Transcript Blue and Grey - The Silver Star Families of America

The Silver Star Families of America

PTS(D)/TBI-A GUIDE FOR FIRST RESPONDERS
Disclaimer
The Silver Star Families of America has been a leading advocate for those wounded in the mind by PTS(D). In fact we do not call it a
disorder so you will see us refer to it here as simply PTS. We are not physicians or mental health experts but we do have some
expertise in dealing with those wounded by PTS and we do have some experience with first responders.
This suggested class outline for police, fire and other first responders came from antidotal cases of PTS and FR contacts and is
offered as a general, but not all inclusive, guide. The Silver Star Families of America offers this as a guide only and cannot be held
liable for any consequence that may or may not arise.
Statistics
PTS and the Military
If you are in the military, you may have seen combat. You may have been on missions that exposed you to horrible
and life-threatening experiences. You may have been shot at, seen a buddy shot, or seen death. These are types of
events that can lead to PTS.
Experts think PTS occurs:

In about 30% of Vietnam veterans, or about 30 out of 100 Vietnam veterans.

In as many as 10% of Gulf War (Desert Storm) veterans, or in 10 veterans out of 100.

In about 6% to 11% of veterans of the Afghanistan war (Enduring Freedom), or in 6 to 11 veterans out of
100.

In about 12% to 20% of veterans of the Iraq war (Iraqi Freedom), or in 12 to 20 veterans out of 100.

Statistics
Other factors in a combat situation can add more stress to an already stressful situation and may contribute to PTS
and other mental health problems. These factors include what you do in the war, the politics around the war, where
it's fought, and the type of enemy you face.
Another cause of PTS in the military can be military sexual trauma (MST). This is any sexual harassment or sexual
assault that occurs while you are in the military. MST can happen to men and women and can occur during
peacetime, training, or war.
Among veterans using VA health care, about:

