Taking a close look at the structure of a CISM team reveals that we accomplish many things with our skills. We help those exposed to traumatic events, critical incidents and the horrors these events can bring. By using a well balanced methodology, good peer skills and mental health professionals, any CISM team can provide numerous benefits.
Anyone who has been involved as a CISM responder knows that we provide an important education piece in the interventions. We speak about taking care of ourselves, removing ourselves from the stressors of the job, eating better, increasing our regular exercise and putting our own needs further up the priority list.
One of the principal goals of CISM is to educate emergency responders that their reactions to traumatic experiences are natural consequences a healthy person can anticipate. We should be validating these reactions through the use of empathetic statements and even just by “being there” through the Ministry of Presence.
All of these proficiencies are part of the basic CISM training and are expected to be used by the CISM Responder. Now, what also has to happen is a technique I refer to as role modeling.
Role modeling is simply doing what we teach and speak about in interventions. Since many of us who are CISM responders come from the emergency services field, we know that the work can be difficult and its many demands can make us feel pressed for time. That pressure, in turn, may prevent us from employing good self-care skills, the type of personal care-giving that is not always easy to do and to manage on a daily basis.
It’s not just the emergency responders who tend to overlook their own needs. This goes as well for the mental health professionals and clergy who are on CISM teams. In today’s environment, the constant demands pressing in on us can easily overwhelm us. We now have instant messaging, instant e-mails, pagers, cell phones, all of which can “steal” our attention immediately, distracting us from our own personal needs and issues that often wind up getting pushed down that priority list.
So, how does a CISM responder achieve good role modeling? Here are just a few behaviors we can begin with:
1. Are we taking a multi-vitamin every day?
2. How much water do we drink each day? 6-8 glasses each day?
3. How’s our diet? Face it, a Twinkie and a diet soda isn’t going to do it!
4. Who often do we unplug from our emergency services work and CISM work?
5. Do we allow for our reactions to critical incidents?
6. Are we self-aware enough to see our own danger signs?
An important lesson I have learned in my many years as a CISM responder is that to be a healthy provider, to be credible as a CISM responder and to be balanced in our work, we have to simply do what we preach and be sure we are not saying one thing and doing a far different one.
Being truthful to yourself and being able to know when you are nearing your limits is an indication that you are indeed healthy and can say “Enough for now.” Being able to unplug and take time away from our duties is a crucial factor in allowing us to stay in the game.
The ability to educate about emergency responder stress, its effects and to how best manage it is still in its infancy. When the first programs were introduced in the late 1980’s, they were not quickly accepted nor used extensively. While this record has improved over the years, there is still much work to do.
Fast forward to today, and you’ll discover that we still are not accomplishing the goal of educating all emergency responders to the damaging effects of stress and the best techniques to use to mitigate its damaging consequences.
When I participate in any CISM intervention, or lecture on this topic, I use the following line to help dismiss the “taboos” that are omnipresent barriers to asking for help.
That line is: “Only the strongest are those who are willing to ask for help.”
In today’s emergency services culture, there remains, in spite of everything, a strong “myth” or perception that if I as an emergency responder (EMS, Law Enforcement, Fire, ED staff, etc.) seek assistance I will be looked upon by my peers as a weak person who may not be “cut out” to do the job. This type of peer pressure is, frankly, damaging or even killing emergency responders on a daily basis.
If you look at our society in general, the same attitude persists that there is something wrong with seeking and using any mental health assistance. This is a sad reflection our culture and indicates that many people remain oblivious to the help others truly need to be healthy, functional and able to move forward.
These taboos and myths can be effectively diminished by the leaders, managers and chiefs of the many emergency services if only they’ll make one simple gesture. By taking the lead and setting an example by attending defusings and debriefings, as well as asking how their employees are after a potentially “bad call,” they can move mountains of misconceptions and poorly focused perceptions of what CISM-based interventions and using pre-education programs are really are about.
Using my sometimes dangerous sense of humor, I also include this statement in the beginning of interventions or pre-education classes: “CISM is not burning incense, listening to Yani music and hugging each other…” This always gets a good bit of fun into the session and breaks down some of these misconceptions. (I will go on record publicly here; I DO listen to and like Yani music, HA!)
The bottom line is this—whether your department is volunteer-based, paid or a combination, you simply cannot afford to lose your most valuable asset, your people. We must do a better job of providing a “vaccination” against emergency responder stress and implementing support programs for their families so that we diminish the heavy-hand of peer pressure that keeps good people from asking for help.
There are resources readily available to assist you with any needs you may have. A true leader will be the first one to look at these resources and be able to garner the positives results of these educational and post event services.
Allow me to repeat myself, “Only the strongest are those who are willing to ask for help.”
I would like to introduce to you a new model within the CISM ‘tool box’ – Acute Traumatic Stress Management (ATSM).
Historically, we as emergency services providers have been well trained to take care of our patients and those who we respond to during medical emergencies. We have been trained to many levels of care and intervention responsibilities are ours to take on.
Due to the ground-breaking work of Mark Lerner, Ph.D., & Raymond Shelton, Ph.D., of the American Academy of Experts in Traumatic Stress (AAETS), there is a powerful tool for all emergency services providers (ESP’s) to both learn and begin to fully utilize. This new tool, ATSM, is designed to address the emergent psychological needs of the patient or victim during traumatic events.
