Welcome
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Critical Incident Stress
Management (CISM)
Jim Crowley
Mike Dismore
Chaplains Central Oregon
Police Chaplaincy
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Americans Say They:
 Need More Fun
68%
 Need a Long Vacation
67%
 Often Feel Stressed
66%
 Feel Time Is Crunched
60%
 Want Less Work, More Play 51%
 Feel Pressure to Succeed
49%
 Feel Overwhelmed
48%

Some statistics from a survey by Hilton Generational Time Survey, Jan 2001
 We Are a Stressed Out Society
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Agenda
 What Is Stress & Its Causes
 Types of Critical Incidents
 Who Is Susceptible?
 Symptoms of Stress
 Resources
 Confidentiality
 Helpful Ideas
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Objectives:
List elements of stress in the emergency
services profession
Understand how a balanced lifestyle reduces
critical incident stress reactions
Understand situations in which critical
incident stress may develop and what may
worsen them
List the CISM services available
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It is not my intention to bore you!
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What is stress and its causes?
 Stress Is Caused When Our Sense of
Order or Right Is Upset
 Critical Incident Stress Defined:
 Normal Reactions of Normal People to
Abnormal Situations
 Any Incident Which Causes Us to
Experience Unusually Strong Emotional
Reactions Which Interfere With Our Ability
to Function, Either During the Event or
Later.
 Life Is Full Of Abnormal Events!
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STRESS: The Good
The Bad
The Ugly
 Eustress (necessary stress) to keep us
motivated to accomplish things in our lives,
i.e.: bills we need to pay motivates us to go to
work, boredom motivates us to take up
activities.
 Distress (too much stress) can overload us
and cause a variety of emotional, physical,
cognitive and spiritual reactions, if left
unresolved
 Chronic Stress (burn-out) can disable us and
in extreme cases cause and/or contribute to
death.
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Stress Will Catch You Unaware
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Just When You Think you are OK
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Critical Incident Stress
 Occurs when you experience an
unusual or extreme emotional reaction
after exposure to an event that is
overwhelming to you. This is subjective
based on each individual’s life
experience and belief systems.
 What is overwhelming to one person
may not be overwhelming to another
person.
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Cumulative Stress
 Occurs when a person’s normal coping
mechanism are continuously overwhelmed. It
can also occur when you don’t build in daily
self care activities that are regenerative and
stress reducing.
 Cumulative stress reactions are very
debilitating. People begin to believe that
frequent headaches, acid stomach, irritability,
poor concentration, are normal. This
produces further stress which can lead to
serious physical and emotional illnesses.
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Delayed Stress
 In some cases stress reactions to an
overwhelming event do not occur until
days, weeks, months or even years later.
They are just as debilitating and impacting
as a recent event.
 Delayed stress can occur when people go
into shock after an event, refuse to
acknowledge the impact of the event, or
when exposure to an event is prolonged.
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What Are Common Stressors?
 Change in Family
 New Kids

Baby
 Blended Families
 Teen Age Children
 Empty Nest
 Spousal Tension
 Divorce
 Change in Your Society
 Loss of Family Member
 Strained Relationship

Family or Work
 Moving to New Digs
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Stressors (Work)
 Administrative Decisions
 I May Not Agree With Fully
 Operator Decisions
 That Might Find Conflict With Administration
 Shift Changes
 Rotating shifts
 Peer Relationships
 Health Problems
 Those That Drain Us

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Lingering Colds, Etc
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A Small Example Of Stress
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Common Stress Triggers
 Argument With Significant Other
 Argument With a Child
 Old Age Parent Care
 Traffic Congestion
 Travel by Air
 Traffic Ticket
 Job Change in Family
 Rebellious Child
 Extended Family Relationships
 Return To Work
 Report Writing - Paperwork
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Factors Affecting
Stress Responses
Duration
Multiplicity
Situational Importance
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Performance and Efficiency
Cumulative Stress Reaction
Critical Incident Stress Reaction
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Emergency Services Philosophy
We the Willing
Led by the Unknowing
Have Been Doing the Impossible
For the Ungrateful.
We Have Done So Much
For So Little,
We Are Now Qualified
To Do Anything With Nothing.
