Critical Incident Stress Management

An Overview
 What is CISM?  Policy and Procedure  Supporting Information

Produced by,

Fraternal Order of Police, of Ohio
Critical Incident Program

Mike Haley, Chairman 222 East Town Street Columbus, Ohio 43215 Phone (614) 224-5700

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Directory
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

page
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Program Chairman Mission Statement & Program Objective Group Critical Incident Stress Management Training What is a “Critical Incident”? Examples of a Critical Incident Critical Incident Stress Management (CISM) Policy Facts about Critical Incident Stress Management Critical Incident Handout (Signs & Symptoms) Key Terms and Concepts Example of departmental Policy for the “Use of Deadly Force”

Informational Documentation
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“Homicide” and “Use of deadly force” Mike Haley CISM of Police Shooting, Peter Volkmann Police Shooting, Mike Cobb

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Program Chairman 1

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Fraternal Order of Police, of Ohio, Inc.
Critical Incident Response Service
Mike Haley, CTR, Program Director 222 East Town Street, Columbus, Ohio 43215 1-800-367-6524 1-614-224-5775 fax

This book is produced for,

Members of the Fraternal Order of Police, by The State Lodge, Critical Incident Program.

FRATERNAL ORDER OF POLICE

State of Ohio MIKE HALEY, C.T.R.
Critical Incident Chairman (614) 224-5700 OFFFICE (614) 224-5775 FAX mhaley@fopohio.org

222 E. Town Street Columbus, OH 43215

Thank you for your interest in this very important area of protection for your Officers. You may use any or all of the parts of this book. If you have any questions feel free to give me a call.

Mike Haley

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Fraternal Order of Police, of Ohio, Inc.
Critical Incident Response Service
Mike Haley, CTR, Program Director 222 East Town Street, Columbus, Ohio 43215 1-800-367-6524 1-614-224-5775 fax

Mr. Mike Haley was a police officer for 26 years and retired in March of 2001 as the Chief of Police for the Clinton Township, Division of Police in Franklin County, Ohio. He is currently the Chairperson of the National Fraternal Order of Police, Critical Incident Program and the Director of the Fraternal Order of Police of Ohio‟s Critical Incident Response Service, which he has chaired since 1996. He is the founder of the Mid-Ohio Critical Incident Stress Management Team, which serves law enforcement in the Columbus, Ohio metropolitan area. Mike responded, on multiple occasions, to the World Trade Center disaster as part of a law enforcement CISM response. He also provided CISM services to the NOPD during the aftermath of hurricane Katrina. Mike is member of the International Critical Incident Stress Foundation faculty, instructor for “The Group Critical Incident Stress Management Course”, “Law Enforcement Perspectives for CISM Enhancement” and “CISM: Individual Crisis Intervention & Peer Support”. He is certified by, the Association of Traumatic Stress Specialists as a “Certified Trauma Responder” (C.T.R.), he is also recognized by The American Academy of Experts in Traumatic Stress as “Board Certified in Emergency Crisis Response” (B.C.E.C.R.) and the International Critical Incident Stress Foundation as a specialist in Emergency Services and Mass Disaster / Terrorism. And he has provided numerous publications and lectures on the topic of CISM.

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Mission Statement & Objective 2

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Fraternal Order of Police, of Ohio, Inc.
Critical Incident Response Service
Mike Haley, CTR, Program Director 222 East Town Street, Columbus, Ohio 43215 1-800-367-6524 1-614-224-5775 fax

Mission Statement
Assist emergency service workers who are effected by a "Traumatic Event" with a coordinated nation wide Critical Incident Stress Management Program. Goal: To provide the effected Emergency Service Worker with services that will mitigate or lessen the impact of the effects of critical incident stress, and accelerate the recovery following a traumatic event

Objective: For the Critical Incident Program is: To establish a Critical Incident Stress Management (CISM) program for law enforcement officers and their families across the United States. The CISM model is well known in many states and countries for EMS, hospital, and disasters responders; however, little attention has been devoted to the law enforcement profession. This program represents an innovative project that will keep law enforcement current in their knowledge of the personal after-affects of stress associated with working with unique and serious crimes. By virtue of the high-risk profession of law enforcement, officers and their families may at some time become victims of stress and psychological trauma. The most significant of all recognized risk factors for the development of posttraumatic stress or Critical Incident Stress is the direct, or indirect, exposure to a highly traumatic event. There are three well-described potential victims for these risks; law enforcement officers are at risk for all three levels of victims (see below for definition of victims). There is no nationwide law enforcement based program that provides Critical Incident Stress Management (CISM) services to law enforcement persons – including both rural/urban departments and volunteer/paid officers. It has been described that the short and long terms affects of stress are perhaps the single most health risks to members of this occupation. This program will be used to develop and implement a nationwide CISM program, which will be available to law enforcement agencies. The CISM program represents an integrated “system” of interventions, which are designed to prevent and / or mitigate the adverse psychological reactions that so often

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accompany emergency services, public safety and disaster response functions. CISM interventions in this program will be especially directed towards the mitigation of posttraumatic stress reactions. Fundamental to this program is the recognition that CISM is more than technique; it is a system of well-integrated interventions. CISM is a philosophy and a belief in the importance and value of the human response, especially within the occupation of law enforcement. The principles of CISM, defusing and related interventions are dependent on knowledgeable professionals who have been training in applying the techniques of the CISM model.

Definition of Victims for the purpose of this application:
1. “Primary Victims” – those individuals most directly affected by a crisis, disaster of trauma; typically thought of as the “direct victims” of the trauma. 2. “Secondary Victims” – those officers who are in some way observers of the immediate traumatic effects that have been wrought upon the primary victims. 3. “Tertiary Victims” – those affected indirectly by the trauma via later exposure to the scene of the disaster or crisis or by a later exposure to primary or secondary victims. Typically tertiary victims were not exposed to the immediate “first hand” aspects of the traumatization thus they were not exposed to the “shocking immediacy.” Family members of law enforcement might be examples of tertiary victims.
Adapted from J. Mitchell, G. Everly. Critical Incident Stress Debriefing. Cheveron Publishing, Ellicot City, MD, 1996.

Critical Incident Stress Management (CISM) intervention will not eliminate Post Traumatic Stress Syndrome (PTSS). Post Traumatic Stress Syndrome is a complex chronic disorder that requires intense psychological services beyond the scope of this program. This program however is focused on prevention of the processor of stress symptoms that are believed, if untreated, will evolve into PTSS. With the application the Critical Incident Response (CIR) the emergency worker will receive pre-incident education including the recognition and definition of a critical incident, identification of the signs and symptoms of a critical incident, and knowledge of available interventions. This education is called Critical Incident Stress Management and is the hallmark of the CIR program. Operationally, upon the event of a critical incident the effected victim will be contacted by a trained peer who will assist them in mitigating the effects of the incident. Optimally, these services are provided within 48 to 72 hours after the incident. If after or during these services it is recognized that the individual requires intervention beyond the scope of this program, they will be referred to a mental health facilitator. Mental health experts are an essential component of this program. Ultimately, this program is designed to reduce the cumulative effect of stress. Without intervention these effects can have a devastating impact on emergency service providers including police officers. By addressing an incidence using the CISM model, especially within a critical time frame, it can reduce the cumulative effects of stress. The effects of acute and/or chronic stress if not addressed can lead to the condition known as PTSS.

