CISM in NOVA SCOTIA

CRITICAL INCIDENT STRESS CRITICAL INCIDENT STRESS MANAGEMENTMANAGEMENT

A PRESENTATION BYA PRESENTATION BY

THE CRITICAL INCIDENT STRESS MANAGEMENT THE CRITICAL INCIDENT STRESS MANAGEMENT TEAMTEAM

FIRE OFFICER’S ASSOCIATION OF FIRE OFFICER’S ASSOCIATION OF NOVA SCOTIANOVA SCOTIA

HISTORYHISTORY Trauma has been around foreverTrauma has been around forever During WW I it was called shell shockDuring WW I it was called shell shock In WW II we called it “lack of moral fibre”In WW II we called it “lack of moral fibre” Twice as many Viet Nam vets have Twice as many Viet Nam vets have

committed suicide as were killed in the warcommitted suicide as were killed in the war Canada’s Gen Dallaire and other Canada’s Gen Dallaire and other

peacekeepers have been affected.peacekeepers have been affected. We’re learning how to manage traumatic We’re learning how to manage traumatic

stressstress CISM is CISM is notnot psycho therapy psycho therapy Sharing of thoughtsSharing of thoughts

WHAT KINDS OF INCIDENTS CAN WHAT KINDS OF INCIDENTS CAN TRIGGER CIS?TRIGGER CIS?

A line of duty deathA line of duty death The death of a childThe death of a child Incidents involving single / multiple Incidents involving single / multiple

casualties or injuriescasualties or injuries Significant injury/threat to Significant injury/threat to

firefightersfirefighters Incidents attracting heavy media Incidents attracting heavy media

coveragecoverage

SOME EXAMPLES FROM SOME EXAMPLES FROM OUR EXPERIENCEOUR EXPERIENCE

Two toddlers drown in a pondTwo toddlers drown in a pond Family delivering presents involved Family delivering presents involved

in fatal Christmas eve MVAin fatal Christmas eve MVA Father and two children die in Father and two children die in

house fire. One of the firefighters house fire. One of the firefighters was born in the house and, as a was born in the house and, as a heavy equipment operator, had to heavy equipment operator, had to demolish it the next day.demolish it the next day.

HOW WILL I KNOW IF I’M SUFFERING HOW WILL I KNOW IF I’M SUFFERING FROM CIS?FROM CIS?

There are a number of physical, There are a number of physical, emotional and cognitive symptoms emotional and cognitive symptoms of CIS. You may experience one or of CIS. You may experience one or a combination of the following:a combination of the following:

CIS Physical Reactions CIS Physical Reactions May BeMay Be

Sleep disturbanceSleep disturbance FatigueFatigue Changes in eating Changes in eating

habitshabits Menstrual cycle Menstrual cycle

changeschanges HeadachesHeadaches NauseaNausea

CIS Emotional Reactions May CIS Emotional Reactions May BeBe

AnxietyAnxiety IrritabilityIrritability DepressionDepression Sense of lossSense of loss Change in need for Change in need for

intimacyintimacy Feelings of isolationFeelings of isolation GuiltGuilt FlashbacksFlashbacks

CIS Cognitive (Thinking) CIS Cognitive (Thinking) Reactions May BeReactions May Be

ConfusionConfusion Difficulty making decisionsDifficulty making decisions Impaired thinkingImpaired thinking Difficulty problem-solvingDifficulty problem-solving Memory lossMemory loss Calculation difficultiesCalculation difficulties Anomia (difficulty Anomia (difficulty

remembering names of remembering names of things)things)

REMEMBERREMEMBER

CIS IS CIS IS

A NORMAL REACTIONA NORMAL REACTION

TO AN TO AN

ABNORMAL EXPERIENCEABNORMAL EXPERIENCE

WHY WE’RE VULNERABLE TO CISWHY WE’RE VULNERABLE TO CIS

CHARACTERISTICS OF CHARACTERISTICS OF FIREFIGHTERSFIREFIGHTERS

ACTION ORIENTEDACTION ORIENTED EXPECT SUCCESSEXPECT SUCCESS LIKE TO CONTROL LIKE TO CONTROL

SITUATIONSSITUATIONS NEED TO CONTROL NEED TO CONTROL

OURSELVESOURSELVES

CHARACTERISTICS OF CHARACTERISTICS OF EMERGENCIESEMERGENCIES

IMPEDIMENTS TO ACTIONIMPEDIMENTS TO ACTION UNSAVEABLE UNSAVEABLE

SITUATIONSSITUATIONS NATURALLY CHAOTICNATURALLY CHAOTIC

SITUATION SITUATION PERSONALIZEDPERSONALIZED

HOW DO WE MANAGE CIS?HOW DO WE MANAGE CIS?

