EMS CIRT NYC A division of The Regional EMS Council of NYC. Critical Incident Response Team

Transcription

1 EMS CIRT NYC A division of The Regional EMS Council of NYC Critical Incident Response Team

2 Critical Incident Stress Management (C.I.S.M.) A Basic Introduction Marie Diglio Operations Coordinator 3/26/2008

3 Critical Incident Stress Management Who takes care of the caregivers?

4 Exposure Control While working with a client... you may have gotten exposed to an infection. Would you seek treatment?

5 Exposure Control After exposed, a physician may prescribe some prophylactic medication. CISM is the prescription following an exposure to stress.

6 The Goals of CISM are: Early Recognition Identifying a potentially stressful situation Activation Page the CISM Coordinator Suppression Set up an Intervention Prevent burnout, encourage the well being of personnel, careers, and Families.

7 San Diego vs. Cerritos

8 Two Plane Crashes San Diego 125 killed-no survivors 16 homes destroyed 15 civilians killed on ground 300 EMS personnel > 10,000 body parts Cerritos 82 killed-no survivors 16 homes destroyed 15 civilians killed on ground 300 EMS personnel > 10,000 body parts

9 Impact of CISM San Diego No CISM Services provided Lost police - 5 in one yr. Lost fire - 5 in one yr. Lost paramedics - 15 in one yr. Increase in mental health services - 31% Cerritos 12 CISM Demobilizations Hotline Follow-up No loss of police or fire personnel 1 paramedic loss Increase in mental health services - 1%

10 What is Stress? Your reaction to stimuli Physical Mental/Cognitive Emotional Stress comes in two forms Eustress Distress

11 What is Distress? A disruptive force that negatively impacts daily health. Mitchell & Bray Physical- Change in eating patterns Mental/Cognitive- Inability to recall simple information Emotional- Hypersensitivity

12 What is Eustress? The positive, motivating reactions to situations Driving force to do your best. Physical - Exercise Mental - Academics Emotional - Optimism

13 Critical Incidents: Events that have the potential to create significant human distress and can overwhelm one s usual coping mechanisms.

14 Psychological Crisis: An Acute Response to a Trauma, Disaster, or Other Critical Incident Wherein: 1) Psychological Balance Is Disrupted 2) One s Usual Coping Mechanisms Have Failed 3) Evidence of Significant Distress, Impairment, Dysfunction

15 Terrorism represents a form of psychological warfare. The war will ultimately be won or lost not on the battlefield, but in the mind.

16 Crisis Intervention was developed in response to the acute mental health needs of those in crisis.

17 Crisis Assessments

18 Acute Mental Status Assessment: Intoxication Head Injury Psychotic Process Delusions Homicidal Ideation Suicidal Ideation

19 Acute Mental Status Assessment: Orientation Long-term Memory Concentration Emotion

20 What is a Critical Incident? Death or injury of a coworker Death or major injury to a child Situations involving extensive media coverage Prolonged situation with negative outcome Mistakes, real or imagined Victim previously know to person

21 What is Critical Incident Stress? Emotional, mental, and/or physical response which interferes with behavior either on scene or after the incident is over. As designed by Dr. Jeffrey T. Mitchell Ph.D.

22 What is cumulative stress? Chronic progressive culmination of small stressors. May result in P.T.S.D., if not managed. Warning: Contents under extreme pressure!

23 P.T.S.D. (Post -Traumatic Stress Disorder) This is a pathological reaction to an abnormal situation. Symptoms inhibit the person from functioning at his/her job. may have day or night terrors.

24 More P.T.S.D. hypersensitivity. may experience intrusive thoughts (flashbacks). Symptoms MUST last for over 30 days. Early Recognition and intervention may prevent the domino effect.

25 What Determines How You Will React? The type of stress you experience is dependant on 5 P s. Perception - How one views an event. Planning - Training and preparation. Preparedness - One s expectations of the stimuli.

26 What Else Determines How You Will React? Proximity Both the physical and emotional closeness to the crisis. Past - The baggage you carry from previous experiences.

