Dear CISM Practitioner,

Images broadcast from the areas stricken by Katrina's wrath engender a myriad of reactions such as shock, awe, disbelief, anger, sympathy, fear, and even betrayal. But for those in the helping professions, a visceral urgency to personally respond may be the primary reaction. Experience has taught us well that such urges are to be tempered with a prudent assessment
of need, a realistic assessment of available resources, and a plan for implementing assistance once on site. The following recommendations are offered as an initial set of guidelines for those considering responding to the disaster mental health needs of those affected by Katrina.

1. All intervention is predicated upon an assessment of a need. Need is not only defined as the determination of the necessity for crisis and disaster mental health support, need also means that such support is desired by those at the local/state level and that such support will effectively augment, rather than complicate or disempower local initiatives. Self-deployment based upon an impulsive need to help is never a good idea.

2. Assistance must be coordinated within an integrated response plan. Ideally, such a plan involves local, state, Federal, and NVOAD resources.

3. Once deployed, effective mental health response should follow the hierarchy of needs described by Abraham Maslow:
a. Meet physiological needs for shelter, food, water, clothing.
b. Meet basic needs for safety, security, and medical care.
c. Meet basic needs to re-establish family and other interpersonal connections. Reuniting families must take priority over all other such support. For rescue and recovery personnel, the establishment of "peer" and mental health support should be emphasized.

4. The principles of psychological first aid are useful guidelines for planning support services beyond that mentioned above:
a. Assess need, assess impairment
b. Stabilize (try to prevent further deterioration of psychological/behavioral functioning through meeting basic needs as described above)
c. Assess need for further support
d. Offer information, education, reassurance, as indicated
e. Connect with sources of continued support
f. Diagnostic and traditional "psychotherapy" functions are not included herein, but are considered as later points on an overall continuum of care.

5. Keep in mind that the psychological/behavioral response to mass disasters typically follow a somewhat predictable trajectory. Civilian reactions will follow a very different course than will the reactions of rescue and recovery personnel. Try not to confuse/intermingle the support
services offered to these two groups. The majority of manifest need for rescue and recovery personnel will come weeks post impact...as this is written (09/06/05), we are still in the impact phase where the most basic of all needs are the priorities.

6. Be sure to plan for your own well-being. Prepare yourself mentally and physically. If going to the Gulf Coast on assignment, carefully assess your own health before going. This is an extreme hardship assignment. The history of disaster response is replete with examples of
helpers becoming victims.

7. Plan a time-limited deployment in order to assist in resource planning and in "self-preservation." Plan for some form of "re-entry" or homecoming for interventionists after their deployment. Don't forget the importance of "debriefing the debriefers" when they come back from an assignment. Disaster response work is highly needed and rewarding, but it is highly stressful, as well.

8. If you are not called, or are called and cannot go out to the impacted disaster area, there may be ways to help in your own communities. Many communities around the country are receiving evacuees and can use trained crisis intervention personnel to help them adjust to their new situations. Local Red Cross or other NVOAD agencies may need volunteers locally to answer phones and help out in their offices. Give them a call and see if you can be of assistance.

9. The media is flooding all of our homes with heart wrenching stories and pictures. Be sure to monitor the "dose" of disaster that you, your family, and especially your children are exposed to. Monitor TV watching, and talk about what you are seeing. Reassure your children that you have a family disaster plan. Now is a good time to review your disaster plan as a family
and update the plan and supplies as needed.

This article was a collaborative project contributed by Diane Myers, RN, MSN, Royal Oaks, California and ICISF

 

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Should anyone be interested in providing a donation, they may review our Donations Link

If there are any inquiries about CISM Training opportunities, you may view the Calendar of Conferences

Finally, please remember that this will be a long term event, pace yourself. Remember to practice appropriate stress management principles.

Further updates will follow as more information is obtained.

 

Donald Howell, Executive Director
International Critical Incident Stress Foundation, In.
Ellicott City MD 21042-2272
http://www.icisf.org
410/750-9600
Fax: 410/750-9601

KAT-05-02

Dear CISM Practitioner,

Disaster deployment requires effective stress management strategies to stay at your best. This article provides a few strategies that may be helpful to you as you deploy.

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Today's Helpful Hints
Within areas that have been affected by Hurricane Katrina, many first responders and other care providers are still on scene and effectively in the "Operations Mode."

At this time, as in most disasters, the priorities will be
1. Meet physiological needs for shelter, food, water, clothing
2. Meet basic needs for safety, security and medical care
3. Meet basic needs to re-establish family and other interpersonal connections, and
4. Timely/accurate information flow.

