7/21/2016
ANY VOLUNTEERS???
Patrol Officer
RECOVERY AFTER THE
CRITICAL INCIDENT
Supervisor
Chief Officer
Spouse
Barry Jacobs
Retired Firefighter/Paramedic
THE CRITICAL INCIDENT
BARRY JACOBS
25 year veteran Fairfax County Fire and
Rescue
Firefighter/Paramedic
Ems Supervisor
Station Commander
Battalion Chief EMS Adm.
Masters Degree Counseling
National Certified Counselor
Certified Adventure Based Facilitator /
Counselor
Equine Assisted Trauma Focused Therapy
At Risk Kids/Families (Trauma), Autism, First
Responders
COMMON ACUTE STRESS REACTIONS
AFTER THE INCIDENT
• Sleep Disturbance
• Irritable, Easily Angered
• Confused, Disorganized
• Intrusive Thoughts
• Feeling numb, detached, or being emotionally unresponsive
• Reduced awareness of your surroundings
• Depersonalization thoughts or emotions don’t seem real or don’t belong to you
• Dissociative amnesia cannot remember one or more aspects of the event
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7/21/2016
DEBRIEFING
PSYCHOLOGICAL FIRST AIDE
Administrative Investigation Protocol
CISM
Goals:
Hypervigilant is Safety
Safety - Meet basic needs (Family, Information)
Family
Connectedness – help contact family/friends/resources
Ready to talk
Promote and Sustain an safe environment
Follow up
Calm – Listen, be prepared for trauma behaviors
Self – Efficacy – support for helping themselves
Hope – Provide encouragement to deal with unknown
LT. COL. DAVE GROSSMAN
COMMON NEUROLOGICAL REACTIONS
As threat increases both body and mind adapt and react
… To a point..
Neurological gear shifting / information overload
Transit HypoFrontality:
Parts of prefrontal cortex shut down.
Time Dilation
Mind field of memory gaps
Remembering other details
Unregulated reactions to high risk threats
Physiological response rapid unregulated spikes in heart rate
Fine Motor Skills
Situational Awareness
Auditory Processing
Visual/ Perceptual Blindness
Cognitive Processing
Dr. John Heil Clinical and Sports Psychologist
Instructor at the Roanoke Police Academy.
Developed Critical Incident Stress Awareness Training
HYPERVIGILANCE
ALWAYS EXPECTING THE WORSE
Are we looking in the right
place?
Dr. Robert Scott: Psychologist Los Angeles County Fire and Rescue
• 187 firefighter/paramedics
• 52% front line medics reported “at risk” PTSD symptoms
• Fairfax County Fire and Rescue Dept.
• 400 firefighter/paramedics
• 48% front line medics reported “at risk” PTSD Symptoms
• Reactive Physiology
• Negative Based Critical Thinking
• Unrealistic performance based thinking
• Now what are we dealing with after the critical incident?
•
52% to 48% report signs and symptoms of PTSD
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7/21/2016
PREPARING FOR THE INCIDENT
On the street everyday
Every call prepare for the next call…
Develop and use your processing protocol everyday!!
Resiliency Skills:
Box Breathing
Negative/Reactive Mindset to
Proactive/Positive Mindset
What is your mental/emotional pulse?
Utilize existing training (Force on Force)
Normal reactions to bad incidents
Develop group after action processing
Train for Recovery
POST INCIDENT PROTOCOLS
How do you want to respond after the incident?
Who are you going to call?
Who has your back?
Who have you been talking to?
Relationships that lead to healing…
Support To the incident scene..
Back up/Relief
What is the ABC of your trauma protocol?
Plan to be three steps ahead of trauma reactions…
Anger, Guilt, Confusion, Panic, Anxiety, Loss of Control.
Who has the family?
What are the three things needed now?
List on refrigerator…
Practical support as good as counseling..
