CITICAL INCIDENT STRESS MANAGEMENT (CISM)

I. Definition:

CISM - Critical Incident Stress Management. A critical incident is defined as any incident that challenges the normal coping mechanisms of the disaster worker.

II. Function:

Recognizing the importance of protecting our TADMAT members mental health, as well as the positive impact of the CISM process, the TADMAT shall recognize a CISM team to facilitate the policies and procedures during education and deployment activities.

A) CISM shall be addressed as an educational topic during a regularly scheduled training session no less than once a year. Training shall be provided by TADMAT personnel and if none is available, the Unit Commander or Executive Officer shall arrange for this service to be available.

B) During configuration of TADMAT teams for an actual deployment, the Chief Medical Officer shall consider CISM by:

1) Distributing CISM trained personnel through team assignments so as to enable them and other team members to observe for signs of critical incident stress syndrome.

a) These signs include, among others:

• Withdrawal or "freezing" on scene
• Inappropriate behavior
• Inappropriate use of humor in an injurious manner
• Clinical changes (insomnia, malaise)

b) Situations that are particularly stressful include:

• Large number of severe injuries or deaths
• Large numbers of injured or deceased children
• Significant injury or death of a fellow TADMAT member
• Insufficient medical resources as a function of number of casualties

c) If noted to be impaired, the affected member will be relieved of duties with a CISM team member made available as soon as possible and the appropriate team leader notified ASAP.

d) Should signs of critical incident stress syndrome surface in an individual, consideration will be given to the need for debriefing the TADMAT as a whole.

C) Minimizing stress upon TADMAT members by:

1. Scheduling rest and recreation activities as often as possible.
2. Allowing communications with family and friends at home as possible.
3. Ensuring proper nutrition and hydration of TADMAT members.

D) Scheduling times for debriefings and group support during deployment and during demobilization phase of the deployment.

E) The CISM team may make themselves available to other rescue workers from other agencies at the disaster site after seeing to the well being of the TADMAT members.

F) The CISM team shall oversee mental health issues of TADMAT treatment and provide assistance to TADMAT medical staff with treatment of patients with acute mental health problems and stress related disorders.

G) The CISM team shall arrange for a CISM debriefing for the team within 2-5 days post deployment and CISM activities will continue on a team or individual basis as deemed necessary by the CISM officer.

III. CISM Team structure:

A. CISM Membership:

This team is comprised of members of TADMAT who have interest / education in line with CISM. Being a team member will require a personal commitment to serve others on a voluntary basis. Members are trained to provide peer support, not professional counseling.

B. Accountability:

The CISM team shall be under the direction of the TADMAT Executive Committee and shall be accountable to the CISM Officer.

C. Training:

All CISM Team members will complete a 2 day training program in CISM approved of by the CISM Officer or have comparable experience at the discretion of the CISM Officer.