"Stress
--- Distress"
II Timothy 1:7, "For God Hath Not given us
the Spirit of Fear; but of Power, and of Love,
and of a Sound Mind."
Introduction:
A. Christians suffer from Stress and Discouragement
just as Non- Christians do.
1. Moses prayed to die.
2. Elijah prayed to die.
3. Job cursed the day he was born.
4. John, in prison, doubted that Jesus was the Messiah.
B. The Surgeon General estimates that "80% of the
people who die of non-traumatic causes (accidents) actually die of Stress Related
Diseases."
I. Stress may be Major Factor in causing:
A. Hypertension and Coronary Heart Disease,
B. Migraine and Tension Headaches,
C. Ulcers,
D. Asthmatic Conditions,
E. Chronic Backache,
F. Arthritis,
G. Allergies,
H. Hyperthyroidism,
I. Vertigo, and Multiple Sclerosis,
II. Stress not only affects our bodies, but it also Affects The
Way We Think And Feel.
III. Stress may Lead To Harmful Habits such as smoking and
overeating, which have been shown to cause or intensify still other diseases.
IV. Stress, Bereavement, and Depression can
significantly Suppress Immunity --- making you More Susceptible to
bacteria and viruses.
A. Stress suppresses immunity In Proportion To the Intensity
of the stressor.
B. Prolonged Stress may be More of a suppressor
of our immune system than Acute, Intense stress.
V. The following Stats indicate that we are Losing The
War On Stress:
A. 30 Million Americans have some form of Major Heart or
Blood-Vessel Disease ----- 1 Million Americans have a Heart Attack every
year.
B. 25 Million Americans have High Blood Pressure.
C. 8 Million Americans have Ulcers.
D. 12 Million Americans are Alcoholics --- $15.6
Billion are lost by American industry each year because of Alcoholism.
E. 5 Billion doses of Tranquilizers --- 3 Billion
doses of Amphetamines --- 5 Billion doses of Barbiturates are
prescribed Each Year.
F. $19.4 Billion are lost by American industry each year
because of Premature Employee Death.
G. $15 Billion are lost by American industry each year because
of Stress-Related Absenteeism.
H. $700 Million are spent each year to Recruit Replacements
for executives with Heart Disease.
VI. Life Without Stress Is Impossible.
A. For Most people --- "stress" is a description of
their Daily Lives.
B. It is related to the Speed at which we live, as well as the
Complexity of our lives.
C. Stress is Not designed by nature to Kill, but rather
to Enhance life.
D. The Right Kind of stress is Helpful and actually Essential
for a Full And Productive Life.
E. Without Stress there would be no change, no growth, and no
productivity --- we would never accomplish anything of value.
F. Stress keeps our Hearts beating, our Digestion
flowing and our Minds sharpened.
VII. When stress gets Out Of Control (Distress) it
becomes a Destructive Force that has a negative impact on: our Health ---
our Personalities --- our Jobs --- and our Families.
A. We must learn how to Control or Manage stress in our
life.
B. Before we can control or manage anything, we must have a Sound
Understanding of that which we seek to control.
VIII. There are Several Different Types of Stress:
A. Environmental stress factors:
1. Nose --- Dirt/dust --- Pollution --- Clutter,
2. Weather Conditions -- Temperature Extremes,
3. Threat of Nuclear War,
4. Confined Space --- Overcrowding,
5. Traffic,
6. lighting,
7. Rapid Decision Making,
8. The Swiftly Expanding Knowledge Base, etc.
B. Psychosocial stress factors --- almost anything that
has to do with Contact With People:
1. Family Relationships,
2. Conflicts With Fellow Workers,
3. Conflicts With The Administration,
4. Lack of Appreciation From Superiors,
5. Abusive Behavior,
6. Taxes --- Financial Success, or Lack of It, The Economy,
7. Changing Values, etc.
C. Personality stress factors --- Focus Within
Ourselves --- relate to ways in which we Think and Feel --- and the Memories
of our past experiences --- including:
1. The Inability To Say "No" To Someone.
2. The Need To Be Liked.
3. Guilt Feelings When We Don't Help Someone.
4. Anxiety Over Our Own Professional Competence.
5. A Mental Outlook In Which We See Everything As Negative.
6. Personal Sensitivity To Criticism.
7. Extremely High Expectations of Ourselves.
8. Guilt Over Mistakes or Not Doing A Perfect Job.
9. Pressures To Achieve Status --- Popularity or The Lack of It, etc.
D. Stress for Young People may include some of these
same stress factors --- they may also include:
1. Pressure To Make Good Grades,
2. Peer Pressure,
3. Need To Belong --- To Be Accepted --- To Be Loved,
4. Need For Recognition,
5. Need For A Support System, (Family, Friends, etc.),
6. Need To Communicate Effectively With Adults and/or Peers,
7. Need To Establish Independence,
8. Need To Prepare For A Career,
9. Need To Select A Mate,
10. Need To Develop Life Skills,
11. Need To Establish Personal Values And To Behave Consistently With
Those Values.
