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Critical Incident Critical Incident Stress Management (CISM)Stress Management (CISM)
LTC Clarence BowserLTC Clarence BowserState Family Programs DirectorState Family Programs Director
National GuardNational Guard
Trained Crisis Responder ProgramTrained Crisis Responder Program
TCR Briefing for Command
Military References…Military References… Trained Crisis Responder Trained Crisis Responder
(TCR)…(TCR)… Crisis Intervention…Crisis Intervention… Critical Incidents…Critical Incidents… Post-Traumatic Stress…Post-Traumatic Stress… TCR Services…TCR Services… Rationale…Rationale…
OverviewOverview
TCR Briefing for Command
DoD:DoD: 6490.5 – Combat Stress Control 6490.5 – Combat Stress Control
ProgramProgram Air Force:Air Force:
AFI 44-153 – Critical Incident AFI 44-153 – Critical Incident Stress ManagementStress Management
AFI 34-1101 Survivor Assistance AFI 34-1101 Survivor Assistance Army:Army:
Field Manual Field Manual FM 16-1, Annex F-1 FM 16-1, Annex F-1 "Critical Event Debriefings""Critical Event Debriefings"
ReferencesReferences
TCR Briefing for Command
The National Guard The National Guard TCR ProgramTCR Program was was
developed from Critical developed from Critical Incident Stress Incident Stress
Management Management (CISM)(CISM) principles…principles…
Trained Crisis Trained Crisis ResponderResponder
TCR Briefing for Command
Crisis InterventionCrisis Intervention
““CISMCISM is a subset of the general is a subset of the general field of field of Crisis Intervention (CI)Crisis Intervention (CI) and may be thought of as the and may be thought of as the application of Crisis Intervention application of Crisis Intervention knowledge and techniques to knowledge and techniques to high risk groups, e.g., high risk groups, e.g., emergency services, military, emergency services, military, etc.”etc.”
(J.T. Mitchell, G.S. Everly, 1995)(J.T. Mitchell, G.S. Everly, 1995)
TCR Briefing for Command
CISM ServicesCISM Services
Trained Crisis Responders Trained Crisis Responders are are the first line of defense in coping the first line of defense in coping with Post-Traumatic Stresswith Post-Traumatic Stress Reactions to Crisis events. Reactions to Crisis events. CISM ServicesCISM Services extend beyond extend beyond the training levels of Trained the training levels of Trained Crisis Responders, therefore it is Crisis Responders, therefore it is important for the TCR’s to work in important for the TCR’s to work in concert with military and civilian concert with military and civilian CISM Teams…CISM Teams…
TCR Briefing for Command
CISM CISM Core Core ComponentsComponents
Pre-Crisis Pre-Crisis preparationpreparation
Demobilization Demobilization Crisis Crisis
Management Management BriefingBriefing
Defusing Defusing Critical Incident Critical Incident
Stress DebriefingStress Debriefing
Individual crisis Individual crisis intervention 1:1intervention 1:1
Family CISMFamily CISM Community Community
consultationconsultation Pastoral Crisis Pastoral Crisis
InterventionIntervention Follow-up/Follow-up/
ReferralReferral
TCR Briefing for Command
Trained Crisis Trained Crisis ResponderResponder
Trained Crisis Trained Crisis
Responders provide Responders provide
psychological and psychological and
emotional emotional “Self-Aid “Self-Aid
and Buddy-Care”and Buddy-Care”
TCR Briefing for Command
IncidentIncident
Crisis Intervention EAP
TCR’s Legal
Chaplain
CISM Mental Health
Psychotherapy
Hospitalization
Refer where needed… Family Support
Rehab
Spectrum Of CareSpectrum Of Care
TCR Briefing for Command
Critical IncidentsCritical Incidents
Major Accidents (Air Crashes, etc.)…Major Accidents (Air Crashes, etc.)…
Line of Duty Death(s)…Line of Duty Death(s)…
Serious Line of Duty Injury(s)…Serious Line of Duty Injury(s)…
Suicide of a Co-Worker…Suicide of a Co-Worker…
Disaster / Multi-Casualty Incident(s)…Disaster / Multi-Casualty Incident(s)…
Shooting(s)…Shooting(s)…
TCR Briefing for Command
Critical IncidentsCritical Incidents
Significant Events Involving Children…Significant Events Involving Children…
Prolonged Incident(s) - Especially with Prolonged Incident(s) - Especially with
loss…loss…
Excessive Community Media Interest…Excessive Community Media Interest…
Any Significant Traumatic Event…Any Significant Traumatic Event…
TCR Briefing for Command
Primary GoalPrimary Goal
CISMCISM and the and the TCRTCR ProgramProgram are are forms of crisis intervention forms of crisis intervention
designed to help reduce Post-designed to help reduce Post-Traumatic Stress Reactions to Traumatic Stress Reactions to
Critical Incidents…Critical Incidents…
TCR Briefing for Command
Post-Traumatic Post-Traumatic StressStress
Post - traumatic stress Post - traumatic stress
is a is a normal reactionnormal reaction, ,
in a in a normal personnormal person, ,
to an to an abnormal eventabnormal event..
