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Use the reading material from the Required Reading and create a PowerPoint presentation including:

Title page (1 slide)

Content (10 slides minimum)

Summary (1 slide)

Reference (1 page) (APA style)

The content of the slides will present the main ideas in bullet format and the discussion will be placed in the Notes Section.


You are the lead for the Community Planning Team. The team is conducting the annual review of the Emergency Preparedness Plan for your community. Currently, the plan does not include an annex for a Stress Management Program.You are creating this PowerPoint presentation to deliver to the team that details a proposed Stress Management Program for first responders, non-governmental organizations, and residents.

The presentation will include the following:


1. Define stress management and the levels of stress

2. Goals and objectives of the program

3. Vulnerable populations and first responders who need this training

4. How the program will be implemented

5. How the program will enhance community resiliency

International Journal of Emergency Mental Health 249 The Critical Incident Stress Debriefing Process for the Los Angeles County Fire Department: Automatic and Effective Melvin Hokanson and Bonnita Wirth, Ph.D. Note: This project was an applied research investigation originally submitted to the National Fire Academy as part of the Executive Fire Officer Progam. ABSTRACT: Los Angeles County Fire Department has one of the oldest Critical Incident Stress Management (CISM) programs in the country. One core component for the LACoFD has been the Critical Incident Stress Debriefing (CISD). Two important questions for the emergency managers are: 1) Do individuals find a significant difference in symptom reduction for events that were debriefed? 2) Does helpfulness of a debriefing for a specific individual correlate with recommending the process for others? A Department-wide evaluative survey was conducted in 1996 to determine the satisfaction and effectiveness of the debriefing program. Individuals reported a significant difference in the speed of symptom reduction for incidents that were debriefed versus incidents that were not debriefed. The majority of individuals would recommend the debriefing process to others regardless of whether they personally found the process helpful or not. Based on this, the recommendations are to continue the debriefing process for specific events and to make the process mandatory; furthermore, it is recommended that the term “mandatory” be changed to “automatic.” By using the term “automatic,” debriefings become standard operating procedures. By doing so, a method to protect the psychological welfare of emergency personnel becomes as automatic as putting on safety protection equipment [International Journal of Emergency Mental Health, 2000, 2(4), 249-257]. KEY WORDS: Critical Incident Stress Debriefing; CISD; Critical Incident Stress Management; CISM; traumatic stress; fire service Melvin Hokanson, L.A. County Fire Department, Los Angeles, CA, and Bonnita Wirth, Ph.D. Address correspondence concerning this article to: Melvin Hokanson, County of Los Angeles, Fire Department, 1320 North Eastern Ave., Los Angeles, CA 90063-3294 The Los Angeles County Fire Department (LACoFD) has one of the oldest Critical Incident Stress Management (CISM; Everly & Mitchell, 1999) programs in the United States. The program, implemented in 1986, is comprehensive. It is based on the “ICISF model” approach to reducing traumatic stress after critical incidents following emergency operations (Mitchell, 1983; Everly and Mitchell, 1999). The program spans the entire three phases of the crisis spectrum: 1) the pre-crisis phase; 2) the acute crisis phase; and 3) the post- crisis phase. It embodies ten components: pre-incident education, demobilizations, on-scene support, defusings, Critical Incident Stress Debriefings (CISD), individual counseling, significant other support, specialty debriefings, follow-up, and a strong peer firefighter support program. The intent is to reduce and control the harmful effects of critical incident stress on LACoFD personnel. Since 1986, the LACoFD has conducted more than 500 Critical Incident Stress Debriefings (CISD and defusings with its personnel. The underlying goals of the CISM program are: 1) To reduce the impact of a traumatic event; 2) To accelerate the normal recovery process from a traumatic event; 3) To normalize the stress response for emergency workers
