Title: First Responders: Self Care, Wellness, Health, Resilience
1First RespondersSelf Care, Wellness, Health,
Resilience Recovery
- Dealing with Stress
- Personal, Department/Job, Home Family in the
Aftermath of Disasters
Philip T. McCabe CSW, CAS, CDVC UMDNJ School
of Public Health- Office of Public Health
Practice Center for Public Health Preparedness
at UMDNJ Robert Wood Johnson Medical
School American Academy of Health Care Providers
in Addictive Disorders American Public Health
Association International Critical Incident
Stress Foundation
2Objectives
- Help first responders better understand stress
and critical incidents - Increase awareness of self care and helpful
resources - Recognize symptoms in ones self and in others
- Is not intended to certify or credential anyone
in clinical care, CISM, or other related activity
3STRESS
- Forty-three percent of all adults suffer adverse
health effects from stress. - 75 to 90 percent of all physician office visits
are for stress-related ailments and complaints. - Stress is linked to the six leading causes of
death--heart disease, cancer, lung ailments,
accidents, cirrhosis of the liver, and suicide. - The Occupational Safety and Health Administration
has declared stress a hazard of the workplace.
4Managing a mass casualty or bioterrorism
situation is no job for a single provider
organization.
5This is, in fact, the responsibility of the
community a composite that, at a minimum,
includes
- fire, police
- emergency medical services
- The public health system
- local municipalities and government authorities
- local hospitals and other health care
organizations.
6Disaster Response and the Publics Health
- Public and Private
- Outpatient/ Hospital
Medical Care System
Emergency Response System
Public Health System
- EMS
- Police/Fire
- Water/Electric/ Communication Emerg.
Response
- Protection
- Prevention
- Promotion
7Mental Health in Disaster and Terrorism
- Change in Safety
- Change in Travel
Distress Responses
Human Behavior in High Stress
Environments
Mental Health/ Illness
- Smoking
- Alcohol/Drugs
- Violence
- Over dedication
8Police/Fire/EMS/Rescue Workers
- Individuals who traditionally work is stressful
environments often develop various coping skills
and strategies. - Resilience Recovery
- Core Identity Development/Personality
- learned behavior reactions
- typical response to difficult situations
9Police/Fire/EMS/Rescue Workers
- Often these skills enable you to respond and
maintain you level of function in performance of
your duties, especially during difficult
situations
10Police/Fire/EMS/Rescue Workers
- Some of the approaches can be considered healthy
or positive - others may have a negative or unhealthy
consequence.
11Police/Fire/EMS/Rescue Workers
- they can be appropriate for the individuals
involved - they may seem unusual or strange to an outsider.
12- Who we are
- What we do
- Does what we do identifies who we are?
- What else defines us?
- List of characteristics
- Personal
- Professional
13First Responders
- Protectors
- Helpers
- Rescuers
- Caretakers
- Miracle Workers
14Personality Traits
- Obsessive Compulsive
- Control Issues
- Action orientated
- Risk taker
- High need for stimulation\
- Highly dedicated
- Easily bored
- Need to be needed
- Difficulty saying No
- Caretakers
- Family orientated
- High tolerance for stress
- Addiction to trauma
15Critical Incident
- Outside the range of normal coping skills
- Normal reaction to an abnormal situation
16What Is A Critical Incident?
- Any situation that results in an overwhelming
sense of vulnerability or loss of control. - Roger Solomon, Ph.D.
- Any situation faced by emergency service
personnel that causes them to experience
unusually strong emotional reactions which have
the potential to interfere with their ability to
function either at the scene or later. - Jeff Mitchell, Ph.D.
17Critical Incidents
- Are sudden and unexpected!
- Disrupt our sense of control!
- Involve the perception of a life - damaging
threat. - May involve emotional or physical loss!
