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Critical Incident Stress Management Interventions Help Heal First Responders

This is an excellent overview of the trauma emergency workers must endure by the nature of their work. There’s a price for this state of readiness and execution-read to find out the personal cost and the expense of the agency and community.

–Thonie

Critical Incident Stress Management Interventions Help Heal First Responders
March 18, 2015
By Dr. Chuck Russo, American Military University, and Carrie Kahn Courtney

First responders are trained to utilize tactical strategies in crisis situations so they can quickly protect lives and property. However, high-crisis incidents can overwhelm normal coping mechanisms and trigger traumatic-stress disorders for first responders.
Officer-involved shootings, line-of-duty deaths and injuries, child victims, employee suicide, and mass-casualty incidents are all events that can trigger traumatic-stress disorders for first responders. Common effects of traumatic stress include:
• concentration impairment
• eating and sleeping disturbances
• psychosomatic symptomology
• addictions
• depression
• irritability
• avoidant behaviors
• changes in libido
• increased personal and professional conflict

Post-traumatic stress disorder (PTSD) is one of the many mental-health disorders associated with traumatic stress. Such disorders often hinder a first responders’ ability to return to a pre-event “normal” status.

[Related article: Sandy Hook, Aurora Leaders Share Commonalities of Responding to Mass Casualty Events]

If post-traumatic stress is not addressed, it can often lead to faulty decision making, increased disciplinary problems, tardiness, on-the-job accidents, citizen complaints, and officer turnover.

While post-traumatic stress is the normal reaction to an abnormal event, PTSD does not have to occur. If post-traumatic stress is left unchecked, unaddressed, and untreated the results can often lead to PTSD.

Help First Responders with CISM Interventions

Critical incident stress management (CISM) is a short-term, psychological first-aid intervention strategy that can help mitigate long-term mental health issues for first responders.
CISM interventions encourage individuals to emote the impact of the cognitive, emotional, and psychological symptoms that manifest as a direct result of exposure to traumatic stress, especially repetitive traumatic stress. CISM aims to return those involved to a pre-event “normal” status quicker than if left to their own devices and deter PTSD.

Impacts of Traumatic Stress on an Agency

Besides taking a toll on the individual, traumatic stress has an impact on the agency. The effects of traumatic stress on organizations often include:
• communication breakdowns
• decreased morale
• deteriorating group cohesiveness
• increased absenteeism
• increased healthcare costs including increased worker’s compensation and disability claims
• decreased ability to retain effective personnel
• decreased employee efficiency and productivity
These financial and morale costs can cause long-term damage to an agency’s community support, resource budget, and recruiting opportunities.
It is important that agencies address the cognitive, emotional, physical, and behavioral symptoms associated with traumatic stress by implementing CISM interventions. Such implementation often includes one-on-one sessions, debriefings, and defusing sessions that are co-facilitated by mental health professionals and peers to combat traumatic stress. Agencies need to take proactive steps to help officers heal and recover from traumatic-stress incidents.

About the Authors:

Dr. Chuck Russo is the Program Director of Criminal Justice at American Military University (AMU). He began his career in law enforcement in 1987 in central Florida and was involved all areas of patrol, training, special operations and investigations before retiring from law enforcement in 2013. Dr. Russo continues to design and instruct courses, as well as act as a consultant for education, government and industry throughout the United States and the Middle East. His recent research and presentations focus on emerging technology and law enforcement applications, in addition to post-traumatic stress and online learning.

Carrie Kahn Courtney, RCSWI, wears many hats as a grant writer, social worker, disaster behavioral health specialist for adults and children, addictions professional, cadre trainer for the Disaster Technical Assistance Center, Vice President of Volusia Interfaith Networking in Disaster,Outgoing Chair for the Mental Health Association of East Central Florida, and as an Advanced Responder for the Florida Crisis Consortium.

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Making Sure Help is on the Way

by The Badge of Life Canada

by Monique Tamminga – Langley Times
posted Jan 21, 2015 at 11:00 AM

Langley resident Rae-Lynne Dicks began her career as a 911 operator in 1995. She left the job after being diagnosed with post-traumatic stress disorder (PTSD) and began studying at University of the Fraser Valley. She has conducted the first research in Canada on the prevalence of PTSD symptoms among Canadian 911 operators as part of her Master of Arts in criminal justice degree.

