welcome to this site--a space for people in activist communities who have faced trauma in actions, people who want to learn about trauma recovery and other generally interested folks. this site was established quickly to get info out to all the people who were assaulted by the police during actions against the ftaa and has grown daily since then. we want to explore issues of mental health as they relate to activist communities--including political trauma, ptsd, dissociation, burnout and how to create healing spaces to work through trauma and sustain the important work we do.

critical incident stress syndrome -- an introduction

source:
search and rescue society of british columbia (sarbc)
http://www.sarbc.org/cis1.html

critical incident stress syndrome (ciss) is a very real and potentially fatal danger to search and rescue personnel. it can cause the break up of families, loss of jobs, and more. that's the bad news; the good news is that it can be treated with few complications if recognized and treated early.

ciss is the adverse psychological and/or physiological reaction to a stressful incident. search and rescue personnel are particularly susceptible to this due to the very nature of their job.

stress does have a cumulative effect on the body. someone who has been involved in numerous incidents without any lasting complications may suddenly develop the signs and symptoms of a stress reaction. another example of the cumulative effect of stress is an individual who is experiencing other stressors such as marital problems, problems with children, or a recent death of a friend or relative, and who then is called out for a sar incident. he may develop the signs and symptoms of a stress reaction in what may seem a particularly uneventful incident.

people who are unprepared for the physical and mental strain of a sar incident are particularly susceptible.

in an incident where a particularly stressful situation develops, sar people are at risk. an incident involving a mutilated or decomposing body, the death or serious injury of a fellow searcher or a politically frustrating situation may all lead to ciss.

everyone involved in a sar incident has the responsibility to be alert for the signs and symptoms of a stress reaction in him/herself and in fellow searchers. the team leader (tl) must be alert for signs of a stress reaction in his/her team members. the team debriefing is an opportune time to assess the searchers. the tl must pass any suspicions on to the tl debriefer. the person debriefing the tl must also be alert for signs and symptoms or ciss in the tl and pass that information along to the ops officer.

what it does:

it can make a grown man cry, vomit, fight for breath, even commit suicide if not treated. it is very important that this syndrome be understood and the need to deal with it be recognized. rescue workers are hidden victims of an overwhelming psychological experience - dealing with the recovery of burned, drowned, decomposed and dismembered human bodies.

if left untreated, they may have unresolved conflicts and feelings that remain long after the trauma. these side effects range from headache, fatigue, and sexual dysfunction, to terrifying dreams, hallucinations, severe withdrawal and apathy.

the syndrome affects firemen, policemen, search and rescue crews - anyone called upon to deal with death and injury in the course of duty.

it is very important to react immediately.

studies show that physical exercise is a great stress release and dissipates adrenaline which has been pumping for hours. even a brisk walk helps clear the head and give a person time to think things out.

rescue crews should be told to stay away completely from coffee and sugar for a few hours - sugar raises the blood pressure and the heart beats faster. coffee is a stimulant.

alcohol and drugs are also out. if people rely on them to unwind, they can become very dependent very fast.

a debriefing can release much of the negative reaction. debriefing is necessary because there are significant differences between normal death and violent or collective death. normal death is usually predictable, and it is surrounded in comforting regulation, dignity and decorum.

in disaster situations such primary coping methods are absent. the indignity is grotesque, the disorder is terrifying.

rescuers must suppress their feelings and concentrate on the task. this delays their psychological reaction. after a disaster ends and normal routine starts, there is often an intense period when repressed feelings start to surface. it is important for workers to talk to their "buddies" to vent their feelings.

rescuers are brave, heroic people and because of this they are sometimes reluctant to seek help. it's the john wayne syndrome - movies have glamorized their careers, made them seem superhuman.

critical stress debriefings have been part of certain federal response agencies for years now. information meetings take place as soon as crews return from a significant mission. they are de-briefed within 72 hours. one-to-one sessions are provided if the individuals require it.

organizations that really care for their personnel are moving in this direction.

in the rescue business it is often the good people that burn out. the ones that are most devoted, most caring. rescuers are unusual in that they must constantly fight natural instinct. they must face very dangerous situations over and over again and move right into them. they put their lives on the line for all kinds of reasons - the public rarely hears about it.

time to heal is vital. during the second world war many troops were sent back home on transport ships. they debriefed themselves by talking to each other. by the time the soldiers got home they were reasonably stable. but in vietnam it was very different. many military personnel were flown home in a matter of hours. the shock was terrible. some still carry the emotional scars.

sometimes a whole community can be traumatized, as in the case of the mount washington (v.i.) bus crash which killed two claremont (victoria) high school students.

what you can do right away is arrange for an on-call counselor in your community.

critical incident stress is the emotional, behavioural and physiological reaction to an emergency worker when confronted with acute trauma. specifically, when there is unexpected mission failure, excessive human suffering or unusual sights or sounds (eg. grotesque victims), or when there is a threat to the life of the worker, emergency personnel can experience a traumatic stress response.critical incident stress (c.i.s.) has the potential to affect one's ability to function either at the scene of an incident or later.

the most effective way to minimize the negative effect of c.i.s. is through a c.i.s. debriefing facilitated by a trained mental health professional. however, there may be times when there is no professional debriefer available or when the incident is of a minor nature and unit chiefs or managers may wish to provide some form of debriefing service. in these situations you may wish to conduct a mini debriefing.

if you find yourself in situation where you feel a mini-debriefing is necessary, here are some guidelines to consider.