18Fight or Flight
- Faced by a threat, your body responds with a
complex cascade of chemicals. - The hypothalamus, alerted by the brain, pumps out
a specialized hormone that ultimately prompts the
two adrenal glands (perched atop the kidneys) to
release the energizing hormone known as
adrenaline. - The resultfaster pulse, higher blood pressure,
sharpened awarenessis the "fight or flight"
response to fear and anxiety.
19Core Issues
- Suicide
- Substance Abuse
- Stress
- Burn-out/PTSD
- Martial- Family
- Violence
- Shut down
- Spirituality
20Understanding the Blue Culture
- Police Officers taught to take care of everyone
else. - To Serve and Protect
- Dont feel
- Use police officer face/persona
- Walking wounded
- Us vs. Them
- Law enforcement officers - all others
21Types of CI for Law Enforcement
- LODD
- Serious injury
- Suicide of co-worker
- Multi-causality Incident
- Police Shooting that ends with injury or death
- Death or violence to a child
- A prolonged event, with a negative results
- Extensive media attention
- Knowing the victim of the event
22Sources of stress for individual officers can be
placed into five general categories
- issues in the officer's personal life
- the pressures of law enforcement work
- the attitude of the general public toward police
work and officers - the operation of the criminal justice system
- the law enforcement organization itself.
23Stress in Law Enforcement
- Internal (department)
- External (community)
- Cumulative (career)
- Critical Incident Stress
- Family Stress
24- What we dont often
- talk about
25Police Suicide
- Impulsive Suicide
- Depressed Suicide
- Suicide as an escape to suffering
- Communication Suicide
- Loss of a loved one
26Risk Factors
- Immediate Plan
- Lethality
- Family history
- Alcohol
- Access to weapon
- History of Attempts
- Family Problems
27Suicide Components
- Hopeless
- Helpless
- Worthless
28Disturbing Legacy of Rescues Suicide
- Bob Long, a surveyor credited with finding the
nine trapped Pennsylvania coal miners, killed
himself in June. - Terry Yeakey, an Oklahoma City police sergeant
who rescued four bombing victims in 1995,
committed suicide the following year. - Robert O'Donnell, a paramedic who played a
crucial role in saving baby Jessica McClure from
a Texas well shaft in 1987, took his life nearly
eight years later.
29Common factors in suicide by law enforcement
officers
- Alcohol.
- Coupled with an always-present firearm
- drinking and depression are major causes of
police officer suicides.
30Common factors in suicide by law enforcement
officers
- Breakup of a relationship or marriage.
- Often, the only people outside law enforcement an
officer trusts are his or her family. - When a relationship ends, an officer loses his or
her emotional support base. - Stagnated career.
- An officer under investigation.
31Common police suicide warning signs
- An officer who starts having a high number of
off-duty accidents. - A rise in citizen complaints about
aggressiveness. - A change in personality in which a sullen officer
suddenly becomes talkative or an officer who is
normally very vocal becomes silent and withdrawn.
- The law enforcement official starts giving away
prized possessions or telling friends they will
be missed. - The officer suddenly writes a will.
- Source The National P.O.L.I.C.E. Suicide
Foundation
32HEALTH WELLNESS
- What is good health?
- What is wellness?
- What is comfort?
33People can use rituals to find comfort
34People can use rituals to find comfort
35People can use rituals to find comfort
36- Even the most experienced and skilled
professional can be affected by their work.
37Whats in a name ?
- Unfortunate Incident
- Urgent situation
- Risky Business
- Disturbance
- Hazardous
- Unsafe
- Treacherous
- Emergency
- Dangerous
- Tragedy
- Distress
- Crisis
- Disaster
- SNAFU
- Critical
- Trauma
38Phases of a Crisis
- Impact
- Inventory
- Rescue
- Recovery
39Topic 1 Psychological Phases of a Disaster
From Zunin Myers (2000)
40Critical Incident
- A critical (or traumatic) incident is any event
outside the usual realm human experience that is
markedly distressing - (e.g. evokes reactions of intense fear,
helplessness, horror, etc.)