IX. What Is Stress?
A. Distress is the Negative Response to a stress
factor.
B. The perception that we are going to be Threatened causes a
negative response --- resulting in stress.
X. Stress is Personal.
A. What is stressful for you may not brother the next person at all.
B. One person may enjoy Mountain Climbing --- the next person
may be frightened to the point of nausea at the idea of climbing a Six Foot Ladder.
C. Phil sees the idea of Inviting Heather For A Date as
threatening:
1. He is afraid of being rejected --- This fear makes him anxious and
uncomfortable.
2. Danny, however, feels no threat --- being turned down is "no
big deal" to him.
Return To Top
How To
Recognize
Stress --- Distress Signals:
( Early Warning Signs / Indicators of Difficulty In Coping)
I. The following Stress Reactions are presented in categories
so that they may be more easily recognized and understood.
A. There is no magic number of these symptoms that suggest difficulty
in coping.
B. Rather, it is the extent to which the noted reaction is a Change
From A Person's Normal Lifestyle that makes a reaction potentially important.
II. Also, it is the Combined Presence of Symptoms that
determines the potency of the problem.
III. Indicators may be Isolated Reactions or Combinations
among the three categories listed below.
IV. The Severity of The Difficulty In Coping is suggested by:
1. The Duration (how long the symptoms have been present and
how long they last).
2. The Frequency of such incidents (how often they happen).
3. The Intensity (strength) with which they are present.
Over The Next Month, You May Experience Normal Reactions
To The Kind of Experience You Have Had Which May Include:
How To Cope
With Trauma or Stress?
(Things To Know And Do)
I. It Is Natural
For Your Judgment To Be Hampered By Stress.
A. Recognize That You Are In Stress And That It May Be A Painful
Period of Adjustment.
1. Admit that you are hurting.
2. It is normal to hurt when you are in stress,
3. Especially if you have experienced a loss.
B. Do Not:
1. Have unrealistic expectations for recovery,
2. Expect the incident Not to brother you,
3. Look for easy answers.
C. Self-Doubts Are Symptoms of Stress.
1. So is an inability to concentrate.
2. When everything seems to be going wrong, it is hard to think about
anything else.
3. Take an emotional breather -- Take all breaks, lunches, etc.
The ones you need the most are the ones you don't want to take.
D. Try To Avoid As Many Decisions As Possible, Especially Major Ones
--- Do Not Make Any Big Life Changes.
1. Deal only with those major decisions that require immediate
attention.
2. However, do make as many daily decisions as possible which will
give you a feeling of control over your life.
3. For example, if someone asks you what you want to eat, answer them
even if you are not sure.
E. Expect To Get Through Your Crisis.
1. There will be good days and bad days.
2. Do not be discouraged when your feelings seem to overwhelm you ---
Just when you thought you were getting it all together again.
F. Know Yourself --- Expand or Develop An Introspective Attitude.
1. Know what you feel and why.
2. Be aware of prior conditioning.
G. Do Not Deny Your Feelings, But Do Not Dwell On Them.
Acknowledge them but do not encourage them.
H. You Are Normal And Having Normal Reaction --- Do Not Label
Yourself Crazy.
II. Deal With One
Thing At A Time --- Keep Your Life As Orderly As Possible.
A. Structure Your Time --- Keep Busy --- Make Schedules, Lists,
Plans, Etc., And Try To Stick To Them.
1. Set appropriate goals.
2. Change what you can --- This is generally not "The
System". Concentrate on smaller goals.
3. Schedule as much activity into the weekends as possible.
4. Do the same thing but do it differently.
B. Take Responsibility For Your Life (Your Actions).
1. Obey those in authority over you.
2. Respect the laws of the land.
3. Don't try to live Above Your Means.
C. Practice Time-Management Techniques In Your Daily Life.
D. It Is A Good Time, However, To Be Nice To Yourself --- Do Things
That Feel Good To You.