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Also there is no repository nationally for statistics regarding the incidence of stress related illness, including PTSS for law enforcement officers. The development of police stress intervention strategies came about only during the last few years. The growing body of research reports that ANY Law Enforcement Officer is at risk and that almost all experience a critical incident in their career. Jeff Mitchell, a nationally known leader in the field conducted a survey among EMS and law officers and reported that eighty percent of the respondents when asked, “What is your greatest problem when you are required to work with an emotionally stressful situation?” answered with “a lack of training”. Theoretically, every occurrence of the following creates an environment that is ripe for stress related disease for law enforcement officers:  Line of duty death  Serious line of duty injury  Suicide of a co-worker  Multi-casualty incident  Police shooting, that ends with injury or death  Death or violence to a child  A prolonged event, with negative results  Incident with extensive media attention  Knowing the victim of the event  Incident charged with profound emotion These incidents represent the involvement of thousands of law enforcement officers. Although data is limited, clearly, officers nationwide are at great risk for stress-related effects and disorders. Ultimately, this program will contribute to a growing body of literature regarding the incidence and prevalence of this disease. References: Reese, J. T. (1987). A history of police psychological services. Washington, DC. U. S. Department of Justice, Federal Bureau of Investigation. Reese, J.T. Critical incidents in policing-revised. Washington, DC:US Government Printing Office, 1991. Mitchell, J.T. (1993). Traumatic stress in disaster and emergency personnel: Prevention and intervention. In JP Wilson and Bevery Rapheal (Eds), International handbook on traumatic stress syndromes. New York: Plenum Press.

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Critical Incident Stress Management (CISM): Group Crisis Intervention 3

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Critical Incident Stress Management (CISM): Group Crisis Intervention The Basic CISM training program is designed to present the core elements of a comprehensive, systematic and multi-component crisis intervention curriculum. The two day course prepares participants to understand a wide range of crisis intervention services including pre and post incident crisis education, significant other support services, onscene support services, crisis intervention for individuals, demobilizations after large scale traumatic incidents, small group defusings and the group intervention known as Critical Incident Stress Debriefing (CISD). The Basic CISM course specifically prepares participants to provide several of these interventions, specifically demobilizations, defusings and the CISD. The need for appropriate follow up services and referrals when necessary is also described. Considerable evidence gathered to date strongly supports the multi-component crisis intervention strategy, which is discussed in this course. The Basic CISM course is designed to specifically teach crisis intervention and Emergency Mental Health skills such as demobilizations, defusing, and CISD. At the completion of this course, participants will be able to : Define stress, CIS, and PTSD; List the 10 basic interventions of CISM; and Define and describe in detail the CISM group processes of Demobilizations, Defusings, and Debriefings. (14 Contact Hours; 14 CE Credits for Psychologists; 14 PDHs for EAPs; 14 CE Hours for Calif. MFTs & LCSWs; 16.8 Nursing Hours; OR 1.4 general CEUs from UMBC)* Completion of The Critical Incident Stress Management (CISM): Basic Group Crisis Intervention class and receipt of a certificate indicating full attendance (14 Contact Hours) qualifies as a CORE class in ICISF‟s Certificate of Specialized Training Program. Day 1: (8:30 a.m. - 5:00 p.m.) General, cumulative, critical incident stress and PTSD High risk populations: emergency services, military, other „Critical Incidents‟ - death, injury, threat, terror, etc. Critical Incident Stress Management (CISM) fundamentals Core intervention tactics Demobilization Defusing of small groups Day 2: (8:30 a.m. - 5:00 p.m.) Defusing Demonstration Essentials of group intervention, Critical Incident Stress Debriefing (CISD) Assessing the need for CISD Factors which enhance CISD success Question / Answer

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What is a “Critical Incident”? 4

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Fraternal Order of Police, Grand Lodge
Critical Incident Program
Mike Haley, C.T.R., Program Coordinator 222 East Town Street Columbus, Ohio 43215 (614) 224-5700 mhaley@fopohio.org

What a “Critical Incident” is Any event that has a stressful impact sufficient to overwhelm the usually effective coping skills of either an individual or group. They are typically sudden, powerful events, which are outside of the range of ordinary human experiences. Because they are so sudden and unusual, they can have a strong emotional effect even on the well-trained and experienced individual.

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Examples of a Critical Incident 5

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Fraternal Order of Police, Grand Lodge
Critical Incident Program
Mike Haley, C.T.R., Program Coordinator 222 East Town Street Columbus, Ohio 43215 (614) 224-5700 mhaley@fopohio.org

These are Incidents that should require an “AUTOMATIC CALL OUT”. This means that a CISM program should always be contacted for each of these events. 1. Line of duty death 2. Serious line of duty injury 3. Suicide of a co-worker 4. Multi-casualty incident 5. Police shooting, that ends with injury or death

These are Incidents that should require contact with a C.I.S.M. program for recommendations for the appropriate intervention plan: 6. Death or violence to a child 7. A prolonged event, with negative results 8. Incident with extensive media attention 9. Knowing the victim of the event 10. Incident charged with profound emotion

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Critical Incident Stress Management (CISM) Policy 6

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Fraternal Order of Police, Grand Lodge
Critical Incident Program
Mike Haley, C.T.R., Program Coordinator 222 East Town Street Columbus, Ohio 43215 (614) 224-5700 mhaley@fopohio.org

Departmental Critical Incident Stress Management (CISM) Policy: A. In the event of a critical incident, the (a CISM Team / the Local Team Name), shall be notified as soon as practical (by phone at [the number or the Team]). 1. A critical incident is defined as any unanticipated event or group of events, which can overwhelm the usual coping skills of an individual or group. 2. The CISM will be contacted and asked to respond in the following situations. a. Any officer related shooting involving a member of the police division (with the exception of the killing of an animal) whether or not officers return fire, b. Any hostage situation, c. A serious physical assault upon an officer, d. A natural disaster, e. Any incident involving multiple fatalities, f. Any sudden or violent death of a member of the police division or a member of their family, g. The suicide of any member of the police division, h. Any other time deemed necessary by any member or the police division (ex: an incident involving the death of a child, several incidents within a short period of time which may overwhelm employees, etc.) 3. Once a CISM first responder team arrives on the scene of an incident it is understood that they will in no way hinder or assist in an ongoing investigation, that their purpose is only to assist the (Departments Name) Division of Police employees and their families to cope with an extreme situations. To achieve that end, members of the responding CISM team shall be given access to all members of the division and their families unless the individual does not want that access. 4. Should the first responder team determine that a debriefing is warranted, or in the case that CISM was not notified in time to send a first responder team but a debriefing is deemed warranted by CISM or the division, the division shall: a. Make the necessary arrangements for all personnel involved in the incident to be able to attend the debriefing. b. Arrange for a suitable, private room for the debriefing to take place.