41Critical Incident
- Such critical incidents usually involve the
perceived threat to one's physical integrity or
the physical integrity of someone else.
42Critical Incident
- Most importantly, critical incidents are
determined by how they undermine a person's sense
of safety, security and competency in the world.
43Critical Incident
- This results in a form of psychiatric injury,
also called traumatic impact or traumatic stress.
44What is a Traumatic Incident?
- A situation that is extraordinary and may
overwhelm coping mechanisms - Causes the worker to experience a stress reaction
- Unusually strong emotional reactions at any time
during or after the incident
45Symptoms of a Stress Reaction
- Can last
- a few days
- a few weeks
- a few months
- and occasionally longer
- Support and understanding of loved ones needed
46Symptoms of a Stress Reaction
- difficulty feeling love and intimacy
- difficulty taking interest and pleasure in
day-to-day activities
47Symptoms of a Stress Reaction
- Professional assistance may be necessary
48Can be broken down into 4 categories
- Emotional
- Cognitive
- Behavioral
- Physical
49Emotional
- feelings of shock
- Anxiety
- Guilt
- Grief
- Severe panic
- Fear
- Uncertainty
- Depression
- Apprehension
- Intense Anger
- Irritability
- Agitation
- Resentment
- Shame
- helplessness
- hopelessness
- emotional numbness
- Feeling overwhelmed
50Cognitive
- Blaming someone
- Confusion
- Heightened or lowered awareness
- Indecisiveness
- Worry
- Shortened attention span
- Self-blame
- Poor concentration
- Memory problems
- Hypervigilence
- Poor problem solving
- Nightmares
- Intrusive images
- Loss of time, place, or person orientation
51Behavioral
- Change in activity
- Change in speech patterns
- Withdrawal
- Emotional outbursts
- Increase or decrease in appetite
- Startle reflex intensified
- Change in sexual functioning
- Erratic movement
- Antisocial acts
- Suspiciousness/
- paranoia
- Pacing
- Alcohol and/or drug consumption
52Physical
- Fatigue
- Nausea
- Muscle cramps
- Twitches
- Chest pain
- Difficult breathing
- Grinding of teeth
- Elevated blood pressure
- Rapid heartbeat
- Thirst
- Headaches
- Visual difficulties
- Profuse sweating
53TRAUMATIC STRESS
- Years ago, PTSD was commonly called "combat
fatigue soldiers heart or "shell shock."
Many people believed that only soldiers or other
people who had been in a war could get PTSD.
54Traumatic Stress
- Trauma is considered an event outside the normal
range of experience.
55Learning from Our Past Experience
- The mental fallout from the Oklahoma City
bombings in 1995 didnt peak until 12 to 18
months after the event.
56Learning from Our Past Experience
- One year after the bombing, three times as many
residents of Oklahoma City reported increased
drinking as those in a control community
(Indianapolis). Rescue workers in Oklahoma City
experienced elevated rates of substance abuse,
depression and suicide.
57 58Beyond the range of normal experience
59(No Transcript)
60Stress-Related Illnesses During the 11 Months
After the Attacks (September 11, 2001--August
22, 2002)
- During the 11 months after the attacks, 1,277
stress-related incidents were observed among FDNY
rescue workers, a 17-fold increase compared with
the 75 stress-related incidents reported during
the 11 months preceding the attacks.
61- As of August 28, 2002, a total of 250 FDNY rescue
workers remain on leave with service-connected,
stress-related problems. Of these, 37 also have
respiratory problems
62- As of August 28, 2002, a total of 358
firefighters and five EMS workers remained on
medical leave or light duty assignment because of
respiratory illness that occurred after WTC
exposure.
63- The number of New York City firefighters and
emergency medical service workers being treated
for alcohol and drug abuse in 2004 is more than
50 percent higher than it was the year previous.
64- The counseling unit of the Fire Department has
seen an increase in every diagnostic category
since Jan. 1. 2004 - After Sept. 11, the department's caseload went
from an annual average of 600 cases over all to
3,600. - Most of those cases are for anxiety and
bereavement after the terrorist attack. - The alcohol and drug treatment cases represent 4
percent of the counseling unit's total caseload.