Make a list of good things to do for yourself and use it to
"treat" yourself from time to time.
E. Keep Your Life As Normal As Possible.
III. Accept
The Help of Others --- And Be Willing To Help Others.
A. Understanding And Support Are Important When You Are In Stress.
1. Do Not Deny Yourself Assistance That May Be Available To You.
2. Do not withdraw from significant others.
B. Develop A Work And Personal Support Group.
1. Have a supportive family
2. Belong to some social or activity group that meets at least once a
month (other than your family).
3. These will provide help, comfort, insight, comparison, rewards,
humor, and escape from stress.
4. Reach out --- people do care --- Spend time with others.
C. Talk To People --- Talk Is The Most Healing Medicine.
1. Talk about what happened in as much detail as possible.
2. Talk about your feelings during the event.
3. However, avoid gripe and confrontational sessions.
D. If Possible, Surround Yourself With Things That Require Nurturing
--- (Children, Plants, Pets, etc.)
E. Help Your Co-Workers As Much As Possible By Sharing Feelings And
Checking Out How They Are Doing.
Realize those around you are also under stress.
IV. Protect
Your Health With Adequate Rest, Proper Diet And Moderate Exercise.
A. Within The First 24 To 48 Hours, Periods of Strenuous Physical
Exercise --- Alternated With Relaxation And Rest --- Will Alleviate Some of The Physical
Reactions.
1. Exercise 30 minutes or longer at least three times a week.
2. Stay within 5 pounds of your "ideal" body-weight
(considering your height and bone structure).
B. The Nutrition Almanac Recommends Supplementing Your Diet
With Vitamins C, B2, B6 And Minerals, Calcium, And Magnesium.
1. Eat nutritionally balanced and wholesome meals.
2. Stay away from caffeine, nicotine, and alcohol.
C. This Is Not A Good Time To Over-Indulge In Alcohol, Drugs,
Eating or Smoking.
1. Be aware of numbing the pain with overuse of drugs or alcohol.
2. You do not need to complicate this with a substance abuse problem.
3. Use medication only under doctors orders.
D. Practice Relaxation Techniques --- These Counteract The Body's
Response To The Fight or Flight Syndrome.
Get ample rest.
V. Do Not
Take Your Work Home With You.
A. Provide A Decompression Time Which Shifts The Energy Focus From
Mental And Emotional Things To Physical or Relaxation-Related Things.
1. Exercise
2. Take a nap
3. Enjoy a hot tub or sauna
4. Have some place in your home that you can go to in order to relax
and/or be by yourself.
5. Meditate upon the Scriptures at least three times a week.
B. Establish Clear Boundaries Between Work And Home Life.
1. Non-working hours should be more than an absence of work.
2. Develop a life of your own.
3. Actively pursue a hobby.
VI. Re-Evaluate
Negative Situations For Positive Results.
A. Force Yourself To Find or Create A Positive In Every Situation.
B. Keep A Journal --- Write Your Way Through Those Sleepless Hours.
C. Do Not Get Caught Up In "If-Onlys" And
"What-Ifs." --- Don't Second-Guess Yourself or Others.
D. Recognize And Reward Yourself.
1. Do something that you really enjoy, "just for yourself",
during the course of an average week.
2. Keep lists of your daily accomplishments.
3. Celebrate the small things.
VII. Don't
Take Things Personally.
A. Objectify --- Then Analyze The Situation.
B. Do Not Get Upset When People Tell You How You "Should"
Feel or "Ought" To Act.
1. Remember, these are Your feelings and they are important.
2. Give yourself permission to feel rotten, and share your feelings
with others.
C. Remember That Emotional Wounds Take Time To Heal And That It Is
Important To Heal At Your Own Pace.
After All, You Are Unique!
Definitions:
"Critical Incident Stress Debriefing"
I. Critical
--- Crisis --- Any Major Distressing Event or the Cumulative
Effect of several small stressors.
A. Any serious Interruption in the steady state of a person,
family, or group.
B. An Emotionally Significant event which acts as a Turning-Point
for better or worse.
C. A Normal Response to an Abnormal Situation.
II. Incident
--- Any Change in our environment (a "Stressor") --- which may
create a crisis.
III. Stress
--- The word "stress" comes directly from the ancient Latin Language. It meant
"Force," "Pressure," or "Strain."
A. A Response to a perceived threat, challenge, or change.
1. A physical and psychological Response to any demand.
2. A state of Psychological and/or Physical Arousal.
B. It is related to the speed at which we live, as well as the
complexity of our lives.
