Critical Incident Stress Management
FBI NAA
Summer Conference
July 2011
Chuck Russo, PhD
American Military University
Daytona Beach Police Department
SPS Group, LLC

• Professor
– AMU
• Police Officer
– Daytona Beach PD
• Team Leader
– RDBHAT (ESF-8)
• Team Member:
– Volusia County CISM
– Daytona Beach PD CISM

NY Daily News Newsday

• Identify the importance of dealing with critical incident stressors
– Psychological and physiological responses related to traumatic stress
• Addressing how to break the code of silence

What is Critical Incident Stress
Management?
• Critical Incident Stress Management (CISM) is a brief intervention utilized to mitigate the stressors associated with exposure to a traumatic event
• CISM is frequently confused with Critical Incident
Stress Debriefing (CISD)
– Debriefing just one component of the overall response

• Police officers address their sworn duties and responsibilities with dedication and valor
• Sometimes the compounded stresses of daily tragedies can become overwhelming and can lead to personal and professional stressors
• Other first responders tend to respond to critical incidents in a team structure; police officers frequently do not

Sources of Stress and Law Enforcement
• Organizational/administrative stressors
• Daily field/job related stressors
• Interaction with the criminal justice system
• Personal stressors including the co-existence of the officer ’ s personal life and their professional life

How Has Law Enforcement Become
More Stressful?
• Unfortunately with current reductions in community resources, officers are faced with more complex emergencies
• Community policing has intensified the level of responsibility placed on officers
• Police officers have to react quickly to solve a multitude of problems

How Does Stress Impact Law
Enforcement Officers?
• Heightened divorce rates
• Substance dependence/abuse
• Depression
• Financial difficulties
• High rates of suicide

Critical Incident Stress & Traumatic Stress
• Critical Incident Stress = Traumatic Stress
• These terms are frequently used interchangeably
• A critical incident usually occurs suddenly, is disturbing, or is an unusually challenging event that generates a strong emotional and/or reaction

Examples of Critical Incidents
•
Events that overwhelm an individuals normal coping mechanisms
– Officer involved shootings
– Line of duty injuries/deaths
– Incidents when a child is a victim
– Incidents involving death/serious injury to others
– Disasters
– Employee suicide

Impact of Traumatic Stress
Engaging in response efforts during a critical incident is often stressful for all those involved in emergency response efforts; regardless of the responder’s ability to acknowledge the impact of their involvement

Impact of Traumatic Stress
While this type of work is personally rewarding and challenging, it also has the potential for affecting responders in negative psychological and physiological ways

Commonly Recognized Definition of Stress
The most commonly accepted definition:
• Stress is a condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilize

Definition of Traumatic Stress
• In the line of duty, first responders are trained to utilize tactical strategies in crisis situations, and they are quick to respond to protect the lives and property of those they serve
• Unfortunately, a hidden danger is often ignored:
TRAUMATIC STRESS!

What is Traumatic Stress?
Precipitated by stressors that include sudden, disturbing, or unusually challenging events that generate a strong emotional and/or cognitive reaction
Stressors Include:
– Gruesome crashes
– Homicides
– Vicious crimes against a child/children
– A close personal brush with death/injury
– Officer involved shooting
Return

Psychological and Physiological
Responses to Traumatic Stress
Exposure and side effects to traumatic stress are individualized and may include:
• Physical symptoms
• Psychological symptoms
• Reoccurrence or re-victimization can occur if the first responder does not address the symptomology

Physiological Responses
Examples encountered may include:
• Increased fatigue – poor sleep and/or nightmares
• Headaches
• Muscle twitches
• Unexplainable body aches and pain
• Gastrointestinal distress

Physiological Responses
Additional examples encountered include:
• Weight loss or gain
• Grinding of teeth
• Chest pain
• Difficulty breathing
• Elevated heart rate and blood pressure

Psychological Responses
Examples encountered may include:
• Emotional detachment
• Withdrawal from social situations
• Mood swings, anger and aggression
• Intrusive thoughts/obsessive compulsive behaviors
• Anxiety, panic attacks, and nervous energy

Additional Psychological Symptoms
More examples encountered may include:
• Attention difficulties
• Feelings of helplessness/hopelessness
• Burnout
• Depression
• Grief
• Interpersonal difficulties

Exposure to Traumatic Stress
Often challenges an individual's sense of:
• Sense of self-worth or self-esteem
• Personal safety or sense of control
• Impairs an individual’s ability to control their emotions
• Increases their feelings of vulnerability

Frequent Exposure to Traumatic Stress
Can lead to hypervigilance:
• A heightened state of alert; whereby an individual is constantly awaiting additional real or perceived threats
• An individual is constantly on guard and this is also referred to as increased arousal

How to Alleviate Symptoms Associated with
Traumatic Stress?
Engage in:
• Debriefing
• Defusing
• Seek peer or supervisory support
• Speak with a chaplin
• Access EAP

Minimizing the Effects of Traumatic
Stress
Goal:
• To facilitate a normal recovery process
• To restore an individual’s level of adaptive functioning to their normal state of functioning

• Definition of a Critical Incident
• The Role of CISM
• What CISM Does Not Do
• How CISM Helps the First Responder
• The CISM Team

We will begin again in 5 minutes.