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B. The division shall support Critical Incident Stress Management concept, 1. This support shall be in the form of providing manpower to both the first responder and the Critical Incident Stress Debriefing Team. a. Members of the division wishing to join the first responder team shall submit a memo to the Chief of Police and the training officer expressing that desire. b. The training officer will obtain information regarding the next available training through the CIRS and enroll the interested member(s). The division shall pay the cost for this training. c. Members of this division interested in expanding their role in the CISM and receive training in Critical Incident Stress Debriefing (CISD) shall submit a memo to the chief of Police requesting permission to do so. d. The training officer will obtain information regarding the next available fourteen (14) hours class in Critical Incident Stress Management (C.I.S.M.) and enroll the approved member(s). The division shall pay the cost for this training. e. This division recognizes that (a CISM Team / the Local Team Name), has the sole authority as to what members are accepted into the team once the training has been completed. 2. Members of this division who are accepted by (a CISM Team / the Local Team Name), as members on either a first responder or debriefing team are subject to immediate call-out. a. Member(s) who are called-out to respond to another agency are part of a CISM team will be immediately relieved of his/her assigned duties, change into civilian clothing, if time permits, and respond where called. 1. Should a member be called-out by CISM while off duty, that member will notify the on-duty supervisor, advising him/her of the call-out and the potential for not arriving for assigned duties when expected, and then respond to the call-out in civilian clothing. b. If the on-duty supervisor determines that the loss of an employee due to a CISM call-out presents a clear detriment to the safety of other on-duty personnel or citizens of the (Name of the city), that supervisors may keep any or all call-out employees from responding. 1. Any supervisor who does not allow an employee to respond to a CISM call-out will submit a memo to the Chief of Police explaining the reasoning for not allowing the employee(s) to respond. c. The Division will not be responsible for the transportation or housing cost of an employee while on a CISM call-out.

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3. Members of this division who are accepted by (a CISM Team / the Local Team Name), as members on a debriefing team will be expected to attend all regularly scheduled meetings and training sessions of the CISM team. Those members whose regularly scheduled work hours conflict with CISM team meeting and training sessions will be allowed to attend providing they have notified their supervisor at least three (3) days in advanced.

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Facts about Critical Incident Stress Management 7

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Fraternal Order of Police, of Ohio, Inc.
Critical Incident Response Service
Mike Haley, CTR, Program Director 222 East Town Street, Columbus, Ohio 43215 1-800-367-6524 1-614-224-5775 fax

CRITICAL INCIDENT STRESS MANAGEMENT
The Critical Incident Stress Management program, known as CISM, is a multi-component crisis intervention curriculum includes the following:            Pre-Incident Education, On scene or near scene management, One-on-One intervention, Demobilization, Crisis Management Briefing, Defusing, Critical Incident Stress Debriefing (CISD), Family Support, Community Crisis Response, Pastoral Crisis Intervention, Follow Up,

CISM: A Standard of Care
We want to explain what our program is about, then how and why your agency might access its service. CRITICAL INCIDENT STRESS Because of the kind of work performed by emergency service workers, you are exposed to situations and events that would be considered "extraordinary" by many people's standards. As you learn and perform your jobs you become accustomed to many of these events. There is a natural "desensitization process" that takes place, which allows you to continue working in the field. There will, however, still be events that occur which are overwhelming for even experienced emergency service personnel. Such events have been called "critical incidents". A CRITICAL INCIDENT IS an event during which the sights, sounds, and smells are so intense that they cause you to feel a significant increase in stress and stress reaction-immediate or delayed. Events that include any of the following usually result in being identified as critical incidents.

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Human-caused events, which elicit stronger feelings and reactions, other than natural disaster, or freak occurrences. i.e. drunk driving accidents, abuse, terrorism etc. Events with unusual sights, sounds, or smells Events in which there are a large numbers of victims i.e. school bus accident Events in which an emergency service personnel sense of professional competence is attacked Events, which violate an employee's sense of how the world is or should be i.e. Death of infant, teenagers, freak natural occurrences involving common objects, Holiday disasters Events, which draw high media coverage Events that have elements that worker identifies with i.e. a child the same age as your own, same shoes as your child etc. Death of a co-worker

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Some events are so significant that most people exposed to the situation will have strong reactions to the event. In other cases, a work-related event might be "ordinary" for one emergency service person, but for another it may be a critical incident. In both situations, providing the involved emergency service personnel with the chance to debrief from the incident has been found to be beneficial. * This would probably be a good time to define, pre-incident education, defusing and debriefings. PRE-INCIDENT EDUCATION An analogy for receiving this type of education is like receiving an immunization against disease. "Pre-Incident Preparation” may well be thought of as a form of psychological immunization. The goal is to strengthen potential vulnerabilities and enhance psychological readiness in individuals who may be at risk for traumatization. One important aspect of preincident preparation is the provision of knowledge. Information about CISM is power. Many traumas result from a violation of expectancy, thus setting realistic expectations serves to protect against violated assumptions. A DEFUSING is conducted within a few hours of a critical incident and is primarily informational. They allow for initial ventilation regarding the incident. It is shorter, less formal. If only one or two people have been affected by an event, a defusing is more appropriate.

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DEBRIEFINGS are most effective when conducted 24-72 hours after the incident has occurred. Debriefing sessions are confidential, non-evaluative discussions of involvement, thoughts and feelings resulting from the incident. They usually last two to three hours and everyone who was involved with the incident is invited to attend. When a whole work group is affected, a debriefing, involving the CISM Team would be utilized. SYMPTOMS, WHICH MAY INDICATE THE NEED FOR A EBRIEFING/DEFUSING Critical incidents are likely to produce physical and emotional symptoms, which develop as part of a stress response and are considered normal. They may appear at several different stages: 1. During the incident symptoms may include confusion non-directed activity, disorientation, tunnel vision, crying, muscle tenseness (clinching teeth, etc.) profuse sweating, chest pain and/or increased heart beat. After the incident symptoms may begin to appear within hours after the incident and may include blurred vision, loss of memory, confusion, non-directed activity disorientation, or restlessness. Delayed post incident stress symptoms may occur weeks or months after the incident and may include restlessness, irritability, chronic fatigue, sleep disturbances, anxiety, depression, moodiness, muscle tremors, difficulties concentrating, increased substance abuse, nightmares, headaches, vomiting, diarrhea and/or suspiciousness.

