CISM Flashcards
What are the 6 stages in the Defusing process?
1) Make contact - acknowledge and contract
2) Get the story - the facts, just the facts
3) Find the impact - emotions
4) How are they doing - safety
5) Educate - handout
6) Ending - follow up
What are 6 key helpful things to mention to someone post-critical incident stress?
1) CIS does not mean you are mentally ill.
2) You are having normal / expected reactions to abnormal situation
3) Your family is involved - let them be a part of your recovery
4) Get help if your symptoms persist
5) Counselling will lessen your CIS
6) Find someone you trust and talk about it
What are 8 things to suggest people DON’T do following critical incident stress?
1) Drink excessive alcohol
2) Use substances to numb post-trauma consequences
3) Withdraw from family and friends
4) Don’t stay away from work necessarily (normal routine will help you feel normal)
5) Don’t fall back on easy answers, blame for incident
6) Don’t think that you are crazy
7) Don’t think you alone were affected
8) Don’t be unrealistic in your expectations for recovery
What are 8 things to suggest people DO do following critical incident stress?
1) Expect the incident will bother you
2) Maintain diet and cut down on sugar, caffeine, stimulants
3) Exercise
4) Take time for leisure
5) Remind yourself that post-trauma consequences are expected / normal
6) Learn as much as you can about stress response
7) Spend time with family, friends, and co-workers
8) Get extra help if you need it
What is stress?
The body’s response to demanding situations.
What are the terms for positive and negative stress?
Eustress and Distress
What consequenses lie at the ends of the stress continuum?
Burnout and boredom
What is an analogy for a healthy level of stress in life?
Violin string. If it’s too tight, it will break, if it’s not tight enough, it won’t sing.
What are the three major components to a critical incident?
1) The distressed state resulting from memories of trauma (experience which shatters sense of invulnerability to harm)
2) Any situation where one is overwealmed by sense of vulnerability or lack of control
3) Any situation faced by emerg services resulting in strong emotional reactions which may interfere with ability to function
What is traumatic stress? How is it different from a critical incident.
Any stress resulting from trauma. Traumatic stress is not necessarily critical incident stress. Death of a sibling may be traumatic, but may not be critical incident, for eg., if death were expected.
What are the four general typical responses to stress?
Acute (in the moment)
Delated (comes back to bite you)
Secondary (compassion fatigue, vicarious trauma)
Cumulative (burnout, several acute situations)
What are the 7 stages of a critical incident?
Alarm (e.g., a pager, phone call, there’s been an accident)
Impact (Rote training kicks in; feel overwealmed)
Inventory (confusion, frustration, disorientation)
Rescue (elated, purposefulness, euphoria, fearfulness, sadness)
Stress management (demobilizations, defusings, debriefing)
Empowerment (achieving mastery)
Loss accommodation (resolution, continuance)
What are the five main categories of critical incident reactions, and an example for each?
Physical (shaking, autonomic nervous system)
Emotional (fear, anger)
Cognitive (confusion)
Behavioural (aggression, blaming)
Spiritual (look for meaning, question beliefs)
Where does critical incident stress sit in relation to PTSD in terms of normal/abnormal reactions?
CIS is involves normal reactions, that will either resolve or possibly develop into abnormal reactions like Acute Stress Disorder or PTSD.
What are the 8 categories of diagnostic criteria for PTSD?
Traumatic event (s) Exposure to actual or threatened death, serious injury, or sexual violence
Intrusion symptoms associated with traumatic event
Persistent avoidance of stimuli associated with traumatic event(s)
Negative alterations in cognitions and mood associated with traumatic event
Arousal and reactivity, marked alterations of.
Duration is more than 1 month
Impairment or Distress is clinically significant
Not attributable to substance or another condition
What are the PTSD diagnostic specifications?
1) With dissociate symptoms (depersonalization, derealization
2) Delayed expression (full criteria are not met until at least 6mo following traumatic event.
PTSD diagnosis: What are the 4 different ways one could be exposed to traumatic event?
1) Direct experience
2) Witnessing it happen to someone else
3) Learning that it happened to family or friend
4) Repeated or extreme exposure to aversive details of traumatic event
PTSD diagnosis: What are the 5 categories of intrusion symptoms and how many are required for PTSD diagnosis?
One or more of following required:
Distressing memories
Distressing dreams related to trauma
Dissociative reactions (flashbacks)
Intense or prolonged psychological distress at exposure to cues (triggers, reminders)
Marked physiological reactions to cues (triggers, reminders)
PTSD diagnosis: What are the 2 categories of avoidance stimuli and how many required for diagnosis?
At least one:
Effort to avoid thoughts memories or feelings related to trauma
Effort to avoid external reminders, like people, places, things, closely associated to trauma
PTSD diagnosis: What are the 7 categories of negative alterations of mood/cognitions, and how many required for diagnosis?
At least 2 of following:
Inability to remember important aspect of traumatic event
Negative beliefs about oneself (I am bad, I can’t trust anyone)
Distorted cognitions of blame or consequences related to trauma
Persistent neg emotions like fear, horror, anger, guilt, shame)
Marked diminished interest in significant activities
Feeling detached, estranged from others
Unable to experience positive emotions like happiness, satisfaction, love)
PTSD diagnosis: What are the 6 categories of arousal and reactivity and how many are required for diagnosis?
At least two of following req’d Irritable and angry outbursts with little provocation Reckless, self-destructive behaviour Hypervigilance Exaggerated startle response Problems with concentration Sleep disturbance
What is the main difference between acute stress disorder and PTSD?
