1	CISM Critical Incident Stress Management
2	Who 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
3	History 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
4	What 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
5	Goals 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
6	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
7	"DFD firefighters supporting NYFD rescue..." DFD firefighters supporting NYFD rescue workers
8	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
9	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
10	"Rescue workers in NYC bringing..." Rescue workers in NYC bringing out body
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12	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
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14	Body’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
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16	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
17	"Accumulation of highly stressful calls..." 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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19	9/11: New York City
20	9/11: Pentagon
21	NASA: Columbia Shuttle
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23	Reactions to Critical Incidents Physical Cognitive / Mental Psychological / Emotional
24	Physical Reactions to Critical Incidents Fatigue Loss of Appetite Nausea Headaches Tremors Insomnia Heartburn Restlessness Tenseness Digestive trouble Sexual dysfunction Startle reactions
25	Cognitive/Mental Reactions Difficulty with concentration Difficulty solving problems Difficulty making decisions Memory disturbances Confusion Decline in job performance
26	Psychological/Emotional Reactions Anger/Irritability Anxiety Numbness Helpless Flashbacks Moodiness Frustration Guilt Withdrawal/Isolation Depression Dreams/Nightmares Questioning Career Aggressive Outbursts Distrust of Department
27	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
28	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%
29	Effectiveness 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…”
30	"“Based on current findings" “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 8^th 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.
31	Departmental Statistics In 2005 15 debriefings 20 defusings 80 one-on-one interventions
32	Future Development of CISM Team Team Growth Grants Equipment Travel Expenses
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35	QUESTIONS?