TCR Briefing for Command
Hallmarks of Crisis Hallmarks of Crisis InterventionIntervention
Immediacy Immediacy ProximityProximityExpectancyExpectancyBrevityBrevityPracticalPractical It’s learning how to toss a life raft, not a course It’s learning how to toss a life raft, not a course
in ship buildingin ship building
TCR Briefing for Command
Post traumatic Post traumatic stressstress
Is everyone who experiences Is everyone who experiences traumatic distress suffering traumatic distress suffering
from the disorder know as Post from the disorder know as Post Traumatic Stress Disorder?Traumatic Stress Disorder?
NO.. NO ..NONO.. NO ..NO
TCR Briefing for Command
Post Traumatic Post Traumatic Stress DisorderStress Disorder
PTSDPTSD represents a represents a contradiction to some contradiction to some
critically important critically important assumption or belief about assumption or belief about
self and/or the world.self and/or the world.
(G.S. Everly, 1995)(G.S. Everly, 1995)
TCR Briefing for Command
Post Traumatic Post Traumatic Stress DisorderStress Disorder
A A pathological and disablingpathological and disabling variant of a normal stress variant of a normal stress reactionreaction
Very clear criteria …symptoms Very clear criteria …symptoms must be must be over 30 daysover 30 days and it is and it is impairingimpairing function function
TCR Briefing for Command
Important TCR Important TCR ConceptConcept
The TCR Program is The TCR Program is NOTNOT a a
stand alone process. stand alone process.
Rather it is meant to be Rather it is meant to be
one part of a one part of a
comprehensive CISM comprehensive CISM
intervention program.intervention program.
TCR Briefing for Command
TCR Services…TCR Services…
TCR’s can be in TCR’s can be in any sectionany section (personnel, security forces, fire, (personnel, security forces, fire, chaplain, medical, family support, chaplain, medical, family support, etc.)…etc.)…
TCR’s are normally among your TCR’s are normally among your first first respondersresponders to an incident… to an incident…
TCR’s can support official military TCR’s can support official military and civilian and civilian CISM TeamsCISM Teams……
TCR Briefing for Command
TCR Services…TCR Services…
Pre-incident educationPre-incident education, , preparation…preparation…
One-on-one crisis interventionOne-on-one crisis intervention……
DemobilizationsDemobilizations (large groups of (large groups of public safety)…public safety)…
Crisis Management BriefingsCrisis Management Briefings [large [large groups of primary, secondary groups of primary, secondary (emergency personnel), and tertiary (emergency personnel), and tertiary (family, co-workers, etc.) victims](family, co-workers, etc.) victims]
TCR Briefing for Command
TCR Services…TCR Services…
Family SupportFamily Support……
Organizational / Community Organizational / Community intervention, consultationintervention, consultation……
Follow-up and referralFollow-up and referral for TCR’s & for TCR’s & CISM services and/or continued CISM services and/or continued care…care…
TCR Briefing for Command
Why have TCR’s and CISM programs?
We can learn from past experience.
RationaleRationale
TCR Briefing for Command
141 ARW Suicide141 ARW Suicide
December 1998 - Fairchild AFB December 1998 - Fairchild AFB WAWA
Just-retired Wing CommanderJust-retired Wing Commander Prior incidents in unitPrior incidents in unit Impact on unitImpact on unit Chaplains from outside called in Chaplains from outside called in
for first UTA following incidentfor first UTA following incident Ministered to entire wingMinistered to entire wing
TCR Briefing for Command
141 ARW CRASH141 ARW CRASH
Six weeks after suicide of Six weeks after suicide of commandercommander
Four members killed in GermanyFour members killed in Germany Chaplains called from outside; Chaplains called from outside;
some had just been theresome had just been there Assigned to each family to assist Assigned to each family to assist
local clergy and chaplainslocal clergy and chaplains Memorial Service and FuneralsMemorial Service and Funerals
TCR Briefing for Command
Red Horse CrashRed Horse Crash
March 2001March 2001 Army NG Sherpa crashed over Army NG Sherpa crashed over
Ga.Ga. 18 ANG and 3 ARNG members 18 ANG and 3 ARNG members
killedkilled Chaplains called in for ministryChaplains called in for ministry Memorial Service and FuneralsMemorial Service and Funerals Continuing care for familiesContinuing care for families
TCR Briefing for Command
Red Horse, cont’dRed Horse, cont’d