65(No Transcript)
66Police Organization ProvidingPeer Assistance
(POPPA)
- POPPA is a confidential, voluntary,
- independent, no departmental assistance program
for the NYPD that uses trained volunteer NYPD
officers as peer support officers.
67Police Organization ProvidingPeer Assistance
(POPPA)
- In the first year, there were about 250 calls to
the help line. - Since 2001, the number of calls has increased to
between 900 and 1,200 per year. - The proportion of callers who accept a referral
for professional assistance has also increased,
from about 30 percent to 45 percent of callers.
68However, the primary reasons for calls over the
years 2003 and 2004 were in the areas of
- stress or anxiety (34 percent)
- alcohol problem (26 percent)
- marital problem (24 percent)
- Traumatic stress (18 percent)
- depression (14 percent)
- bereavement issues (7percent).
- Because of confidentiality issues, detailed
information is unavailable.
69New Jersey Cop 2 Cop
- Cop 2 Cop which began in November of 2000 saw an
immediate increase of 300 in calls following
9/11. - Since that time Cop 2 Cop has received over
15,000 calls and have become a model for other
programs.
70NJ Cop2Cop
- There were over 550 Critical Incident Stress
Management Response Services within the first two
years including at the closing of Ground Zero. - a specialized large group crisis CMB's called
"reentry" for the Port Authority Police Dept. - had Direct Contact with over 1,900 rescuers
directly involved with the rescue and recovery at
the WTC Site and have supported and created
supplemental programs and hotlines.
71On The Front Line The Work of First Responders
in a Post 9/11 World.
- 9/11 attacks on the World Trade Center put
firefighters and officers, especially those who
were on the site of the disaster during the month
of September, at an increased risk of developing
emotional health problems. - Samuel B. Bacharach, Ph.D.
- Institute for Workplace Studies School of
- Industrial Labor Relations Cornell University
72- Also highlighted in the report is a unique
strength of FDNY firefighters and officers they
work in highly supportive self-managed teams,
which enable them to operate as highly effective
work units in fighting fires and confronting
other emergencies.
73The New York State Office of Alcoholism and
Substance Abuse Services
- reports that demand for alcohol and drug
treatment in New York City increased immediately
after the World Trade Center attacks.
74Who is at greatest risk for severe stress
symptoms?
75Groups Potentially Vulnerable to Terror-Related
Issues Demartino 2001
- Rescue Workers
- Medical Personnel
- Leaders
- Hero
- Persons deemed responsible
- Media representatives
- Elderly
- Children
- Single Parents
- Injured
- Bereaved
76Who is at greatest risk for severe stress
symptoms?
- Rescue workers who directly experience or witness
any of the following during or after the disaster
are at greatest risk for severe stress symptoms
and lasting readjustment problems
77Who is at greatest risk for severe stress
symptoms?
- Life threatening danger or physical harm
(especially to children)
78Who is at greatest risk for severe stress
symptoms?
- Exposure to gruesome death, bodily injury, or
dead or maimed bodies
79Who is at greatest risk for severe stress
symptoms?
- Extreme environmental or human violence or
destruction
80Who is at greatest risk for severe stress
symptoms?
- Loss of home/family
- valued possessions
- neighborhood
- community
81Who is at greatest risk for severe stress
symptoms?
- Workers who experience
- Loss of communication with or support from close
relations
82Who is at greatest risk for severe stress
symptoms?
- Workers who experience
- Extreme fatigue
- weather exposure
- Hunger
- sleep deprivation
83Who is at greatest risk for severe stress
symptoms?
- Workers who experience
- Intense emotional demands (such as searching for
possibly dying survivors or interacting with
bereaved family members)
84Who is at greatest risk for severe stress
symptoms?
- Extended exposure to danger, loss,
emotional/physical strain
85 Who is at greatest risk for severe stress
symptoms?