Looking at the traditional CISM response plans, they are driven towards the intervention for the ESP’s after the traumatic event. These plans are designed to address the psychological needs of the ESP’s after the traumatic events they have worked. When we are working with a patient or victim during that traumatic event, we administer to their physical and medical needs, as we do the respective jobs our training has taught us.
Acute Traumatic Stress Management (ATSM) takes this typical response an entire step further and looks at the whole patient or victim, considering their physical, medical and psychological needs.
As quoted in the training manual for ATSM, “Acute Traumatic Stress Management is a pragmatic process that was developed for all emergency responders to address the emergent psychological needs of individuals who are exposed to traumatic events. The application of ATSM, along with traditional emergency medical intervention, offers a comprehensive response strategy to meet the needs of the ‘whole person.’”
The ATSM model teaches and demonstrates effective ‘tools’ for the responders to use and allows for them to further connect and identify with their patient or victim.
Having completed this training and now being certified to instruct it, I strongly suggest that you look into this new and effective model to thoroughly examine when and where it can fit within your organization’s response tactics. In addition, it offers new techniques for furthering patient care and increasing victim intervention effectiveness. ATSM truly puts the pieces of the CISM puzzle together, assuring that the other CISM tools interlock together nicely.
Over my many years of conducting CISM training classes, defusings and debriefings, I have discovered a piece of valuable information is often lacking for participants in these training sessions and interventions.
In my early psychology classes, we heard a great deal about human circadian rhythms and how they normally run their course in each of us as individuals. It’s easy to understand how these personal cycles will most likely be different in each of us. From these classes, I gained an appreciation of the crucial ways that circadian rhythms can get out of their normal cycle during stressful or traumatic events and how that change directly affects the entire person.
Throughout the many interventions I have participated in, I have heard literally hundreds of times how the Emergency Services Responders’ (ESP’s) sleep and waking patterns and daily functional abilities are heavily impacted after a traumatic experience. These symptoms can also be the result of cumulative stress.
After hearing these comments for a several years, I have recently incorporated a section teaching a basic understanding of the individual’s circadian rhythms and how to ‘re-set’ them in both my CISM pre-educational programs and while doing post-event interventions.
Teaching these tactics helps to mitigate the symptoms ESP’s describe currently experiencing. By comprehending what’s actually behind the typical sleeplessness, feeling of constant exhaustion, etc., they now have a better base to work from and to better understand why they are feeling this way. Thus empowered, they can put further learning opportunities to work.
A major part of this lesson involves suggestions on how to ‘re-set’ their circadian rhythms and how to manage them while under stress. I suggest as they approach their normal bedtime, to start gradually reducing the amount of ambient light levels at least 2 hours before going to sleep. It’s important not to fight sleeplessness and, if they can’t fall asleep in about 20-30 minutes, get out of bed to read, listen to soothing music, or try milk or apples which have natural enzymes in them that help trigger the sleep hormone, melatonin.
By adding these very basic circadian rhythm points into teachings and interventions, we can do a better job helping those under traumatic stress understand why they are feeling they way they are, how to best react to it, and how to get these basic rhythms back on their normal course.
What it takes to be prepared
In my consulting business, I’m often asked how does a corporation, Emergency Services department or hospital plan for the effects of critical incident stress (CIS) and how do they know those plans are effective.
I see these as excellent concerns and ones that deserve careful planning in order to have a pre-plan in place that is well-thought out, easy to deploy, and able to be easily understood by all departmental management levels.
To start with, a pre-plan has to begin with the clear understanding that CIS is real and affects everyone. No matter if you are a Fortune 500 company or a rural ambulance corps, CIS is there and needs to be both recognized and planned for. Wherever you are, it is absolutely essential to get management buy-in at the very beginning stages of planning.
Recognizing the reality of CIS and fully realizing the risks it presents, allows you to be prepared for that risk. Companies and departments plan for disasters, employee illness, fires, floods, but so few plan for CIS and the traumatic after-effects it leaves behind.
Once this recognition stage is accomplished, you then need to develop a CIS awareness level of training and education. I see this is one of the most effective tools you can ‘arm’ your business or department with—to, in a sense, ‘inoculate’ your people against CIS.
- Begin by talking about the basics of stress and how it affects the way we live, work and play. No one can avoid stress and we need to face it head-on. Everyone needs to recognize that stress is a natural, to-be-expected part of daily life and it’s important to recognize when it gets out of balance.
- Educate about the signs and symptoms of traumatic stress. These can include hyper-vigilance, avoidance of re-living the incident, changes in ‘normal behaviors’ (such as not being the outgoing type of person you normally are), changes in sleep patterns, changes in eating patterns, poor problem solving, anxiety, etc.
- Speak to what is known as the ‘imprints of horror,’ those visual impacts to one’s senses of the actual event, the things that may have been seen, heard, smelled, and witnessed. These imprints need to be off-loaded and that is best done with the defusing/debriefing processes within the Mitchell Model methodology.
- Teach that one of the leading causes of employee burnout, especially in the emergency services, is CIS.
It is my firm belief that if we can apply basic pre-educational techniques, we can better prepare those employees to what they may experience, how they may feel and how to best survive and take care of themselves after the critical incident.
Welcome to the new home of the official CISM Perspectives blog. We have much more information to come. We hope you enjoy reading our blog and will return often.