1. not everyone can conduct mini-debriefings. those best suited have good interpersonal skills, know from experience that c.i.s. is real and a normal reaction to acute trauma, are comfortable with the expression of emotion in themselves and others and are trusted by those they plan to assist. knowledge of crisis intervention, grief and loss is a definite plus.

2. you must be seen as an ally to the crew you plan to debrief. sometimes even the warmest supervisor cannot lead a debriefing due to the attitude some may have towards management or an existing climate between groups and management. it is recommended that debriefers be at the peer level. if there is no one else, simply put your cards on the table right away. inform the group (or individual, if that is the case) that your role here is as a supportive friend, not as a boss. if you feel your position would get in the way of a debriefing, get someone else to lead the process.

3. make the rules clear. this is to be a debriefing, not a critique. the purpose of the session is to share your feelings about a difficult call, not to criticize others. also make sure participants agree that the proceedings will be confidential.

4. pick a time and a place that is comfortable and where there will be no interruptions. the debriefing should be a continuous process with no one else wandering in and out.

5. do not assume how participants are feeling. explain why you have initiated the debriefing and your knowledge about c.i.s. then simply invite participants to individually respond to how the call has impacted them. listen and watch for signs of emotional vulnerability. if there is none, fine, you have done your job. if there is, let it flow and the group will establish its own emotional level. remember, the expression of extreme emotion is a healthy, normal process that emergency workers have learned to suppress.

6. don't force the group process, but do get each individual to contribute at least once. one suggestion is to follow the traditional debriefing steps and have participants discuss what they actually said and heard at the scene. if individuals have been traumatized, it normally shows through their tone of voice. when this happens, let them express themselves. affirm that what they are experiencing is normal given the circumstances.

7. stop criticism of others.
a critique can come later, but if individuals start complaining about others behaviour, stop it by saying something like: "bob, we will be doing a critique later this week. the purpose of this session is to share our feelings about the call. tell us how you felt during the call when things started going wrong." being criticized by others before you are debriefed can be more traumatic than the incident itself.

8. do not permit tough, insensitive comments or any gallows humor. this will quickly put an end to the expression of personal feelings.

9. watch for the non-participant especially the one who is visibly shaken. touch base with him/her later in private to make sure he/she is not simply reluctant to talk in a group setting.

10. if the mini-debriefing becomes emotional, do not stop until all the grief and pain is out. you may go through the entire group without any expression of feelings and finally the last person shares some emotional pain. make sure you allow time to go around the group again allowing others to do the same.

11. end the session with some form of "where do we go from here?" question. after an emotional session there is a need for a transition. talking about action plans gives time for individuals to internalize what has happened and get ready to return home or to work.

12. finally, after the session is over, you should contact a trained debriefer and debrief yourself. doing this will release any pent-up stress and build your confidence about further debriefings.

remember, the worst thing you can do when others have experienced c.i.s., is to criticize them before they are emotionally debriefed. the second worst thing you can do is not

to facilitate some form of psychological debriefing.

if you ever find yourself in a situation where the emergency workers around you may be in emotional pain, i urge you to take action. if it means doing your first mini-debriefing, "go for it". remember, all you can be is yourself and all you can do is your best. if your colleagues know you are sincere in your intentions, they will support you in what you are attempting to do.

suggested post critical incident "do's and don'ts"

source:
lawrence h. bergmann, ph.d.
post trauma resources
803-765-0700

depending on the critical incident and post-trauma consequences, these are examples of coping skills which may assist recovery.

1. magnitude of the disaster
2. the duration of the exposure
3. the degree of personal danger
4. the individual's personality and emotional stability
5. the coping mechanisms developed from past experiences
6. the role of the worker
7. the frequency of similar experiences
8. the individual's expectations
9. the individual's training in ciss
10. a recent tragedy in the individual's life
11. the support and understanding of fellow-workers
12. the support and understanding of management
13. ostracism by co-workers, family, or the general public
14. media interference
15. personal acquaintance with the victim(s)

cognitive reactions

• disorientation
• impaired thought processes
• reduced judgement and memory
• comprehension problems
• inability to concentrate
• loss of skills
• amnesia
• inability to distinguish between trivial and important matters

things to do to help you through

• immediately following the activity stage, do vigorous exercises for a short period of time.
• deal with feelings now or they'll deal with you later.
• talk it out with each other and with friends and family.
• help each other.
• remember it's ok to have feelings.
• remember the symptoms will subside.
• if your progress is not to your satisfaction - seek help.
• take pride in what you have accomplished.
• exercise to reduce stress.
• relax by deep muscle relaxation technique
  relax by deep breathing exercises
  relax by yoga
• eat regularly and well (vitamin b supplement may be required).
• have fun - laugh.
• make short-term plans to keep you busy and interested.
• do not use drugs, alcohol, coffee or too much sugar.