- Workers who experience
- Exposure to toxic contamination
- gas or fumes
- Chemicals
- radioactivity
86Risk Factors
- Life threatening danger/physical harm
- Exposure to gruesome death or bodily injury
- Extreme environmental/human violence or
destruction - Loss of home, possessions, community
- Loss of communication with, or support from,
close relations - Extreme fatigue, weather exposure, hunger or
sleep deprivation - Extended exposure to danger, loss, or
emotional/physical strain - Exposure to toxic contamination
87The psychological problems that may result from
disaster experiences include Physical reactions
- Tension
- Fatigue
- Edginess
- difficulty sleeping
- bodily aches or pain
- startling easily
- racing heartbeat
- Nausea
- change in appetite
- change in sex drive
88The psychological problems that may result from
disaster experiences include
- Interpersonal reactions in relationships at
school, work, in friendships, in marriage, or as
a parent
- feeling rejected or abandoned
- being distant
- Judgmental
- over-controlling
- Distrust
- Irritability
- Conflict
- Withdrawal
- Isolation
89What severe stress symptoms can result from
disasters?
- Most responders only experience mild, normal
stress reactions, and disaster experiences may
even promote personal growth and strengthen
relationships.
90Severe Stress Symptoms
- However, as many as one out of every three rescue
workers experience some or all of the following
severe stress symptoms, which may lead to lasting
Post Traumatic Stress Disorder (PTSD), anxiety
disorders, or depression.
91Severe stress symptoms
- Dissociation (feeling completely unreal or
outside yourself, like in a dream having "blank"
periods of time you cannot remember)
92Severe stress symptoms
- Intrusive re-experiencing
- terrifying memories
- Nightmares
- Flashbacks
93Severe stress symptoms
- Extreme attempts to avoid disturbing memories
(such as through substance use)
94Severe stress symptoms
- Extreme emotional numbing (completely unable to
feel emotion, as if empty)
95Hyper-arousal
- panic attacks
- rage
- extreme irritability
- intense agitation
96Severe anxiety
- paralyzing worry
- extreme helplessness
- compulsions or obsessions
97Severe depression
- complete loss of hope
- self-worth
- motivation
- purpose in life
98TERRORISM
Crisis Stress Trauma Terror
99The ultimate tool of the terrorist
- is not chemical, biological, nuclear or
radiological.
It is psychological. Terror is fear.
100How is Terrorism Different?
- Terrorism wins only if you respond to it in the
way the terrorist wants you to - You can control the fate of the terrorist act in
terms of your response to it. - Psychologically speaking, the impact is up to you
and not to the terrorist. - Adopted from DeMartino 11/15/01 and his
interpretation of Franklin 1975
101Traumatic Crisis
- An event in which people experience or witness
- Actual or potential death or injury to self or
others. - Serious injury.
- Destruction of homes, neighborhood, or valued
possessions. - Loss of contact with family/close relationships.
102Mediating Factors
- Prior experience with a similar event
- The intensity of the disruption in the survivors
lives - Individual feelings that there is no escape,
which sets the stage for panic - The emotional strength of the individual
- The length of time that has elapsed between the
event occurrence and the present
103 104Stabilizing Individual
- Assess the survivors for injury and shock.
- Get uninjured people involved in helping.
- Provide support by
- Listening.
- Empathizing.
- Help survivors connect with natural support
systems.
105Avoid Saying . . .
- I understand.
- Dont feel bad.
- Youre strong/Youll get through this.
- Dont cry.
- Its Gods will.
- It could be worse or At least you still have .
. .
106Managing the Death Scene
- Cover the body treat it with respect.
- Have one family member look at the body and
decide if the rest of the family should see it. - Allow family members to hold or spend time with
the deceased. - Let the family grieve.
107Informing Family of a Death
- Separate the family members from others in a
quiet, private place. - Have the person(s) sit down, if possible.
- Make eye contact and use a calm, kind voice.