A former 911 operator who was diagnosed with Post Traumatic Stress Disorder is hoping to help prevent other operators in Canada from going through the same experience.
Langley resident Rae-Lynne Dicks began her career as a 911 operator in 1995 and transitioned to B.C.’s biggest 911 call centre, E-Comm, in 1999.
911-center-4While most of us think of police as first responders, it is actually 911 operators who usually are the first to deal with emergency situations.
Dicks experienced hundreds of in-progress emergencies, including rapes, bridge jumpers, fire deaths, home invasions and domestic assaults.
“It is the helplessness of being on the phone, help is on the way, and there is nothing more you can do but listen to a person take their last breath full of smoke, hear them scream as they fall and then hit the water, hear the gunshot from the weapon pointed at their own head, hear the daddy beating mommy as you try to calm the child hiding in the closet and mommy stops screaming because she is unconscious,” writes Dicks in her capstone major paper about PTSD among Canadian 911 operators.
She has conducted the first research in Canada on the prevalence of PTSD symptoms among Canadian 911 operators as part of her Master of Arts in criminal justice degree at University of Fraser Valley.
Dicks sent survey questions to operators at six different organizations across Canada, including police, ambulance and fire that included a PTSD check list, requested information about how they cope and education, prevention and treatment provided by their employers.
Of the 146 operators who responded, 80.14 per cent reported experiencing at least one PTSD symptom, 30.8 per cent had a total symptom severity score of equal to or greater than 28, and 8.9 percent met all the symptom criteria for diagnosis of PTSD.
More than 88 per cent said they cope by making their situation better but 43 per cent said they use alcohol or drugs to cope. A shocking 19 per cent said they have given up on the attempt to cope.
The pool of operators surveyed should be bigger, she said, but her findings indicate that more support and more research is needed.
From her findings, Dicks is now hoping to work with 911 call centres around the country to assist organizations in developing and implementing peer support programs to ensure operators are receiving the support that they need after dealing with a major crisis. She has joined a group of professionals through the Mood Disorders Society of Canada to do just that.
“In almost all emergencies, once we are done with that call, we continue taking calls. For an officer, after an emergency call they do paper work and debrief. For 911 operators, they keep working. They can’t unplug,” she said.
And in a big call centre like E-Comm, an operator can take 40 to 120 calls a shift.
“It’s the constant exposure to trauma that is the difference,” she said. “A police officer will deal with up to 12 calls per shift.”
Plus, there is no closure for a 911 operator.
“We don’t get the satisfaction of arresting the bad guy or knowing what happens to the bad guys after we take the call,” she said.
She believes there should be protocol in place that allows an operator to say, “I’m traumatized. I need a break.”
That person would then be able to go off and talk with a person trained in debriefing after trauma.
But like other first responder cultures, there is stigmatization that everyone needs to be tough, and that leads to no one speaking up. The silence has led to suicides among 911 operators, she said.
Suicides among paramedics and police officers has been on the increase in Canada and highly publicized as of late.
Operators are also not allowed to talk to anyone close to them about what they dealt with at work, for fear that someone’s privacy would be compromised. This leaves them no one to talk with and reduces a circle of support. “It creates a disconnect,” Dicks said.
One of the key components of being a good 911 operator is the ability to make really important decisions quickly. When you have PTSD, decision making becomes difficult, she said.
For Dicks, the accumulation of traumatic incidents over many years created a downhill spiral that led to her diagnosis in 2002. She suffered night terrors in which her psyche replaced victims from calls she took with her family members.
Everyone’s experiences with PSTD is different. For Dicks, her diagnosis is considered chronic because it has lasted for more than one year.
Dicks thinks awareness and education amongst 911 operators and management is another key component to assisting operators see the early warning signs and seeking help to prevent it becoming full-blown PTSD.
Dicks is a volunteer at Badge of Life Canada, http://www.badgeoflifecanada.com. She recently spoke at the Justice Institute during the 2014 Heroes are Human tour for Tema Conter Memorial Trust.
She believes with the right education and support, PTSD can be mitigated among 911 operators.