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WHAT IS THE PURPOSE OF A CRITICAL INCIDENT DEBRIEFING? The purpose of a debriefing is to offer emergency service personnel the opportunity to come together as a group and to identify their own personal reactions to the event. Being involved in a critical incident:   Can make a person feel isolated Trigger responses that are unfamiliar and frightening.

A debriefing:     Provides information about normal human responses to abnormal events, Helps emergency service personnel understand what they are experiencing, Accelerates the normal recovery of normal people with “normal reactions to abnormal events”, Helps emergency service personnel develop strategies for coping with their reactions to the event.

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There is significant evidence that demonstrates, having strong social supports after a traumatic event helps the effected individuals reestablish a sense of psychological wellbeing and regain equilibrium. Emergency service personnel say that it is difficult to share these events with friends and family who weren't there and wouldn't understand. They don't want to expose them to the details of these situations. THE WHO, WHAT, WHERE, OF CRITICAL INCIDENT DEBRIEFING
WHO LEADS A CRITICAL INCIDENT DEBRIEFING?

Mental health professionals and peer debriefers trained in crisis intervention and traumatic stress reactions, make up the CISM team, which facilitates a debriefing. Team members are selected by an application and review process and have completed a CISM training program. WHAT HAPPENS IN A DEBRIEFING? 1. HOW LONG DO THEY LAST? When you participate in a debriefing, you will be asked to stay for the entire length of the debriefing (2-3 hours). It is important not to "box yourself in" with other appointments, since it is difficult to determine ahead of time exactly how long a debriefing will last. If you carry a pager you should make arrangements to have your calls forwarded. 2. AM I REQUIRED TO ATTEND? Any emergency personnel who were involved in the incident should be invited to attend the debriefing. This includes supervisory staff. To exclude them produces an "us and them" atmosphere within the organization. It is the nature of the human response to events of this magnitude to experience some shock and denial. This means that people often don't realize immediately that they are having reactions. Certain events simply will precipitate reactions in almost everyone: what these reactions are will vary among people; but everyone will have some reaction. In our experience, it is often the person who thinks they need a debriefing the least that has found the debriefing to be the most beneficial. Understanding the experience of your co-employees during a critical incident is also important. You will need to be working with them and depending on them soon. We have found that debriefing are helpful in reestablishing the effective functioning of work groups.

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WHAT ABOUT CONFIDENTIALITY? One of the main reasons that debriefings are helpful is our requirement that confidentiality is essential. a. There is not rank at a debriefing. If managers are present, they are there because they participated in the event. No notes or records are taken during the debriefing. Participants are told that they may share their own experiences of the incident and their own reactions to the debriefing process with people who did not participate in the debriefing, but they may not talk about anyone else's experience or comments during the debriefing.

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SHOULD MANAGERS ATTEND? Managers who were involved in the incident should attend. However, they are there because they participated personally and also need the opportunity to explore their own personal responses.

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WHAT IF I AM UNCOMFORTABLE TALKING ABOUT MY EXPERIENCES DURING A DEBRIEFING? Most people find that they will want to contribute some information about their experience during a critical incident during a debriefing. Participants are invited to share their experiences to the extent that you feel comfortable doing so. No one is "forced” to talk if they choose not to.

WHAT LONG TERM EFFECTS ON PERSONNEL MAY OCCUR IF A DEBRIEFING IS NOT HELD? The long-term adverse effects of the stress response syndrome, although normal, have the potential to become dangerous to the employee‟s health, if symptoms become prolonged. Departments may experience increased absences, moral problems and increased employee health care costs over the years following the incident. Any costs incurred for overtime to allow employees to attend a debriefing will most certainly be saved over the long term in avoidance of these potential costs through the course of emergency service personnel careers.

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REQUESTING CISM SERVICES Anyone can identify or recognize significant incidents that may require debriefings. A debriefing should be requested as soon as possible after the event. The best policy is to have a plan for personnel to request CISM intervention. The Critical Incident Response Service can help your department when needed. Services can be arranged by contacting, your local CISM Team. Be prepared to provide a contact person‟s name, the location of the scene, and a brief description of the critical incident. The CISM Team will evaluate the need for a debriefing. If a debriefing is needed, contact will be made with the department to set up a convenient time and location.

If you do not have a Team in your area, please contact Mike Haley (614-224-5700) form the Critical Incident Response Program to see about the development of a program for your needs.

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Critical Incident Handout (Signs & Symptoms) 8

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Fraternal Order of Police, of Ohio, Inc.
Critical Incident Response Service
Mike Haley, CTR, Program Director 222 East Town Street, Columbus, Ohio 43215 1-800-367-6524 1-614-224-5775 fax

You have experienced a traumatic event or a critical incident (any incident that causes emergency service personnel to experience unusually strong emotional reactions which have the potential to interfere with their ability to function either at the scene or later). Even though the event may be over, you may now be experiencing or may experience later, some strong emotional or physical reaction. It is very common, in fact quite normal, for the people to experience emotional after shocks when they have passed through a horrible event. Sometime the emotional aftershocks (or stress reactions) appear immediately after the traumatic event. Sometimes they may appear a few hours or a few days later. And, in some cases, weeks or months may pass before the stress reactions appear. The signs and symptoms of a stress reaction may last a few days, a few weeks or a few months and occasionally longer depending on the severity of the traumatic event. With understanding and the support of loved ones the stress reactions usually pass more quickly. Occasionally, the traumatic event is so painful that professional assistance from a counselor may be necessary. This does not imply craziness or weakness. It simply indicates that the particular event was just too powerful for the person to manage by himself or herself.

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Fraternal Order of Police, of Ohio, Inc.
Critical Incident Response Service
Mike Haley, CTR, Program Director 222 East Town Street, Columbus, Ohio 43215 1-800-367-6524 1-614-224-5775 fax

Within the First 24-48 Hours * * * * * * * * * * * * * * * * * * Periods of physical activity (based on your physical condition and physical limitation), alternated with relaxation will alleviate some of the physical reaction. Structure your time - keep busy. You‟re normal and having normal reaction - don't label yourself crazy. Talk to people - talk is the most healing medicine. Be aware of numbing the pain with overuse of drugs or alcohol, you don't need to complicate this with a substance abuse problem. Reach out - people do care. Maintain as normal a schedule as possible. Spend time with others. Help your co-workers as much as possible by sharing feelings and checking out how they are doing. Give yourself permission to feel rotten and share your feeling with others. Keep a journal; write your way through the sleepless hours. Do things that feel good to you. Realize those around you are under stress. Don't make any big life changes. Do make as many daily decision as possible which will give you a feeling of control over your life, if someone asks you what to eat-answer them even if you're not sure. Get plenty of rest. Reoccurring thoughts, dreams or flashbacks are normal - don't try to fight them they‟ll decrease over time and become less painful. Eat well-balanced and regular meals (even if you don't feel like it).

