6-23-14 - UW Health

Emergency Care & Trauma
Symposium 48th Annual
June 23, 2014
Debriefing Strategies to Consider
When Coping With Acute Stress
Lynnda Zibell Milsap PMH CNS-BC
• Identify acute stress & coping responses
• Review strategies to enhance one’s
coping with acute stress
• Review triggers, interventions to prevent
compassion fatigue.
What Do You Read & Hear?
News headlines on recent cases
involving support from EMS /First
1. The Multiple Stabbing on East
Washington with deaths
2. Missing Girl, Tortured Boy, Body of
Mother Found at Wisconsin House
3. Foggy pileups kill 2, involve more
than 100 vehicles
Key First Responder Stress Reponses
Feeling overwhelmed
Normal Stress Reactions After a
• Anger, irritability, sorrow
• Detachment, guilt ( “I should have done
• Dreams & nightmares
• Distractibility, flashbacks
• Frequent thoughts of what happened
• Strains in family and work relationships
Cumulative Stress
Just like it sounds, when you are
unable to relieve stresses that build,
they add up & take a toll, which can
reach a critical point.
Importance of Psychological
• Affect our physiological responses
• Overwhelming emotions can disrupt
rational problem-solving
• Promote adaptive and maladaptive
individual and group behaviors
First Responder & Signs of Potential
Acute Stress Response
Potential Stress Responses to a traumatic event
• Hyper-arousal:
• Avoidance:
• Intrusions:
• Psychic numbing
What is a Traumatic Event?
Identifies a traumatic event as one in which we experience:
a threat (actual or perceived) of death or serious injury to self or
others , with a response of “intense fear, helplessness or horror.”
• It is not the event itself, but the meaning it has for the individual that
makes it traumatic.
Critical or Traumatic Situation
Causes a rescuer to experience:
Unusually strong emotions that interferes
with the ability to function either during the
incident or after; a highly stressful incident
What Happens After A Traumatic
‘Normal people’ experience a range of normal
reactions, including:
Feeling “revved up;”
Fatigue; irritability;
Problems sleeping;
Exaggerated startle response,
Change in appetite;
Feeling overwhelmed; impatience;
Withdrawing from family and friends.
Might just feel fine
Emotional Condition marked by :
Tiredness, feelings of exhaustion
Loss of interest, reduced work effort
Frustration that interferes with job performance.
Result from prolonged stress
 No joy left in doing your job
 Apathy
 “What’s the point?” attitude
 Happens over time
 Alienation from job activities
Secondary Traumatic Stress
When a friend is experiencing a trauma in
their life that you have personal experience
with, this can trigger past emotions &
physical abuse
emotional abuse
Secondary Traumatic Stress
1. People who come into continued, close contact
with trauma survivors
2. Knowledge about a traumatizing event
experienced by a significant other
3. The stress resulting from helping a traumatized
or suffering person
Bride, B. (2007). Prevalence of Secondary Traumatic Stress Among Social Workers. Social Work: 51(2): 63-70.
Cost of Caring
What is Compassion Fatigue?
A debilitating weariness brought about by
repetitive, empathic response to pain and suffering,
`is a result of absorbing & internalizing the
emotions of others & sometimes, coworkers…”
Who is at Risk for Compassion Fatigue?
Those who have:
• Trauma – (experience as a witness or as a patient)
• Unusual recent stressors-long term or life demands
• Excessive empathy (leading to blurred professional
• Those who are more anxious
• Poor self care
• Limited support
• Daily barrage of trauma material
Abendroth, M. & Flannery, J. (2006). Thos
Additional Factors that Make One
Vulnerable to CF
• Inability or refusal to control work
• Lack of satisfaction for the work
• Previous unresolved trauma
• Viewing or hearing about abuse and
trauma on a routine basis
Figley, C. R. (Ed.) (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel
Compassion Fatigue Symptoms
• Affects many dimensions of your wellbeing
• Nervous system arousal (Sleep disturbance)
• Emotional intensity increases
• Cognitive ability decreases
• Behavior and judgment impaired
• Isolation and loss of morale
Symptoms, continued
Depression and PTSD (potentiate)
Loss of self-worth and emotional modulation
Identity, worldview, & spirituality impacted
Beliefs and psychological needs-safety, trust,
esteem, intimacy, and control
• Loss of hope and meaning=existential despair
• Anger toward perpetrators or causal events
Emotional Indicators
Anxiety / increased negative arousal
Numbness / flooding
Lowered frustration tolerance / irritability
Grief symptoms
Physical Indicators
Intrusive thoughts / images
GI symptoms
Insomnia / nightmares / sleep
• Decreased immune response
• Lethargy
• Becoming more accident prone
Personal/Work Indicators
Decrease in sense of safety ( 911)
Self isolation
Difficulty separating work life from personal life
Diminished functioning in non-professional
Increases in ineffective or self destructive self
soothing behaviors
Small Group Exercise #1
• Discuss a case that caused you to take it home
with you- or caused some symptoms of
compassion fatigue
• Identify what factors caused you to identify with
the person/victim/family/event
• Note commonalities and choose a person to
share these findings with the larger group
Panos, A
Although symptoms vary, these may indicate that
you or coworkers have compassion fatigue
Substance abuse
Sleep disturbances
Low self-esteem
Frequent headaches
Increased irritability
Less ability to feel joy
Chronic lateness
Extra work
(physical or
How Do You Feel?
