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Psychological First AID in CISM
Psychological First Aid
In this scenario, an act of terrorism has occurred at a nuclear power facility. Portions of the facility were destroyed by the explosion, killing some of the workers instantly. However, the threat of a core meltdown is imminent and both remaining workers and first responders are on the scene trying to prevent a community-wide radiation event. Both remaining workers inside the plant and the first responders will be experiencing a similar type of stress. Stress will be due to the loss of life, including friends and coworkers, as well as the dangers to their personal well-being from the potential radiation exposure. Tertiary stress is caused by a feeling of responsibility for protecting the community from the potential radiation release, including the lives of their own families who live in the area.
Acute Stress Symptoms
Stress reactions in this situation can be expected to vary from individual to individual. Many factors can influence a stress reaction that an individual experiences, and there are many ways in which they may express it. The first priority is those experiencing acute stress reactions. According to the VA National Center for PTSD (2010), acute reactions can include dangerous actions or suggestions of dangerous actions by the individual, extreme agitation, hyper-vigilance, irritability, panic, or complete shutdown.
Those who are experiencing acute psychological reactions should be removed from the scene immediately, because of that point they are more harm than good to the rest of the crew and to themselves. They should receive immediate treatment for trauma as soon as it is feasible. One of the complicating factors in this situation is that mental health workers will not be able to enter the area due to the danger of radiation exposure. Those who must leave the scene must be properly decontaminated and moved to an area outside of the danger zone before mental health treatment can begin. The crew and supervisors need to be aware of the signs of acute stress reaction and be ready to remove those who show signs that indicate they are in extreme mental stress.
Some of the more common stress reactions according to the VA National Center for PTSD (2010) include a feeling of hopelessness about the future, feeling detached or unconcerned about others, having trouble concentrating in making decisions, feeling jumpy and easily startled a sudden noises, feeling on guarding constantly alert, having disturbing dreams, memories, were flashbacks, having problems at work and school. Physical reactions to stress can include upset stomach, fatigue, trouble sleeping, feeling edgy, pounding heart, bracket breathing, sweating, headaches when thinking of the event, failure to engage in self-healthcare, excessive smoking, alcohol, drugs, or food addictions, and having ongoing medical problems getting worse.
Common emotional problems can include feeling shocked, numb, unable to feel love or joy, feeling nervous, sad, easily upset are agitated, being irritable or having outburst of anger, having negative views of yourself or the world, distrusting others, getting in the conflicts, being over controlling, feeling withdrawn, abandoned, or rejected, feeling detached and a loss of intimacy. It is common for the person experiencing any of the stress symptoms to be prone to turning to addictive behavior such as substance abuse, alcohol use, or other coping mechanism such as smoking or food addiction (Hartman, 2010).
Talking to someone such as family or friends can be helpful and one must realize that recovery can be a gradual process (CISM International, 2010a). When talking to family or friends is not enough, then it is important to get professional help and talk to a counselor who is experienced in trauma and stress related mental conditions. It is important not to wait and begin the recovery process as soon as possible, otherwise the symptoms can become fixed and more stubborn to treat (CISM International, 2010b). They can even develop into more serious mental illness over time. Time is critical in providing a complete recovery from traumatic experiences.
Immediate Objective in Providing PFA
There is been considerable controversy over providing early psychological support in the form of CISM. Debriefing has become the most criticized of these practices, with some studies indicating that it can even do more harm than good in some cases Regel (2007). In this scenario, official debriefing cannot occur until after the incident is under control and workers can be released from the radioactive area. If the event is prolonged, then workers can be assessed before beginning their rest and relaxation period.
The primary objective in providing PFA in this scenario is to identify those who are experiencing a cute emotional trauma and getting them the help and support that they need immediately. Some of them may be able to return to productivity once they have been properly treated, but others might not be able to return to the scene and be productive members of the team. The secondary objective will be to prevent common stress reactions from turning into long-term problems or developing into PTSD.
Major Incident Management Components
All the debriefing is a controversial topic, it is felt that if it is handled by a skilled professional and in a sensitive manner, then it can be affective. The individuals needs to be able to decide if they wish to participate, or if they just want to be present and listen. Debriefing will take place within 24 to 72 hours after personnel begin to be cleared from the area. In a radiation disaster, personnel often leave in groups and each group will have their own debriefing session. This will continue until all personnel are out of the area.
The next component of the incident management program will consist of defusing. Defusing typically takes place within a week of the event and is a place for the workers to unload their feelings and frustrations about what has occurred. If the event involves an attack that harmed loved ones, or friends, it is important for the person to be able to deal with their anger about what has happened. If the incident is long were ongoing, defusing and debriefing will take place in waves among various groups.
Training is the last component of the incident management program. Training will help responders and workers to deal with stressors, manage their life, and recognize the warning signs that they need help. Training will help them to normalize what has happened to them and manage their lives more productively. Individuals will learn where and how they can obtain the supports that they need to return to as normal life as possible after the trauma. The goal of program is to assure full recovery from the traumatic incident.
Criteria Used for Referral to Additional Support
Criteria need to be established for referring individuals who require additional support aside from that provided by the department. The first criteria will be that anyone who feels they need it will be referred for additional services. Those that are demonstrating acute stress reactions will also be referred immediately for additional services. Those who express that they are experiencing common stress reactions during the defusing and training periods will also be referred for additional services. Criteria for referring individuals for additional support will be flexible enough to meet individual needs. No one will be denied access to additional services who needs it.
Available Supports for Workers
The first supportt available to the workers will be the debriefing, defusing, and training sessions for the group. A list of local community resources will be provided to all workers and they will be encouraged to make use of those services. In addition to the supports, a 24/7 hotline will be established where they can talk to a trained mental health worker. If needed, the worker can help them find the assistance that they need, even if it means going as far as making the first appointment for them. The support services will also be available for close family and children who may have been affected by the traumatic event themselves, or in response to having their loved one in danger. Funds will be available to help defray the costs of additional services that are not covered by insurance. The supports will help make certain that workers, first responders, and their families can recover from the trauma of the incident as quickly and completely as possible.
Mindfulness Regarding the Incident
Mitchell (n.d.) explores several important factors that can help responders and psychological first aid workers to respond to the critical incident. The first thing to keep in mind is that the worker may need to recognize the possibility that they may experience stress symptoms as a result of helping others manage their stress. All workers should take frequent rest breaks and try to get as much sleep as possible. Mitchell prescribes at least 1/2 day off every five days or a full day off after 10 days in consecutive disaster work. This will be considered the bare minimum.
Worker should be mindful not to use humor to relieve stress, because this can…[continue]
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