disruptions in appetite, diarrhea, constipation & diabetes.

Symptoms of Sleep Deprivation: difficulty concentrating; irritability; depression; memory loss; cognitive disorganization (can’t think clearly); chronic fatigue, anxiety.

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Human beings are social by nature Humans are nurtured by love from another. Families are an important source of support and help regenerate you. Having good conflict resolution skills is critical in a family.

Your work relationships act like an extended family.

There is never a good reason to neglect time with family or adoptive family (a family you have chosen to be a support to you).

FamilyFamily

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Enjoy time to play and interact with others is critical.

Work friendships mean “Minimal shop talk” while off duty.

Playing, laughing, time to share opinions and receive support all help bring a sense of well-being and stability emotionally and psychologically.

Enjoyment and fun helps your physical body release tension and stress.

FriendsFriends

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Money is a frequent stressor in life. People often define who they are by their job and/or wealth.

Stay within your means.

Occasional overtime is fine (Eustress) but don’t become dependant upon it (Distress).

Are you a Workaholic?

Having hobbies, friends, stability with family, spiritual activities, helps define who you are. If your work gets disrupted and you have time off you will need these other areas to keep you from boredom.

JobJob

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Engaging in activities that bring you a sense of peace, calm and accomplishment decreases stress in your life. Meditation and prayer are a restorative activities.

Those who do these kinds of activities tend to recover from stressful events much easier.

It is important to take time every week (every day if possible) to do things that calms your nervous system.

RebuildRebuild

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Spirituality can be the foundation to all of the previously covered areas. Whether you have a specific spiritual practice, religious belief or just live by a sense of ethics within yourself, it is important to have an internal moral compass and means to assess how you are with that moral compass.

Finding time for yourself to review where you are with your ethical, moral, spiritual or religious beliefs is a proactive way of heading stress off and can reduce your vulnerability to stress reactions resulting from any critical incident.

SpiritualitySpirituality

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A Balanced Lifestyle

Learning to balance all aspects of life is critical to managing stress

You will find help when you apply the following principles

Each is designed to get you to think of what you do and manage every aspect of your life.

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Basic Principle

Surround yourself with healthy people People with few problems You deal with the others all day (night)

Adding an outward focus is beneficial Helping others is often is the best way to

help yourself. Putting others first is most rewarding The only real balance is to “look up and

out” not inward Pets may help.

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Some Restorative Activities

Humorous Movie Ski Trip Read a good book “Take a hike” Ride a Bike Volunteer service Gardening Crafts Sports (participatory)

Sponsor or Coach a Sport Team

Be a Scout Leader Join a Church Group Bowling Roller Skating Tennis Gym Workout (Regular) Walk With A Friend Your Ideas

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Your Job and Stress Management

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Objectives: How did we do?

List elements of stress in the emergency services profession

Understand how a balanced lifestyle reduces critical incident stress reactions

Understand situations in which critical incident stress may develop and what may worsen them

List the CISM services available

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Thank-You For Serving All!

You Are The Voice Of Calm In the Storms

You Care When There is No One Else.

You Offer Help To All In Need And Some not so needy

Bless You!

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Contact InfoContact Info

COPC Office; 325 NE Kearney Ave.COPC Office; 325 NE Kearney Ave.

Bend, OR 97701Bend, OR 97701

COPC (Mail); PO Box 1898COPC (Mail); PO Box 1898

Redmond, OR 97756Redmond, OR 97756

Chaplain Jim Crowley; (541) 410-6128Chaplain Jim Crowley; (541) 410-6128

[email protected]@bendbroadband.com

Chaplain Mike Dismore; (541) 788-3364Chaplain Mike Dismore; (541) 788-3364

[email protected]@juno.com

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Documents

Chaplain Jim Crowley COPC 1 Welcome 1 Chaplain Jim Crowley COPC 2 Critical Incident Stress Management (CISM) Jim Crowley Mike Dismore Chaplains Central