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CISMCISM
Critical Incident Stress Management
Critical Incident Stress Management
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Who We AreWho We Are
• The Dallas Fire-Rescue Department Critical Incident Stress Management Team (CISM Team) is a volunteer organization within the Department consisting of fire-rescue personnel and licensed mental health professionals specially trained in CISM procedures and protocol
• The Dallas Fire-Rescue Department Critical Incident Stress Management Team (CISM Team) is a volunteer organization within the Department consisting of fire-rescue personnel and licensed mental health professionals specially trained in CISM procedures and protocol
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History of CISM TeamHistory of CISM Team• The team was founded in 1993 and
originated with 13 members• Currently, the team has over 50 members• Since the formation of the team 12 years ago,
members have given no less than 11,000 volunteer hours inside and outside the Department
• Dallas Fire-Rescue CISM team has not only responded to DFR personnel, but also to Oklahoma City, New York City, Dallas Zoo,FW & Carrollton PD, Bonham and Terrell FD’s, the NASA shuttle disaster, Hurricanes Katrina and Rita
• The team was founded in 1993 and originated with 13 members
• Currently, the team has over 50 members• Since the formation of the team 12 years ago,
members have given no less than 11,000 volunteer hours inside and outside the Department
• Dallas Fire-Rescue CISM team has not only responded to DFR personnel, but also to Oklahoma City, New York City, Dallas Zoo,FW & Carrollton PD, Bonham and Terrell FD’s, the NASA shuttle disaster, Hurricanes Katrina and Rita
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What We DoWhat We Do
• The CISM program strives to enhance members of the Dallas Fire-Rescue Department’s ability to cope effectively with stress both during critical incidents and during the more routine events of everyday life
• The CISM program strives to enhance members of the Dallas Fire-Rescue Department’s ability to cope effectively with stress both during critical incidents and during the more routine events of everyday life
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Goals of CISMGoals of CISM
• Provide support• Lessen the impact an incident will have• Speed up recovery from stress reaction• Provide information about critical
incident stress• Enhance psychosocial welfare of
members and their families• Ensure a long satisfying career
• Provide support• Lessen the impact an incident will have• Speed up recovery from stress reaction• Provide information about critical
incident stress• Enhance psychosocial welfare of
members and their families• Ensure a long satisfying career
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What is CISM?What is CISM?
• CISM is a structured discussion of a critical event
• It is designed to lessen the overall impact of an event by helping normal people deal with extraordinary circumstances
• It is confidential• Simply put—CISM is firefighters helping
firefighters
• CISM is a structured discussion of a critical event
• It is designed to lessen the overall impact of an event by helping normal people deal with extraordinary circumstances
• It is confidential• Simply put—CISM is firefighters helping
firefighters
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DFD firefighters supporting NYFD rescue workers
DFD firefighters supporting NYFD rescue workers
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What CISM is not?What CISM is not?
• It is NOT psychotherapy• It is NOT an investigation or operational
critique• It is NOT a “gripe session”• It is NOT treatment—it is merely a tool
to keep emergency personnel functioning at work, home, and in the community
• It is NOT psychotherapy• It is NOT an investigation or operational
critique• It is NOT a “gripe session”• It is NOT treatment—it is merely a tool
to keep emergency personnel functioning at work, home, and in the community
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What is a Critical Incident?What is a Critical Incident?
• “Any event during which the sights, smells, or sounds are so vivid and disturbing so as to cause an unusual increase in stress or stress reactions, either immediate or delayed.”
• Overwhelms the body’s normal coping mechanisms
• “Any event during which the sights, smells, or sounds are so vivid and disturbing so as to cause an unusual increase in stress or stress reactions, either immediate or delayed.”
• Overwhelms the body’s normal coping mechanisms
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Rescue workers in NYC bringing out body
Rescue workers in NYC bringing out body
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Rescue workers in DallasRescue workers in Dallas
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What is stress?What is stress?