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Some Facts
 80% of All Non-trauma Deaths Are Caused
by STRESS
 Chaplains Typically Live Longer (Joke)
 Law Enforcement & Emergency Services
Personnel Under Extreme Traumatic
Stress Will Manifest the Same Symptoms
As a DRUNK
X
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More To Think About
 Police Stats:
 140-170 Officers Killed in Line of Duty
Each Year
 Police Suicides are a reality
 There IS a Need for Stress Management
Within the Emergency Service Community
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Personality Profile of Law
Enforcement & Emergency
Services Personnel
 Obsessive/compulsive  Rescue Personality
 Very Controlling
 Driven by Internal
 Action Oriented
 Detail Oriented
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 High Need for

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Stimulation
Easily Bored
Dedicated
Risk Taker
Needs to Be Needed
Can’t Say NO
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Motives
Good Guy Vs Bad Guy
High Tolerance for
Stress
Ambiguity Toward
Stress
Goal Oriented
Family Oriented
Others
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Comprehensive CISM Program
Why have a critical incident
stress management program?
We can learn from past
experience.
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Comparison
Both Airliners Collided with Small Planes
San Diego
Cerritos
September 25, 1978
August 31, 1986
Total Killed From Planes
137
Plane Survivors
0
Homes Destroyed or Damaged 22
Killed On Ground
7
Emergency Personnel
+/-300
Body Parts Found
+/-10,000
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0
12
15
+/-300
+/-10,000
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Comparison
“Twin” disasters
Support Services Provided
San Diego
Cerritos
 Sporadic One on One  On Scene One on One
 Demobilizations
 12 Debriefings
 Hot Line Number
 One on One Follow Up
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Comparison
Personnel Lost in 1 Year
San Diego
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Cerritos
Police
Fire
Paramedics
Dispatch
5
7
17
?
0
0
1
?
Increase in
Mental Health Use
31%
1%
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Critical Incident Stress Management
Core Components
 Pre-incident preparation
 Demobilizations
 Crisis Management Briefings
 Defusings
 Critical Incident Stress Debriefing
 Individual crisis intervention
 Family/organizational CISM
 Follow-up/Referral
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Critical Incident Stress
Management (CISM)
 Pre-incident Traumatic Stress Education
 Before It Happens – TRAINING
 CISM Is Managing Stressors of Life
 On scene Support
 Support for Dispatchers (New Concept?)
 Significant Other
 Family
 Peer Team work - IMPORTANT
 Professional Counseling
 Specialty Defusing and Debriefing
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Critical Incident Stress Management
 CISM Is a Comprehensive, Multi-
component Crisis Intervention Program
 A Useful Stress Management Concept Is to
Reduce or Eliminate the Use of Self
Medication During Periods of Increased
Work-related or Personal Distress
 To Prevent Being “Crippled By Stress”
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Forms of Self Medication
 Coffee - Tea
 Soda (With Caffeine)
 Drugs (Both Legal and Illegal)
 Tobacco Products
 Alcohol
 Eating Disorders
 Sweets (Chocolate)
 Diet Pills
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Self Medication - Emotions
 Anger
 Affairs – Pornography Addiction
 Shopping – Malls or Internet
 Complaining – Grumbling
 Abuse – Physical, Verbal, Sexual
 Self harm
 Gambling
 Others
Refuse to give stress
permission to shape your
reactive emotional response
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Notice the Teamwork Emphasis
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Team Work
“We’re Not Just Building A
Plane Here, We’re Building A
Dream”
Our Goal as Chaplains is to
Build on Their Teamwork to
promote wellness in each life.
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Team Management
 The team concept of stress management
involves each member to support and
encourage those who may be experiencing
adverse emotional or physical symptoms
due to a stressful incident(s)
 Discussion of incidents among members
is often enough to avert serious problems
if used on a regular basis
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Team Cooperation
 Avoid put-down comments
 Realize some incidents can be
extremely stressful for some while
routine for others – Allow for it!
 Talk over every incident
 Post Incident - Ask questions like –
How did this incident affect you?
Did this one bother you? What are
you thinking?
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Team Confidence
 Keep comments positive
 Avoid terms like
“You can handle it”
 “Buck-up wimp”
 “Get a grip”
 “Greenhorn”

 Be supportive and listen, listen, listen
 Never Never share a co-worker’s stress
reaction with others as gossip
 If a co-worker displays symptoms of
stress overload, go with them to get help
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Defusing
Defusing means to render something
harmless before it can do damage.
A small group intervention applied
within hours of a critical incident.
