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Emergency Care & Trauma Symposium 48 th Annual Conference June 23, 2014
Emergency Care & Trauma Symposium 48th Annual
ConferenceJune 23, 2014
Debriefing Strategies to Consider When Coping With
Acute StressLynnda Zibell Milsap PMH
CNS-BC
• Identify acute stress & coping responses
• Review strategies to enhance one’s coping with acute stress
• Review triggers, interventions to prevent compassion fatigue.
Objectives
News headlines on recent cases involving support from EMS /First Responders;
1. The Multiple Stabbing on East Washington with deaths
2. Missing Girl, Tortured Boy, Body of Mother Found at Wisconsin House
3. Foggy pileups kill 2, involve more than 100 vehicles
What Do You Read & Hear?
• Fear• Grief• Sorrow• Disbelief• Numbness• Feeling overwhelmed• Anguish
Key First Responder Stress Reponses
• Anger, irritability, sorrow• Detachment, guilt ( “I should have
done more”).• Dreams & nightmares• Distractibility, flashbacks• Frequent thoughts of what happened• Strains in family and work
relationships
Normal Stress Reactions After a Response
Just like it sounds, when you are unable to relieve stresses that build, they add up & take a toll, which can reach a critical point.
Cumulative Stress
• Affect our physiological responses
• Overwhelming emotions can disrupt rational problem-solving
• Promote adaptive and maladaptive individual and group behaviors
Importance of Psychological Responses
8
Potential Stress Responses to a traumatic event• Hyper-arousal:• Avoidance:• Intrusions: • Psychic numbing
First Responder & Signs of Potential Acute Stress
Response
DSM-V, Identifies a traumatic event as one in which we experience: a threat (actual or perceived) of death or serious injury to self or others , with a response of “intense fear, helplessness or horror.”
• It is not the event itself, but the meaning it has for the individual that makes it traumatic.
What is a Traumatic Event?
Causes a rescuer to experience:Unusually strong emotions that interferes with the ability to function either during the incident or after; a highly stressful incident
Critical or Traumatic Situation
‘Normal people’ experience a range of normal reactions, including:
1. Anxiety,2. Feeling “revved up;”3. Fatigue; irritability; 4. Problems sleeping;5. Exaggerated startle response, 6. Change in appetite; 7. Feeling overwhelmed; impatience; 8. Withdrawing from family and friends.9. Might just feel fine
What Happens After A Traumatic Event?
Emotional Condition marked by :
Tiredness, feelings of exhaustionLoss of interest, reduced work effortFrustration that interferes with job performance.Result from prolonged stress No joy left in doing your job Apathy “What’s the point?” attitude Happens over time Alienation from job activities
Burnout
When a friend is experiencing a trauma in their life that you have personal experience with, this can trigger past emotions & feelings
Examples;homelessness, physical abuseemotional abuse
Secondary Traumatic Stress
1. People who come into continued, close contact with trauma survivors
2. Knowledge about a traumatizing event experienced by a significant other
3. The stress resulting from helping a traumatized or suffering person
Bride, B. (2007). Prevalence of Secondary Traumatic Stress Among Social Workers. Social Work: 51(2): 63-70.
Secondary Traumatic Stress
.
Cost of Caring
A debilitating weariness brought about by repetitive, empathic response to pain and suffering, `is a result of absorbing & internalizing the emotions of others & sometimes, coworkers…”
What is Compassion Fatigue?
Those who have:• Trauma – (experience as a witness or as a patient)• Unusual recent stressors-long term or life demands• Excessive empathy (leading to blurred professional
boundaries)• Those who are more anxious• Poor self care • Limited support• Daily barrage of trauma material
• Abendroth, M. & Flannery, J. (2006). Thos
Who is at Risk for Compassion Fatigue?
• Inability or refusal to control work stressors
• Lack of satisfaction for the work• Previous unresolved trauma• Viewing or hearing about abuse and
trauma on a routine basis
Figley, C. R. (Ed.) (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized . New York: Brunner/Mazel.