The suggested tool for "timely information flow" would be the Crisis Management Briefing (CMB). Please review this article for additional information about this component in the CISM toolbox.

Of the many tools that are available when providing Crisis Management services, Debriefings (per the ICISF Model) should be utilized rarely if at all at this stage of a disaster. The CISD should only be used with homogenous groups of people who worked on the disaster together. Their mission should be complete and they should have experienced approximately the same level of exposure. No personnel should be forced to participate. Should you wish to review the appropriateness of an ICISF Debriefing for a particular circumstance, please feel free to contact the ICISF office. Additional suggestions shall be forthcoming within the next several days.

 

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Announcing New Course
ICISF is pleased to announce a new curriculum being launched this Fall, entitled "Grief Following Trauma." Co-authors for this exciting and dynamic program are:

H. Norman Wright, LMFT, CTS, American Association of Christian Counselors Executive Board
Kevin L. Ellers, MDiv, Territorial Disaster Coordinator with the Salvation Army, and
Nancy E. Crump, MS, Director of the Trauma Support Network

Course Description:
In the course of nearly everyone's life, they will, at some time, encounter people grieving the loss of a loved one due to a traumatic event.

This new course is designed to help both professionals and lay people identify characteristics of trauma and traumatic events, the normalcy of traumatic grief reactions, learn good death notification and body identification techniques, become skilled at identifying warning signs of complications, and learn the importance of early interventions and support utilizing the SAFER-R model. Participants will increase their knowledge of how trauma impacts the grief process and will gain skills for evaluating and supporting persons who have experienced traumatic loss.

Course objectives are:

• Identify types of traumatic events and the characteristics of trauma and grief
• Describe normal responses to trauma and normal grief responses
• Describe factors that may complicate the traumatic grief process
• Learn practical and effective methods of death notification and preparation for body identification
• Identify the primary needs of people experiencing grief following trauma
• Outline techniques for supporting people grieving a trauma and for self-care

Additionally, some courses have already scheduled. Please refer to the Calendar of Conferences.

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Should anyone be interested in providing a donation to support disaster mental health services related to hurricane Katrina, they may review our Donations Link

If there are any inquiries about CISM Training opportunities,you may view the Calendar of Conferences

Finally, please remember that this will be a long term event, pace yourself. Remember to practice appropriate stress management principles to preserve your own well-being.

Further updates will follow as more information is obtained.

 

Donald Howell, Executive Director
International Critical Incident Stress Foundation, In.
Ellicott City MD 21042-2272
http://www.icisf.org
410/750-9600
Fax: 410/750-9601

KAT-05-03

Dear CISM Practitioner,

In today's update, we provide a new article written by Jeffrey T. Mitchell, PhD, CTS, ICISF President Emeritus, as well as links to two articles written by George S. Everly, Jr., PhD, F.A.P.M., Chairman of the Board Emeritus of ICISF. The information is both timely and appropriate for those anticipating or considering deployment to the areas impacted by hurricane Katrina. I urge you to read all three of these articles and to share them with others whom you feel could benefit from the information.

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Easy Does It
Jeffrey T. Mitchell, PhD, CTS
ICISF President Emeritus

It happens in almost every disaster and it is happening on the Gulf Coast now. Some folks just cannot resist the temptation to self-deploy. Truthfully, some independent responders have been helpful under certain circumstances in the past. Freelance responders, however, are more likely to inadvertently generate further problems for people already in the disaster zone.

Because self-deployed people do not always have the "big picture" in mind, they may end up in areas where they are not needed or where their services compete with organized response programs. Independent responders usually run out of supplies quickly and lack the benefit of an organized supply system. Frequently they request additional supplies from already strained stockpiles of disaster relief goods that organizations have shipped into the area to do their work. Needless to say, feelings of resentment on all sides can be easily stimulated under such circumstances.

Unfortunately, some people, who attempt to function in disaster areas on their own, find more trouble than they anticipated. They experience numerous difficulties finding food and water; they have no real base of operations and no dependable lodging. Often they lack communications and have no liaison with organizations such as the Red Cross, the Salvation Army, the National Organization of Victim Assistance and the International Critical Incident Stress Foundation.

In the past, a few people with fragile health self-deployed to disaster zones. They became sick and needed to be rescued. That, of course, further strained already overworked rescue and healthcare services. Others, who chose to work in areas where civil order was not yet restored, have become victims of robbery, violence and sexual assault. In summary, independent response adds further pressure to the rescue, health care, security and recovery systems that are attempting to restore order and reduce chaos.