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Defusing
 Shortened Version of CIS Debriefing
 20 Min to 1 Hour Intervention and
Teaching - Often During Same Shift
 Factual in Nature
 What Did You Feel
 Not Fact Finding
 Not an Investigation
 Strictly Confidential
 Allows Impact to Be Dealt With
Quickly
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Debriefing
 1 ½ to 3 Hours Group Meeting to
Reduce the Impact of an Event and
Accelerate Recovery of Personnel
 Deals With a Serious Incident to
Assess Personnel Impact
 To Promote Re-entry to Normalized
Work
 Strictly Confidential
 Done With CISM Team
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Some are Oblivious – Others Not
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Types of Critical Incidents
 Not Limited to These:
 Line of Duty Death or Injury
 Serious Threat to Significant Others or Self
 Suicide of Co-worker or Family
 Multiple Casualties
 Injury or Death of a Child
 Personally Known Victims
 Prolonged Incident
 Excessive Media Coverage (reminders)
 Community Wide Disasters
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Burnout Defined
A state of mental,
physical and emotional
exhaustion
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Burnout or Cumulative Stress
 Mix of Home and Work Stress
 I.E. Divorce Rate For Law
Enforcement and Dispatch
 Builds up Over Time
 Erodes Personal Resources
 Normal Coping Mechanisms
 Often Is Cause of Depression
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Burnout - First Stage
Arousal
 Leading To: Anxiety, Panic, Difficulty
Concentrating, and Feeling Out of Control
 Physical Symptoms:
 Tachycardia – Fast Heart
 Arrhythmias – Irregular Heart
 Gastrointestinal Distress – Stomach
 Rashes (Shingles)
 Acute Elevation in BP
 Muscle Tensions and Spasms
 Headaches+
 Diaphramatic - Respiration
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Burnout - Second Stage
Energy Conservation
 Displays Procrastination
 Lateness
 Absenteeism
 Increased Stimulant Usage
 Withdrawal, Avoidance
 Personality Shift
 “That’s Not Like You”
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Every Day Is a Monday
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Burnout - Third Stage
Exhaustion
 Feeling Hopeless / Helpless
 Fully Developed Depression
 Serious Consideration of Job Change
 Serious Consideration of Changes of
Personal Living Situations (I.E. Divorce)
 Desire to Withdraw / Take a “Geographic
Cure”
 Substance Abuse
 Contemplation of Self Destructive Actions
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Who’s Susceptible to CIS?
 Any Person Who Is Traumatized by a Bad Scenario
 Hearing, But Not Able to See the Incident
 Family Members in Tragedy
 Close Friend – Resident
 Child Death by Abuse or SIDS, Etc
 Multi Fatality Incident
 Mass Casualty
 No Closure After an Incident (Dispatch?)
 Basically Everyone Is Susceptible
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Post Traumatic Stress Disorder
 PTSD – Problem Identified After Viet Nam
 Not New – Problem Has Always Existed
 Seen in People With Extensive Trauma From
Incidents (Think of Viet Nam)
 Flight Home Versus Ship Ride Home
 Lack of Time to Process
 90% US Adults exposed to major trauma in a
lifetime
 1-3% General Population End Up with PTSD
 10-15% of Law Enforcement end up with
PTSD
 Dispatch, EMS and Fire, and SAR are
similar
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Symptoms of stress physical
May require medical attention by physician
 Muscle Tremors
 Chest Pain
 Fatigue
 Difficulty Breathing
 Chills
 Elevated Blood
Pressure
 Rapid Heart Rate
 Sweating
 Gastro-intestinal  Weakness
Distress
 Headaches
 Dizzy Spells
 Visual Problems
 Hunger
 Sensitivity to Noise
 Sleep Disorder
 Hic-cups
 Nausea
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Symptoms of Stress
Thinking
 Confusion
 Poor Attention
 Poor Decision Making
 Altered Alertness
 Poor Concentration
 Hyper Vigilance
 Poor Problem Solving
 Nightmares
 Sleep Irregularities
 Intrusive Images (Flashbacks) -
Recurring Sounds
 Regrets – Woulda Coulda Shoulda
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Symptoms of Stress
Relational
 Isolated
 Resentful
 Lonely
 Lack of Intimacy
 Lashing Out
 Social Withdrawal
 Intolerant of Others
 Nagging
 Assaultive
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Symptoms of Stress
Emotional
 Emotional Numbness  Anxiety
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 Withdrawal, Lack of
 Guilt
Enjoyment
 Emotional Shock
 Feeling
Overwhelmed
 Hopeless & Helpless
 Panic Feelings
 Loss of Emotional
Control
 Loss of Confidence
in Future
 Grief
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 Denial
 Fear
 Uncertainty
 Depression
 Intense
Anger
 Irritability
 Apathy
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Symptoms of Stress
Behavioral
Clues To Stress Overload
 Overly Protective of Self
& Family
 (Over Jealous, Restrictive)
 Suspicious
 Appetite Changes
 Increased Self
 Overly Alert, Easily
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Startled (Jumpy)
Sleep Habit Changes
Avoidance Behaviors
Increased Conflicts at
Home & Work
Changes in Association
With Fellow Workers
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Medication
Tearful
Changes in Personal
Hygiene
Prolonged Silences
Loss of Interest
Withdrawal
Abusive
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We need to take care of ourselves!