A critical incident is defined as:
• A sudden or disturbing event
• That generates a strong emotional and cognitive reaction

Examples encountered in may include:
• Officer involved shootings
• Line of duty injuries/deaths
• Incidents when a child is a victim
• Incidents involving death/serious injury to others
• Disasters
• Employee suicide

CISM is:
• Early psychological support for First
Responders

• To mitigate the impact of the event
• Facilitate normal recovery processes
• Restoration to adaptive function

To provide:
• Temporary
• Active
• Supportive
• Confidential
Assistance to aid the individual in crisis

Not
CISM is NOT a function of/to:
• Professional standards/internal affairs
• Determine fitness for duty
• Determine if policy was followed
• Determine if state law was followed
• Pass judgment on someone’s actions

CISM helps by providing:
• One-on-one peer support
• Demobilization of information
• Crisis management briefings
• Defusing
• Critical incident stress debriefings

Peer support is provided to individuals:
• Mitigate symptoms
• Return to previous level of functioning
• Provide referrals if needed

This occurs:
• At shift disengagement
• To inform and consult
• Provide psychological decompression
• Stress management
• Typically occurs in large groups

This occurs:
• At anytime post crisis
• To inform and consult
• Provide psychological decompression
• Stress management
• Typically occurs in large groups

This occurs:
• Post crisis (within a 12 hour time period)
• To address symptom mitigation
• To assist with providing possible closure
• Triage of services and presenting symptoms
• Typically occurs in small groups

Critical Incident Stress Debriefing
This occurs:
• Post crisis (occurs within 1-10 days, 3-4 weeks following mass disasters)
• Facilitates psychological closure
• To address symptom mitigation
• Triage of services and presenting symptoms
• Typically occurs in small groups

• Temporary
• Active
• Supportive
• Confidential
• Assistance to aid individuals involved in crisis situations

The CISM Team consists of:
• Team Coordinator
• Team Leader
• Team Members
• Mental Health Professional
• Police Chaplin Volunteers

• Specialized crisis intervention training
• Small or large group crisis tactics
• Recommended 50 to 80 hours of crisis intervention training in specialized areas

Team members:
• Have a responsibility and duty to keep information confidential
• Shall not accuse or blame others of wrong doing
• Shall refrain from engaging in any discussion involving responsibility or blame

• Responsibility of On-Scene Commander
• Notify the CISM Team Coordinator of:
– Officer involved shootings
– Employee suicide
– Mass casualty incident
– Death or life threatening injury to a child
– Incidents producing a high level of immediate or delayed emotional reaction

Team members should:
• Avoid direct involvement in the incident
• Make contact with the involved employees
• Separate the employee from the scene if approved
• Ensure involved employees are allowed to contact family members if desired
• Assist the involved employee until stabilized

Team members should ensure employees:
• Are allowed to stabilize/calm down in a private environment
• Permitted to shower and change when approved for such action
• Have clergy and other spiritual needs met
• Have food and drink if desired
• Encouraged to seek follow up counseling, if needed

• Negatively impacts all involved
• Can lead to faulty decision making
• Increased disciplinary problems

• Excessive use of sick leave, tardiness, and onthe-job accidents
• Increased citizen complaints
• Re-occurring officer turnover

• Is for the employee experiencing a normal reaction to an abnormal event
• Is to help the employee recover quicker from such an event
• Is temporary, active and supportive
• Is confidential

Every year, hundreds of officers experience intense, traumatic events that can have serious long-term consequences for them, their families, and their departments.

It is incumbent upon police administrators to ensure that their officers and their departments have the tools at hand to cope with such.

Conclusions
• Discussed the importance of dealing with critical incident stressors immediately following the traumatic event
• Identified the deleterious impact of psychological and physiological stressors on first responders who frequently encounter traumatic stress

Conclusions
• Discussed the importance of seeking CISM services to break the code of silence among first responders

Questions concerning CISM should be directed to:
Daytona Beach Police Department CISM Team
Chuck Russo, PhD russoc@dbpd.us
CharlesRusso7@mycampus.apus.edu
ChuckRusso@SPSGrp.com