CISM Program Proposal for Surry Nuclear Power Plant

Introduction to Critical Incident Stress Management

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, which represents an important gap that must be considered going forward. The proposed addendum will modify the existing plan through the addition of mental health services for the community.

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

Critical incident stress management (CISM) is a protocol designed to reduce the short- and long-term symptoms of stress caused by a dramatic event. CISM includes education intended to help the person adapt to the traumatic event and resume normal life as quickly as possible. The program also includes access to resources that address individual needs — such as cultural considerations or professional counseling when required. It must be understood that CISM is not psychotherapy and does not replace psychotherapy; rather, it is a first step in facilitating the process of obtaining healing resources 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 an event do not end when victims have been transported to a medical facility and the cleanup is complete. In the past, the psychological effects of stress were not addressed at all. First responders were expected to possess some special ability to handle what most people cannot. They were expected to portray an image of strength and emotional stamina. However, it is now recognized that they do not have special powers and that they too can succumb to the stress associated with a critical incident. This program is being developed to help first responders obtain the help they need to heal and attain as normal a life as possible in a world that can seem filled with chaos.

Why a CISM Program Is Necessary for the Surry Nuclear Facility

Nuclear energy is an important part of modern culture. It has the ability to provide an abundant supply of energy upon which our nation depends. 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. These standards reflect the reality that nuclear energy also has the ability to cause great harm to life and property if something goes wrong. Any incident involving the release of radiation is potentially life-threatening for citizens hundreds of miles from the site. This potential is the key reason for developing a critical incident stress management program that encompasses many levels of victims.

A critical incident that occurs at 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 a potential radiation leak and its consequences for the human body. Stress from a critical incident involving a nuclear power plant does not end when the situation is brought under control and the short-term effects of the accident are over. People in and around the facility, or those directly involved in the accident, may experience stress for many years concerning the effects of radiation on their bodies. This is a valid concern that must be specifically identified and addressed in any CISM program at a nuclear power facility.

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

The purpose of the proposed CISM program is to provide psychological services to first responders and members of the local community in the event of any emergency involving the plant. It will be implemented in addition to the standard emergency procedures already in place. The following proposal describes the elements of the program as they relate to the facility and its 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). CISM is particularly important for this station due to its proximity to major population centers. The reactors sit directly across the river from Jamestown. The emergency preparedness plan for the reactor includes evacuation plans for the Surry area, as well as the North and South Anna areas. The evacuation areas and protective action zones around the plant encompass a large area with a dense population.

The plant has been proactive in developing safety plans for persons within the area. Evacuation routes have been established, and emergency centers are in place to care for the physical needs of persons within the affected area. An extensive emergency management system exists to address the physical and medical needs of community members. However, no portion of the plan currently addresses the mental health needs of that same community. The potential for long-term mental health consequences in the community is significant. Regardless of the source of an emergency at the nuclear power plant, the potential for long-term trauma effects is real, yet no plan currently exists to address these needs. This proposal addresses that gap and proposes an addendum to the current emergency plan to cover mental health needs in the event of a nuclear accident.

Prevention and Intervention Strategies

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

Secondary victims will include the immediate family members of first responders and plant workers. Their concerns will stem from worry about their loved ones and, if they live close to the plant, concern for their own well-being and that of their family. Another category of secondary victims includes medical personnel who must treat those who are injured or become ill. These workers can experience stress from the long hours of caring for others. Tertiary victims will include members of the community who are not directly affected by the emergency but who are affected by news of the emergency and the associated anxiety.

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

1. Preventative educational programs to prevent critical incident stress.
2. Training personnel 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. Understanding the role of culture and how it may affect the design and implementation of these measures.

Primary

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

Prevention. As with the other groups in this plan, preventative measures will focus on education about the emotional effects of a potential event, as well as exercises and practice in the development of coping strategies before, during, and after the event. These workers will receive this education in training classroom sessions with a qualified instructor. 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 burnout, fatigue, and diminished self-esteem and self-efficacy. Unless individuals have the tools needed to make a complete recovery, these symptoms can progress into long-term disorders such as depression and anxiety. First responders' self-esteem and self-efficacy have been found to be predictive of their ability to recover after a critical incident (Pietrantoni & Prati, 2008).

While self-esteem and self-efficacy arise from a combination of factors that cannot be fully controlled within the scope of a CISM program, steps can be taken to help individuals 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 receive debriefing within 48 hours of the incident, group counseling, and individual counseling for those determined to need such services. These services are designed to provide an individualized approach to building resiliency among primary victims.

Secondary

Secondary victims of the incident will be provided a more generalized approach to building resiliency. Because members of this group are not formally part of the organization, they cannot be required to attend formal preventative classes. The exception is 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 wish to attend from Surry and the surrounding counties. Classes will be conducted at local hospitals by personnel from a consultancy firm specializing in CISM training.

In addition to these classes, the consultancy will also offer classes to families of first responders and power plant personnel. These classes will be voluntary, as it is recognized that for some families the material might increase anxiety rather than relieve it. This is a key reason for using a voluntary approach for secondary victims. Knowledge can be a powerful tool in alleviating fear. Providing families with resources and a plan for what to do if the worst should happen can be comforting and stress-reducing.

Tertiary

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

References

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Appendix I: Proposed Budget

Personnel: $75,000
Printed Materials: $27,000
Live Media Ads: $74,000
Office and Facilities: $92,000
Miscellaneous Supplies: $1,000
Training for Personnel on Scene: $5,000
Subcontracted Services for Individuals in Need: $226,000