Please, rather than self-deploying, we urge all of you to join with existing appropriate non-profit disaster response organizations like the Red Cross, Salvation Army, National Organization of Victim Assistance and the International Critical Incident Stress Foundation. If you are not able to go to a disaster zone, your donations to any of those organizations helps more than you can imagine. Joining up or donating funds or volunteer time enhances the possibility that your resources and skills will be used in the most effective manner. There are huge benefits when our response to a disaster is part of an organized, comprehensive, integrated, systematic and multi-component approach. Please, do not freelance in a disaster. Thank you!

 

The following articles by George S. Everly, Jr., PhD, F.A.P.M., are being distributed with the permission of Chevron Publishing.

Toward a Model of Psychological Triage: Who Will Most Need Assistance?

Early Psychological Intervention: A Word of Caution

 

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In anticipation that ICISF will be requested to deploy CISM Teams for hurricane Katrina (NOTE: there have been NO definitive requests for assignments through ICISF as of yet), please be aware of the priority system that will be applied in fulfilling such requests:

A). ICISF will contact State CISM Team Coordinators / CISM Teams in geographic concentric circles outward from the location of the agency making the request.

B). First priority of contact within those states will be ICISF CISM Teams that are listed as "Current" in our files. Once we have exhausted ALL "Current" Teams,

C). ICISF will contact, within those states, ICISF CISM Teams that are listed as "Not Updated" in our files. Once we have exhausted ALL "Not Updated" Teams,

D). ICISF may reach out to those CISM Teams who are not listed in our database.

E). The last priority will be those individuals who are not affiliated with a CISM Team. There may be some additional useful needs / assignments for those individuals as well.

I would suggest that you view the list of CISM Teams on the ICISF website (see link below) to determine if your Team is "Current." Should you wish to update or list your Team, please contact Rev. George Grimm, ICISF Hotline CISM Team Program Manager, at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Team List

 

I also ask that each CISM Team and each CISM Team member understand that the impact of this disaster is coming back to you. It comes in the form of returning USAR Teams, DMORT Teams, Fire/Police/EMS/Communications groups and faith-based groups, as examples, that have responded from around the country and may now have been impacted and in need of CISM services. Remember, to make a significant contribution to those affected by this tragedy, one doesn't have to get mud on their shoes, blood on their sleeves or see "firsthand" the devastation. Some of the most important services you can provide are far away from the impact zone. Please provide your services when formally requested by any reputable agency, where you are needed, not where you want to be.

The impact of this situation will last for months to come and so will the need for CISM Services.

Also, keep in mind that all folks, to include emergency services personnel, are resilient by nature, therefore assure that your interactions are both timely and appropriate.

Further updates will follow as more information is obtained.

Donald Howell, Executive Director
International Critical Incident Stress Foundation, In.
Ellicott City MD 21042-2272
http://www.icisf.org
410/750-9600
Fax: 410/750-9601

KAT-05-04

Dear CISM Practitioner,

In today's update, we provide links to two articles written by George S. Everly, Jr., PhD, F.A.P.M., Chairman of the Board Emeritus of ICISF--one on the topic of Pastoral Crisis Intervention and the other discussing the Crisis Management Briefing (CMB). In addition, this message includes the text of articles written by two guest contributors: Daniel W. Clark, PhD, Washington State Patrol Psychologist, serving on invitational orders with the US Coast Guard; and D. Craig Newton, MSW, LCSW, BCD, DCN Consulting. The information in these articles is both timely and appropriate for those anticipating or considering deployment to the areas impacted by Hurricane Katrina. I urge you to read all four of these articles and to share them with others whom you feel could benefit from the information.

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The following articles by George S. Everly, Jr., PhD, F.A.P.M., are being distributed with the permission of Chevron Publishing.

Pastoral Crisis Intervention': Toward a Definition

 

Crisis Management Briefings (CMB): Large Group Crisis Intervention in Response to Terrorism, Disasters, and Violence

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The Coast Guard's CISM Response to Hurricane Katrina
Daniel W. Clark, PhD
Washington State Patrol Pschologist, serving on
invitational orders with the US Coast Guard

The US Coast Guard CISM program has assisted 1,645 Coast Guard personnel since September 1st in response to Hurricane Katrina. Thirty-eight CISM trained peers from all over the Coast Guard deployed to 13 locations across the Gulf Coast region. The CISM response is being coordinated from Alexandria, LA within the Coast Guard Incident Command Post and is co-located with the Chaplian Corps. Contract mental health professionals are at Alexandria to assist.