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250 Hokanson/THE CISD PROCESS FOR THE LOS ANGELES COUNTY FIRE DEPARTMENT in traumatic events; and 4) To provide for education in stress management and coping techniques. The underlying assumption among Department management personnel is that CISM meets these goals. However, supporting evidence had never been gathered. In 1996, the author undertook a Department-wide evaluative survey to determine the satisfaction and effectiveness of the CISM program, focusing specifically on three components: defusings, CISD, and individual peer support. The results of this survey were previously reported in a National Fire Academy document (Hokanson, 1997). The results showed that the CISM program is effective in educating LACoFD personnel about stress symptoms, coping techniques, and creating an environment where open discussion of traumatic events is possible. Overwhelmingly, the program was well received and participants expressed their overall satisfaction with the defusing, debriefing, and peer support processes. One of the questions within CISM programs for emergency personnel has been whether CISD attendance by an individual should be mandatory or voluntary. Mitchell (1983) initially stated that emergency responders should be required to attend debriefings. Later, he softened a bit on this and stated that they should be required for specific incidents such as line-of-duty deaths, multiple fatality events, large-scale disasters, suicide, or critical injury of personnel (Mitchell & Everly, 1995) leaving other events up to the decision of the responders. There is often an inherent resistance by firefighters to admit the presence of virtually any psychological or emotional problem as well as a persistent, often dysfunctional, need to maintain a “macho image.” These are some of the reasons that within LACoFD, debriefings have always been mandatory. For the purposes of the current paper, specific data from the original survey (Hokanson, 1997) were reanalyzed to answer these questions: 1) Did individuals find a significant difference in symptom reduction for events that were debriefed vs. events that were not debriefed? 2) Does helpfulness of a debriefing for a specific individual correlate with recommending the process for others? Background and Significance The Los Angeles County Fire Department provides fire suppression, prevention, emergency medical services (paramedics), terrorism preparedness, urban search and rescue, hazardous materials management, ocean lifeguard services, and public education services to over four million residents in a 2,298 square mile area. The Department is comprised of 157 fire stations serving 57 contract sites and employs over 3700 men and women whose lives may be Table 1: CISM Interventions Following Cerritos Air Disaster Cerritos Air Crash, 1986 CISM Interventions Total fatalities 86 Planes lost Homes destroyed 2 16 Civilians killed on ground 18 Firefighters engaged 300 Body parts recovered >10,000 Demobilizations Debriefings Hotline Follow-up Firefighters filing workers’ compensation Increase in mental health utilization after each shift 12 1 by Employee Assistance Program 1 1%
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Daniel H. Guenthner is Emergency Management Director for Lincoln County Emergency Management Office, Nebraska and a Doctoral Learner at Capella University in the School of Public Service Leadership studying emergency management with a concentration in homeland security. He studied at Columbia Southern University and attained a MS in occu- pational safety and health with a concentration in environmental management. Daniel is a stu- dent member of IAEM and has over 30 years’ experience in law enforcement, the fire service, emergency medical services, occupational safety and health, emergency management planning and training, and environmental man- agement in both the public and private sectors. As an experienced first responder he has wit- nessed and experienced critical incident stress during natural disasters such as flooding, torna- dos and severe thunderstorms in the Midwest; earthquakes in southern California; and typhoons and earthquakes on mainland Japan and Okinawa. From these disasters and crises, he understands the need for business continuity and planning; and implementing programmes that promote self-efficacy in stress management and community resilience. A BSTRACT A literature review was performed on critical incident stress after September 11th, 2001 (9/11), and Hurricanes Katrina and Rita, which focused on the need to implement a holis- tic critical incident stress management programme for first responders and business organisations. Critical incident stress management is required to handle acute stress and other distress in the face of natural or man-made disasters, including terrorist attacks. A holistic approach to commu- nity resilience through a well-planned and implemented critical incident stress management programme has been shown in the literature to promote self-help and self-efficacy of individuals and organisations. The interventions and pro- gramme elements defined clearly show how a number of different intervention and prevention strategies will promote business and community resilience and also self-efficacy in a culturally- diverse community and organisation. Implementing a critical incident stress manage- ment programme within a responding business organisation is critical because of the fact that first responders are the most susceptible every day to exposure to critical incidents that will affect their mental health; and business employees will suffer some of the same maladies as first responders in the event of a disaster or crisis. Utilising the framework provided, a holistic critical incident stress management programme can be imple- mented to help reduce the effects of burnout, absenteeism, acute stress, post-traumatic stress, substance use and traumatic stress, and to work Journal of Business Continuity & Emergency Planning Volume 5 Number 4 Page 298 Journal of Business Continuity & Emergency Planning Vol. 5 No. 4, pp. 298–315 q Henry Stewart Publications, 1749–9216 Emergency and crisis management: Critical incident stress management for first responders and business organisations Daniel H. Guenthner Received (in revised form): 3rd January, 2012 Lincoln County Emergency Management Office, 715 Jeffers St, North Platte, NE 69101, USA Tel: +1 (308) 532 7383; Fax: +1 (308) 534 1692; E-mail: [email protected] Guenthner:JSC page.qxd 04/05/2012 11:53 Page 298