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Spiritual Stress Symptoms
 Religious Reappraisal
 Questions About Reality/meaning/justice/fairness
 Asking Core Questions “Why Me” – “Why Did God”
 Needing Reassurance of God’s Presence & Power
 Question the Power of Prayer
 Feelings of Hopelessness and Fatalism
 Questioning Core Faith and Spiritual Values
 Guilt, Shame
 Changing Assumptions About Life and Afterlife
 Feeling Need to Be Punished
 Needing Acts/rituals of Purification
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Often Overlooked Help
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Results of trying to do too much
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Things to Try When Stressed Out
 Talk to People – Talking Is Healing
 Reach Out – People Do Care
 Maintain As Normal a Schedule As
Possible (Maintain Goals)
 Do Things You Enjoy Doing
 Avoid Self Medication
 Alcohol, Caffeine Tobacco, Diet
Pills, Drugs, Etc
Don’t Let Pride Keep You
From Help!
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Find A Way To Laugh
 A cheerful heart is a good medicine,
but a downcast spirit dries up the
bones.
 Medical Science is proving this is
true
 A Good Sense of Humor Adds To
Life
 Be Creative – Find What Makes You
Laugh
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Good Back Massage Helps
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When Stressed Out . . .
 Avoid Making Major Decisions
 Get Plenty of Rest
 Eat Well-balanced and Regular Meals
 Exercise to Reduce Physical Stress
 Share This Information With Significant
Others
 Seek out a trusted Spiritual Counselor
 World Wide Web Resources
 Stress, ICISF
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CISM And Family Systems
 Within a law enforcement career,
families are affected by situations
outside of their control.
 Police (for example) are trained in
crisis situations …
 . . . Families are NOT!
 What happens at work affects the
family, just as events at home affect
you while on duty.
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When your spouse is a
First Responder
 Listen Carefully
 Spend Time With the Person Affected
 Offer Your Attention and Listening Ear
 Reassure Them That They Are Safe
 Give Them Opportunities for Private Time
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For Family Members & Friends
 Don’t Take Their Anger or Feelings
Personally
 Familiarize Yourself With What
Affects Families
Signs & Symptoms of Stress
and Emotional Trauma
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Social Life
 Expand Your Life Outside of The
Agency
 Friends
 Faith Community
 Community Services
 Recreational Outlet
 Enjoy a Hobby
 Find a Balance of Work and Outside Activities
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Enjoy a Hobby
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Or try a new hobby
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Resources
 Chaplain – Talk to One
 They Will Maintain Confidentiality
 Peers – Talk Over the Incident
 Leadership
 They Likely Have Been There
 Massage Therapy
 Mental Health Providers
 Trained in Stress Management
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Confidentiality
 What You Discuss Is to Remain Confidential
 Defusing – for Exploring Emotional Reactions
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Not Hashing Over Facts
Defusing Should Be SOP for Stressful
Incidents
Debriefing – for in Depth Look Into the Impact
of a Critical Incident on the Emotional Morale
of the Emergency Workers Present, Including
Multiple Agencies and Dispatch
Debriefing Should Be Used, But With
Discretion
Discussion Stays Within the Room
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Wheel of Success
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 Diet - Fueling your body for Peak Performance
 Some bodies do better with meats, poultry, fish,
some do better with a vegetarian diet.
 Food’s Negative Effects:


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

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Chronic Illness
Physical Complaints
Sleep disruption
Emotional Response
Allergies
Energy Depletion
Inability to Concentrate
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 Cardiac Fitness ~ Muscle Strength ~ Flexibility
 Exercise is critical for the development of certain
neurotransmitters in the brain, called endorphins.