Terry Blais is overseeing the Coast Guard CISM response as a technical specialist in accordance with the National Incident Management System. CISM coordination has been organized into several sections:

• daily operations and logistics are managed by several senior peers;
• planning, resource requests and Standard Operation Procedures are being managed by Kristin Cox as deputy CISM technical specialist;
• clinical support and just in time refresher training (CMBs, demobs and referral protocol) for peer supporters and staff, and daily consultations with the International Critical Incident Stress Foundation, are provided by Dr. Dan Clark.

In accordance with Coast Guard Commandant Instruction 1754.3, the CG CISM program follows International Critical Incident Stress Foundation guidelines for disaster response. The Coast Guard is providing one to one interventions, demobilizations and Crisis Management Briefings only at this time. As of 9/17/05:

• 606 one to one interventions
• 686 personnel provided demobilizations
• 352 personnel provided Crisis Management Briefings
• Over 1200 lbs of immediate-need transported to field units
• Ongoing, constant communication with various commands and the ICP providing briefs and command consults

The majority of Coast Guard units have received pre-incident CISM training. CISM team members from all over the Coast Guard receive standardized International Critical Incident Stress Foundation training in accordance with Coast Guard Policy Commandant Instruction 1754.3, which facilitates coordination of ad hoc peer teams on scene. The CISM technical specialists have received NIMS Incident Management training which facilitates operating within the emergency operation.

The Coast Guard Gulf Coast CISM team has received annual training on Disaster Response to include the following incidents: OKC bombing, TWA Flight 800, Alaska Air Flight 261, Line of Duty Death, September 11th, Top-off exercise April 2005, and the Rhode Island Nightclub Fire as well as topics from previous World Congresses. We highly recommend other CISM teams include lessons learned from CISM disaster response in their training.

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A Local Response to Katrina 
D. Craig Newton, MSW, LCSW, BCD
DCN Consulting Services

Starting just after Katrina hit, there has been an outpouring of support from emergency responders all over the country by going to ravaged areas of our South. Responders have signed on for weeks at a time to assist their peers in the devastated areas. Many hospital personnel have also volunteered to go to affected areas to assist with meeting area needs.

As CISM teams across the country feel the need to consider mobilizing for a possible trip to Louisiana, Alabama, Mississippi or Texas, it is important also to think in terms of being available locally to those emergency responders who are returning from their tour of duty in the South. Local responders will have left their loving families, supportive friends and secure jobs for an extended period of time. Upon returning they will predictably have many thoughts and emotions that they will have only just begun to process.

Imagine the responders may be living and working in places with no running water, no electricity, minimal food, and very basic sheltering. The environment is hot, buggy, with rank odors, damp, and the responders are surrounded by the devastation.

Responders will encounter men, women and children who have lost everything including loved ones. They will have been told incredibly sad stories that will touch their hearts. They will bear witness to the survivors' physical and emotional pain. Responders will have felt true helplessness in their ability to make a significant impact. They will have worked long and hard, often with very little sleep. Responders will have seen horrific sights that they may describe as surreal and they may be unable to put their experiences into words.

After several weeks of this emotional exposure, our local responders will return to the comfort and safety of their homes. They will have the love and support from their family and friends. This is where the readjustment will take place and the healing will begin.

The availability of Peer support when they return can be helpful. As responders return to work, CISM trained peers can provide support by just listening to their stories. Listening without asking questions is an important intervention. In their own time, returning responders may express a range of feelings including anger, sadness and shame. Difficulty concentrating might not be an unusual experience in the beginning. They may seem somewhat distant, lost in their thoughts and they could find it a challenge to return to a regular routine. They may seem to be "on edge." It is very important that each CISM Trained Peer maintain close contact with an experienced Mental Health provider. The Mental Health Provider will help the Peer to triage appropriately and assist in making referrals if they are indicated.

Local CISM teams, because of their acceptance by the emergency responder culture, can provide a powerful, supportive resource. Peers just listening to the stories of Katrina and its devastation can be the most helpful. Each returning responder will have a different reintegration process and we must allow them to let their story unfold over time at their own pace. This is a perfect opportunity for CISM trained teams to provide Peer support locally by listening to their own.

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Further updates will follow as more information is obtained.

Donald Howell, Executive Director
International Critical Incident Stress Foundation, In.
Ellicott City MD 21042-2272
http://www.icisf.org
410/750-9600
Fax: 410/750-9601

KAT-05-05