Duration. ASD is 3 days to 1 month following trauma exposure. Symptoms begin very soon after trauma and persist for at least 3 days.
What is compassion fatigue?
A state of tension and preoccupation with trauma of clients manifested in one or more of 1) re-experiencing traumatic event; 2) avoidance or reminders of trauma; persistent arousal
What is the difference between compassion requirement and compassion trap?
The requirement is for feeling for another’s suffering; the trap is a lack of balance between therapeutic alliance and emotional over-involvement
What are 3 major ares of the brain that are affected by acute stress and trauma, and how are they affected?
Hippocampus (suppressed in acute stress; decreases in volume with PTSD)
Amygdala (activated during acute stress)
Reticular activating system (in face of danger, shuts down energy to cerebral cortex, leading to drop in creativity and logic, and reliance on training and instinct)
What is the main function of the hippocampus?
Seat of spatial and temporal experience, and has role in sorting and categorizing stimuli in short term memory
What is main function of amygdala?
Linked to emotions, reaction to danger, evaluates emotional meaning of stimuli, stores emotional memory, leads to hormonal fight or flight signals
What is the main function of reticular activating system?
Switching device between hippocampus, amygdala, and ceberal cortex
What is the filing analogy for the brain?
The brain is like a filing cabinet. There is an executive assistant filing experiences. Clerks come out at night and file. For unpleasant experience there can be delayed reaction, and no one wants to deal with it. It sits in the inbox, on top.
What are 3 categories of risk factors of susceptibility to critical incidents?
Individual stress factors (relationship stress, age, health, etc)
Working environment stress factors (Management, morale, training)
Incident stress factors (Time to prepare, severity, duration, children involved)
According to Kelly McGonigal, what are the benefits of stress?
Stress makes you social
Oxytocin is part of stress response
Caring for others builds resilience
Chasing meaning is better for you than avoiding discomfort
Who were the 3 major 19th century names involved in trauma thought?
Charcot (symptom classification in asylums)
Janet (trauma = dissociation)
Freud (behaviour of adults related to childhood trauma)
How did WWI influence trauma theory?
40% of casualties were victims of mental breakdowns. They were shamed as traitors and cowards.
How did WWII and Korean war influence trauma theory?
Kardiner studied ‘combat trauma’. Grainker and Spiegel (Men Under Stress) found constant danger lead to extreme dependence on peers and leaders. It was found that any man could break down. Intervention was provided close to battle lines.
How did the Vietnam war influence trauma theory?
Neuropsychiatric disorders increased following the war.
Veterans were returned home very quickly and had no time to debrief and prepare for return
Vietnam vets were not considered heroes on return.
What are the 10 elements of the Mitchell model for CISM?
Pre-crisis prep
Rest, Information, Transition Services (RITS) or Demobilizations and staff consultation
Crises management briefing (civilians, schools, businesses)
Defusing
Critical Incident Stress Debriefing
Individual crisis intervention (one to one)
Family CISM
Organizational consultation
Pastoral crisis intervention
Follow up/referral
When is demobilization used:
In prolonged rescue attempts, and is done at the end of a first shift.
What is the demobilization process? (5 steps)
assess well-being of workers
mitigate impact of event
provide stress management info
provide opportunity for rest and food (explain the importance of)
assess need for debriefing and other services
What is not discussed in a demobilization, and why?
The incident, one’s feelings. Because rescuers need to get back to dealing with incident.
How long does demobilization take?
30 minutes - 10 minutes info session, 20 minutes for food and rest.
What are the 8 goals of crisis management briefings?
provide info control rumours reduce chaos provide coping resources facilitate follow up care cohesion and morale assess further needs restore personnel to adaptive functions
What are the 4 steps of CMB?
Assemble participants
provide facts
Discuss and normalize common reactions,
Discuss stress management, direct to resources
When does the diffusing process occur?
Shortly after an incident has ended (same day)
Who provides a defusing?
Peer support, or CIS-trained person.
What are the three phases of defusing?
Introduction
Venting
Normalization
What are the 8 steps of a walk-and-talk defusing?
make contact acknowledge incident invite person for walk-and-talk get agreement get story get impact educate closure (get them home safely)
Why would you offer someone coffee OR tea before a defusing?
To give them a choice. Get them making choices. Empower them. (rather than just would you like a coffee?)
Who is the target audience of CISD?
Persons in a workplace who are normal and have normal reactions, and who have experienced a critical incident
What is the purpose of CISD?
Reduce impact of event and accelerate recovery.
What are the 7 steps of CISD?
Intro Facts Thoughts Reactions Symptoms Teaching Re-entry
What are the problems in CISM research attributed to?
Participants not knowing each other, debriefing occurring too late (off protocol)
What are other 9 intervention models?
Continuum of care Decompression Didactic debrief Lines and Ladders Multiple Stressor Debriefing Model National Organization for Victim Assistance Psychological Debrief Psychological Educational Debriefing Psychological First Aid
What is a healing circle symbolize?
Interdependence of all life
What is the function of a talking circle?
To teach important lessons of life, and for people to internalize and verbalize the learning
What are the goals of the healing circle?
to begin healing process to promote understanding To prevent or solve problems To build trust To respect each persona and oneself To share common experiences To realize we are not alone To learn from others about life To identify personal issues which help us to understand and grow
What is the time limit of a CISD?
None
What are the 4 R’s of Forgiveness?
Reframe
Responsibility
Rewrite
Reconnect
