What does it look like???

Transcription

1 Critical Incident Stress Management Managing the Stress Response Erica Diethorn RN RN, Psychiatric Emergency Nurse, UPMC Mercy Critical Incident Stress Management Team Member 1

2 What is a Critical incident? Out of the ordinary Self defined Mass casualty incident High media interest Death of a coworker Serious on the job injury Relatives or a known victim Death involving children Acts of Terrorism Prolonged incidents especially with a loss 2

3 What is the Stress Response? Chemical Surge: Adrenal Medulla: Epinephrine [heart, blood vessels, sweat glands] Nor epinephrine [Emotional behavior, Information processing] Dopamine [Mood states, Fear, pleasure] Acetylcholine Adrenal Cortex: Corticotrophin releasing factor- stimulates the Anterior Pituitary: ACTH, Endorphins Glucocorticoids Cortisol Mineral Corticoids Aldosteroine Somatotropin Releasing Factor stimulates the Anterior Pituitary : growth Hormone increase glucose, decrease free fatty acids Thyrotropin Releasing Factor effects TSH, T3, T4, prolactin Posterior Pituitary releases Vasopressin, Oxytocin, testosterone, luteinizing hormone Cognitive [Thinking] Distress Sensory Distortion Confusion Poor concentration Difficulty making decisions Guilt Preoccupation with the event Inability to understand consequences of your behavior Suicidal / homicidal ideations Psychosis Emotional Distress Anxiety Irritability Anger Panic Vegetative e depression ession Fear, phobia s, phobic avoidance Grief vs. pathological grief- severe, impair ability to function Elevated state of arousal can lead to PTSD, Acute Stress Disorder, panic Attacks, depression, Alcohol and other drug abuse 3

4 Behavioral Distress Impulsive Risk taking Excessive eating Alcohol or drug use Hyper startle Sleep disturbance Withdrawal Family discord Crying spells 1000 yard stare Violence Physical Distress Tachycardia, Bradycardia Headaches Hyperventilation Muscle spasms Sweating Fatigue, Exhaustion Indigestion, nausea, Vomiting, [blood] Chest pain Loss of consciousness Anger with God Spiritual Distress Withdrawal from faith 4

5 What does it look like??? 5

6 FEMA Disaster Recovery Plan Worrying: Event will happen again. Someone close will be killed. They will be left alone / Separated from their family. News coverage eliciting fear, anxiety, confusion with kids 6

7 Safety How do you intervene Emotional Support Mobilize Resources Supports. CISM Teams Nourishment Help, work relief Long events: resting station away from the incident, phone available, Mental Health Teams After the incident is completed Nourishment Job relief Support Defusing/Briefing: Tell them what to expect Offer informational sheets with crisis support numbers. Do they need any further intervention before going home??? CISM personnel on hand Assess who all has been affected 7

8 Important Points The majority of individuals exposed to a traumatic event will not need formal psychological intervention, beyond being provided relevant information. The focus should be on the individual more so than the event. Don t ask them to relive the event. Assessment is essential; an ongoing dynamic process. Normalization of the crisis response is to be encouraged. Crisis intervention should be voluntary. Try to reduce vicarious traumatization. CISM Normalize the response. They are normal people who are having normal reactions to abnormal events Educate the responder on what to expect Restore to adaptive functioning Mitigate impact of the event [lower tension] Most crisis intervention is done by pre hospital personnel, nurses, physicians, soldiers, clergy, hospital workers, community members. 8

9 Interventions Assessment / triage Small groups: Defusing, CMB, Debriefing One on one Demobilization Follow up and referral Pre incident education Strategic planning in the incident command structure Dissipating the Stress Response Time Avoid numbing alcohol, drugs / stimulants Venting On Scene Support / Demobilization Defusing Briefing Debriefing Pre-incident education Reaction to a critical event. Variables: Personality type: A Negative Too center focused Catastrophizing Realistic expectations Controlling Mistrustful 9

10 Pre-Emptive Have a personal disaster plan in place. Keep a change of clothes at work. Carry extra personal medications. Know yourself. Check your coworkers. Have resources easily available. How do I reduce my stress Postpone chores Delegate Allow yourself to say NO Increase you knowledge of new hurdles you must accomplish Try to decrease conflicts, improve relationships [Those who anger you, conquer you] Keep perspective Have a sense of humor Better time management Get plenty of sleep 10

11 The Pittsburgh CISM Team CISD [2473] Allegheny County Re-Solve Crisis Network: Beaver County: Butler County: Fayette County: Indiana County: Lawrence County: Mercer County: Washington County: Westmoreland County: References Molecules and Mental Illness; Samuel H. Barondes; 1993 Critical Incident Stress Management [CISM]: Group Crisis Intervention; 4 th edition Jeffrey T. Mitchell, Ph.D., C.T.S.; 2006 FEMA Disaster Recovery Plan 11