The Surgeon General estimates that "80% of the people who die of
non-traumatic causes actually die of stress diseases."
C. As we experience Increasing Levels of Distress:
1. We begin to Lose Our Mental Efficiency.
a. Concentration is difficult and we become more easily
distracted.
b. We lose our Mental Flexibility and become Rigid in
our views of problems and solutions.
c. Criticisms of our ideas or suggestions are viewed as Criticisms
of Ourselves and we respond defensively as though we had been attacked.
2. We Lose Our Sense of Humor and can no longer laugh at
ourselves or the situation.
a. Humor is one of the primary coping strategies we use to help us
through traumatic events in our lives.
b. Its loss leaves us more defenseless and vulnerable to
stress-induced emotional depletion.
3. Our Ability To Trust Others Lessens.
a. The foundation for most intense personal relationships is trust.
b. We fear that others will not be capable of helping us.
4. We Withdraw From People who are our Primary Support.
a. We become isolated from the very people we Need The Most.
b. A Vacuum Is An Unnatural State in Physics and also
in Human emotions.
D. The Losses we encounter as a part of our stress reactions
are replaced with Increased Fantasies and Wishful Thinking.
E. Stress is Exhibited in our lives in Three
Stages:
1. First, By Physical and Emotional Exhaustion.
2. Second, By Apathy.
3. Third, By a Deterioration In Performance.
F. Stress is a Necessary part of our life:
1. Stress Can Be Positive. Without it we are not Creative
or Productive.
a. Stress is Not designed by nature to kill, but rather to Enhance
life.
b. The right kind of stress is helpful and actually Essential
for a Full And Productive Life.
2. Our job is to Manage Stress --- Not Take It Away!
G. There Four Main Types of Stressors:
1. Normal Stressors:
a. Environmental Stress Factors --- External situations
that pertain to nature or conditions in the responders surrounding environment.
(1) Noise --- Dirt/dust --- Pollution --- Clutter,
(2) Weather conditions --- Temperature extremes,
(3) Threat of nuclear war,
(4) Confined space --- Overcrowding --- Spectators in the way,
(5) Traffic --- Speed on calls --- Pressures of rapid response,
(6) Lighting,
(7) Swiftly expanding knowledge base --- Rapid decision making, etc.
b. Psychosocial Stress Factors --- almost anything that
has to do with contact with people:
(1) Family relationships,
(2) Conflicts with fellow workers,
(3) Conflicts with the administration,
(4) Lack of appreciation from superiors,
(5) Abusive behavior by patients --- Intoxicatedpatients --- Media at
the scene,
(6) Taxes --- Financial success --- The Economy,
(7) Changing values, etc.
c. Personality Stress Factors --- focus within
ourselves --- relate to ways in which we think and feel --- and the memories of our past
experiences --- including:
(1) The inability to say "no" to someone.
(2) The need to be liked.
(3) Guilt feelings when we don't help someone.
(4) Anxiety over our own professional competence, Extremely high
expectations of ourselves.
Guilt over mistakes or not doing a perfect job,
(5) A negative mental outlook.
(6) Personal sensitivity to criticism.
(7) Pressures to achieve status --- Popularity or the lack of it,
etc.
d. Adolescence Stress Factors:
(1) Pressure to make good grades --- Need to prepare for a career ---
Need to develop life skills,
(2) Peer pressure --- Need to belong --- to be accepted --- to be
loved,
(3) Need for recognition --- Need to establish independence,
(4) Need for a support system, (family, friends, etc.),
(5) Need to communicate effectively with adults and/or peers,
(6) Need to select a mate,
(7) Need to establish personal values and to behave consistently with
those values.
e. All of these are Normal Stressors, now
notice some Adnormal Stressors:
2. Acute or Incident-Prompted Stress ---
Symptoms of acute stress may begin at the scene of the incident or within 24 hours
following the incident.
3. Delayed Stress or Held Over Stress ---
The pathological end to incident prompted stress.
a. May occur days, weeks, months, years after the event.
b. Usually, delayed stress is indicated by Biochemical Reactions
and other Physical and Emotional Symptoms.
4. Cumulative Stress or Burnout
--- Usually caused by a combination of a wide range of Work and Non-work
stressors.
a. It occurs as a result of Prolonged Exposure to Many
stressors over a long time.
b. The condition is Slow To Develop (usually taking several
years to manifest itself).
c. Impending cumulative stress reactions are Predominantly
Emotional in nature.
d. May lead to PTSD.