23 out of 100 women (23%) reported sexual assault when in the military

55 out of 100 women (55%) and 38 out of 100 men (38%) have experienced sexual harassment when in
the military
Even though military sexual trauma is far more common in women, over half of all veterans with military sexual
trauma are men.
Resources
http://www.va.gov/
http://www.ncptsd.va.gov/ncmain/information/
How do Americans Celebrate the Day
By Nancy Spoerke
How do Americans celebrate the day
That our nation with fireworks does display
How can I be a part of all of this now
When my mind takes me back to the war somehow
The sound of the sky rockets that cause all the glee
It sounds like mortar rounds to me
To all that smile at the beautiful sights in the sky
They look like tracer rounds through my eyes
So how can others not see all of this
Why can't they see my fears and paralysis
How much more need I take
How far can I go before I break
Am I a rock so solid and strong
NO, you make it so hard for me to go on
I love our country beyond belief
But I can't handle this, I need relief
How strong can I be, please let me be strong
Sometimes I have the feeling I can't go on
How strong do you think I can be
When the shots of hell are still inside of me
as I cower from the beautiful sights
This 4th celebration, sometimes night after night
Please remember I so want to be free
I love my country, my flag,
. . . Remember I gave my mind for thee.
A GUIDE FOR FIRST
RESPONDERS
A GUIDE FOR FIRST RESPONDERS
A PROJECT OF THE SILVER STAR FAMILIES OF AMERICA
SECTION 1
Understanding PTS and TBI
SECTION 2
Why this is important to you and the Wounded?
SECTION 3
Suggested responses for dealing with the Wounded
SECTION 4
Delivering Psychological First Aid
Recommendation
*The SSFOA highly recommends the Crisis Intervention Team program started by the Memphis Police Department in 1988 who joined
in partnership with the Memphis Chapter of the National Alliance on Mental Illness (NAMI), mental health providers, and two local
universities (the University of Memphis and the University of Tennessee) in organizing, training, and implementing a specialized unit.
This unique and creative alliance was established for the purpose of developing a more intelligent, understandable, and safe approach
to mental crisis events.
This program trains officers to recognize mental issues and teaches de-escalation techniques. While the SSFOA does not consider
PTS a disorder or illness, many of the techniques used are applicable to those wounded with PTS.
Section 1
UNDERSTANDING PTS/TBI
Many of the same symptoms can be displayed for both wounds, PTS and TBI. This is often the reason why the diagnoses are found
with one and then later the other.
PTS(D) is nothing to be ashamed of, embarrassed by,
feel guilty about or laughed at.
PTS(D) -- Post Traumatic Stress
known as PTSD or Post Traumatic Stress Disorder. SSFOA feels that PTS(D) is not a disorder but is a
wound that affects thousands of service members and their families. We believe PTS(D) sufferers should be treated with the same
respect, care and honor as all wounds and illness receive.
Cont.
Basically, Post Traumatic Stress is unconscious, automatic physical, emotional reaction(s) brought on by a delayed reaction to severe
physical and psychological experiences that are outside the normal human range of emotions. Veterans of combat are the most
publicized group of sufferers.
But law enforcement officers; emergency medical personnel; firefighters; survivors of life threatening accidents, fire, flood or natural
disasters; victims of violent crime; and victims of domestic, child or sexual abuse can and do suffer from PTS(D). ANYBODY can be
affected by PTS(D). Even family members and friends of those who have PTS(D) can suffer from what is called Secondary Traumatic
Stress Disorder (STSD). It is believed that 7-8% of the population have PTS(D) at some point in their lives.
Cont.
The following behavior/reactions are contributed to the affects of PTS(D) (not a complete list, each person reacts differently and a
person's reaction is different due to the source of the trauma):
- Flashbacks, or reliving the traumatic event(s) for minutes or even hours
- Feelings of shame or guilt
- Having upsetting dreams about the event(s)
- Trying to avoid thinking or talking about the event(s)
- Feeling emotionally numb
- Irritability or anger
- Poor relationships
- Self destructive behavior - use of drugs or drinking too much
- Feeling hopeless about the future
- Having trouble sleeping
- Memory problems
- Trouble concentrating
- Being easily startled or frightened
- Not enjoying activities that once were enjoyed
- Hearing or seeing things that aren't there
Cont.
Signs and symptoms of PTS(D) usually show up within 3 months of a traumatic event. However, for some, PTS(D) signs may not
occur until years afterwards. Symptoms can come and go.
Usually more symptoms become apparent during times of higher stress or when experiencing symbolic reminders of the event(s).
These reminders might be something remembered, something seen, something heard or even something smelled.
There is no one cause of PTS(D) and research is ongoing in this area. As with any mental health issue, the individual's biology and
genetics, life experiences, temperament and changes in the natural chemicals of their brains all play a part.
To help those with PTS(D) everyone is encouraged to do the following - general:
- Become aware of what PTS(D) is
- Offer understanding and support to those (along with their family members and friends) who are living with this condition
TRAMACTIC BRAIN INJURY*
What is Traumatic Brain Injury?
Traumatic brain injury (TBI), also called acquired brain injury or simply head injury, occurs when a sudden trauma causes damage to
the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain
tissue. Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain. A person with a mild
TBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. Other symptoms of mild TBI
include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth,
fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or
thinking. A person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or
does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both
pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion,
restlessness, or agitation.
Section 2
WHY IS THIS IMPORTANT TO YOU AS A FIRST RESPONDER?
Your personal safety and the safety of by standers is your prime responsibility. Refer to your training. However taking a few simple
steps can protect you and the person wounded with PTS.
Remember that the person with combat PTS has fought for his country and if you can defuse a situation without harm to anyone you
have served your country as well.
Section 3
SUGGESTED RESPONSES IN DEALING WITH PTS WOUNDED
The following is information that may be helpful when dealing with someone with combat related PTS(D) These recommendations
come directly from combat veterans.
When in contact with someone who has combat related PTS(D) or you think has it:
- Be calm
- Keep the number of people involved to a minimum
- Do away with unnecessary noise, bright lights
- Do not move quickly toward them
- Be patient
- Speak slowly with frequent pauses
- Avoid interruptions when they are speaking, as they may forget what they are trying to say
Crowds, loud noise, bright lights, fast movement, yelling are all things reminiscent of combat and can trigger a flashback or intensify
the situation if the individual is currently experiencing a flashback.
Anything that can be done to keep the conditions affecting the person
with PTS(D) as non-threatening as possible will go a long way in defusing a potential confrontation.
If possible remove sunglasses. Being able to see someone's eyes helps build trust
Section 4
Delivering Psychological First Aid*
Professional Behavior
Introduce themselves and give their job title.....police, EMT, paramedic, etc.
Model healthy responses; be calm, courteous, organized, and helpful.
Be visible and available.
Maintain confidentiality as appropriate.
Remain within the scope of your expertise and your designated role.
Make appropriate referrals when additional expertise is needed or requested by the survivor.
Be knowledgeable and sensitive to issues of culture and diversity.
Pay attention to your own emotional and physical reactions, and practice self-care.
Cont.
Guidelines for Delivering Psychological First Aid
Politely observe first, don't intrude. Then ask simple respectful questions to determine how you may help. Ask if they know where they
are.
Often, the best way to make contact is to provide practical assistance (food, water, blankets).
Initiate contact only after you have observed the situation and the person or family, and have determined that contact is not likely to be
intrusive or disruptive.
Be prepared that they will either avoid you or flood you with contact.
Speak calmly. Be patient, responsive, and sensitive.
Speak slowly, in simple concrete terms; don't use acronyms or jargon.
If the wounded want to talk, be prepared to listen. When you listen, focus on hearing what they want to tell you, and how you can be of
help.
Give information that directly addresses the wounded immediate goals and clarify answers repeatedly as needed.
Give information that is accurate.
Remember that the goal of Psychological First Aid is to reduce distress, assist with current needs, and promote adaptive functioning,
not to elicit details of traumatic experiences and losses.
Cont.
Some Behaviors to Avoid
Do not make assumptions about what wounded are experiencing or what they have been through.
Do not pathologize. Most acute reactions are understandable and expectable given what the wounded have experienced. Do not label
reactions as symptoms,or speak in terms of diagnoses,conditions,pathologies, or disorders.
Credit
The Silver Star Families of America also operate the Law Enforcement Equipment Program
Special thanks to the National Center for PTSD
http://www.ncptsd.va.gov/ncmain/index.jsp
National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov/
http://www.memphispolice.org/crisis%20intervention.htm
STAY SAFE!
REMBERING, HONORING AND ASSISTING THE
WOUNDED AND ILL OF THE ARMED FORCES
THANK YOU
The end