27 Pathways to Resolution Acute Stress Cumulative Stress Defusing Debriefing P.T.S.D. C.I.S.M P.T.S.D. Resolution Debriefing P.T.S.D. Resolution P.T.S.D. Resolution Resolution

28 Critical Incident Stress Management...is a comprehensive, organized approach for the reaction and control of harmful aspects of stress. Jeffrey T. Mitchell Ph.D. Forms of intervention: Pre-incident Education Debriefing (C.I.S.D.) Defusing Crisis Management Briefing (CMB) Demobilization 1:1

29 For Whom is C.I.S.M. Targeted? Normal people, experiencing normal reactions to abnormal situations.

30 C.I.S.M. is not for CRAZY People! C.I.S.M. is not designed to be therapy or a replacement for therapy.

31 Critical Incident Stress Debriefing is a method for mitigating the harmful effects of work-related trauma, and ultimately preventing P.T.S.D. Jeffrey T. Mitchell Ph.D.

32 What is a Defusing? A small group process which is initiated after any traumatic event that is powerful enough to overwhelm one s usual coping mechanisms Short version of a Debriefing

33 What Does Defusing Mean? Means to render something harmless before it can do damage Overall objective is to reduce the potential for harm to those who were exposed to a critical incident

34 Usual Effects of Defusings May possibly eliminate need for formal Debriefing It will enhance effectiveness of Debriefing process if one is needed

35 Defusing Goals Achieve a rapid reduction in the intense reactions to a traumatic event Attempt to normalize the experience Attempt to re-establish the social helping network of the group Assess need for formal Debriefing process

36 Additional Goals of Defusings Information transfer between members Re-focusing of thinking process; getting your act together Education as to survival skills over next few days Identifying support resources/personnel

37 Debriefing - What is It? A formal group discussion designed to help alleviate the effects of critical incident stress A prevention program for burn-out

38 What Happens at a Debriefing? Team Location Phases Introduction Fact Thought Reaction Symptom/teaching Re-entry

39 Desired Emotional Responses During an Intervention Degree of Em otion East Introduction Fact Thought Reaction Sym ptom T eaching Re-Entry 10 0 Phases of a Debriefing

40 Introduction Phase Introduce members Establish ground rules Explain process

41 Fact Phase Who are you and what was your job, or how were you involved in the incident? What happened from your point of view?

42 Thought Phase What was your first or most prominent thought once you came off auto pilot?

43 Symptom Phase The group is asked to describe: any cognitive, physical, emotional or behavioral symptoms they experienced at the scene symptoms they experienced in the following days symptoms they continue to experience

44 Teaching Phase All team members teach about symptoms one may experience Find a positive outcome, or gift that may have come out of tragedy Utmost concern for group

45 Re-entry Phase Clarify issues Answer questions Team members make summary comments

46 Follow-up and Referral May return for another debriefing if group decides May have an individual who may ask for further help

47 Signs and Symptoms Physical Chest Pain Elevated BP Headaches Muscle tremors Cognitive Confusion Poor attention Intrusive images Nightmares

48 Signs and Symptoms Emotional Guilt Anxiety Depression Behavior Withdraw Loss or increase of appetite Changes in sleep patterns Increased alcohol consumption

49 The Keys to Unlocking a Successful Career After a Critical Incident: Helping a Peer Listen carefully Spend time with the traumatized person Help with everyday tasks Know your limitations as a peer supporter

50 The Keys to Unlocking a Successful Career Helping yourself * Eat well-balanced and regular meals Drink plenty of water * Get plenty of rest * Structure your time - Keep busy * Allow yourself to be emotional * Look to your peers and family for support

51 REMSCO CIRT NYC A division of The Regional EMS Council of NYC Critical Incident Response Team

52 History of the REMSCO CIRT NYC Program Began in 1989 Graduate School Project EMS Volunteers Free

53 Program Management The CIRT is a Steering Committee consisting of community members from: EMS, Fire, Police Mental Health Clergy Clinical Coordinator REMSCO Staff Borough Coordinators

54 Main goals of CISM To jump start your natural support systems To help keep your baggage at a manageable level To get you back to work and functioning at an optimal level after a critical incident

55 Team Make-up EMS/ Medical Professionals EMT s, Paramedics, PHRN s Mental Health Professionals Clergy

56 Who Can Activate the CIRT Team? CISM may be activated by any member of any Emergency Service in New York City. It is advised that these requests go through a supervisor or an administrator.

57 How to Access the Team The Official REMSCO CIRT Hotline 24/7 Hotline : Contacting the Regional EMS Council 9am 5pm Mon-Fri : jraneri@nycremsco.org