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Fraternal Order of Police, of Ohio, Inc.
Critical Incident Response Service
Mike Haley, CTR, Program Director 222 East Town Street, Columbus, Ohio 43215 1-800-367-6524 1-614-224-5775 fax

For Family Members & Friends

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Listen carefully. Spend time with the traumatized person. Offer your assistance and a listening ear if they have not asked for help. Reassure them that they are safe. Help them with everyday tasks like cleaning, cooking, caring for the family, and minding children. Give them some private time. Don't take their anger or other feeling personally. Don't tell them that they are "lucky it wasn't worse" - that statement does not console traumatized people. Instead, tell them that you are sorry such an event has occurred and you want to understand and assist them.

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Fraternal Order of Police, of Ohio, Inc.
Critical Incident Response Service
Mike Haley, CTR, Program Director 222 East Town Street, Columbus, Ohio 43215 1-800-367-6524 1-614-224-5775 fax

Here are some very common signs and signals of a stress reaction:
Physical fatigue vomiting nausea fainting muscle tremors twitches chest pain* difficulty breathing* elevated BP headaches thirst visual difficulties grinding of teeth weakness dizziness profuse sweating chills shock symptoms* etc... Emotional anxiety guilt grief denial severe panic (rare) emotional shock fear uncertainty loss of emotional control depression inappropriate emotional response agitation apprehension feeling overwhelmed intense anger etc... Cognitive confusion poor attention poor decision heightened or lowered alertness poor concentration memory problems hyper vigilance
difficulty identifying familiar objects or people

rapid heart rate
increased or decreased awareness surroundings

poor problem solving poor abstract thinking loss of time, place or person, orientation
disturbed thinking, nightmares, intrusive images

etc...

Behavioral change in society change in speech patterns loss or increase of appetite withdrawal emotional outbursts suspiciousness change in usual communication skills pacing startle reflex hyper alert to environment alcohol consumption inability to rest antisocial acts nonspecific bodily complaints erratic movements change in sexual functioning

*definite indication of the need for medical evaluation

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Key Terms and Concepts 9

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Key Terms and Concepts
One of the founding fathers of psychosomatic medicine, George Engel, noted that rational predicated upon the consistent use of terms. Let us briefly review some key terms and concepts relevant to the field of emergency mental health, more specifically, crisis intervention. STRESS - A response characterized by physical and psychological arousal arising as a direct result of an exposure to any demand or pressure on a living organism. The more significant the demand, the more intense the stress reaction will be. Some stress is actually positive. Stress reactions, which are moderate, are actually helpful in that they motivate us to make positive changes, grow and achieve goals. When stress is helpful, it is called "Eustress." When stress reactions are prolonged or excessive, they can cause harm. The destructive nature of stress is called "distress." Stress is perhaps best thought of as the sum total of "wear and tear" (Selye, 1956,1974) and as such may be thought of as accelerating the aging process. STRESSOR - A stressor is any event acting as a stimulus, which places a demand upon a person, a group or an organization. Mild stressors produce a mild stress reaction and severe stressors produce excessive stress reactions. CRITICAL INCIDENT - A stressor event (crisis event), which appears to cause, or be most associated with, a crisis response; an event which overwhelms a person's usual coping mechanisms. (Everly & Mitchell, 1999). The most severe forms of critical incidents may be considered traumatic incidents. CRITICAL INCIDENT STRESS - The stress reaction a person or group has to a critical incident. A wide range of cognitive, physical, emotional and behavioral signs and symptoms characterizes critical incident stress. Most people recover from critical incident stress within a few weeks. CRISIS - An acute response to an event wherein: 1. Psychological homeostasis (balance) has been disrupted; 2. One‟s usual coping mechanisms have failed; and, 3. There are signs and / or symptoms of distress, dysfunction, or impairment (Caplan, 1961, 1964). COGNITIVE IMPAIRMENT IN CRISIS - It has been commonly observed that individuals in crisis routinely exhibit an acute cognitive dysfunction. This phenomenon has been referred to by terms such as cognitive distortion, cortical inhibition syndrome, and even the "dumbing down" effect. This may serve as an explanation for many of the "irrational," or "illogical" things people do in a crisis. A common cognitive error that is made by primary victims is a failure to understand the consequences of their actions while in a crisis state, thus people in crisis may be seen to act quite impulsively and often self-defeatingly. Similarly, those interventionists who commonly work with secondary victims, i.e., rescue workers, police and fire personnel, emergency medical personnel, and disaster workers, may proper from the recognition that these professionals are often likely to make a second cognitive error of faulty self-attribution, i.e., they are likely to blame themselves for adverse Outcome when no such causal attribution is appropriate.

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TRAUMA - An event outside the usual realm of human experience that would be markedly distressing to anyone who experienced it. In the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; APA, 1994) a trauma is defined exclusively in terms of the exposure to human suffering, i.e., personal or vicarious exposure to severe injury, illness, or death. A trauma, therefore, may be seen as a more narrow form of critical incident. TRAUMATIC STRESS - The stress response produced when a person is exposed to a disturbing traumatic event. 'Traumatic stress" may be thought of as a subset of critical incident stress (Mitchell & Bray, 1990; Everly, 1989); the traumatic stress reaction may be immediate or delayed. POSTTRAUMATIC STRESS DISORDER (PTSD) - A formally recognized psychiatric disorder which may result from an exposure to a "traumatic event" (APA, 1980,1987,1994). Three characteristic clusters of symptoms, which follow a psychological trauma, identify posttraumatic stress disorder: 1. Intrusive recollections of the trauma, 2. Physiological arousal, 3. Numbing/withdrawal/avoidance The traumatic event is one that is closely associated with threatened or actual physical injury or death and produces intense fear, horror, or helplessness (APA, 1994). CRISIS INTERVENTION - Urgent and acute psychological support sometimes thought of as "emotional first-aid." The hallmarks of crisis intervention have historically been immediacy (early intervention), proximity (intervention is often done within close physical proximity to the critical incident), expectancy (both person in distress and interventionist have the expectation that the intervention will be acute and directed toward the goal of symptom stabilization and reduction, not cure), simplicity (relatively concrete, uncomplicated intervention strategies that avoid complex psychotherapyoriented tactics), and brevity (the total duration of the intervention is short, typically consisting of one to three contacts). The goals of crisis intervention are: 1. Acute stabilization of symptoms and signs of distress and dysfunction (to keep things from getting worse); 2. Facilitation of symptom reduction (intervene so as to reduce acute distress and dysfunction); 3. Facilitation of a restoration of acute, adaptive independent functioning (successful reduction of impairment); 4. Facilitation of an access to a higher, or more continuous, level of care, if needed (Caplan, 1961,1964; Everly & Mitchell. 1999). CRITICAL INCIDENT STRESS DEBRIEFING (CISD) - A proper noun referring to a specific model of psychological debriefing. The CISD is a 7-phase, structured group discussion, usually provided one to 14 days post crisis (although in mass disasters it may be used 3 weeks or more post incident). Jeffrey T. Mitchell, Ph.D, developed this form of group crisis intervention. The CISD is designed to achieve the goal of psychological closure subsequent to a critical incident or traumatic event, or similarly serve as a forum 39

