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OG 4.9 Critical Incident Stress Management
Terms in this set (33)
Critical Incident Stress Management (CISM)
is a process designed to reduce stress and enhance recovery from a traumatic event based upon principles of crisis intervention and education.
A traumatic event is?
any situation that causes strong emotional reactions that have the potential to interfere with an emergency worker's ability to function on-scene or negatively impact their job performance and personal life.
The very nature of the firefighter occupation exposes personnel to traumatic events that they may or may not be able to work through satisfactorily on their own. Factors that cause stress to one individual may be non-stressful for another. Research has shown that only a very small percentage of emergency workers are not affected by traumatic events.
Approximately what percentage of those who demonstrate symptoms can resolve those alone?
Approximately one-half of those who demonstrate symptoms related to traumatic events can resolve these alone; the other half continue to be affected.
Response to traumatic events may be immediate and incident specific, or may be cumulative, building up over a long period of time and including many incidents. Exposure to traumatic events can lead to?
Post Traumatic Stress Disorder (PTSD). PTSD is a serious mental condition that, when left untreated, can have a significant negative impact on the health and wellness of emergency responders.
-Portland Fire & Rescue is committed to providing education to recognize events that can lead to PTSD and provide specific procedures proven to maintain the mental health and wellness of emergency responders.
Sources for Individual Counseling
PF&R offers inter-personal, family, and mental heath services to members of PF&R and their families through the Employee Assistance Program (EAP) which contracts with Cascade Centers or the City Select and Kaiser Medical plans.
-For a synopsis of the City Select and Kaiser benefits, refer to the current "Benefit Highlight" brochure found in your station library. Contact PF&R's EAP Coordinator at (503) 502-1998 for assistance in accessing mental health services.
The Peer Support Team is a component of?
EAP and is a voluntary and confidential resource for all PF&R employees and their family members.
-Peer Support Team volunteers are sworn and non- sworn PF&R personnel of all ranks. Volunteers have been trained to provide assistance to co-workers experiencing problems ranging from work-related issues to personal problems like divorce, financial strain, parenting or elder-care concerns, serious illness, or death.
The concept of peer support builds on the well- established tradition of firefighter helping
firefighter. Because of the unique demands of the job, many firefighters prefer to talk to someone who comes to the conversation with an understanding of what being a firefighter is like. Peer Support Team members are trained to be effective listeners and to provide feedback, clarify issues, and assist co-workers in identifying options for problem solving. When appropriate, the peer supporter will assist the member with referrals to mental health professionals or other outside resources.
With Peer Support....Typically, people will be matched up with someone of the same?
rank and gender, and, when appropriate, with someone with expertise or experience in the area of concern.
-Peer support is available 24 hours a day, 7 days a week. Peer Support Team members may be contacted directly, or contact the EAP Coordinator at (503) 502- 1998 for help in finding a peer supporter who is a good match.
Our contracted mental health provider is?
Cascade Centers, which offers five free visits per fiscal year per family member. The diversity of services provides an array of mental health resources, including social workers, psychologists, psychiatrists, nurse practitioners, and critical incident response personnel. Cascade Centers has many providers in the greater Portland/Vancouver Metro area. The phones are staffed with Masters level counselors who can provide advice and make appointments with other professionals. To access Cascade Centers 24-hours a day, please call 1-800-433-2320 or text 503-980-1777.
Peer support personnel will provide?
support, information, and referrals to individuals involved in critical incident situations.
The CISM Team consists of?
1) EAP Coordinator
2) mental heath professionals
3) peer supporters
4) a chaplain.
They will provide an organized approach to the management of stress responses for firefighters having been exposed to, or showing signs of, traumatic stress experienced in the line of duty.
CISM consists of the following areas of support:
On scene support for community members:
One-on-one peer counselors, contacted after the event, providing understanding, feedback, problem solving, and referrals. Counseling is available through Cascade Centers. Cascade Centers can also assist with critical incidents involving personal or family related issues not associated with on-duty response.
On scene support for community members:
Used only on significant events. This is a brief crisis intervention with those in distress. Assistance is given to victims, survivors, and family members directly involved in the event.
A group intervention used after a large-scale event to provide information on critical incident stress. It is a transition from the event to routine. Demobilizations allow for normalization and assessment when personnel are released from scene. Performed by mental health professionals and off-duty peers. Demobilization can be followed later by a debriefing.
Rapid, brief interventions immediately following a disturbing event. This is an informal, shorter debriefing with a small number of personnel immediately after the event. Defusings are used to provide facts, minimize rumors, and literally reduce the emotional sting of the event. A defusing session led by two or three peer counselors ordinarily lasts less than one hour and prepares the worker to return home with a lighter emotional burden. If needed, a more intense debriefing can be organized.
A formal group educational intervention designed to mitigate stress responses to a critical incident. The process will address the fallacy of uniqueness and abnormality, and increase group cohesiveness.
If it is found that a debriefing is warranted, the Oregon Critical Response Team will be contacted.
Oregon Critical Response Teams consist of?
consist of both mental health professionals and peer support team members.
A debriefing is optimally conducted within __________ hours of the incident?
24-72, and generally not beyond one-week. A 24-hour normalizing period following the incident is recommended. If large numbers of individuals are involved, debriefing begins with those most involved with the incident.