Additional Factors that Make One Vulnerable to CF
• Affects many dimensions of your well-being
• Nervous system arousal (Sleep disturbance)
• Emotional intensity increases• Cognitive ability decreases• Behavior and judgment impaired• Isolation and loss of morale
Compassion Fatigue Symptoms
• Depression and PTSD (potentiate)• Loss of self-worth and emotional
modulation • Identity, worldview, & spirituality
impacted• Beliefs and psychological needs-
safety, trust, esteem, intimacy, and control
• Loss of hope and meaning=existential despair
• Anger toward perpetrators or causal events
Symptoms, continued
• Anxiety / increased negative arousal• Numbness / flooding• Lowered frustration tolerance /
irritability• Grief symptoms• Anger• Sadness• Depression
Emotional Indicators
• Intrusive thoughts / images• Headaches• GI symptoms• Insomnia / nightmares / sleep
disruptions• Decreased immune response• Lethargy• Becoming more accident prone
Physical Indicators
Decrease in sense of safety ( 911)Self isolationDifficulty separating work life from personal lifeDiminished functioning in non-professional circumstancesIncreases in ineffective or self destructive self soothing behaviors
Personal/Work Indicators
• Discuss a case that caused you to take it home with you- or caused some symptoms of compassion fatigue
• Identify what factors caused you to identify with the person/victim/family/event
• Note commonalities and choose a person to share these findings with the larger group
Panos, A
Small Group Exercise #1
• Substance abuse• Sleep disturbances• Blaming• Low self-esteem• Frequent headaches• Increased irritability• Less ability to feel joy
Although symptoms vary, these may indicate that you or coworkers have compassion
fatigue
• Depression• Anger• Chronic
lateness• Hypertension• Extra work• Exhaustion
(physical or emotional)
• Overwhelmed by unfinished personal business
• Stress affects you deeply• Personal concerns often intrude
on work• Feeling vulnerable all the time• Association with trauma affects
you deeply• Small changes are enormously
draining
How Do You Feel?
• A daily act of self-centering can “bring you back” to awareness of the goodness of the world.
• Set an alarm for the same time each day and take four deep breaths
• Create another act where you can sink into the experience, feel the sensations, and note, “I am worthy of my own time.”
Daily self-centering
• Mindfulness meditation• Reconnect with others• Boundary maintenance• Up to date education• Routine Supervision
Time to Keep Healthy
• Spend time daily on an activity you find meaningful that is not related to work.
• Examples include; reading, writing, walking, listening to music, building, playing - whatever re-energizes you.
Your Self Care Plan
A= Awareness Issues and Contributing Factors
What types of cases contribute to your stress level increasing your vulnerability to compassion fatigue?
• Being attuned to ones needs, limits, emotions and resources• Knowing your “renewal
zones”• Accepting and acknowledging
that we are changed by what we do
Awareness
Self Care• Find someone to
talk to• Understand that the
pain is normal• Start exercising and
eating properly• Get enough sleep • Take some time off• Develop interest
outside of work• Identify what’s
important
Suggestions of What Not To Do
• Blame others• Fall into the
habit of complaining
• Hire a lawyer• Work harder and
longer• Self medicate• Neglect personal
needs and interests
Even Mother Teresa Understood Compassion Fatigue Effects
Wrote in her plan to her superiors that it was MANDATORY for her nuns to take an entire year off from their duties every 4-5 years to allow them to heal from the effects of their care-giving work.
1. Have quiet alone time in a calm place- a safe retreat where you feel safe & renewed
2. Have an awareness of what restores and replenishes you.
3. Find ways to acknowledge loss and grief
4. Stay clear with commitment to career goals or your personal mission
5. Learn to focus on what you can control
6. Look at situations as entertaining challenges and opportunities, not problems or stresses
Balancing Yourself
• Long-term sleep disturbances • Feelings of isolation or depression• Rage• Sudden change in life attitude• Sudden catastrophic decision-making
( quit job, divorce)
Potential Serious Signs of Distress After An Event
• Be as non judgmental & accepting of yourself as you would in dealing with those your treat who have undergone a traumatic event
• Remember that the symptoms you are experiencing as a result of the traumas are related to the experience itself not that you are a weak person
• The need to support you is ongoing
Hey You Are A Strong Person!
When should I seek outside support for dealing with a
tough case?Approximately 2-3 months
• Who is responsible for your self-care?• What are barriers listed in priority
that keep you from self-care activities?
• What is your current level of energy?• How does your team care for each
other with challenging patient care issues?
• Draw a circle…represent 24 hours a day….
Your Self-Care Plan
Local;Red Cross, Chaplains, Social Workers, Area Hospitals, professional counselors, “Your team”National;1. International Critical Incident Stress Foundation2. SAMHSA ( Substance Abuse & Mental Health Services Administration)-free handout for coping for your team
Resources
• Mental health screening & triage• Crisis intervention• Emotional care and support• Problem solving & referrals• Advocacy & education
Red Cross Resources for You & Your Team
• Compassion Fatigue Awareness Project www.compassionfatigue.org
• Compassion Fatigue http://www.breathofrelief.com
• Google “compassion fatigue” and you will find many other helpful resources
• SAMHSA• ICISMF• Red Cross
On-line resources
Thanks For All You Do….
