Transcript Slide 1

Understanding, Mitigating, and
Responding to the Psychological
Impact of Search and Rescue and
Disaster Relief Missions
Chaplain (Capt) Chad Kline, CAP
CISM Officer, Maryland Wing
Capt Christopher Hiles, RN BSN, MS, CAP
Nurse Officer, Maryland Wing
Introduction: Course Goals
Identify how people react to a stressful event
Identify how cadets may respond differently than adults
Identify symptoms of a negative response
Be able to help members at the scene and post-mission
Introduction: What This Course Is Not
 Critical Incident Stress Management training
 Medical or psychological certification or continuing
education course
Introduction: Overview
• Psychology 101
• Before the Mission
• During the Mission
• After the Mission
Psychology 101
Psychology 101
• Acute Disequilibrium/Psychological Crisis
• Post Traumatic Stress Disorder
• Response in Teenagers
Acute Disequilibrium/Psychological
Crisis
“A state of emotional turmoil wherein one’s usual coping
mechanisms have failed in the face of a perceived challenge or
threat.” –Everly and Mitchell, 2000
Acute Disequilibrium/Psychological
Crisis
There are four ways crisis effects an individual:
• Physically
• Emotionally
• Behaviorally
• Cognitively
All of these signs are ABOVE normal levels
Physical Effects of Crisis
• Feeling faint or dizzy
• Hot or cold sensations
• Tightness in throat, stomach, or chest
• Agitation, nervousness, or hyper
arousal
• Fatigue or exhaustion
• Stomach distress or nausea
• Increased or decreased appetite
• Headache
• Worstening of previous condition
Behavioral Effects of Crisis
• Sleep disturbances or nightmares
• Jumpiness or being easily startled
• Hyper-vigilance, scanning for danger
• Crying or tearful for no apparent reason
• Conflicts with family, friends, and
coworkers
• Avoidance of reminders of trauma
• Inability to express feelings
• Isolation or withdraw from others
• Increased use of drugs (including
prescription medication) or alcohol
Emotional Effects of Crisis
• Shock or disbelief
• Anxiety, fear, or worry about safety
• Numbness
• Sadness or grief
• Longing or pining for the deceased
• Feel powerless, helpless, or
vulnerable
• Disassociation or “shellshock”
• Anger, rage, or desire for revenge
• Irritability or shortness of temper
• Hopelessness or despair
• Blame self and/or others
• Survivor guilt
• Unpredictable mood swings
• Re experiencing pain associated
with previous trauma
Cognitive Effects of Crisis
• Confusion or disorientation
• Poor concentration or memory problems
• Impaired thinking or decision making
• Complete or partial amnesia
• Repeated flashbacks or intrusive
thoughts and images
• Obsessive self criticism or self doubts
• Preoccupation with protecting loved
ones
• Questioning of spiritual or religious
beliefs
What is PTSD?
“Post-traumatic stress disorder is a type of
anxiety disorder. It can occur after you've seen
or experienced a traumatic event that involved
the threat of injury or death.”*
*National
Institutes of Health
PTSD Symptoms
• Re-experiencing the traumatic event
• Flashbacks and nightmares
• Similar events triggering a large response
• Avoidance and emotional numbing
• Stop activity in CAP
• Withdrawn from family, friends, and team members
• Increased arousal
• Bursts of anger
• Inability to concentrate or becomes forgetful
• Anxiety symptoms as listed before
Effects of Stress on Adolescents
• Have same concerns as adults except:
• Varying levels of cognitive development
• May not fully understand the “why”
• May not have the same amount of experience or types of
experiences as adults
• May have lower thresholds of resistance and resilience
Before the Mission
Before the Mission:
Resistance/Resilience
Resistance: The ability to resist psychological effects
of a traumatic experience
Resilience: The ability to recover from the effects of a
traumatic experience
Before the Missions: Factors Effecting
Resistance/Resiliency
• Previous Experience
• History of Psychological and Substance Abuse
• Natural “Fight or Flight” Response
• Family Stability
• Cognitive Development
• Faith in Leadership
• Effective Use of Social Support Systems
Before the Mission: Building
Resistance/Resilience
• Get Experience
• Training at the Squadron Level
• Training through Exercises
• Build Social Support
• Build Relationships in the Squadron
• Use the Working Relationships Built within the Ground
Team/Air Crew
Before the Mission: Knowing If You’re Ready
• The best person to know if you’re ready is you
• How have you responded to crisis in the past?
• How have you responded to SAR exercises?
• How have you responded to previous SAR missions?
• Have you attempted desensitization?
Before the Mission: Are Your Team Members
Ready?
• Don’t just check your team for skills proficiency
• How do they handle stress?
• How do they act at the squadron?
• Have they talked to you about previous issues
• Get to know your team
• Discuss their concerns about possible
psychologically stressing scenarios
• Use discretion to determine discussions at a
group or individual level
Before the Mission: Are Your Cadets Ready?
• Do not make decisions in a vacuum, talk to:
• Cadet and senior staff working with the cadet
• The cadet’s parents or guardians
• Ground team members and leaders working with the cadet
• The cadet
• Age may not be best way to determine readiness
• As a cadet gets older, they should be reevaluated
You and Your Squadron
• How do you know if you’re ready?