Late July - Early August reportLate July - Early August report Some possible questionsSome possible questions Chaplains and Line Colonels Chaplains and Line Colonels
formed teams for each familyformed teams for each family Trained at Langley then deployedTrained at Langley then deployed There to walk families through There to walk families through
report and to offer pastoral carereport and to offer pastoral care
TCR Briefing for Command
ComparisonComparison
Total KilledTotal Killed 125125 8282
Plane SurvivorsPlane Survivors 00 00
Homes DestroyedHomes Destroyed 1616 1616
Killed On GroundKilled On Ground 1515 1515
Emergency PersonnelEmergency Personnel 300300 300300
Body Parts FoundBody Parts Found 10,00010,000 10,00010,000
San Diego, CASan Diego, CAAir Crash - 1978Air Crash - 1978
Cerritos, CACerritos, CAAir Crash - 1986Air Crash - 1986
TCR Briefing for Command
ComparisonComparison
Cerritos, CACerritos, CAAir Crash - 1986Air Crash - 1986
On Scene One on On Scene One on OneOne
DemobilizationsDemobilizations 12 Debriefings12 Debriefings Hot Line NumberHot Line Number One on One One on One
Follow UpFollow Up
Support Services ProvidedSupport Services ProvidedSan Diego, CASan Diego, CAAir Crash - 1978Air Crash - 1978
Sporadic One on Sporadic One on OneOne
TCR Briefing for Command
ComparisonComparisonPersonnel Lost in 1 Personnel Lost in 1
YearYear
Police 5 -Fire 7 -
1Paramedics 17 -Increase inMental HealthServices increase of 31% increase
of 1%
San Diego, CASan Diego, CAAir Crash - 1978Air Crash - 1978
Cerritos, CACerritos, CAAir Crash - 1986Air Crash - 1986
TCR Briefing for Command
RationaleRationale
Trauma and stress-related disorders Trauma and stress-related disorders are sometimes disabling and costly are sometimes disabling and costly to treat…to treat…
Interventions are designed to assist Interventions are designed to assist in preventing “burnout” and PTSD…in preventing “burnout” and PTSD…
Healthy employees are more Healthy employees are more productive and effective on the job…productive and effective on the job…
TCR Briefing for Command
Example 1…Example 1…
100 trauma victims100 trauma victims Intervention began Intervention began afterafter 6 6
monthsmonths Average cost = Average cost = $46,000.00 ea.$46,000.00 ea. 94%94% filed civil litigation filed civil litigation
Friedman, et al, EAP Digest, 1988
TCR Briefing for Command
Example 2…Example 2…
100 trauma victims100 trauma victims Intervention began Intervention began withinwithin 6 6
monthsmonths Average cost = Average cost = $8,300.00 ea.$8,300.00 ea. 13%13% filed civil litigation filed civil litigation
Friedman, et al, EAP Digest, 1988
TCR Briefing for Command
RationaleRationale
On any given trauma/disaster, On any given trauma/disaster, 4%-97%4%-97% of the individuals of the individuals exposed will develop exposed will develop Symptoms similar to PTSD.Symptoms similar to PTSD.
16-30%16-30% of emergency of emergency responders are at risk of responders are at risk of developing PTSD symptoms.developing PTSD symptoms.
TCR Briefing for Command
RationaleRationale
Disaster / Trauma planning Disaster / Trauma planning (including CISM protocols) is (including CISM protocols) is
appropriate for not only appropriate for not only emergency response emergency response
personnel and institutions, but personnel and institutions, but for all business and industrial for all business and industrial (and military) settings as well.(and military) settings as well.
Yandrick, EAPA Exchange, 1990Yandrick, EAPA Exchange, 1990
TCR Briefing for Command
Main GoalMain Goal
Trained Crisis Trained Crisis Responders helpResponders help
keep your teamkeep your team
on the job!on the job!
TCR Briefing for Command
WHERE YOU CAN WHERE YOU CAN LEARN THIS STUFF!LEARN THIS STUFF!
Ch, LtCol Charles E. WoodsCh, LtCol Charles E. Woods
Chief, Crisis InterventionChief, Crisis Intervention
McGhee Tyson ANG Base, TNMcGhee Tyson ANG Base, TN
Academy for Academy for Innovative MinistryInnovative Ministry
TCR Briefing for Command
AIM COURSESAIM COURSES
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!
TCR Briefing for Command
CHAPLAIN SERVICE CHAPLAIN SERVICE AND FAMILY AND FAMILY
SUPPORTSUPPORT
WHY DO CHAPLAINS EXIST?WHY DO CHAPLAINS EXIST?
- First Amendment- First Amendment
- ‘Provision without - ‘Provision without establishment’establishment’
RequirementsRequirements SkillsSkills ‘‘neutral zone’neutral zone’ 100 % Confidentiality100 % Confidentiality
TCR Briefing for Command
Chaplain Service Chaplain Service and Family Supportand Family Support
LET’S TALK!LET’S TALK!