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Chaplain Jim Crowley COPC 2
Critical Incident StressManagement (CISM)
Jim CrowleyMike Dismore
Chaplains Central OregonPolice Chaplaincy
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Chaplain Jim Crowley COPC 3
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 SocietyWe Are a Stressed Out Society
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Chaplain Jim Crowley COPC 4
Agenda
What Is Stress & Its CausesTypes of Critical IncidentsWho Is Susceptible?Symptoms of StressResourcesConfidentialityHelpful 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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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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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 Lingering Colds, Etc
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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 AffectingStress Responses
Duration
Multiplicity
Situational Importance
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Performance and Efficiency
Cumulative Stress Reaction
Critical Incident Stress Reaction
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Chaplain Jim Crowley COPC 20
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 Very Controlling Action Oriented Detail Oriented High Need for
Stimulation Easily Bored Dedicated Risk Taker Needs to Be Needed Can’t Say NO
Rescue Personality Driven by Internal
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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ComparisonBoth Airliners Collided with Small Planes
Total Killed From Planes 137 67
Plane Survivors 0 0
Homes Destroyed or Damaged 22 12
Killed On Ground 7 15
Emergency Personnel +/-300 +/-300
Body Parts Found +/-10,000 +/-10,000
San DiegoSeptember 25, 1978
CerritosAugust 31, 1986
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Comparison“Twin” disasters
San Diego
Sporadic One on One
Cerritos
On Scene One on One Demobilizations 12 Debriefings Hot Line Number One on One Follow Up
Support Services Provided
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ComparisonPersonnel Lost in 1 Year
Police 5 0
Fire 7 0
Paramedics 17 1
Dispatch ? ?
Increase inMental Health Use 31% 1%
San DiegoSan Diego Cerritos
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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” Law Enforcement Wellness Association Inc
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Forms of Self Medication
Coffee - TeaSoda (With Caffeine) Drugs (Both Legal and Illegal)Tobacco Products AlcoholEating DisordersSweets (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 stressstress permission to shape your reactive emotional response
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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 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 everyevery 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 ConfidentialDone With CISM Team
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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 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 StageArousal
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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Burnout - Third StageExhaustion
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
Muscle Tremors Fatigue Chills Nausea Sweating Gastro-intestinal
Distress Dizzy Spells Hunger Sleep Disorder
Chest Pain Difficulty Breathing Elevated Blood
Pressure Rapid Heart Rate Weakness Headaches Visual Problems Sensitivity to Noise Hic-cups
May require medical attention by physician
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Symptoms of StressThinking
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 Withdrawal, Lack of
Enjoyment Emotional Shock Feeling
Overwhelmed Hopeless & Helpless Panic Feelings Loss of Emotional
Control Loss of Confidence
in Future
Anxiety Guilt Grief 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)
Overly Alert, Easily Startled (Jumpy)
Sleep Habit Changes Avoidance Behaviors Increased Conflicts at
Home & Work Changes in Association
With Fellow Workers
Suspicious Appetite Changes Increased Self
Medication Tearful Changes in Personal
Hygiene Prolonged Silences Loss of Interest Withdrawal Abusive
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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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Things to Try When Stressed Out
Talk to People – Talking Is HealingReach Out – People Do CareMaintain As Normal a Schedule As
Possible (Maintain Goals)Do Things You Enjoy DoingAvoid 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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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
StressStress, 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 PersonallyPersonally
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
FriendsFaith CommunityCommunity ServicesRecreational OutletEnjoy a Hobby Find a Balance of Work and Outside ActivitiesFind a Balance of Work and Outside Activities
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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
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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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: Chronic Illness Physical Complaints Sleep disruption Emotional Response Allergies Energy Depletion Inability to Concentrate
DietDiet
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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.
ExerciseExercise
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SleepSleep
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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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).
FamilyFamily
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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.
FriendsFriends
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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.
JobJob
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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.
RebuildRebuild
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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.
SpiritualitySpirituality
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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 Ski Trip Read a good book “Take a hike” Ride a Bike Volunteer service Gardening Crafts Sports (participatory)
Sponsor or Coach a Sport Team
Be a Scout Leader Join a Church Group Bowling Roller Skating Tennis Gym Workout (Regular) Walk With A Friend Your Ideas
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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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Chaplain Jim Crowley COPC 87
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 InfoContact Info
COPC Office; 325 NE Kearney Ave.COPC Office; 325 NE Kearney Ave.
Bend, OR 97701Bend, OR 97701
COPC (Mail); PO Box 1898COPC (Mail); PO Box 1898
Redmond, OR 97756Redmond, OR 97756
Chaplain Jim Crowley; (541) 410-6128Chaplain Jim Crowley; (541) 410-6128
[email protected]@bendbroadband.com
Chaplain Mike Dismore; (541) 788-3364Chaplain Mike Dismore; (541) 788-3364
[email protected]@juno.com
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