Critical Incident Stress Management (CISM)
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National Guard Critical Incident Stress Management (CISM) Trained Crisis Responder Program LTC Clarence Bowser State Family Programs Director Overview TCR Briefing for Command Military References… Trained Crisis Responder (TCR)… Crisis Intervention… Critical Incidents… Post-Traumatic Stress… TCR Services… Rationale… References TCR Briefing for Command DoD: 6490.5 – Combat Stress Control Program Air Force: AFI 44-153 – Critical Incident Stress Management AFI 34-1101 Survivor Assistance Army: Field Manual FM 16-1, Annex F-1 "Critical Event Debriefings" Trained Crisis Responder TCR Briefing for Command The National Guard TCR Program was developed from Critical Incident Stress Management (CISM) principles… Crisis Intervention TCR Briefing for Command “CISM is a subset of the general field of Crisis Intervention (CI) and may be thought of as the application of Crisis Intervention knowledge and techniques to high risk groups, e.g., emergency services, military, etc.” (J.T. Mitchell, G.S. Everly, 1995) CISM Services TCR Briefing for Command Trained Crisis Responders are the first line of defense in coping with Post-Traumatic Stress Reactions to Crisis events. CISM Services extend beyond the training levels of Trained Crisis Responders, therefore it is important for the TCR’s to work in concert with military and civilian CISM Teams… CISM Core Components TCR Briefing for Command Pre-Crisis preparation Demobilization Crisis Management Briefing Defusing Critical Incident Stress Debriefing Individual crisis intervention 1:1 Family CISM Community consultation Pastoral Crisis Intervention Followup/Referral Trained Crisis Responder TCR Briefing for Command Trained Crisis Responders provide psychological and emotional “Self-Aid and Buddy-Care” Spectrum Of Care TCR Briefing for Command Incident Crisis Intervention EAP TCR’s CISM Legal Chaplain Mental Health Psychotherapy Hospitalization Refer where needed… Family Support Rehab Critical Incidents TCR Briefing for Command Major Accidents (Air Crashes, etc.)… Line of Duty Death(s)… Serious Line of Duty Injury(s)… Suicide of a Co-Worker… Disaster / Multi-Casualty Incident(s)… Shooting(s)… Critical Incidents TCR Briefing for Command Significant Events Involving Children… Prolonged Incident(s) - Especially with loss… Excessive Community Media Interest… Any Significant Traumatic Event… Primary Goal TCR Briefing for Command CISM and the TCR Program are forms of crisis intervention designed to help reduce PostTraumatic Stress Reactions to Critical Incidents… Post-Traumatic Stress TCR Briefing for Command Post - traumatic stress is a normal reaction, in a normal person, to an abnormal event. Hallmarks of Crisis Intervention TCR Briefing for Command Immediacy Proximity Expectancy Brevity Practical It’s learning how to toss a life raft, not a course in ship building Post traumatic stress TCR Briefing for Command Is everyone who experiences traumatic distress suffering from the disorder know as Post Traumatic Stress Disorder? NO.. NO ..NO Post Traumatic Stress Disorder TCR Briefing for Command PTSD represents a contradiction to some critically important assumption or belief about self and/or the world. (G.S. Everly, 1995) Post Traumatic Stress Disorder TCR Briefing for Command A pathological and disabling variant of a normal stress reaction Very clear criteria …symptoms must be over 30 days and it is impairing function Important TCR Concept TCR Briefing for Command The TCR Program is NOT a stand alone process. Rather it is meant to be one part of a comprehensive CISM intervention program. TCR Services… TCR Briefing for Command TCR’s can be in any section (personnel, security forces, fire, chaplain, medical, family support, etc.)