• A physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation
--Webster’s Dictionary
• A physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation
--Webster’s Dictionary
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Body’s Reaction to StressBody’s Reaction to Stress
• Fight or Flight– Release of Hormones
• Adrenaline• Cortisol
– Some stress is beneficial• Enables to perform at a higher level• Learn coping skills
• Fight or Flight– Release of Hormones
• Adrenaline• Cortisol
– Some stress is beneficial• Enables to perform at a higher level• Learn coping skills
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Critical incidents experienced by firefighters and EMS
Critical incidents experienced by firefighters and EMS
• Line of Duty Death• Death or injury of a child (especially
Child Abuse)• Mass Casualty Incidents• Particularly unusual or gruesome injury
or death• An incident with a high media presence
• Line of Duty Death• Death or injury of a child (especially
Child Abuse)• Mass Casualty Incidents• Particularly unusual or gruesome injury
or death• An incident with a high media presence
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• Accumulation of highly stressful calls in a short period of time
• Living through an extremely dangerous emergency event, or being the victim of an attack
• Serious on-duty injury to self or department member
• Any incident outside one’s “normal”range of experience
• Accumulation of highly stressful calls in a short period of time
• Living through an extremely dangerous emergency event, or being the victim of an attack
• Serious on-duty injury to self or department member
• Any incident outside one’s “normal”range of experience
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Oklahoma City bombing
Oklahoma City bombing
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9/11: New York City9/11: New York City
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9/11: Pentagon9/11: Pentagon
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NASA: Columbia ShuttleNASA: Columbia Shuttle
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Reactions to Critical IncidentsReactions to Critical Incidents
• Physical • Cognitive / Mental• Psychological / Emotional
• Physical • Cognitive / Mental• Psychological / Emotional
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Physical Reactions to Critical Incidents
Physical Reactions to Critical Incidents
• Heartburn• Restlessness• Tenseness• Digestive trouble• Sexual dysfunction• Startle reactions
• Heartburn• Restlessness• Tenseness• Digestive trouble• Sexual dysfunction• Startle reactions
• Fatigue• Loss of Appetite• Nausea• Headaches• Tremors• Insomnia
• Fatigue• Loss of Appetite• Nausea• Headaches• Tremors• Insomnia
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Cognitive/Mental ReactionsCognitive/Mental Reactions
• Difficulty with concentration• Difficulty solving problems• Difficulty making decisions• Memory disturbances• Confusion• Decline in job performance
• Difficulty with concentration• Difficulty solving problems• Difficulty making decisions• Memory disturbances• Confusion• Decline in job performance
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Psychological/Emotional Reactions
Psychological/Emotional Reactions
• Guilt• Withdrawal/Isolation• Depression• Dreams/Nightmares• Questioning Career• Aggressive Outbursts• Distrust of Department
• Guilt• Withdrawal/Isolation• Depression• Dreams/Nightmares• Questioning Career• Aggressive Outbursts• Distrust of Department
• Anger/Irritability• Anxiety• Numbness• Helpless• Flashbacks• Moodiness• Frustration
• Anger/Irritability• Anxiety• Numbness• Helpless• Flashbacks• Moodiness• Frustration
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SAN DIEGO VS. CERRITOS AIR DISASTERS
SAN DIEGO VS. CERRITOS AIR DISASTERS
San Diego Cerritos
• Total Killed 125 82• Plane survivors 0 0• Homes Destroyed 16 16 • Emergency Workers 300+ 300+• Body Parts Recovered 10,000+ 10,000+• Increase in Mental
Health Utilization 31%/1 yr 1%/1 yr• Loss of Responders 20+/ 1 yr 1/1 yr• Intervention 1:1 CISM: 12CISD
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THE BANKS OF AUSTRALIA
THE BANKS OF AUSTRALIA
NO CISM CISM CHANGE
1985 1988
Holdups 30 36 +16%Sick Days 281 112 -60%Indir. Sick 668 265 -60%Compen. $18,488 $6,326 -68%
NO CISM CISM CHANGE
1985 1988
Holdups 30 36 +16%Sick Days 281 112 -60%Indir. Sick 668 265 -60%Compen. $18,488 $6,326 -68%
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Effectiveness of CISMEffectiveness of CISM
• “New Yorkers who received emergency crisis counseling following WTC disaster suffered significantly fewer mental health problems for up to 2 years after the disaster occurred…”
• “…less long-term risk for binge drinking, alcohol dependence, posttraumatic stress disorder (PTSD) symptoms, major depression, anxiety, and overall mental health impairment than those who did not…”
• “New Yorkers who received emergency crisis counseling following WTC disaster suffered significantly fewer mental health problems for up to 2 years after the disaster occurred…”
• “…less long-term risk for binge drinking, alcohol dependence, posttraumatic stress disorder (PTSD) symptoms, major depression, anxiety, and overall mental health impairment than those who did not…”
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• “Based on current findings, we suggest that crisis intervention services should be considered as a first line of emergency management for those potentially affected by large-scale community disasters,”
Reported by The New York Academy of Medicine, with support from NIMH at 8th
World Congress on Stress, Trauma and Coping 02/19/05. Results to be published in the International Journal of Emergency Mental Health, Winter Issue 2005, a quarterly peer-reviewed journal.
• “Based on current findings, we suggest that crisis intervention services should be considered as a first line of emergency management for those potentially affected by large-scale community disasters,”
Reported by The New York Academy of Medicine, with support from NIMH at 8th
World Congress on Stress, Trauma and Coping 02/19/05. Results to be published in the International Journal of Emergency Mental Health, Winter Issue 2005, a quarterly peer-reviewed journal.
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Departmental StatisticsDepartmental Statistics
• In 2005• 15 debriefings• 20 defusings• 80 one-on-one interventions
• In 2005• 15 debriefings• 20 defusings• 80 one-on-one interventions
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Future Development of CISM Team
Future Development of CISM Team
• Team Growth• Grants• Equipment• Travel Expenses
• Team Growth• Grants• Equipment• Travel Expenses
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QUESTIONS?QUESTIONS?