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to promote community resilience and toughen individuals against the effects of stress. Taking care of the needs of the employees of a business organisation, and of those of first responders, is clearly required. Keywords: self-efficacy, business conti- nuity, resilience, burnout, emergency planning, critical incident stress, 9/11, Hurricanes Katrina and Rita INTRODUCTION If a public-safety, emergency-management, or non-governmental organisation has not implemented a Critical Incident Stress Management (CISM) programme to handle stress during a disaster or crisis; they are encouraged to so. It may save first responders and other individuals from more severe psychological trauma that leads to critical incident stress, acute stress disorder (ASD), burnout, depression, post-traumatic stress disorder (PTSD), and even substance use disorder (SUD) — even worse, suicide. There is a large body of research conducted post-9/11 and in the past decade that sug- gests that the burden of PTSD among indi- viduals with a high exposure to 9/11 and Hurricanes Katrina and Rita was substan- tial. 1 A CISM programme will also help build community resilience and provide community support, which is crucial to stress management among first responders and for business organisations and continu- ity. According to Silver, ‘the attacks of 9/11 did far more than destroy buildings and kill thousands of innocent people … [T]hey shattered a sense of security and perceptions of invulnerability among residents of the United States and the Western world’ (p. 427). 2 Until a disaster strikes and one experi- ences it first-hand, one may not fully com- prehend or realise all the emotions everyone will go through. It is true that a great number of traumatic disasters have been witnessed through television sets with live on-the-spot coverage as they unfold (eg 9/11, Hurricanes Katrina and Rita, tornados in Joplin, Missouri and Tuscaloosa, Alabama). One starts to get a sense of the emotion that builds up from just sitting there in the confines of one’s own home or workplace watching the events unfold before one’s eyes. Multiply those emotions and traumatic stressors ten or even a hundred times over; then one starts to get a sense of what people actually feel that is part of the lived experience. Post 9/11, researchers began reporting a wide range of mental and physical health issues, which have continued for over a decade now. 3 According to Neria, DiGrande, and Adams in their research into post-9/11 PTSD, they identified trauma in specific populations that included rescue and recovery workers, Pentagon staff, World Trade Center evac- uees, New York City workers, primary care patients, mixed adult samples, and children and adolescents. 4 Of special inter- est to this literature review are the rescue and recovery workers and the World Trade Center evacuees in the Neria et al . research article, and the population affected by Hurricanes Katrina and Rita. According to an article recently pub- lished in the New York Times (NYT) Health Section, the journal American Psychologist recently published a collection of articles relating to 9/11. 5 An interesting further point made in the NYT article was that: ‘researchers later discovered that the standard approach at the time, in which the therapist urges a distressed person to talk through the experience and emo- tions, backfires for many people. They plunge even deeper into anxiety and depression when forced to relive the mayhem’. 6 This intense approach failed, and from these Page 299 Guenthner Guenthner:JSC page.qxd 04/05/2012 11:53 Page 299
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First Responders: Mental Health Consequences of Natural and Human-Made Disasters for Public Health and Public Safety Workers David M. Benedek, Carol Fullerton, and Robert J. Ursano Center for the Study of Traumatic Stress, Uniformed Services University School of Medicine, Bethesda, Maryland 20814-4799; email: [email protected], [email protected], [email protected] Annu. Rev. Public Health 2007. 28:55–68 The Annual Review of Public Health is online at http://publhealth.annualreviews.org This article’s doi: 10.1146/annurev.publhealth.28.021406.144037 Copyright c ± 2007 by Annual Reviews. All rights reserved 0163-7525/07/0421-0055$20.00 The U.S. Government has the right to retain a nonexclusive, royalty-free license in and to any copyright covering this paper. Key Words public health workers, critical incident, disaster, traumatic stress response Abstract First responders, including military health care workers, public health service workers, and state, local, and volunteer ±rst respon- ders serve an important role in protecting our nation’s citizenry in the aftermath of disaster. Protecting our nation’s health is a vital part of preserving national security and the continuity of critical na- tional functions. However, public health and public safety workers experience a broad range of health and mental health consequences as a result of work-related exposures to natural or man-made disas- ters. This chapter reviews recent epidemiologic studies that broaden our understanding of the range of health and mental health conse- quences for ±rst responders. Evidence-based psychopharmacologic and psychotherapeutic interventions for posttraumatic distress reac- tions and psychiatric disorders are outlined. Finally, the application of public health intervention models for the assessment and manage- ment of distress responses and mental disorders in ±rst-responder communities is discussed. 