Endorphins help us develop a sense of well being
 Aerobic activity after a stressful event will help release the
stress response from the muscle.
 Exercise can conflict with the immune system during times
of illness. You might need to rest while it is regenerating.
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 Research shows that having a stable sleep schedule
and enough sleep every day is essential to physical and
psychological health.
 It takes 30 days for your body to readjust every time
you change your sleep schedule or get less sleep than
your body needs. You cannot “make-up” sleep you can
only get back into balance.
 Workers who are subjected to chronic changes in sleep
schedule have a higher risk for cardiovascular disease,
neurotic disorders and depression; poor diet:
disruptions in appetite, diarrhea, constipation &
diabetes.
 Symptoms of Sleep Deprivation: difficulty
concentrating; irritability; depression; memory loss;
cognitive disorganization (can’t think clearly); chronic
fatigue, anxiety.
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Family
 Human beings are social by nature Humans are
nurtured by love from another. Families are an
important source of support and help regenerate
you. Having good conflict resolution skills is
critical in a family.
 Your work relationships act like an extended
family.
 There is never a good reason to neglect time with
family or adoptive family (a family you have
chosen to be a support to you).
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Friends
 Enjoy time to play and interact with others is critical.
 Work friendships mean “Minimal shop talk” while off
duty.
 Playing, laughing, time to share opinions and receive
support all help bring a sense of well-being and
stability emotionally and psychologically.
 Enjoyment and fun helps your physical body release
tension and stress.
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Job
 Money is a frequent stressor in life. People often
define who they are by their job and/or wealth.
 Stay within your means.
 Occasional overtime is fine (Eustress) but don’t
become dependant upon it (Distress).
 Are you a Workaholic?
 Having hobbies, friends, stability with family, spiritual
activities, helps define who you are. If your work gets
disrupted and you have time off you will need these
other areas to keep you from boredom.
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Rebuild
 Engaging in activities that bring you a sense of
peace, calm and accomplishment decreases stress
in your life. Meditation and prayer are a restorative
activities.
 Those who do these kinds of activities tend to
recover from stressful events much easier.
 It is important to take time every week (every day if
possible) to do things that calms your nervous
system.
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Spirituality
 Spirituality can be the foundation to all of the
previously covered areas. Whether you have a
specific spiritual practice, religious belief or just live
by a sense of ethics within yourself, it is important to
have an internal moral compass and means to
assess how you are with that moral compass.
 Finding time for yourself to review where you are
with your ethical, moral, spiritual or religious beliefs
is a proactive way of heading stress off and can
reduce your vulnerability to stress reactions
resulting from any critical incident.
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A Balanced Lifestyle
 Learning to balance all aspects of life is
critical to managing stress
 You will find help when you apply the
following principles
 Each is designed to get you to think of
what you do and manage every aspect of
your life.
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Basic Principle
 Surround yourself with healthy people
 People with few problems
 You deal with the others all day (night)
 Adding an outward focus is beneficial
 Helping others is often is the best way to
help yourself.
 Putting others first is most rewarding
 The only real balance is to “look up and
out” not inward
 Pets may help.
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Some Restorative Activities
 Humorous Movie
 Sponsor or Coach a
Sport Team
 Be a Scout Leader
 Read a good book
 Join a Church Group
 “Take a hike”
 Bowling
 Ride a Bike
 Roller Skating
 Volunteer service
 Tennis
 Gardening
 Gym Workout (Regular)
 Crafts
 Sports (participatory)  Walk With A Friend
 Your Ideas
 Ski Trip
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Your Job and Stress Management
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Objectives: How did we do?
List elements of stress in the emergency
services profession
Understand how a balanced lifestyle reduces
critical incident stress reactions
Understand situations in which critical
incident stress may develop and what may
worsen them
List the CISM services available
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Thank-You For Serving All!
 You Are The Voice Of Calm In the Storms
 You Care When There is No One Else.
 You Offer Help To All In Need
 And Some not so needy
 Bless You!
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Contact Info
COPC Office; 325 NE Kearney Ave.
Bend, OR 97701
COPC (Mail); PO Box 1898
Redmond, OR 97756
Chaplain Jim Crowley; (541) 410-6128
jbcrowley@bendbroadband.com
Chaplain Mike Dismore; (541) 788-3364
pastordiz@juno.com
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