McGuire Friday PCP6A

Managing Post Disaster Traumatic Stress ©: 

Managing Post Disaster Traumatic Stress ©

Today’s agenda/goals: 

Today’s agenda/goals Traumatic stress reactions to disasters PTSD: Physiological and Psychological responses PTSD: What to look for PTSD: Suggested action plans New Model: Acute Traumatic Stress Management

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What is a Crisis? A traumatic event that seriously disrupts our natural, built-in coping and problem-solving abilities.

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Nature of Human Stressors Stress further defined as: Our physical and psychological response to these perceived threats (fight or flight) Our world view has changed, norms, values, past experiences are disrupted Can lead to Maladaptive Coping strategies for both victims and responders

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Nature of Human Stressors Stress-related diseases Cardiovascular disease Gastrointestinal disorders Hypertension Anxiety Disorders PTSD Profound long-term health consequences are a direct result!

Traumatic Stress: Introduction: 

Traumatic Stress: Introduction What is traumatic stress? Emotional responses Cognitive responses Behavioral responses Physiological responses Spiritual responses Overpowers coping capabilities TRAUMATIC EVENT Unexpected Uncontrolled Volatile in nature

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TRAUMATIC STRESS: Disables People Causes Disease Precipitates Mental Health Disorders Leads to Substance abuse, and Destroys Relationship and Families Traumatic Stress : Introduction

Traumatic Stress : Introduction: 

Traumatic Stress : Introduction Is traumatic stress caused by 'severe' events? Not always, can be less severe for some but with greater reactions to the stress for others However, all traumatic events have the potential to cause significant damage Increased index of traumatic stress is commensurate with the Imprints of Horror present at each scene/event

Imprints of Horror: 

Imprints of Horror Sights: traumatic injuries, complete devastation Sounds: explosions, screams, threatening voices Smells: blood, vomit, gasoline, natural gas Tactile: wet/dry, hot/cold, sticky, etc. Tastes: Burning materials, air-bag powders

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The Imprint of Horror...

Or this….: 

Or this….

Or this….: 

Or this….

Common Disaster Traumatic Reactions: 

Impact Phase: Fight or flight Stunned reactions Cognitive difficulties Helplessness Forced dislocation Responsibility guilt Common Disaster Traumatic Reactions

Common Disaster Traumatic Reactions: 

Common Disaster Traumatic Reactions Recoil/Rescue Phase Immediately after disaster Denial Shock/Direction-less Intense Grief Imprints of Horror/Flashbacks Anger Despair

Common Disaster Traumatic Reactions: 

Recovery Phase Also known as the ‘Honeymoon phase’ Grateful to have survived May hesitate to show distress, grief Frustration CNN Stress Sleep disturbances, GI problems, aches/pains constant fatigue Social and Family support erosion Common Disaster Traumatic Reactions

Post Traumatic Stress Disorder: 

Post Traumatic Stress Disorder Video Introduction

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Post Traumatic Stress Disorder Remember this key fact: Those with PTSD are truly re-living the event, not merely remembering it.

History of PTSD: 

History of PTSD This is nothing new! 490 BC - Greek battle of Marathon, reports of soldiers returning from battle with stress-induced blindness, deafness (conversion reactions) 1678 Swiss military MD’s coined the term ‘Nostalgia' to define battle-worn soldiers reactions, disturbed sleep patterns, anxiety, etc.

History of PTSD: 

History of PTSD First formal definition not until 1980 by the American Psychiatric Association (DSMV-III) Was considered ‘controversial’ when first introduced Confusion as to if it was and internal or external infliction of causes Defined as: An experience outside of the normal range of human experiences

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PTSD vs. BURN OUT Burn out TRAUMATIC EVENTS P E R F O R M A N C E TIME Breaking Point

PTSD vs. BURN OUT: 

PTSD vs. BURN OUT PTSD MAJOR TRAUMATIC EVENT P E R F O R M A N C E TIME Breaking Point

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PTSD IS NOT THE SAME AS BURNOUT!

Post Traumatic Stress Disorder: 

Post Traumatic Stress Disorder Common ‘causes’ of PTSD: Witnessing a violent act Directly involved in a violent act Involved in a disaster (natural or man-made) Exposure to extreme injuries/trauma (Imprints of Horror) Combat exposure Results from traumatic exposure with high indexes of fear, loss of safety, bodily injury and profound horror

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Post Traumatic Stress Disorder Traditional signs/symptoms of PTSD Extreme fear of re-experiencing the event High index of intrusive imagery/flashbacks Avoidance of the event/location Numb reactions (Emotional anesthesia) Hyper-startle reflex Hyper-arousal state