We do this through a program called We do this through a program called Critical Incident Stress Management. Critical Incident Stress Management. The components of CISM are:The components of CISM are:

PRE-INCIDENT EDUCATIONPRE-INCIDENT EDUCATION ON SCENE INTERVENTIONSON SCENE INTERVENTIONS DEFUSINGSDEFUSINGS DEBRIEFINGSDEBRIEFINGS FOLLOW UPFOLLOW UP

DEFUSINGDEFUSING

Ideal time 1-2 hours after incidentIdeal time 1-2 hours after incident 20-45 minutes in length20-45 minutes in length Done in a group, led by a team of Done in a group, led by a team of

Peer debriefer(s)Peer debriefer(s) Not an operational critique but Not an operational critique but

venting of emotionsventing of emotions

DEFUSING PROCESS DEFUSING PROCESS

Three stages:Three stages:

INTRODUCTIONINTRODUCTION EXPLORATIONEXPLORATION INFORMATIONINFORMATION

DEBRIEFINGSDEBRIEFINGS

A more in depth version of a DefusingA more in depth version of a Defusing They are held 24-72 hours after an They are held 24-72 hours after an

incidentincident Done in a group led by a team of at Done in a group led by a team of at

least one mental health professional, least one mental health professional, trained in the fire service, and one trained in the fire service, and one firefighter trained in CISM.firefighter trained in CISM.

Not an operational critique but venting Not an operational critique but venting of emotionsof emotions

THE DEBRIEFING PROCESSTHE DEBRIEFING PROCESS

1.1. INTRODUCTION AND GROUND RULESINTRODUCTION AND GROUND RULES

2.2. DESCRIPTION OF THE FACTSDESCRIPTION OF THE FACTS

3.3. RESPONDERS THOUGHTSRESPONDERS THOUGHTS

4.4. RESPONDERS REACTIONSRESPONDERS REACTIONS

5.5. EXPLANATION OF CIS SYMPTOMSEXPLANATION OF CIS SYMPTOMS

6.6. STRATEGIES FOR COPING WITH CISSTRATEGIES FOR COPING WITH CIS

7.7. CONCLUSIONCONCLUSION

HOW DO WE KNOW IF WE NEED A HOW DO WE KNOW IF WE NEED A DEFUSING OR DEBRIEFING ?DEFUSING OR DEBRIEFING ?

A call involving a fatality, especially a child, line of A call involving a fatality, especially a child, line of duty death, significant injury or serious incident duty death, significant injury or serious incident outside your department’s normal duties can trigger outside your department’s normal duties can trigger CISCIS

If you or any of your fellow firefighters experience If you or any of your fellow firefighters experience CIS symptoms.CIS symptoms.

If in doubt then have one – prevention is everything.If in doubt then have one – prevention is everything. Remember, only members involved in the incident Remember, only members involved in the incident

attend debriefings.attend debriefings. Members not experiencing CIS symptoms should Members not experiencing CIS symptoms should

attend as their input can often be very helpful.attend as their input can often be very helpful.

HOW DO WE ARRANGE HOW DO WE ARRANGE A DEBRIEFING?A DEBRIEFING?

IT’S EASY. Simply call the Fire Marshall’s IT’S EASY. Simply call the Fire Marshall’s office. They’ll collect details from you and office. They’ll collect details from you and call out the Critical Incident Stress call out the Critical Incident Stress Response TeamResponse Team

Like you, CISRT members are volunteers Like you, CISRT members are volunteers and provide the service for free.and provide the service for free.

1-800-559-3473 1-800-559-3473

24 / 724 / 7

DOES CISM WORK?DOES CISM WORK?

A STUDY, BY MARY HANNEMAN, OF N.S. FIREFIGHTERS WHO A STUDY, BY MARY HANNEMAN, OF N.S. FIREFIGHTERS WHO HAD EXPERIENCED A DEBRIEFING FOUND DEBRIEFINGS:HAD EXPERIENCED A DEBRIEFING FOUND DEBRIEFINGS:

PROVIDED A COMPLETE PICTURE OF THE INCIDENTPROVIDED A COMPLETE PICTURE OF THE INCIDENT ALLOWED FIREFIGHTERS TO VENT ALLOWED FIREFIGHTERS TO VENT FACILITATED THE EXPRESSION OF EMOTIONSFACILITATED THE EXPRESSION OF EMOTIONS HELPED FIREFIGHTERS KNOW THEY WEREN’T ALONE IN HELPED FIREFIGHTERS KNOW THEY WEREN’T ALONE IN

THEIR REACTOINSTHEIR REACTOINS BOOSTED MORALE AMONG FIREFIGHTERSBOOSTED MORALE AMONG FIREFIGHTERS HELPED FIREFIGHTERS UNDERSTAND THEMSELVES AND HELPED FIREFIGHTERS UNDERSTAND THEMSELVES AND

EACH OTHER BETTEREACH OTHER BETTER RESULTED IN DEEPER, MORE MEANINGFUL DISCUSSIONS RESULTED IN DEEPER, MORE MEANINGFUL DISCUSSIONS

THAN USUAL.THAN USUAL.

HOW TO GET MORE HOW TO GET MORE INFORMATIONINFORMATION

Talk to a member of the CISM teamTalk to a member of the CISM team

Visit our website: Visit our website: www.nsfirecism.ca

this site will give you additional this site will give you additional information on CISM and some good information on CISM and some good links links

CONCLUSIONCONCLUSION

You provide a valuable service – the job You provide a valuable service – the job isn’t easyisn’t easy

The likelihood of you being exposed to The likelihood of you being exposed to a critical incident is increasinga critical incident is increasing

Just as you take care of your Just as you take care of your equipment, you need to take care of equipment, you need to take care of yourselvesyourselves

We are proud to provide you with CISM We are proud to provide you with CISM support and encourage you to call on ussupport and encourage you to call on us