What kind of location should be selected for a debriefing?
A location should be selected for the debriefing that is free of distractions and represents a neutral environment (e.g., school, church, or other meeting facility as opposed to a fire station).
Other emergency personnel involved in the incident should be invited to the debriefing and encouraged to attend. This includes, but is not limited to, fire, law enforcement, dispatch and emergency medical services (EMS) personnel.
A time for the debriefing should be selected that is most convenient for those responders anticipated to attend.
In rare instances, a group intervention may not be appropriate for an individual. Company officers should be cognizant of this fact and notify who?
EAP Coordinator if they feel a member of their crew may fall into this category. If a member is excused, they will be contacted personally by the EAP Coordinator for subsequent follow-up.
Conducted weeks or months after the incident. Concerned with delayed or prolonged stress symptoms.
When a situation is identified as a potential traumatic event, PF&R's CISM structure should be notified. Such incidents may include, but are not limited to the following:
1) Serious injury or death of a PF&R member in line of duty.
2) Death or serious injury of police officer when PF&R personnel are involved.
3) Loss of life of a patient following extraordinary and prolonged expenditure of physical and emotional energy during rescue efforts by emergency services personnel.
4) Serious injury or death of a civilian resulting from PF&R operations. This could include injury or death of a civilian as a result of a collision with an emergency vehicle.
5) Traumatic death or violent injury of a child.
6) An incident that is charged with profound emotion (e.g., firefighter placed in danger due to firearms, hostage situation, or threats of physical harm).
7) Incidents that attract extremely unusual or critical news media coverage.
8) Mass casualty incidents.
9) Suicide of a co-worker.
10) Victims known to emergency personnel.
Because of the time involved in even a minimal CISM response (thirty minutes to an hour) activation to a scene must be limited to extended operations. Any member observing a need may contact the?
incident commander (IC), through the chain of command, to initiate CISM.
Who does the IC notify?
IC notifies the Fire Dispatch Liaison
Fire Dispatch Liaison pages who?
-the EAP Coordinator, (503) 502-1998, and if not already on scene, the battalion chief and on-duty Emergency Operations (EOPS) Deputy Chief (C103) with incident type, address, and cell phone number of the IC.
What will the EAP coordinator do?
-EAP Coordinator phones the IC. Together they will determine the appropriate level of on-scene response.
-The EAP Coordinator will contact each on-scene company officer to determine whether their crew was involved to the extent that a defusing or debriefing would be beneficial. Once the companies are selected, the company officers will assure that all members of the affected crews will attend and are encouraged to participate.
-EAP Coordinator will contact the needed resources: Peer Support Members, Chaplain, and/or the NW Critical Incident Response Team. The Coordinator will act as liaison with other agencies requesting to be involved in the debriefing.
-With the input of the EAP Coordinator, the IC will determine if affected companies will be placed out-of-service until after CISM intervention. The IC will subsequently notify C103 concerning the disposition of out-of- service crews.
If individuals are affected to the extent that, with the agreement of their company officer, the IC, and the EAP Coordinator, remaining on-duty may not be in PF&R's or the member's best interest.........
the on-duty deputy chief will be notified of their recommendation to excuse the individual(s) from active duty. The deputy chief may place the member(s) on "detail" status for up to two shifts. Continued absence can be sought by using accrued sick and/or vacation leaves, or by pursing a disability claim.
Because of the multi-jurisdictional nature of significant events, such as large- scale transportation accidents and complex crime scenes, etc., a demobilization may take place before Portland's CISM guidelines are implemented. If PF&R's IC is contacted by an outside CISM agency (such as NW CISM), that person should?
have them contact Portland's EAP Coordinator to assure efficient multi-agency cooperation.
How can a company officer request CISM help and advice?
by either calling the EAP Coordinator directly at (503) 502-1998, or requesting the EAP Coordinator through the Fire Dispatch Liaison.
Additional options for any PF&R member:
1) can call the EAP Coordinator directly at the numbers listed above. The coordinator will collect information concerning the event, then make the appropriate referrals for individual support, defusing, or debriefing.
2) Members may choose to select peer supporters on their own and/or make direct arrangements for private counseling through Cascade Centers.
3) The "Traumatic Event" check-box, located in the responder tab of the Incident System, should be activated anytime that emergency response crews are subjected to a traumatic event. Activation of this box will provide a record of traumatic events and generate an automatic e-mail to the Safety Chief and the Deputy Chief of Medical Services and Training. The purpose of the notification is to ensure that appropriate follow-up action is being taken to help maintain the health and wellness of emergency responders and help prevent the possible development of PTSD.
When a traumatic event automatic e-mail is received?
The Safety Chief or Deputy Chief of Medical Services & Training will notify the regularly assigned battalion chief that a crew under their supervision has experienced a traumatic event. The battalion chief will review the incident and make contact with the company officer to assess the need for further action.
Supervisors and co-workers of members that have been exposed to a traumatic event should watch for signs that indicate that the member has been adversely impacted. These signs may include:
1) a change in mood or behavior
2) disturbance of normal eating or sleeping patterns 3) avoidance of the topic.
Presence of these signs may indicate the need for intervention using the resources described in this document.
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