# Presentation: 270518

## CISM 

**          ****Critical **
**   ****Incident Stress****       **
**       ****Management**

## CISM: What It Is  ... 

**Designed to ... ****Maintain the health and productivity of CAP members**
**Enhance cohesiveness and bonding**
**Prevent/mitigate traumatic stress effects**
**Ventilate and validate feelings**
**Reduce the fallacy of abnormality**
**Restore personnel to normal function**
**Pre/post-incident education/referral**

## CISM: What It Isn’t ...

**A critique of operations**
**No notes, no judgments, no evaluations, no gathering of information for later use, no finger pointing, no speaking for anyone but yourself**
**Counseling**

## STRESS Is ...

**A Response to a Perceived Threat, Challenge or Change**
**A Physical and Psychological Response to a Demand**
**A State of Physical and Psychological Arousal**

## STRESS Can Be ...

**Both Positive and Negative**
**Good Stress is Motivating**
**New car/You’re HIRED!**
**Negative Stress may lead to health erosion**
**Bad grades/You’re FIRED!**
**Individuals Vary In Their Ability to Manage Stress**

## Responses To Stress

**Some people exposed to the same event may not suffer any effects at all.  Stress reactions can be alarming and unsettling; remember that you are NOT losing your mind or “falling apart.”**
**Dr. David Banner/The Hulk**

## Signs/Symptoms of DIStress

**Physical:**
**Nausea, Fatigue, Rapid Heart, Difficulty Breathing, Muscle Cramps, Headaches**
**Emotional**
**Anxiety, Guilt, Grief, Denial, Fear, Depression, Panic, Irritability, Depression, Apprehension**
**Cognitive**
**Memory/Attention/Decision Problems, Nightmares, Flashbacks, Hyper-alertness**
**Behavioral**
**Withdrawal, Restlessness, ETOH, Avoidance, Speech/Appetite Changes, Blaming Others, Pacing**

## Stress Reactions

**The physical, emotional, cognitive and behavioral responses to stress listed earlier are normal reactions that normal people experience after an abnormal event.  The intensity and frequency of these reactions usually decrease after one to three weeks.  They are *****self-limiting.***

## CISM

**Traumatic stress:   **
**“*****Any event which has sufficient emotional power to overwhelm a person’s ability to cope*****.”   **
** ****- Jeffery T. Mitchell, Ph.D.**

## CISM/ICISF

**ICISF: Formerly Mitchell Model**
**For high-risk occupational groups**
**Firemen, EMS, Police, Emergency Medicine, Disaster Response Personnel, Military**
**Debriefings: MHP Led and Peer Supported**
** ****One Mental Health Professional and one or more Peers**
**Confidential**
**No Badge Collectors **

## CISM Goals

**Rapid Reduction of Intense Reactions**
**Keep Affected Members Functioning**
**Members share information, responses and feelings about the incident **
**Supply information and skills to help with the coping process**
**Reaffirm that they are valued and important**
**Instill confidence in their ability to handle their reactions to this event**
**Access additional support resources**

## Debriefing Incidents: 

**Mass casualty/multiple deaths**
**Death or injury to a child**
**Serious injury/death in the line of duty**
**Prolonged SAR time/excessive media**
**Excessive media attention**
**Outsiders/family interfering with operations**
**Victim known to the members/personal identification**
**Any incident which is extremely grotesque by sight, smell, sound or other circumstance likely to produce an emotional (memory) imprint**

## CISD (Debriefing) Guidelines

**Voluntary Participation**
**Strictly Confidential**
**No Breaks **
**No Rank/Grade: Everyone is Equal**
**Not Operational Investigation or Critique**
**No Notes **
**Incident Specific, Situational**
**Cell Phones and Pagers OFF**
**Identify Anyone Who Shouldn’t Be There**

## Factors Influencing Recovery

**Previous experience with loss/trauma**
**Intensity of event**
**Proximity to event**
**Identification with victims**
**Degree of social support**
**Age, sex, personality and maturity level**
**Outcome of the event**
**Cause of the loss or injury**

## The Recovery Process

**Appropriate physical exercise/rest**
**Structure your time - keep busy**
**You’re not crazy - normal reactions**
**Talk is the most healing medicine**
**Reach out, people DO care**
**Give yourself permission to feel rotten for awhile; share those feelings with others**
**Don’t “numb the pain” with drugs/ETOH**

## The Recovery Process

**Maintain a normal schedule **
**Keep a journal through sleeplessness**
**Make as many daily decisions as possible**
**Don’t fight reoccurring thoughts dreams or flashbacks, they are normal - they will decrease over time and become less painful**
**Eat well balanced and regular meals, get plenty of rest**

## CISM For Family Members

**Listen carefully**
**Spend time with the traumatized person**
**Offer your assistance with daily tasks**
**Reassure them that they are safe**
**Give them some private time**
**Don’t take their anger personally**
**Tell them you are sorry the event occurred and you want to help them**

## CISM 

**  ****CAPR 60-5**

## CAPR 60-5  General

**CAP encourages ICISF training**
**ES/Peers/Chaplains**
**Training is self-provided**
**Identify and use local teams**
**Web search (CISM/CISD)**
**Contact local EMS/Fire/Police**
**Wings self assess for CIST need**
**Low/high mission exposure?**