IV. Post
Traumatic Stress Disorder (PTSD) ---
--- The Abnormal end result of a powerful and overwhelming
stressful incident.
A. When emergency workers resort to Excessive Suppression of
their emotions --- and when they Avoid Preventive Strategies such as psychological
debriefings after a traumatic event --- they may be setting themselves up for PTSD.
B. PTSD is Beyond The "Normal" response to stress.
1. PTSD is a Serious Condition that can lead to Personality
Changes, Illness, and even Suicide.
2. PTSD is a Pathological state and a Anxiety disorder
(not a psychosis).
3. It is called a disorder because it disrupts the normal functions
of one's life.
C. PTSD is a Diagnosis that can Only Be Made By
psychiatrists, psychologists, and other mental health professionals.
D. However, some of the Characteristic Signs and Symptoms
of Post Traumatic Stress Disorder are:
1. Disturbing memories of the event which pop to mind unexpectedly.
2. Dreams or nightmares related to the incident.
3. Feeling as if the event were happening again.
4. Psychological distress around the anniversary of the trauma.
5. Numbing of one's emotions.
6. Avoidance of thoughts or feelings associated with the event.
7. Avoidance of activities that recall the incident.
8. Loss of memory associated with important aspects of the event.
9. Feeling detached and estranged from others.
10. Loss of loving feelings toward others.
11. A sense of a shortened future.
12. Difficulty falling asleep and staying asleep.
13. Intense irritability.
14. Difficulty concentrating.
15. Startle reflexes.
16. Excessive suspicion and caution in dealing with others.
17. Physical reactions in circumstances similar to the original
incident.
18. Feeling keyed up and unable to relax.
19. Loss of emotional control.
E. PTSD does Not Just Disappear by itself.
1. It may hang on indefinitely,
2. It may produce unbelievable disruption in our life:
Alcoholism --- Marital or relationship discord --- Personality
changes --- Loss of one's career --- even suicide.
3. A person suffering from PTSD would be well advised to seek out at
least an evaluation by a mental health professional.
V. Debriefing
--- A Peer driven, Clinician guided, group discussion of a traumatic event.
Lessons We Have
Learned:
I. CISD is Not Psychotherapy.
II. The Population is Normal --- the Events they
experience are Abnormal.
III. Debriefing --- a Peer Driven Clinician Guided
group discussion of a traumatic event.
IV. CISD has Psychotherapeutic Elements.
V. CISD is Not helpful After the
traumatic Event Has Become Fixed --- (Best time is after 24 hours --- before 72
hours)
VI. Most debriefing Lose Effectiveness After 8-12 Weeks.
A. Every day it goes by makes it less effective.
B. After 16 weeks you may do more harm than good.
VII. Debriefings Average 2-3 Hours. All personnel involved
ventilation / information.
VIII. Never Probe Excessively.
(If it is a therapy issue it will come up later)
IX. Do Not Pursue Personal Items.
X. Respect The Right of Refusal.
(Required to tell them so)
XI. Do Not Embarrass Participants.
XII. CISD's Are Positive:
A. Short term
B.
C.
D. Educational
E. Sources of information
F. Encouragement for post-
G. Group relationship
H. Confidential
I. Used only when necessary.
XIII. Emergency people always Need To Be In Control.
XIV. Don't forget Special Groups:
A. SWAT Team
B. Corrections
C. Task Forces
D. Dispatchers \ Alarm Office
E. SAR (Search & Rescue)
F. Forest Fire Fighters
G. Command Staff
H. Overhead Teams
XV. Common CISD Mistakes:
A. Interruptions
B. Over-reacting
C. Under-reacting
D. Trying to do therapy
E. Probing
F. Not using silences --- (Allow silences to work)
Debriefing
(Critical Incident
Stress)
Introduction:
Surviving Trauma: When To Seek Help
Use the following guide to help you know when the survival of a
critical incident should be referred for post-trauma counseling.
A. When The Traumatic Event Involves:
1. Several Wilson chart ingredients at mid to high intensity.
2. or, One or more ingredients at very high intensity.
3. or, Any catastrophic events.
4. or, Any first very bad run or call.
B. When The Post-Trauma Symptoms:
1. Have not subsided in two or three days.
2. When numbing or withdrawal persists.
3. When Intrusive Recollections, flashbacks or sleep
difficulties persist.
4. When there is a marked reduction of interest in one or more
significant activities of the involved people.
I. The Critical
Incident
A. The Situation
Any event which is extraordinary and produces significant reactions
in emergency personnel.