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Post Traumatic Stress Disorder Traditional signs/symptoms of PTSD Poor sleep hygiene/health (insomnia) Anger, hostility of which is difficult to control Panic attacks Depression (loss of hope, motivation, etc.) Decrease in personal hygiene habits

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Post Traumatic Stress Disorder Warning signs of PTSD Emotional numbing Withdrawal Intensive anxiety Rage Loss of memory Loss of trust Signs-symptoms persist for greater than 30 days or more

PTSD Chemical Cascade: 

PTSD Chemical Cascade Traumatic event Event processed by psyche (traumatic or not) Surge of neurotransmitters/ high arousal state Return to baseline/homeostasis NO YES

PTSD Chemical Cascade: 

PTSD Chemical Cascade Brain Bursts of activity: Fight or flight instinct BP, HR, RR all increase Muscles contract Metabolic rates increase Diminished pain receptor activity Blood clotting rates increase

Chemical dump: 

Chemical dump Norepenepherine (increases muscular contractility, increases heart rate, blood pressure and blood clotting Serotonin (mood stabilizer, decreases impulsive behaviors Endrogensopiates (decreases pain sensitivity and fear reactions Benzodiazapine (stabilizes the actions of other NE’s secreted) Adrenaline (strengthens muscle contraction, increases metabolic rates)

OK, now what do we do?: 

OK, now what do we do? A path forward

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What to look out for : Hypervigilance, unable to ‘disengage’ Unable to simply ‘un-plug’ Restlessness/ on the ‘edge’ Intrusive imagery (playing the tape) Extreme changes in their normal ways Fear of experiencing the incident again Looking to blame someone/thing for the event Appearing ‘distant’

What to look out for :: 

What to look out for : More suspicious, pessimistic Less willing to spend time with friends Less willing to talk about feelings, reactions from the critical incident More critical with/about family and friends Unable to admit to mistakes or bad decisions

How to start helping:: 

How to start helping: Start by: Choosing the right time Listen deeply, carefully, thoroughly Validate their feelings, fears Let them speak openly Avoid statements like 'It could have been worse…' Don’t take their anger personally Don’t get in over your head, encourage them to get professional help

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Post Traumatic Stress Disorder Actions, reactions and referrals Has this person been exposed to a higher than normal traumatic event(s) recently? Is the person approachable? Is there someone close to them who can be contacted? What EAP sources are readily available? Referral to a mental health professional is a must

Post Traumatic Stress Disorder: 

Post Traumatic Stress Disorder Traditional treatments for PTSD Removal from any ‘triggers’ Trauma exposure work-up Cognitive Behavioral Therapy Use of anti-anxiety/depression Rx’s PTSD awareness training for family, employer, etc.

What about ourselves?: 

What about ourselves? Do as I say… not as I do??

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Characteristics of the ESP’s Strong ‘family’ ties with their work (role conflict) Driven internally by high motivation Risk takers Highly dedicated Unfamiliar (Unwilling??) with how to unplug from their duties Average to poor dietary habits Used to running on ‘near-empty’

Characteristics of the ESP: 

Characteristics of the ESP Our little red wagons

Is there anything else we can do??: 

Is there anything else we can do??

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Pre-event planning Crisis Response During The Critical Event Let-down Phase Re-entry Phase Acute Traumatic Stress Management Crisis Strikes Typical Crisis Response Plans ©CISM Perspectives, Inc.

Acute Traumatic Stress Mgmt.: 

Acute Traumatic Stress Mgmt. 3 Key areas of training: Traumatic stress mgmt. of the Emergency Responder during the event Traumatic stress mgmt. of the person responded to, during the event Mitigate/educate on the long term effects of traumatic stress

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The 10 Stages of ATSM Assess for Danger/Safety Consider Mechanism of Injury Evaluate Level of Responsiveness Address Medical Needs 5 Observe and Identify 6 Connect with the individual 7 Ground the individual 8 Provide Support 9 Normalize the Response 10 Prepare for the Future

In summary: 

In summary Disasters andamp; traumatic events create a myriad of stress reactions Disasters andamp; traumatic events don’t have to leave only negative impacts PTSD is real and effects all of those involved (victims/responders) Are we taking care of our own mind/body/soul?

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Advocate this: Only the strongest, are those who are willing to ask for help.

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PTSD Resources National Center for PTSD www.ncptsd.org Gift From Within www.giftfromwithin.org PSTD Alliance www.ptsdallience.org American Academy of Experts in Traumatic Stress www.aaets.org

Thank you!: 

Thank you!

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Daniel J. McGuire, FAAETS, BCETS Senior Consultant, President 12 Sudbury Drive Rochester, NY 14624-2619 585-739-9011 cism79@frontiernet.net www.cismperspectives.com THANK YOU FOR WHAT YOU DO, SO WELL!