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CISD is not Group Therapy. It is a form of crisis intervention with the goal of stabilization, symptom reduction, return to adaptive functioning and facilitation to continued care as needed.
1. Introductions and description
2. Review of factual material
3. Sharing of initial thoughts and feelings
4. Sharing of emotional reactions to incident
5. Instruction about normal stress reactions
6. Review of symptoms
7. Closing and further needs assessment
Brief CERT personnel beforehand
Remember CERT is a team
Rest and regroup
Take breaks away
Eat properly, stay hydrated
Arrange for debriefing
Rotate teams and duties
Phase out workers gradually
Get enough sleep
Exercise regularly
Eat a balanced diet and drink water
Balance work, play, and rest; pace yourself.
Allow yourself to receive as well as give
Connect with others, take time off to relax.
Use spiritual resources such as meditation and prayer.
Avoid excessive amounts of caffeine and alcohol.
Do not use tobacco or illegal drugs.
Be aware of trauma that can follow a disaster
Explain to family members and friends what you need:
Have a plan to manage tasks: do important things first. Avoid making life changing decisions.
Know that feeling stressed, depressed, guilty, or angry is common after a traumatic event.
Loss of appetite or eating too much
Headaches or chest pain
Diarrhea, stomach pain, or nausea
Hyperactivity
Increase in drug and/or alcohol consumption
Nightmares
Insomnia
Fatigue
Tremors, muscle twitches
Easily startled
Sweating or having chills
Your own personal losses
Working in your neighborhood
Assisting neighbors, friends, coworkers who have also been injured
Not feeling safe and secure
Assess survivors for injury or shock
Get uninjured people to help
Provide support by:
Listening
Empathizing
Help survivors connect with natural support systems
Provide comfort (drink, blanket, food...)
Provide a distraction
Ask them to take deep breathes
Take them for a walk
Keep groups calm, remove upset individuals
Give information and find answers to their questions
Encourage people to follow directions of first responders
Encourage those that can to help others by giving tasks
Shield children from the scene
Stay with children and assist with finding family
Explain multiple times what you need them to do (children and elderly)
Provide stuffed animals to children for comfort
Give older children and the elderly tasks to stay busy that they can handle.
Help elderly to physically get around
Encourage to leave their homes if in danger.
Give the person your full attention
Make eye contact
Have an open posture and get on their level
Listen for "feelings"
Paraphrase what the person is telling you
Clarify that you are understanding their message
Summarize
Be Non-Judgemental
Watch para verbal and nonverbal communication (i.e. tone/volume/cadence, eye rolling)
What not to say!
"I understand”
“Don’t feel bad”
“You’re strong” or “You’ll get through this”
“Don’t cry”
“It’s God’s will”
“It could be worse”
“At least you still have…”
“Everything will be okay”
"If I were you I would....."
first 7 min.
Cover the body; treat it with respect
Move the body to temporary morgue
Follow local laws and protocols
Talk with local authorities, (if this is a crime scene must get approval from authorities before intervening)
Inform family/friends of their loved one's death:
Irritability or anger
Self-blame or blaming others
Isolation and withdrawal
Fear of recurrence
Feeling stunned, numb, overwhelmed
Feeling helpless
Mood swings
Feeling heroic, euphoric or invulnerable
Sadness, depression, grief, frequent crying
Denial
Concentration and memory problems, feeling confused and difficulty making decisions
Relationship problems/marital discord
Rescues may be unpleasant or uncomfortable
Psychological and physiological symptoms of trauma
Take steps to reduce stress
CISD is one intervention
Four emotional phases of a disaster
Stress affects cognition, health, and interactions
Stabilize individuals
Be an empathetic listener
People can recover and become more empowered with the right supports and interventions.
Emergency Management Institute (U.S.) United States Fire Administration. United States. Federal Emergency Management Agency. United States. Department of Homeland Security. Human Technology, Inc. Citizen Corps (USA Freedom Corps) (2003). Community emergency response team. Washington, D.C.?: FEMA.
Mitchell, J. T. (2006). Critical incident stress management (CISM): Group crisis intervention. Ellicot City, MD: International Critical Incident Stress Foundation.
National Child Traumatic Stress Network (2008). Child welfare trauma training toolkit: Trainr's guide. Los Angeles, CA: NCTSN, National Center for Child Traumatic Stess.
Tips fo survivors of truamatic event managing your stress (NMH05-0209R). (2007). US Department of Health and Human Services Substance Abuse and Mental Health Services Administration Center for Mental Health Services.
Training Video: Psychological First Aid Basics [Video file]. (n.d.). Retrieved from
United States. Substance Abuse and Mental Health Services Administration (2005). Psychological first aid: A guide for emergency and disaster response workers. Rockville, MD: Substance Abuse and Mental Health Services Administration, U.S. Dept. of Health and Human Services.
Learning Objectives