B. Incident Examples:
1. Serious injury or death in the line-of-duty.
2. Suicide of an emergency person.
3. Serious multiple-casualty incident, especially where equipment and
personnel are insufficient.
4. Hazardous material incident (even blood, body fluids).
5. Serious injuries or death of child or infant.
6. Events with excessive media interest --- extremely unusual
attention to event.
7. Victims known to the emergency person.
8. Similarity of the victim to one's friends / relatives.
9. Death to a civilian caused by emergency operations such as an
accident between the civilian's car and the responding emergency vehicle.
10. Human Sound of Pain --- (2000 - 4000 htz. are Painful
to the human ear and Human Screams are at about 3000 htz.)
II. Types of
Critical Incident Stress Debriefings:
A. On-Scene or Near-Scene Debriefing.
1. Provide One-On-One assistance with those emergency service
providers who are obviously distressed.
2. This assistance is limited and Brief.
3. Observe the responders for signs of Fatigue or severe Stress
reactions and act as an Advisor To Management if he/she feels particular
individuals or crews should be relieved from duty.
4. Keep a Low Profile during this intervention.
5. Assistance to Victims and Family Members to help
reduce possible Interference with emergency operations.
B. Initial Defusing
1. Purpose is to Stabilize the emergency service providers who
have just worked an incident.
2. Allows for an initial Ventilation of feelings.
3. Detailed discussion providing Support and Reassurance.
4. Closure stage where Resources are mobilized.
5. Allows CISD team member to determine if a Formal Debriefing is
Needed.
C. Formal CISD
1. Usually following 24 hours or more delay
2. Should be mandatory:
a. Serious line-of-duty injury or death.
b. Major disaster or major multi-casualty incident.
c. Peer suicide.
3. General Format:
a. Introduction phase --- Setting the stage
b. Fact phase --- Telling the story
c. Feeling phase --- Looking at the consequences of survival
d. Symptom phase --- Understanding the consequences of survival
e. Teaching phase --- Contracting for recovery
f. Re-entry phase --- Closing and evaluating
4. Three to four hours to cover all six elements
D. Follow-Up CISD
1. Several weeks or months after incident
2. Performed with group or portion of initial group
3. May take several sessions
E. Post-Trauma Consequences --- What To Do About Flashbacks:
1. Remember ....
2. Flashbacks may follow a "Trigger" .....
3. Learn how to talk to yourself .....
4. Learn how to talk to others ....
5. Flashback interference .....
III. Difficult
Debriefings
A. Symbolic Debriefing.
1. When a current incident reminds a group of one or more powerful Past
Events.
2. The group Shifts The Emphasis from the current incident to
the past incident(s).
3. Trigger Mechanism --- what got you to thinking about the
past incident?
B. Multiple Incident Debriefing.
C. Multiple Line of Duty Deaths.
D. Family Members Present.
E. Infiltration of Old Events (Personal Events)
F. Hysterical Reaction.
(Team-member takes them out)
G. Intoxicated Subject.
H. Highly Resistant Personnel or Administration.
1. Only allows one hour.
2. "It appears that you want this ..... to fail --- set-up to
fail.
I. The Obstructionist.
J. The Soap Box. --- (Has an ax to grind)
1. Stop it --- don't let it go on.
2. "That's not the reason we are here.
K. The Obsessive Talker.
L. Eaters and Smokers.
M. Pagers and Radios.
1. Turn them off.
2. If required to have --- use earphones.
N. Media Relations.
1. Limit Contact
2. Provide Information
3. Proactive
4. Debrief Separately
5. Use To Contact The Public
6. Emphasize Normal Maintenance
7. Coordinate With Organization
Questions &
Answers
1. Q. Define the term "Critical Incident Stress."
A. The extreme stress reactions that emergency personnel experience
after particularly stressful or "critical" incidents.
2. Q. Why is a certain amount of stress Natural and Necessary
to perform you job?
A. Stress often contributes to the Mental Alertness and Physical
Readiness you need to Respond Quickly and perform your job Efficiently
during emergencies.
3. Q. List Five Incidents that often cause critical
incident stress reactions.
A. Any five of the following:
a. Injury or death of a co-worker.
b. Incident where responder's own life or safety is threatened.
c. Death of a child, especially at the hands of an adult.
d. Mass casualty incident (auto accident, plane crash or other
disaster), especially when triage is difficult.
e. Incident where victim is someone whom the responder knows or who
reminds the responder of someone.
f. Victim's death despite a prolonged rescue attempt.