• Overwhelmed by unfinished personal
• Stress affects you deeply
• Personal concerns often intrude on work
• Feeling vulnerable all the time
• Association with trauma affects you deeply
• Small changes are enormously draining
Daily self-centering
• A daily act of self-centering can “bring you
back” to awareness of the goodness of the
• Set an alarm for the same time each day
and take four deep breaths
• Create another act where you can sink into
the experience, feel the sensations, and
note, “I am worthy of my own time.”
Time to Keep Healthy
Mindfulness meditation
Reconnect with others
Boundary maintenance
Up to date education
Routine Supervision
Your Self Care Plan
• Spend time daily on an activity you find
meaningful that is not related to work.
• Examples include; reading, writing,
walking, listening to music, building,
playing - whatever re-energizes you.
A= Awareness
Issues and Contributing Factors
What types of cases
contribute to your
stress level
increasing your
vulnerability to
• Being attuned to ones needs,
limits, emotions and resources
• Knowing your “renewal zones”
• Accepting and acknowledging
that we are changed by what we
Self Care
• Find someone to talk to
• Understand that the pain
is normal
• Start exercising and eating
• Get enough sleep
• Take some time off
• Develop interest outside
of work
• Identify what’s important
Suggestions of What Not To Do
• Blame others
• Fall into the habit of
• Hire a lawyer
• Work harder and
• Self medicate
• Neglect personal
needs and interests
Even Mother Teresa Understood
Compassion Fatigue Effects
Wrote in her plan to her
superiors that it was
MANDATORY for her nuns
to take an entire
year off from their duties
every 4-5 years to
allow them to heal
from the effects of their caregiving work.
Balancing Yourself
1. Have quiet alone time in a calm place- a safe
retreat where you feel safe & renewed
2. Have an awareness of what restores and
replenishes you.
3. Find ways to acknowledge loss and grief
4. Stay clear with commitment to career goals or
your personal mission
5. Learn to focus on what you can control
6. Look at situations as entertaining challenges and
opportunities, not problems or stresses
Potential Serious Signs of Distress
After An Event
Long-term sleep disturbances
Feelings of isolation or depression
Sudden change in life attitude
Sudden catastrophic decision-making (
quit job, divorce)
Hey You Are A Strong Person!
• Be as non judgmental & accepting of
yourself as you would in dealing with those
your treat who have undergone a
traumatic event
• Remember that the symptoms you are
experiencing as a result of the traumas are
related to the experience itself not that you
are a weak person
• The need to support you is ongoing
When should I seek outside
support for dealing with a tough
Approximately 2-3 months
Your Self-Care Plan
• Who is responsible for your self-care?
• What are barriers listed in priority that
keep you from self-care activities?
• What is your current level of energy?
• How does your team care for each other
with challenging patient care issues?
• Draw a circle…represent 24 hours a
Red Cross, Chaplains, Social Workers, Area
Hospitals, professional counselors, “Your team”
1. International Critical Incident Stress Foundation
2. SAMHSA ( Substance Abuse & Mental Health
Services Administration)-free handout for coping
for your team
Red Cross Resources for
You & Your Team
Mental health screening & triage
Crisis intervention
Emotional care and support
Problem solving & referrals
Advocacy & education
On-line resources
• Compassion Fatigue Awareness Project
• Compassion Fatigue
• Google “compassion fatigue” and you will find
many other helpful resources
• Red Cross
Thanks For All You Do….
Thank You For Allowing Me to
Participate in Your Conference
[email protected]