Critical Incident Stress Management CISM

CISM Program Surry Nuclear Power Plant

What is CISM?

Why is a CISM program necessary for the agency?

Agency description, community, and social context

Prevention and Interventions

Primary

Secondary

Tertiary

Interventions

Chronic health and innovative approaches

Cultural Issues

Proposed Budget .17

Critical incident stress management plays an important role in assuring the psychological resilience necessary for those who are exposed to a traumatic incident. This proposal outlines a program to add mental Health Services to the existing emergency management plan for the Surry Power Plant. The current plan does not address mental health issues, and this is an important need that will need to be considered in the future. The current plan will modify the existing plan through the addition of mental health services for the community.

Proposal: CISM Program

What is CISM?

A critical incident is any event that produces stress or trauma to personnel that are directly or indirectly involved. Stress reactions and symptoms vary among individuals and among the circumstances surrounding their proximity to the critical incident. Stress reactions to dramatic events can be influenced by a person's coping skills, personality, and their ability to adapt to the situation. If a person does not react in a way that is emotionally healthy, they can develop long-term symptoms that can last the rest of their life. Minor stress that is long-term can be just as damaging or harmful as acute stress that is of shorter duration.

Critical incident stress management (CISM) is a protocol that is designed to reduce the short- and long-term symptoms of stress cause by a dramatic event. CISM includes education that is designed to help the person adapt to the traumatic event into resume normal life as quickly as possible. The program also includes access to resources that can help individuals address the needs, such as cultural issues, or professional counseling if needed. It must be understood that CISM is not psychotherapy and does not replace psychotherapy, but it is a first step to facilitating the process of obtaining resources for healing as quickly as possible. The goal of CISM is to prevent the long-term effects of stress for the individual and their family.

CISM recognizes that the effects of the event do not end when the victims have all been transported to the medical facility, and the cleanup is complete. In the past, psychological effects of stress were not addressed at all. First responders were expected to have some type of special ability to handle what most cannot. They were expected to have a certain role in to portray a certain image of strength and emotional stamina to the rest of the world. However, it is now recognize that they do not have special powers and that they too can succumb to the stress associated with the critical incident. This program is being developed to help first responders obtain the help that they need to heal and attain a storm will lives as possible in a world that can seem filled with chaos.

Why is a CISM program necessary for the agency?

Nuclear energy is an important part for culture in the modern world in which we live. It has the ability to provide an abundant supply of energy upon which our nation is dependent. Nuclear energy is generally considered safe and reliable. The Nuclear Regulatory Commission (NRC) requires plants to operate with multiple layers of safety standards in place. The standards are a result of the reality that nuclear energy also has the ability to cause great harm to life and property if something should go wrong. Any incident that involves the release of radiation is potentially life threatening for citizens hundreds of miles away from the site. This potential is the key reason for the need to develop a critical incident stress management program that encompasses many levels of victims.

A critical incident that occurs in a nuclear energy facility differs in many ways from other critical incidents. The mechanism that causes the incident is less important than the effects of the potential radiation leak and its potential effects on the human body. Stress from the critical incident involving a nuclear power plant is not over when the situation is under control in the short-term effects of the accident are over. People in and around the facility, or those who were directly involved in the accident can have stress for many years concerning the effects of radiation on their body. This is a valid concern and one that needs to be specifically singled out and addressed in a CISM program at a nuclear power facility.

A CISM program is necessary for every nuclear power facility. In addition, the program needs to extend beyond first responders, their families, and those directly associated with the nuclear power facility. A CISM program knees to extend to the community and offer services to those who live close to the plant. The physical and mental effects of the accident are more likely to be acute the closer to the source of the radiation one is located. The CISM program for nuclear power facility can provide excellent public relations and demonstrate to the public that a comprehensive plan is in place to take care of their needs, should something go wrong at the facility. In multifaceted approach is needed for a CISM program involving a nuclear power facility. This proposal describes a program designed to be implemented at a nuclear power facility located in the local vicinity.