## CAPR 60-5 CIST Membership

**Regional CIS Teams:   3 each of ...**
**Mental Health Professional **
**Psychiatrist/Psychologist/MSW)**
**Medical Professional**
**(Trauma/ICU Doc/Nurse)**
**Pastoral Support **
**(ES qualified Mission Chaplain)**
**Peer Representative**
**Non-caregiver advocate**
**Family Support**
**Representative to assist with the family**

## CAPR 60-5 CIST Training

**Team members require specific training**
**CIST Chief **
**MHP with Advanced CISM training (etc.)**
**CIST Members**
**Basic CISM course, ICISF model**
**Peer support/crisis intervention courses suggested**
**Course Scheduling **
**ICISF **_**[http://www.](http://www.icisf.org/)**__**[icisf](http://www.icisf.org/)**__**[.org/](http://www.icisf.org/)**_** or call 410.750.9600**
**Cost is borne by each member**
**Consider sponsorship/funding/donations or a dedicated course**

## CAPR 60-5 Serving on a Team

**Documentation of credentials and contact information to HQ CAP/DOS**
**Currency **
**CIST Chief maintains professional credentials and**
**Participates in one actual CIS event per five years or**
**Attends a CAP sponsored refresher per five years**
**CIST Member**
**Same actual incident participation as with MHP or**
**Attends the basic CISM course again within five years of initial qualification**

## CAPR 60-5 Team Activation

**Support Requests **
**During/near conclusion of activity**
**After is too late ... members have dispersed**
**Do NOT forget to observe ancillary personnel**
**Any member can request the team for themselves or their co-members**
**Contact Incident CC (Wing CC if activity suspended)**
**Deployment**
**Wing CC will request CAP or local CISM team**
**Pre-incident contact information is crucial **
**Incident information regarding participants is crucial**

## CAPR 60-5 Team Funding

**Requestor shall provide team food/shelter **
**Non-reimbursable**
**Suggest using host families**
**For SAR and Disaster Relief Missions**
**CAPR 173-3 Normal Mission Costs Reimbursable**
**CIS Funding does NOT affect training allotments**
**Outside of SAR/DR**
**Concurrence of HQ CAP-USAF/XO and HQ CAP/DO**
**Funding addressed on a case by case basis**

## CAPR 60-5 Reporting

**Funded/Non-Funded Utilization**
**AAR (After Action Report) to                HQ CAP/DOS**
**There was an event (general description)**
**Number of personnel supported (no names)**
**Confidentiality Highly Supported**
**Follow-up recommendations will be made by MHP’s as needed**

## CISM 

**  ****OPLAN 32-1**

## OPLAN 32-1  Activation

** **
**Appendix 1 to Annex D to GLR 32-1**
**Critical Incident Stress Team**
**Disaster/Large Scale Incident Declaration:  CIS Team  is activated through Region CIST Coordinator upon request of the supported Wing CC**
**	**

## OPLAN 32-1 Personnel

**Supported Wing provides personnel estimates**
**Participants/Debriefers ratio**
**COMPLETE and CURRENT contact list of incident participants (CAP/Civilian/Military)**
**CISTC will coordinate with assigned local resources**
**Supported Wing should have list of local CISM teams if prior contact established**
**Determination per CISTC of appropriate format to use: demobilization, defusing, debriefing**

## OPLAN 32-1 Resources

**CISTC works with Logistics Officer/Designee**
**Assign Coordinator  to direct personnel, assist CISTC throughout debriefing process**
**Make sure Coordinator has a radio or phone**
**Arrange for building for Debriefing**
**Off site, close to mission base for easy access**
**Large room (or two), private (no windows to debriefing room preferred), clearly marked “NO ENTRY,” chairs, bathroom access, tissues**
**On base staff to direct local CISM personnel to this facility**

## OPLAN 32-1 Resources

**Arrange transportation to and from debriefing facility**
**Designated van with driver preferred**
**Arrange coordination with ARC/local volunteers, etc.**
**Staffing a snack/rest area for incident demobilization: snack/juice/water/decaf. (no caffeine beverages) supplies**

## OPLAN 32-1 Checklist

**Early contact with CISTC IMPERATIVE**
**Establish dialog at onset of activity**
**Early alert assists with prep for possible involvement of CIST, provides information to mission base staff**
**See CIST Activation Checklist **
**Contact information for CISTC provided**
**Arrange CISTC/staff transportation (flight)**
**Lodging/transportation/meals for CISTC/staff**

## OPLAN 32-1 Checklist

**Arrange computer/printer access.**
**Internet access preferred; phone access incoming/outgoing required.**
**Alert Medical Staff to CISD site/time.**
**Have transportation to medical facility available as needed.**
**Advise CISTC/staff of medical facility location.**

## OPLAN 32-1 Checklist

**Alert Chaplain to CISD site/time.**
**Advise CISTC/staff of Chaplain availability. **
**Advise Admin. Officer of all supportive Non-CAP personnel to send post-incident letters of appreciation.**

## GLR *CISTC

**Contact ****sherryljones@ameritech.net**
**CISM url **_**[http://miwg.cap.gov/cism](http://miwg.cap.gov/cism)**_
**(H) 810.773.2629**
**(C) 810.362.7437**
***Critical Incident Stress                            Team Coordinator**