for psychological triaging so as to facilitate access to a higher level of psychological support. Psychological closure, operationally, is generally thought to mean a facilitation of psychological and behavioral rebuilding in the wake of a crisis or trauma. The CISD is designed to be used with small groups of 4 to 25 participants, although 8 to 10 seems to be ideal. The members of the “CISD team” usually consisting of 2 to 4 specially trained crisis interventionists facilitate it. The CISD begins with a set of introductory remarks which set the tone for the debriefing, motivate the participants to accept and cooperate with the process and to establish the working rules for the discussion. The second phase of the CISD is the fact phase in which the participants describe what happened during the incident. The third phase is the thought phase and the participants are asked about their first or most prominent thoughts while they were going through the incident. The reaction phase is the fourth phase. Here the participants discuss the elements of the situation, which were the worst for them. The signals or symptoms of distress, which were encountered during or after the critical incident, are described in the fifth phase of the CISD, which is called the symptom phase. During the sixth phase, the teaching phase, team leaders and peer debriefers spend a fair amount of time providing information and suggestions which can be used to reduce the impact of the stress. In the seventh and final phase, reentry, participants' questions are answered and loose ends are tied up. The last phase of the debriefing is where the intervention team summarizes the group discussion, attempts to facilitate closure, and responds to any remaining concerns. The CISD is commonly confused with other "psychological debriefing" techniques which remain without standardization and are ill-defined (Dyregrov, 1997,1998.1999; Everly and Mitchell, 1999). The CISD intervention remains the only consistently validated form of group psychological debriefing (Everly and Boyle, 1999; Everly and Piacentini, 1999; Watchom, 2000; Deahl, et al., 2000). Due to its structure, the CISD may take up to 2 to 3 hours to complete. The CISD will sometimes be used subsequent to the crisis management briefing and the defusing. The CISD is almost always followed by intervention on an individual basis with those individuals who require such. Referral for more formal mental health intervention may then follow. Although the aforementioned points may seem rather straightforward, historically, there has been some confusion as to the actual nature of CISD. So, a brief historical review seems useful at this point. Originally, Mitchell (1983) used the term CISD to refer to an overarching approach to crisis intervention, which contained four elements: 1. 2. 3. 4. Individual or group on-scene crisis intervention, Initial small group discussions referred to as "defusings," Formal 6-phase small group discussions referred to as the "formal CISD," and Follow-up services.

As can be imagined, the author's use of the term CISD to denote a) the overarching crisis intervention approach, as well as, b) the "formal" 7-phase group discussion process led to significant confusion. Later the term CISD as the label for the overarching crisis 40

intervention system was abandoned in favor of the term Critical Incident Stress Management (CISM; Everly and Mitchell, 1999). More recently, then, the term CISD was reserved for a 7-phase group crisis intervention designed to facilitate psychological closure (rebuilding) subsequent to a critical incident or traumatic event for primary, secondary, and even tertiary participants. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) is a comprehensive, integrated multi-component crisis intervention system (Everly and Mitchell, 1999; Flannery, 1998). It has been recommended by the Occupational Safety and Health Administration (OSHA) and utilized by organizations such as the U.S. Air Force, U.S. Coast Guard, Airline Pilots' Association, U.S. Navy, the Bureau of Alcohol, Tobacco and Firearms (ATF), the Federal Bureau of Investigation (FBI), the Australian Navy, the Australian Army, the Hospital Authority of Hong Kong, the Armed Forces of Singapore, and numerous law enforcement agencies, fire departments, school systems, employee assistance programs, and hospitals throughout North America, Scandinavia, Europe, Australia, and/or Asia (See Everly and Mitchell, 1999). As a good golfer would never play a round of golf with only one golf club, a good crisis interventionist would never attempt the complex task of intervention in a crisis or disaster with only one crisis intervention technology. As noted above CISM is an integrated multi-component crisis intervention system. Table 1.2 summarizes the core elements of the CISM approach to crisis intervention. The CISM system (Everly and Mitchell, 1999; Flannery, 1998) appears to be the most widely used crisis intervention system in the world and has been validated through narrative reviews (Everly and Mitchell, 1999; Everly, Flannery and Mitchell, 2000; Flannery and Everly, 2000), as well as statistical reviews (Flannery, Everly and Eyier, 2000; Everly, Flannery, Eyier, in press; Everly, Flannery, Eyier and Mitchell, in press). It may be suggested that CISM is the emerging standard of care in the crisis intervention field due to its high frequency of utilization and the extent of its empirical validation. In an age of professional scrutiny and accountability, practitioners must be prepared to utilize the arguable "standard of care" or to defend a lack of adherence to such putative standards. The crisis intervention practitioner is encouraged to practice as current and comprehensive an approach to intervention as is reasonable.

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Example of departmental Policy for the “Use of Deadly Force” 10

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2.0

USE OF DEADLY FORCE PolicyIt is the purpose of the directive to provide departmental guidelines for the use of firearms and deadly force.

3.2

Definitions Deadly force, as used in this regulation, is defined as any violence, compulsion or constraint physically exerted by any means upon or against a person, which carries a substantial risk that it will proximately result in the death of any person.

3.4

Specific authorization for the use of Deadly Force Deadly force may only be used when an officer reasonably believes it is necessary to prevent serious bodily harm or death to the officer or others. Discretion to use a firearm rests with the officer and proper justification and evaluation of the circumstances is required when an officer uses deadly force or a firearm. Only in situations where there is a significant risk of death or serious bodily harm shall an officer employ deadly force against a human being.

3.7

Certification and Training A. B. All officers shall be certified with their primary and secondary on-duty weapons. Certification shall include training regarding the legal, moral and ethical aspects of firearms use, safety in handling firearms and proficiency in the use of firearms. Firearms certification shall be required at least annually. In the event of an accidental discharge, the officer must undergo immediate recertification training prior to returning to full duty. Officers who fail to meet certification requirements shall be granted a 10day grace period in which to obtain certification. Officers shall be qualified under the direction of a trained firearms instructor. The Chief of Police shall designate the instructor or instructors who have the necessary qualifications to adequately train our officers.

C.