The purpose of the proposed CISM program is to provide psychological services to first responders and those in the local community in the event of any emergency involving the local nuclear power facility. It will be implemented in addition to stand in emergency procedures already in place at the plant. The following proposal describes the elements of the program as they relate to the facility and the surrounding community.

Agency Description, Community, and Social Context

The Surry Power Plant began operation in 1972 and is situated in Surry county Virginia. It generates 1,598 MW of Electric Power from its two nuclear reactors (Dominion, 2011). The CISM is important for the station due to its situation in close proximity to major population centers. The reactors sit directly across the river from Jamestown. The emergency preparedness plan for the reactor includes plans for evacuation of the Surry area, as well as the North and South Ana areas. The evacuation areas and present action zones around the plants encompases a large area with dense population.

The plant has been proactive in the development of safety plans for persons with in the area. They have established evacuation routes and they have emergency centers to care for the physical needs of the persons within the affected area. They have an extensive emergency management system in place to provide for the physical and medical needs of persons within the community. However, there is no part of the plan that addresses the mental health needs of the same community. The potential for long-term mental health consequences in the community is significant. Regardless of the source of the emergency of the nuclear power plant, the potential for long-term effects from trauma are significant, yet there is no plan currently in place to address these needs. This proposal addresses these needs and will propose an addendum that can be added to the current emergency plan to address the mental health needs of the community in the event of a nuclear accident, regardless of the source of the accident. The following proposal addresses these needs.

Prevention and Interventions

Prevention and intervention strategies take place on several different levels depending on the person's proximity to the nuclear power plant. Personnel and needs will be divided into three separate areas. Primaries will be those who work of the facility and first responders who will be closest to the radiation source. They will be at greatest risk for exposure to radiation and will be likely to have the highest level of anxiety associated with the event.

Secondaries will include the immediate family of first responders and plant workers. Their concerns will stem from concern for their loved one and if they live close to the plant, for their own well being and for that of their family. Another category of secondary zinc lutes medical personnel who must read those who are injured or become ill. These workers can experience stress from the long hours of caring for others. Tertiaries will include members of the community that are not directly affected by the emergency, but who are affected by news of the emergency in their community and the associated anxiety.

The CISM will include strategies to address the needs of all three of these groups. The plan will include the following elements.

1. Preventative educational programs to prevent critical incident stress

2. Training personnel on how to recognize the symptoms of critical incident stress in themselves and others

3. Developing appropriate interventions for plant workers and first responders who display these symptoms

4. Developing interventions to promote resiliency among all victims in stressful situations

5. To understand the role of cultural and how it may affect the design and implementation of these measures.

The following will address the specific needs of each group victims.

Primary

The group of primary targets for the program will include first responders and plant workers who are at the greatest danger of illness from radiation exposure. Those that are closest to the accident are also the most likely to develop posttraumatic stress disorder (PTSD) as result of this exposure (Pietrantoni & Prati, 2008). The focus of the CISM for these workers will be preparing them for the possibility of stress from an emergency at the Surry plant. The focus will be first on prevention, then relief of acute symptoms, followed by measures to help alleviate long-term consequences from stress.

Prevention .As with the other groups in this plan, preventative measures will focus on education about the emotional affects of a potential event, as well as exercises and practice in the development of strategies to help cope with feelings and emotions before, during, and after the event. These workers will be provided this education in a training classroom session with an instructor who is qualified to teach the course. The course will be funded by community resources in conjunction with the existing emergency plan.

Resilience. Resilience and recovery from the incident will be the second major goal of the CISM plan. Stress resulting from critical incidents can cause symptoms that include burnout, fatigue, and diminish self-esteem and self-efficacy. Unless the person has the tools that they need to make a complete recovery, the symptoms can lead to long-term disorders such as depression and anxiety. First responders' self-esteem and self-efficacy were found to be predictive of their ability to recover after a critical incident (Pietrantoni & Prati, 2008).