- Use the following words to tell the family
members about the death Im sorry, but your
family member has died. I am so sorry.
108Emergency Mental Health and Traumatic Stress
- Disasters, whether natural or terrorist-related,
may result in human trauma that requires special
attention. - Following such events, the need for crisis
counseling is just as important as the need to
clean up debris and reconstruct property.
109Emergency Mental Health and Traumatic Stress
- Most people who are coping with the aftermath of
a disaster have normal reactions as they struggle
with the disruption and loss caused by the
disaster.
110Emergency Mental Health and Traumatic Stress
- They do not see themselves as needing mental
health services and are unlikely to request them.
- Community outreach may be necessary to seek out
and provide mental health services to individuals
who may be affected by a disaster.
111Individual Stress Management Training
- Primary Stress Prevention
-
- How we think,
- how we live,
- how we work
112Traditional Mental Health Practice
Crisis Counseling
- Is primarily home and community based.
- Focuses on assessment of strengths, adaptation of
existing coping skills and development of new
ones. - Seeks to restore people to pre-disaster levels of
functioning. - Accepts content at face value.
- Validates the appropriateness of reactions to the
event and its aftermath and normalizes the
experience. - Has a psycho-educational focus.
- Is often office based.
- Focuses on diagnosis and treatment of a mental
illness. - Attempts to impact the baseline of personality
and functioning. - Examines content.
- Encourages insight into past life experiences and
their influence - on current problems.
- Has a psycho-therapeutic focus.
113COMMON CRISIS COUNSELING SERVICES
- Information
- Education
- Outreach
- Counseling
- Supportive listening
- Referrals
- Training
- Collaboration with other programs
114Individual Stress Management Training
- Secondary Stress Prevention Relaxation
exercises, physical fitness, spirituality and
faith, emotional outlets.
115Individual Stress Management Training
- Tertiary Stress Prevention Psychological
counseling/therapy, medical care for
stress-related physical or psychological
illnesses.
116Disaster Stress Interventions
- Individual stress management training
- Social support and creating a supportive
organization - Traumatic incident stress management techniques
117Disaster Stress Interventions
- Social support is one of the most important and
powerful stress reducers.
118Disaster Stress Interventions
- Two powerful ways of healing from disaster
- For the individual, creating and telling the
story of the disaster - Rituals and memorials, which bring the community
of responders, victims and public together
119Traumatic Incident Stress Management Techniques
- An intervention specifically for dealing with
traumatic events - Helps those involved in a traumatic incident to
share their experiences, vent emotions, learn
about stress reactions and symptoms - Confidential, voluntary and educative process
- NOT psychotherapy
120Types of Traumatic/ Critical Incident Stress
Management
- Emergency Preparedness
- Crisis Management Briefing
- Defusing
- Debriefing
- Critical Incident Stress Debriefing
- FEMA/CMHS
- Red Cross Crisis Response Team
- NOVA
- Grief and Loss
- Individual Crisis Intervention
- Family CISM
- Organizational Consultation
- Follow-up/ Referral
121Types of Traumatic Incident Stress Management
Debriefing
- Proactive intervention involving a group
meeting/discussion about a particularly
distressing event
122Debriefing
- Designed to mitigate the impact of the event and
assist those in recovery from the associated
stress
123Debriefing
- Facilitated by a specially trained team
- Ideal to have it conducted between 24 and 72
hours after the incident
124Critical Incident Stress Debriefing
- CONDUCTED BY TRAINED PROFESSIONALS
125Types of Traumatic Incident Stress Management
Defusing
- Shorter, less formal version of a debriefing