4. Q. The Four Types of Warning Signs of critical
incident stress are Physical, Mental, Emotional and Behavioral,
list Four of the possible Physical Warning Signs.
A. Any four of the following:
a. Elevated respiration or heartbeat.
b. Chest pains.
c. Nausea or diarrhea.
d. Muscle aches or tremors.
e. Dizziness or lack of coordination.
f. Excessive sweating or chills.
g. Headaches.
h. Difficulty sleeping.
5. Q. List Two of the Mental Warning Signs of
critical incident stress.
A. Any two of the following:
a. Relive the event over and over.
b. Have nightmares about it.
c. Have difficult remembering things.
6. Q. List Three of the Emotional Warning Signs
of critical incident stress.
A. Any three of the following:
a. Feel anxious or afraid.
b. Be easily startled.
c. Feel very angry or frustrated.
d. Feel guilty about the event.
7. Q. List Two of the Behavioral Symptoms of
critical incident stress that a person may exhibit While On Duty At An Emergency.
A. Any two of the following:
a. Have Difficulty Concentrating.
b. Be overly active without accomplishing much.
c. Freeze up when faced with tasks.
8. Q. List Three of the Behavioral Symptoms of
critical incident stress that a person may exhibit At Any Time.
A. Any three of the following:
a. Irritability or anger.
b. Marked difference in personality or personal habits.
c. Calling in sick more often.
d. Avoiding anything connected with the event.
e. Excessive drinking or drug use.
9. Q. How can stress affect Your Home Life?
A. Family members do not always understand how stress affects
emergency personnel and misunderstandings may result. Continued tension can cause domestic
problems.
10. Q. Chronic stress can adversely affect your health. List Three
of the Five Major Illnesses that have been associated with stress.
A. Any three of the following:
a. Heart disease
b. Coronary artery disease
c. Diabetes
d. Peptic ulcers
e. Cancer
11. Q. Methods for reducing the effects of critical incident stress
are called __________ __________ techniques.
A. Stress-coping
12. Q. Stress-reducing methods are used in Three Settings: in Groups,
One-On-One, or On Your Own. What is the name of the stress-reducing method
used in Groups?
A. Critical Incident Stress Debriefing
13. Q. What is the purpose of a critical incident stress debriefing?
A. To give all personnel involved in a critical incident a chance to
react to the event and put it into better perspective.
14. Q. What is the Single, Most Important Ground Rule of a
critical incident stress debriefing?
A. Maintaining confidentiality.
15. Q. One-On-One stress coping techniques usually take the
form of discussions with co-workers after a critical incident. List Four Tips
for Discussions with a co-worker.
A. Any four of the following:
a. Don't be afraid to ask how someone is doing.
b. Be prepared to just listen and say nothing.
c. Don't take anger or other reactions personally.
d. Share your own feelings about the incident.
e. Try not to impose our own ideas about why an incident happened.
f. Don't tell them they're lucky it wasn't worse.
g. Don't brush off the incident or encourage co-workers to "just
forget about it."
h. Encourage co-workers to take advantage of employee assistance
services.
16. Q. List Two Personal Coping Techniques that
can be used During Critical Incidents.
A. Any two of the following:
a. Practice deep breathing.
b. Take breaks during prolonged incidents.
c. Concentrate on teamwork.
d. Use humor appropriately.
17. Q. What is the benefit of Vigorous Exercise after a
critical incident?
A. Vigorous exercise relieves stress by putting your excess energy to
good use.
(Discussion Point: Regular, vigorous exercise stimulates the release
of natural body tranquilizers called endorphins. Consistent exercise will reduce the
physical and psychological build-up of stress.)
Quiz
1. (True or False) If you are experiencing stress due to difficulty
in your personal life, it can contribute to work-related stress.
_X_ a. True
___ b. False
2. Check all the items below that add to the stress of a critical
incident.
_X_ a. The high visibility of emergency response work.
_X_ b. The possibility of being sued later for treatment choices.
_X_ c. Depersonalization.
3. Check all the items below that apply to critical incident stress.
_X_ a. Delayed reactions to a critical incident may show up in a day,
a week, or even months after the incident.
___ b. Individual reactions to critical incidents do not vary
greatly.
_X_ c. Stress reactions can occur even if a particular incident is
not that devastating.
4. Check the statements below that apply to the warning signs of
critical incident stress.
_X_ a. Some individuals may never show any outward signs of stress,
even though they may be severely stressed.