Meals ok.. Getting things done better.. Just Being there best…
TRAIN TO RECOVER
TACTICAL CRITICAL INCIDENT SKILLS
Movement: Keep walking reduces Adrenalin
Rhythmic Pattern Calm the Brain
Box Breathing
Know your pulse… Know Your HRV..
Set goals for 1 minute, 5 minutes, 15 minutes, 1 hour..etc..
Tactical Thinking.. Stop reactive / negative / fear
Do not examine performance
Stop negative / mistake based perception
Avoid Rumination
What is your negative reaction to a bad outcome?
Know your reactivity
Know yourself!!!
FXCO TROT “Was not going to go”
Dallas Police “I was headed Home”
AFTER ACTION DEBRIEFING
Everyday… Develops best practices for street.
Same Group
What did you learn?
Action: Do something
What did we do well?
What can we improve?
Develop Trauma Processing Skills
Trauma Processing vs. emotional stuffing vs. denial..
Develop Plan for Positive Steps forward.
Develop Emotional Resiliency Skills
Natural Lifemanship
Equine Assisted Trauma Focused Learning/Therapy
Train for balanced, emotional response vs over reaction and emotional dysregulation
Trauma effects relationships… leads to isolation… makes things worse…
Who do we tell?
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7/21/2016
REAL PROBLEMS
• Wife came home to neighbor dying in house fire. Calls you at work…
• Therapist does not take insurance… Out of pocket expensive.
• First Responder continues to work his shift…
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PEER SUPPORT
Peer Support
Firefighter off on medical leave for suicidal ideation.
EAP limited scope.
Therapist change
Intensity of needs and services exceed available resources.
Ongoing Support for first responders and their families
Goals:
Provide support for emotional wellness
• Stigma of adm, restricted, light duty, loss of job, career, identity..
• Rush to get back.
• Cumulative Level of stress response prior to the incident…
• straw breaks camels back..
• Typically underestimate severity of situation..
IDENTIFY COMMUNITY SUPPORT
• Experts in practical support who take care of the little things…
• Financial, Family, Travel, Notifications, Home
Georgia State Patrol's Post Critical Incident Seminar
First Responders from Columbine, Virginia Tech, Sandy Nook
Led by fellow officers as well as mental health professionals.
Operation Restore: Tampa Bay Police Trauma Retreat.
A four-day training retreat designed to process critical incidents and traumatic scenes officers
deal with on a daily basis, throughout their careers.
Education sessions, group process, one-on-one confidential sessions
START TALKING NOW
Build support relationships now
Trauma Informed Professionals
Culturally aware experts
Proven experience with first responders
Counselors: Anyone been shot lately?… LCSO
FFBHA trains counselors to work with first responders
Support Services prepared for
Crisis response, Short Term, Long Term, Residential, Family
• Hospice.. (2 years automatic / free in home/community based counseling)
• Chaplin / Faith Based Support
• Family Resiliency Training
• Family put back together.. Family experiences/meals.
ADMINISTRATIVE PLAN
Your on Leave…. Now What?
Did we just create another crisis?
Your on Adm Duty/Light Duty?
What job are you going to do?
What are you interested in doing?
What skills do you have to be productive?
Preplan.. Have meaningful projects ready to go
Suicide Response. What to do when someone raises their hand.
Individual Safety, Family Education, Family support
Military Embedded Services:
Counselors on Aircraft Carriers
Exercise Physiologist, Nutritionist, Sports / Performance Psychology
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7/21/2016
GETTING BACK
NEXT GENERATION
Fitness for Duty Protocol
Collaboration of Adm, Union, Peer Support, Professionals.
What’s the plan?
Transition to return to duty.
Day work, Partnered Shift work, Follow up, Family support
What’s the back up plan?
Be prepared to go backwards?
That is trauma!!
Signs and symptoms watch out for… everyone
Go get your license
Education / Research for next level of care
Training Specialties for First Responders, Trauma
Political Resources to maintain career longevity and after retirement
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