- Best conducted within 1 to 4 hours after an
incident
126Defusing
- Confidential and voluntary
- Sharing of reactions to an incident and venting
emotions - Main purpose stabilize people affected by the
incident so that they can return to their normal
routines
127Types of Traumatic Incident Stress Management
Grief and Loss Session
- Structured group or individual session following
a death - Assists people in understanding their own grief
reactions - Creates a healthy atmosphere of openness and
dialogue around the circumstances of the death
128Types of Traumatic Incident Stress Management
Crisis Management Briefing
- A large homogeneous group intervention used
before, during and after crisis - Present facts, facilitate a brief controlled
discussion, Q A and information on stress
survival skills and/ - or other available support services
- May be repeated as situation changes
129Managing Stress During Disaster
- On scene briefings for incoming responders
- Develop a buddy system
- Watch out for each other
130Managing Stress During Disaster
- Take care of yourself physically
- Take frequent rest breaks
- Drink plenty of fluids
- Eat healthy foods
131Managing Stress During Disaster
- Take breaks away from the work area
- Give yourself permission to feel rotten
132Fatigue as a Health HazardThe Health Effects of
Working Long Hours
- Stress
- Causes a lack of concentration, memory loss and
errors in judgment - Depression
- May be caused by extended periods of stress
- Can be caused when workers experience high
demands and low levels of control over their work
- Burnout (Work Exhaustion)
- When workers undergo extended periods of high
demanding high stress situations coupled with
long hours work overload
133 134Psychological First Aid
- Recognizing that some phases of disasters, such
as the impact phase, and some type of disasters,
such as bioterrorism and other public health
emergencies, are characterized more by acute fear
and anxiety than by classic traumatic stress
reactions, the Institute of Medicine and other
leading mental health authorities are
increasingly promoting the use of "Psychological
First Aid" as means of addressing the intense
physiological and emotional arousal that
accompanies certain crisis events.
135Psychological First Aid
- (PFA) is quickly becoming another necessary tool
in the disaster mental health responder's tool
kit, and training in for New Jersey's disaster
mental health responders will soon be offered in
several counties.
136Psychological First Aid
- This research is beginning to suggest that
waiting several hours, or days, before providing
basic psycho-social support may miss an important
window of opportunity in helping people
emotionally recover from the aftershock of a
traumatic event. - Psychological first aid may be best applied
during a critical incident and in the minutes and
hours immediately following the event.
137Psychological First Aid is not new
- Long established principle of buddy-care in
U.S. military - Growing body of empirical evidence demonstrating
relationship between physiological arousal and
PTSD development following crises - Recommended by the National Academy of
Sciences-Institute of Medicine and National
Center for PTSD
138Working Definition
- Psychological first aid (PFA) refers to a set of
skills identified to limit the distress and
negative behaviors that can increase fear and
arousal. - (National Academy of Sciences, 2003)
139Psychological First Aid is
- Psychological first aid (PFA) is as natural,
necessary and accessible as medical first aid. - Psychological first aid means nothing more
complicated than assisting people with emotional
distress resulting from an accident, injury or
sudden shocking event.
140Psychological First Aid
- Like medical first aid skills, you don't need to
be a doctor, nurse or highly trained
professional to provide immediate care to those
in need.
141General Principles of Psychological First Aid
- The most urgent tasks for the Psychological
First Responder is to focus on restoring
emotional equilibrium.