D. E.

3.8

Training It is believed and understood that there is no Substitute for adequate training and that, as an officer is trained, so shall the officer act. All training in the proper use of firearms shall encompass this policy and shall be consistent with the following patterns of encounter:

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3.8.1 3.8.2 3.8.3 3.8.4 3.8.5 3.8.6 3.8.7 3.8.8 3.9

Weapons encounters are close (90% less than ft.); Usually in low level light; Usually suddenly and very quick (5-7 seconds); Often more than one assailant; Officer usually standing or exposed and usually assaulted before gunfire exchanged; Usually outdoors near other persons; Assailants usually moving toward officer; Officer usually caught unaware of the gravity of the situation

Weapons Regulations A department-approved handgun (on-duty, secondary, off duty), intended for use by an officer, must meet the following requirements: 3.9.1 3.9.2 The standard sidearms of the Any Police Department are the 38 Special revolver, the 9mm auto-pistol or 45 cal auto-pistol. Only those officers who have successfully completed the department sanctioned and approved auto-pistol course are authorized to carry the 9mm auto-pistol. All other officers authorized to carry sidearms shall be required to carry and qualify with the weapon recognized as their issue weapon.

3.9.3

3.10

Personally Owned Sidearms Members who wish to carry a personally owned sidearm, while on or off duty, must satisfy the following conditions: 3.10.1 Request permission, in writing through chain of command. 3.10.2 The sidearm must be in good, safe working order and must chamber and fire department authorized ammunition. 3.10.3 The officer must qualify and be certified on the department range by the department range officer. 3.10.4 The weapon must have a minimum barrel length of 4 inches and a maximum barrel length of 6 inches for uniformed officers. Two-inch minimum barrel length is acceptable for plain clothes officers. 3.10.5 Fancy bone, pearl or decorative grips are not acceptable for uniformed officers.

3.11

Ammunition A. B. Only authorized factory loaded ammunition shall be carried in any weapon. As the specific types of ammunition may change from time to time, the range officer shall maintain a list of authorized ammunitions and post the list on the indoor range bulletin board and in various other conspicuous places.

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3.12

Procedures for Firearms Discharge A. Whenever an officer discharges any weapon, either accidentally or purposefully (except during authorized range practice), the officer shall report the fact to the supervisor on duty, regardless of whether the officer is on or off duty. The supervisor, upon being notified of such a discharge, shall cause the Chief of Police to be notified. The officer shall protect the weapon for examination and submit it to the appropriate investigator upon request. The officer shall not discuss the incident with anyone except the investigator or supervisory personnel, the officer‟s attorney, clergy, critical incident stress management peer-professional, mental health professional or immediate family. Officer involved in such incidents shall not make any statements except as provided, without the express authority of the Chief of Police. A complete detailed written report, by the officer, shall be forwarded to the investigator in charge, no sooner than 72 hours after the incident. A supervisor shall proceed immediately to the scene and conduct a preliminary field investigation and forward a detailed written report to the Chief of Police within 24 hours of the incident.

B. C. D.

E. F.

3.13

Firearms Review Board In each and every case where a firearm has been discharged, a firearms review board shall be convened to review all facts and statements pertinent to the firearms discharge. The firearms review board shall decide whether the discharge of the firearm were: 3.13.1 3.13.2 3.13.3 3.13.4 3.13.5 Lawful and within department guidelines and policy; Outside departmental guidelines and policy, or; Accidental The firearms review shall be conducted by the Chief of Police The employee shall be afforded his or her due process rights, prior to and during the inquiry by the firearms review board. Such rights shall include notice of the nature of the inquiry, including specifications of any violations, if applicable, and an opportunity to respond or make a statement. 3.13.6 The Chief upon factual determination(s) shall make appropriate disciplinary action recommendations.

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3.14

Administrative Leave A. An officer, directly involved in a deadly force incident, may be placed on administrative leave or may be assigned to administrative duty for a period of time deemed appropriate by the Chief, upon completion of the officer‟s detailed report. This leave shall be without loss of pay or benefits, pending the outcome of the investigation and determinations of the firearms review board. The assignment of administrative leave shall not be interpreted to imply or indicate that the officer has acted improperly. While on administrative leave, the officer shall remain available at all times, for official department interviews and statement regarding the shooting incident and shall be subject to recall to duty at any time.

B. C. D.

3.15

Psychological Services A. In all cases where any person has been injured or killed a result of a firearms discharge, 1. The department should provide the services of a Critical Incident Stress Management Program to all effected officer(s) of the event. Services that may be provided may include, but not limited to: a. One-on-One Crisis Intervention b. Demobilization c. Crisis Management Briefing d. Defusing e. Critical Incident Stress Debriefing f. Family Support g. Pastoral Crisis Intervention 2. The officer(s) may also be required to schedule an appointment to discussion of the event with a mental health professional, selected and paid for by the department as soon as possible, but within 24 hours of the incident. a. The purpose of this appointment shall be to allow the officer to express his/her feelings and to deal with the moral, ethical and/or psychological after effects of the incident. b. The appointment shall not be related to any department investigation of the incident and nothing discussed in the debriefing shall be reported to the department. c. The discussion shall be protected by the privileged physician patient relationship.

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Informational Documentation

“Homicide vs. Use of Deadly Force”
by Mike Haley, C.T.R.

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“Homicide vs. Use of Deadly Force”
In providing public safety, society has made the decision to arm law enforcement officers with the expectations that these officers will enforce the law. Therefore, law enforcement officers have been given the authority and the responsibility for the use of deadly force. With this responsibility, the officer understands that this degree of force is only to occur when the officer has determined that the situation jeopardizes the life or lives of its citizenry or the life of the law enforcement officer. Due to this responsibility and nature of the law enforcement profession, there are many risks that the officer encounters during the performance of their duty. Most people assume and view these risks as solely physical. However, other risks are associated with the psychological processes of the officer such as “Psychological Traumatization”. Every day, officers are at a significant risk of suffering from “Psychological Trauma”. If this risk is not recognized it can reduce the productive years of the officer and have negative effects on the individual as well as the department. The officer, to use deadly force, may link “Psychological Trauma” to the traumatic effects of the decision. Many of these effects are manifested in, but not limited to, the following areas: “Perception”  The belief that their own life is at risk.  The belief that officer‟s family could be left without a spouse, father, or mother.  Absorbing the impact of taking another persons life.  The making of a split second decision under life and death pressure.  The perception of what may come after taking another‟s life. “Departmental”  Being isolated, before and after questioning.  Being required to provide an official statement before having sufficient time to process the event.  Having their weapon taken for evidence and not being replaced.  Becoming a suspect in a criminal investigation.  Immediately being placed on administrative leave.  Being placed on light duty upon their return to service. “Aftermath”  Being put in a life-threatening situation, as a requirement of the officer‟s job in order to protect the lives of the citizens.  The impact of the questioning of the officer‟s motives, actions, training, etc. by the department, the media, the public and civic groups who have hours to study all aspects of the event. Unlike the officer who is often times alone and only has seconds to process the limited amount of information that they have at the time.