Self-esteem and self-efficacy are a result of a combination of factors that cannot be controlled within the scope of the CISM program. However, actions can be taken to help increase the person's ability to recover and develop appropriate coping mechanisms so that acute symptoms do not progress into long-term conditions. Under the proposed plan, first responders and those closest to the accident site would be provided debriefing within 48 hours of the incident, group counseling, and individual counseling for those who are determined to be in need of such services. The services are designed to help provide an individualized approach to building resiliency among primary victims of the incident.

Secondary

Secondary victims of the incident will be provided a more generalized approach to building resiliency from the incident. As members of this group are not formally a part of the organization, they cannot be required to attend formal classes intended to provide preventative services. The only exception to this is in the case of medical personnel, who will be provided trainers to conduct educational classes on how to prevent critical incident stress in the event of an emergency at the Surry Power Plant. These classes will be offered to any medical personnel who wishes to attend from Surry and the surrounding counties. Classes will be conducted at local hospitals of personnel from a consultancy firm that specializes in CISM training.

In addition to these classes, consultancy will also will offer classes to families of first responders and power plant personnel. These classes will be voluntary and it will be recognized that for some families these classes might increase anxiety, rather than relieve it. This is a key reason for using a voluntary approach to classes for secondary victims. Knowledge can be a powerful tool in the ability to alleviate fear. Providing family's with resources and a plan in the event that the war should happen, can be comforting and reduce stress.

Tertiary

Tertiary victims of mental health issues resulting from a critical incident at the nuclear power plant will include community intervention aimed at providing general information to the larger part of the population surrounding the plant. This approach will include distribution of materials in the former brochures and other written media that informs the public about measures they can take in the event of an emergency at the Surry Power Plant. Prevention and preparation are the key to eliminating many of the problems associated with an incident at the plant. Other media will also be used such as local television in radio to deliver targeted public service information to the public about what to do in the event of an emergency at the plant. It is felt that the more information public has about what to do and steps they can take to prepare, the less the impact would be if an actual emergency were to occur. These efforts will be funded through public funding in grants provided for such activities.

Interventions

Interventions will be focused on prevention and building resiliency and those who are potentially in harm's way. However, certain interventions are targeted to take place during the actual event, or as soon after as possible. Interventions will include psychological first aid and treat debriefing, treatments for acute stress and the screening in monitoring for development of PTSD. Actions will also be taken to prevent the development of chronic health problems as result of the incident. The primary focus of interventions will be primary victims. They will receive the intervention first, as soon as is safe at the scene according to the situation.

Psychological first aid or debriefing.Psychological first aid, or debriefing, has been controversial in the past and it is even being claimed that it may do more harm than good (Regel, 2007). Although it is received mixed empirical results (Jacobs, Horne-Meyer, & Jones, 2004), it is still practiced in critical incident scenarios. It is the belief of this consultancy that debriefing which is done by trained professionals and in a way that is sensitive to the needs of individuals can be an excellent tool for screening and for the prevention of or serious problems in the future (Blesdoe & Barnes, 2003;Mitchell, 1986; Ostrow, 1996). The debriefer understands that individuals may respond to the critical incident differently (Mitchell, 1983). The debriefing will be performed by a seasoned professional who understands the needs a primary victims of critical incidents.

Acute Stress. All on-scene manager taking part in this program will receive special training on how to recognize the signs of acute stress. Preventative educational programs will also be directed loved ones of those who may become involved in a critical incident. The first step in treating acute stress is to recognize it. Often a person who is experiencing the signs of acute stress cannot recognize it in themselves. Managers will be trained to recognize the signs of acute stress and how to take appropriate measures to get the person the specialized help that they need as quickly as possible. As part of the CISM, it will be mandated that anyone who shows signs of acute stress will be removed three lower stress position as soon as feasible (VA National Center for PTSD, 2010).