142Psychological First Aid responders should
- Present a calm, reassuring demeanor
- Be direct, informative, authoritative, nurturing,
and problem-solving oriented
143Psychological First Aid
- Counter denial, by encouraging
- individuals to deal with the facts of the event
- give accurate information and explanations of
what happened and what to expect - never offer false or unrealistic assurances
144Psychological First Aid
- Talk to individuals about their emotional
reactions and encourage them to deal with such
reactions as another facet of countering denial
and other defenses that interfere with restoring
equilibrium
145Psychological First Aid
- Convey a sense of hope and positive
expectation--that a crisis changes things, there
are ways to deal with the impact - Normalize the individual's emotional reaction as
much as feasible
146Psychological First Aid
- Facilitate emotional expression (e.g., through
use of empathy, warmth, and genuine concern) - Explain what can and will be done to assist the
individual, their family and community
147Protect
- Individuals from further physical or emotional
harm, including gruesome or graphic sights and
sounds - Individuals' dignity and privacy following a
crisis - Individuals from media intrusion or curious
well-wishers - Individuals from danger to self or others
148Direct
- Individuals toward quiet, safe areas
- With calm, compassionate but authoritative tone
- Any available personnel to appropriate tasks and
to offer support to co-workers
149Connect
- Individuals with mental health and social service
resources - Individuals and their families with available
printed and online resources for coping with the
emotional consequences of crises - Friends, family, co-workers and other sources of
emotional support - Individuals to information about the event or any
relevant news pertaining to the situation
150Psychological First Aid is not
- Debriefing
- Counseling
- Psychotherapy
- Mental health treatment
151Managing Stress after a Disaster
- Attend end of shift briefing
- Reach out
- Reconnect
- No big life decisions
- Rest
- Eat well
- Mood swings
- Slow down
- Dont overwhelm children
- Stress relief
- Recall what is important
- Avoid use of drugs or alcohol
152Workers Families
- Workers have valid concerns for their families.
- Families worry about workers health and safety.
153Helping Children Feel Better
- Carry out daily routines and outings
- (when possible)
154Helping Children Feel Better
- Encourage children to talk and ask questions
155Helping Children Feel Better
- Reassure children they are safe
156Helping Children Feel Better
157Self Care for Critical Incidents
- Alternate strenuous exercise and relaxation for
the first 24-48 hours after the incident. - Keep busy. Structure your time. Be with people,
especially those who have "been there." - Remember that your reactions are normal and
expected. Don't label yourself as "crazy" or
"weak." - Keep your life as routine as possible. Avoid
making any big life changing decisions. However,
you should make a lot of small choices about your
daily life this will return a sense of being
back in control to you.
158Self Care for Critical Incidents
- Avoid alcohol and drug usage. Any relief that is
felt will be short lived and your feelings
afterwards will be more extreme than before. - Give yourself permission to feel rotten.
- Watch your diet. You should avoid sugars and
caffeine. Eat regular, balanced meals. Increase
your intake of fruits and vegetables. - Realize that others have gone through this before
and have felt the same way you are feeling now. - Don't hesitate to call a trusted and experienced
peer anytime you need to talk.
159A day at the Jersey Shore
Small Group Exercise
160SUMMARY of CISM
- When implemented as prescribed, CISM appears to
be an effective crisis intervention, capable of
reducing signs and symptoms of distress
associated with an acute psychological crisis. - When providers are not properly trained and
experienced and when the debriefing is provided
as a stand-alone intervention, it is likely to
ineffectual and perhaps harmful. - When providers apply CISM tactics to individuals
for whom it was never intended under
circumstances for which it was never designed and
with a complete disregard for standardization and
quality assurance the interventions may be
ineffective and possibly harmful.
161KISS Keep it Simple Silly
- Remember you are dealing with a very stressful
situation and its aftermath - TALK- especially to other who relate to your
situation - DONT make major decisions alone
- LIMIT Expectations on self and others
162HALT
- Avoid Being
- Hungry
- Angry
- Lonely
- Tired
163REMEMBER
- Take care of yourself.
- Take care of family.
164Available Resources
- Mental health benefits may be available
- Local and national organizations
- Community services and hotlines
- Mental health resources
- Financial resources
- Legal resources
165Acknowledgments
- Dr. George Everly, International Critical
Incident Stress Foundation - Jamie F. Becker of the Laborers Health and
Safety Fund of North America. - Steven M. Crimando MA, BCETS
- Deborah J DeWolfe PHD, MSPH Training Manual for
Mental Health and Human Service Workers in Major
Disaster. SAMHSA Publication - National Centers for Posttraumatic Stress
Disorders - Dept of Veterans Affairs
- American Psychological Association
- American Psychiatric Association
- American Public Health Association
- The American Academy of Experts in Traumatic
Stress - FEMA
- CDC
- NIDA, NIH, NIAAA
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