• Does your squadron evaluate psychological preparedness?
• How can this information be applied to your squadron?
Remember, MDWG CISM Team can assist you and your unit by
providing training and advice
During the Mission
During the Mission: Critical Incident Stress
Management
“Critical Incident Stress Management (CISM) may be defined as
a comprehensive, integrated, multi-component crisis
intervention system.” – CAPR 60-5
During the Mission: How CISM Helps
• Demobilization and Staff Consultation: Consultation to the incident
or activity commander who believes a CISM response may be
necessary
• Crisis Management Briefing: A briefing with the incident or activity
commander about the best ways to support responders
• Defusing: A session held within 12 hours of an incident, usually in
small groups, that are designed to allow people who may been
exposed to a traumatic event used to determine if a member will
require some follow up or further assistance
During the Mission: How CISM Helps
• Critical Incident Stress Debriefings: A group session held
between 1 and 10 days after an incident where members are
evaluated for trauma and referred to further services
• Individual Crisis Intervention: A one on one discussion with an
effected member that can occur anytime and at any place requested
• Family CISM: A session with family members of an effected member
designed to provide the family with resources to help support the
member
During the Mission: How to Reach the CISM
Team
• During a mission/activity: Request CISM services through the
chain of command. The Incident or Activity Commander will contact
the MDWG CISM Officer.
• What if I can’t get anyone on the CISM team? Contact the NHQ
Duty Officer at 1-888-211-1812
During the Mission: CISM and Privacy
• Any provided CISM services are considered confidential
• National Headquarters requires the number of people provided
services and the number of referrals made
• No identifying information is recorded or reported to anyone outside
the CISM team (this includes names, ranks, home units, CAP ID’s,
etc.)
During the Mission: Scenarios
• Read the scenario
• You will control our actors by suggesting courses of action
During the Mission: Scenario 1
During a missing aircraft search, a ground team discovers the
wreckage with human remains on board. A senior member, a 32 year
old male GTM 3, immediately turns away, throws up, and stands,
facing away from the site, trembling. As the GTL, what should you
do?
During the Mission: Scenario 1
Expected Actions
• Approach the GTM in a caring manner
• Removing member from scene while completing mission tasks
(e.g. cordoning of the site, relaying information to mission base)
• Get member to mission base
• Request CISM support
• Maintain member confidentiality
During the Mission: Scenario 2
After finding the scene, a ground team relays crash site details to
mission base including the finding of the remains of the two people
on board. None of the information is graphic. A 15 year old female
cadet in the radio room records the information. An hour later, the
cadet begins to withdraw. A friend of the cadet, also in the radio
room, approaches you and becomes concerned stating that it isn’t
her normal way of acting.
During the Mission: Scenario 2
Expected Actions
• Report concern up the chain of command
• Request CISM assistance
• Watch cadet and gently approach if necessary
After the Mission
After the Mission: How Long Will
Symptoms Remain
• Initial reaction symptoms may last weeks, months, or even years
after the event
• Symptoms of anxiety may disappear and reappear months later
• Be wary of any sudden changes of behavior, even months after
the incident
After the Mission: Where to Get Help
• Local resources
• Squadron Chaplain
• Squadron Health Services Officer
• Wing resources (All contact information is online at
www.mdcap.org)
• Wing Critical Incident Stress Management Officer
• Wing Chaplain
• Wing Health Services Officer
• NHQ Duty Officer at 1-888-211-1812
After the Mission: Getting Back on the
Horse
• Don’t force it
• Members may want to pursue other issues within the ES
mission or in Aerospace Education or Cadet Programs
• Forcing a member back into the field may cause them to
quit altogether
• Take it slow
• It may be better to only participate in exercises and work
back to a mission
• Be honest with yourself
After the Mission: How CISM Helps
• Organizational consultation: Consultation with a unit to help foster
communications and support for potentially effected members
• Follow-up/Referral: One-on-one consultation with effected
members who have already been evaluated in one of the previous
intervention
After the Mission Scenario
After locating a crash scene, the ground team cordons off the site and
begins crash site surveillance. A half hour later, the local coroners
office clears the remains and a new ground team relieves the original
team. This team stays in place for 6 hours until the mission is closed
and, without incident, return home. At the next squadron meeting, a
16 year old male cadet on the crash site surveillance team begins to
act out, not an unusual occurrence. However, when redirected, he
normally responds well. This time he continues to act out and
threatens cadet staff with violence when they try to correct them,
which has never happened before. You are the Deputy Commander
for Cadets and were not on the mission. What do you do?
During the Mission Scenario
Expected Action
• DCC alerts CC
• Approach cadet gently
• Isolate cadet from general cadet corps
• Contact cadet’s parents
• Request CISM support and/or unit chaplain
Questions
Contact Information
Chaplain (Capt) Chad Kline, CAP
CISM Officer
Maryland Wing
443-794-7186
[email protected]
Capt Chris Hiles, RN BSN, MS, CAP
Nurse Officer
Maryland Wing
410-926-6840
410-255-5041