___ b. If left untreated, chronic stress will not adversely affect
mental and physical health.
_X_ c. The warning signs of stress may be physical, mental, emotional
or behavioral.
5. Choose the description below that best describes
"depersonalization".
___ a. Emotional detachment an emergency responder may feel as a
result of the stress of a critical incident.
___ b. Refusal to accept reality exhibited by victims of traumatic
incidents after an extreme shock such as losing a loved one.
_X_ c. Technique in emergency response work that allows emergency
personnel to put emotional distance between themselves and their victims.
6. In extreme cases, untreated stress can accumulate and may lead to
(check all that apply):
_X_ a. Poor performance on the job.
_X_ b. Dissatisfaction with your job.
_X_ c. Job burnout, which could cause you to quit or be fired.
_X_ d. Relationship problems.
7. (True or False) Research shows that stress slows down the immune
system, increasing susceptibility to colds and other illnesses.
_X_ a. True
___ b. False
8. As stated in the videotape presentation, there are five phases of
a stress debriefing. For each description below, write the name of the correct phase.
(Each phase may be used more than once.)
a. ___Reentry_____ Wraps up the session and describes how to obtain
further assistance.
b. ___Fact________ Participants recall their role in the event to
recreate the "big picture".
c. ___Reaction____ Allows participants to relate how they were
feeling during and after the incident.
d. __Introduction_ The mental health professional explains the
purpose of the debriefing and emphasizes confidentiality.
e. ___Teaching____ The facilitator explains that stress reactions are
a normal, human response to abnormal events.
f. ___Reentry_____ Debriefing leader or peer counselor explains
departmental employee assistance programs.
g. ___Teaching____ Provides information about the warning signs and
stress-coping techniques.
9. Check all items below that describe pre-incident activities that
reduce stress reactions after critical incidents: (check all that apply)
_X_ a. Training classes that improve procedural knowledge.
___ b. Deep breathing.
_X_ c. Review and reinforce standard operating procedures.
10. After a critical incident, talking things over with people you
trust allows you to __________ your feelings. (select the best answer)
___ a. Control
___ b. Ignore
_X_ c. Ventilate
___ d. Pacify
Randy Shilts, --- Full time Reporter for the San Francisco
Chronicle, and one of the lead reporter covering the San Francisco earthquake 10/17/89,
and author of the best selling book, "And The Band Played On;" as he appeared on
"Nightline" with Ted Coppel said:
"People in the neighborhoods then started getting together, and
turning to each other for support. Neighbors who never met each other, started getting to
find out who their neighbors were as they begin to do what neighbors are suppose to do,
which is to take care of each other.
You know we live in a humanistic age. And I think we all believe
that, as human beings, we are the masters of the universe. You know, it was much
easier for the people who lived in the dark ages to cope with things like earthquakes
because they believed that they were nothing more than the pons of forces that were
beyond their control. But we, in our enlightened age, have come to believe that
we are the master of everything. People don't get sick because we have antibiotics.
You know, we have clean water and we have heat, we have all these things that we never
question and then something like this (earthquake) happens; and you realize that,
you know, we are small creatures still."
Then Ted Coppel turned to:
Robert Maynard, --- editor president Oakland Tribune
and asked him to comment:
"I was touched by Randy Shilts' last line that we are reminded
by this event that we are small creatures still. Despite the fact that we travel to space
and we have conquered diseases and done so many things that make us seem so smart. Nature
has a way of reminding us of the overwhelming power and force that has shaped the
universe and we felt something of that force the other day and I think that we all are
sobered, humbled, and perhaps a little matured by what we saw. --- ... every once
in a while, nature comes alone and reminds us that what ever we may do nature has the
upper hand when all is said and done.
1. 30 Million Americans have some form of Major Heart or
Blood-Vessel Disease ----- 1 Million Americans have a Heart Attack every
year.
2. 25 Million Americans have High Blood Pressure.
3. 8 Million Americans have Ulcers.
4. 12 Million Americans are Alcoholics --- $15.6
Billion are lost by American industry each year because of Alcoholism.
5. 5 Billion doses of Tranquilizers --- 3 Billion
doses of Amphetamines --- 5 Billion doses of Barbiturates are
prescribed Each Year.
6. $19.4 Billion are lost by American industry each year
because of Premature Employee Death.
7. $15 Billion are lost by American industry each year because
of Stress-Related Absenteeism.
8. $700 Million are spent each year to Recruit Replacements
for executives with Heart Disease.