… TCR’s are normally among your first responders to an incident… TCR’s can support official military and civilian CISM Teams… TCR Services… TCR Briefing for Command Pre-incident education, preparation… One-on-one crisis intervention… Demobilizations (large groups of public safety)… Crisis Management Briefings [large groups of primary, secondary (emergency personnel), and tertiary (family, co-workers, etc.) victims] TCR Services… TCR Briefing for Command Family Support… Organizational / Community intervention, consultation… Follow-up and referral for TCR’s & CISM services and/or continued care… Rationale TCR Briefing for Command Why have TCR’s and CISM programs? We can learn from past experience. 141 ARW Suicide TCR Briefing for Command December 1998 - Fairchild AFB WA Just-retired Wing Commander Prior incidents in unit Impact on unit Chaplains from outside called in for first UTA following incident Ministered to entire wing 141 ARW CRASH TCR Briefing for Command Six weeks after suicide of commander Four members killed in Germany Chaplains called from outside; some had just been there Assigned to each family to assist local clergy and chaplains Memorial Service and Funerals Red Horse Crash TCR Briefing for Command March 2001 Army NG Sherpa crashed over Ga. 18 ANG and 3 ARNG members killed Chaplains called in for ministry Memorial Service and Funerals Continuing care for families Red Horse, cont’d TCR Briefing for Command Late July - Early August report Some possible questions Chaplains and Line Colonels formed teams for each family Trained at Langley then deployed There to walk families through report and to offer pastoral care Comparison TCR Briefing for Command San Diego, CA Air Crash - 1978 Total Killed 125 Plane Survivors 0 Homes Destroyed 16 Killed On Ground 15 Emergency Personnel 300 Body Parts Found 10,000 Cerritos, CA Air Crash - 1986 82 0 16 15 300 10,000 Comparison TCR Briefing for Command Support Services Provided San Diego, CA Cerritos, CA Air Crash - 1978 Sporadic One on One Air Crash - 1986 On Scene One on One Demobilizations 12 Debriefings Hot Line Number One on One Follow Up Comparison Personnel Lost in 1 Year TCR Briefing for Command San Diego, CA Air Crash - 1978 Police Fire Paramedics Increase in Mental Health Services 5 7 17 increase of 31% Cerritos, CA Air Crash - 1986 - 1 1% increase of Rationale TCR Briefing for Command Trauma and stress-related disorders are sometimes disabling and costly to treat… Interventions are designed to assist in preventing “burnout” and PTSD… Healthy employees are more productive and effective on the job… Example 1… TCR Briefing for Command 100 trauma victims Intervention began after 6 months Average cost = $46,000.00 ea. 94% filed civil litigation Friedman, et al, EAP Digest, 1988 Example 2… TCR Briefing for Command 100 trauma victims Intervention began within 6 months Average cost = $8,300.00 ea. 13% filed civil litigation Friedman, et al, EAP Digest, 1988 Rationale TCR Briefing for Command On any given trauma/disaster, 4%-97% of the individuals exposed will develop Symptoms similar to PTSD. 16-30% of emergency responders are at risk of developing PTSD symptoms. Rationale TCR Briefing for Command Disaster / Trauma planning (including CISM protocols) is appropriate for not only emergency response personnel and institutions, but for all business and industrial (and military) settings as well. Yandrick, EAPA Exchange, 1990 Main Goal TCR Briefing for Command Trained Crisis Responders help keep your team on the job! Academy for Innovative Ministry TCR Briefing for Command WHERE YOU CAN LEARN THIS STUFF! Ch, LtCol Charles E. Woods Chief, Crisis Intervention McGhee Tyson ANG Base, TN AIM COURSES TCR Briefing for Command AIM course offerings available on-line: https.//tys.tnknox.ang.af.mil/AAIM/AAIM.HTM This web site is accessible from a ".mil" computer only! CHAPLAIN SERVICE AND FAMILY SUPPORT TCR Briefing for Command WHY DO CHAPLAINS EXIST? - First Amendment - ‘Provision without establishment’ Requirements Skills ‘neutral zone’ 100 % Confidentiality Chaplain Service and Family Support TCR Briefing for Command LET’S TALK!