55 Annu. Rev. Public. Health. 2007.28:55-68. Downloaded from www.annualreviews.org by Uniformed Services University - HSC EBVC Account on 02/26/11. For personal use only.
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ASD: acute stress disorder PTSD: posttraumatic stress disorder INTRODUCTION The terrorist attacks of September 11, 2001, focused the attention and energy of the United States on the “global war on terror- ism” and the Nation’s security. This was fur- ther emphasized by the anthrax attacks of 2001, the response and recovery efforts of the 2004 Southeast Asia tsunami, the mul- tiple hurricanes that struck Florida in 2004, and hurricanes Katrina and Rita in 2005. Nat- ural and human-made tragedies (e.g., war) have demonstrated the extent to which our national infrastructure can be threatened, damaged, or destroyed by disasters. These events have emphasized the important role of our public health and public safety ±rst responders—including uniformed services, military and public health, and state, local, and volunteer ±rst responders—in protect- ing our nation’s citizenry in the aftermath of disaster. The de±nition of “public health work- ers” is somewhat arbitrary. Police, ±re±ght- ers, search and rescue personnel, and emer- gency and paramedical teams are included in most de±nitions and have been studied most extensively. However, nurses, physicians, lab- oratory personnel, and ancillary hospital staff have also played important roles in the re- sponses to recent natural disasters in the United States and abroad, in rescue-and- recovery operations after terrorist attacks, and in the identi±cation, management, and treat- ment of infectious outbreaks such as SARS. These providers will no doubt play important roles in response to future natural and human- made disasters, in particular an Asian in- fluenza pandemic. Truck drivers, heavy equip- ment operators, laborers and carpenters have also worked (and continue to work) to restore basic needs such as shelter and workspace in the aftermath of natural disasters, limiting the spread of infection or disease related to envi- ronmental exposure or malnutrition. Others have assisted in the recovery of human re- mains, reducing infection and bringing a de- gree of closure to survivors of deceased vic- tims. These efforts, which augment the roles of traditional ±rst responders, call for an ex- panded de±nition of “±rst responder” and may also suggest an expanded de±nition of “public health worker.” Regardless, protect- ing the health of care providers and other re- sponders is an important aspect of disaster re- covery and of preserving continuity of critical community functions. Within various responder groups, the po- tentialnegativeemotionalconsequenceofdis- aster work resulting from exposures to trau- matic events, high levels of work demand, work with disrupted communities and evac- uee populations, and separation from home and loved ones has been the subject of con- siderable investigation. Acute stress disor- der (ASD) and acute and chronic posttrau- matic stress disorder (PTSD) are the focus of considerable study (3). The broad range of posttraumatic reactions which can affect health, performance and morbidity include not only these disorders but also subclini- cal emotional symptoms (e.g. fear), altered health risk behaviors and other traditional dis- orders. Ultimately, healthy adjustment (re- silience) should be expected in most, how- ever, traumatic responses include: distress, worry, disturbed sleep or concentration, al- terations in work function, dif±culties with interpersonal relationships, increase in sub- stance use, somatization, and depression (8, 25). Response to loss of loved ones or signif- icant others may include symptoms of trau- matic grief (24) or complicated grief (39, 43). The intertwined nature of distress related be- haviors, sign and symptoms of mental disor- ders, and distress responses not amounting to diagnosable mental disorders are depicted in Figure 1 . In the following pages we review the spec- trum of emotional and behavioral conse- quences of traumatic events as part of un- derstanding the effects of disaster work on public health responders. We address recent advances in our understanding of the health, particularly mental health, consequences of disaster in public health workers and 56 Benedek · Fullerton · Ursano Annu. Rev. Public. Health. 2007.28:55-68. Downloaded from www.annualreviews.org by Uniformed Services University - HSC EBVC Account on 02/26/11. For personal use only.
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