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.

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

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.

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.

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