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   

 

 

Having their phone ring constantly at all hours, of the day and night, for weeks following the event. Stories about the suspect, which are often quite sympathetic. Stories about the officer, which are often quite severe and judgmental. Trying to explain to their spouse, children and other family members what happened and why. o Providing to them information, which will not interfere with the investigation, so that they may deal with the encounters from their friends. They are threatened with both criminal and civil charges. Officers are subjected to a court case, which may consume a tremendous amount of personal time, energy, and often times, their own money. o It will also dramatically impact all members of their family including children who may be asked questions far beyond their knowledge. They may feel attacked by the society they are risking their lives to protect. Dealing with the development of information that was not known at the time, either supportive or detrimental, but the point is the information was not available at the time of the split second decision.

The byproduct of this trauma is known as “Critical Incident Stress” which occurs when any situation overwhelms the usual coping skills of an individual or group. Some examples of a traumatic event are, but not limited to: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Line of duty death Serious line of duty injury Suicide of a co-worker Multi-casualty incident Police shooting, that ends with injury or death Death or violence to a child A prolonged event, with negative results Incident with extensive media attention Knowing the victim of the event Incident charged with profound emotion

It is extremely important that not only the law enforcement officer, but also the public knows there are considerable differences between “Homicide” and “Use of Deadly Force”. As law enforcement officers are placed in situations that require the use of deadly force, there must be a clear understanding that it is the officer‟s decision to use deadly force. This decision is based on the facts available to the officer at the time, knowing that it was the suspect who put the officer in the position to make the decision to use deadly force.

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The officer‟s survival following a traumatic event is directly effected by the department‟s ability to recognize the existence of “Critical Incident Stress”. It is incumbent upon each agency to make available the services that are provided by a Critical Incident Stress Management (C.I.S.M) Program. C.I.S.M. provides an Integrated and Multi-Faceted Approach to Crisis Care. The Critical Incident Response Services (C.I.R.S.) mission is: To assist emergency service workers who are affected by a "Traumatic Event" with a coordinated state wide Critical Incident Stress Management Program. The Critical Incident Response Services (C.I.R.S.) Goal is: To provide the effected Emergency Service Worker with services that will mitigate or lessen the impact of the effects of critical incident stress, and accelerate the recovery following a traumatic event. CISM: Is A Standard of Care.

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Informational Documentation

CISM of Police Shootings
By Peter Volkmann, MSW, CSW

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CISM of Police Shootings Police shootings in America. A phenomenon that has been happening since the beginning of law enforcement. Law enforcement officers have always carried a weapon on their side. It is a necessary evil for that officer, the ultimate and last resort to stay alive or keep another alive. No other profession has the sanction from the government to use deadly physical force in order to discharge his or her duty as a professional. The decision of utilizing the weapon is solely based upon the officer‟s perceptions at the time of use. His or her perception or misperception is reality at that moment. Law enforcement officers differ from any other profession that uses weapons. There are many misperceptions of the use of deadly force by society and officers themselves. Officers are not trained to “shoot to kill,” but to “shoot to live.” They are trained to save their life or another person‟s life. Therefore, any perception of a threat must be processed by the officer in reaction to another person‟s intent. One must encompass within that reaction that the use of deadly physical force is to save a life. This happens within a millisecond of processing along with survival mechanisms of “fight or flight” responses. Many of our human survival responses are of “flight,” yet an officer must ignore those normal choices and opt for “fight responses” only. This is an extremely stressful and difficult task to say the least. Understanding an officer‟s ability to cognitively process critical incidents has evolved through research and studies. Training officers in the ability to make “use of force” decisions has provided that officer the best chance for survival. We have learned the survival mechanisms that kick in are both physical and psychological reactions. The psychological survival response is what appears to be the greatest stress following a shooting incident. We have given the officer the highest level of training in physically responding to a threat, yet lack in providing the information and ability to fight the psychological and emotional trauma that affects the heart and soul of that officer. Critical Incident Stress Management (CISM) is the ammunition that officers deserve to receive in order to “fight” the psychological and emotional trauma following a critical incident that includes a law enforcement shooting. What exactly is CISM? It is a comprehensive, systematic program that mitigates the effects of critical incident stress, which is also known as posttraumatic stress. The International Critical Incident Stress Foundation (ICISF) in Ellicott City, MD has developed an internationally recognized standard of care that is effectively being utilized by federal, state, and local law enforcement agencies throughout the world. Through research and experience, CISM has become a successful model that combats residual known negative effects of stress upon officers today. Such negative effects may include, alcoholism, drug abuse, domestic violence, heart disease, high blood pressure, cynicisms of “not caring anymore”, sleep deprivation, irritable bowel syndrome, abuse of sick time and workmen‟s compensation, changing personality, utilization of extreme force in response to a similar experience, and so many more examples. Historically, there has been a quiet acceptance of these negative “shadows” on the law enforcement profession today. So many departments have extensive application processes that screen out physical and psychologically unfit officers. Yet, when a deadly physical force decision is made, it is critical incident stress that traumatizes an officer

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along with the whole department and causes a complete negative change in their personalities. The areas of bad stress may include physical, emotional, behavioral, cognitive and spiritual areas. A police shooting will disrupt many officers‟ normal psychological coping skills and cause human survival responses that are ineffective skills within the law enforcement profession. Normal? Yes. All reactions, whether written or verbal following a critical incident, are taken into the spotlight publicly and expected to be precise with no exception of human error or mistakes. Every little moment is dissected through investigations with enormous responsibility placed upon that officer compared with any other person in our society. The normal human reactions, such as short-term memory lapse, to this abnormal situation are ignored, or perceived as a coverup. The unfortunate part about this is the officer is so ridden with survival human emotions following an incident that he or she does not comprehend the responsibility of recollection of this experience, whether the officer is a shooter or a witness to the shooting. Modern day policing has increased the responsibility and accountability of an officer‟s actions. Therefore, the aftermath of any incident can be more traumatizing than the incident itself. CISM has become the standard intervention to deal with the normal human reactions to an abnormal situation. There are certain elements of CISM that need to be utilized for specific needs of those in crisis. Elements include: Pre-incident Education: This is an educational overview of critical incident stress management. Officers receive knowledge and skills in dealing with a critical incident, are prepared for what CISM interventions would entail, and understand what a CISM team offers and does not offers in providing services. Group Interventions: Group interventions include demobilizations, defusings, crisis management briefings, and debriefings. Each intervention is tailored for specific needs of the group following an incident. The interventions are voluntary attendance and consist of talking about the experience as human beings. Officers explain to the CISM team the experience they endured, are provided an opportunity for ventilation of human emotions, and are given specific stress management skills of coping with the psychological and emotional aftermath. Family Factor: When a critical incident happens to an officer and the department, as a whole, the families of those officers must have CISM services. The families of officers endure tremendous day-to-day stress and a critical incident to an officer can cause longlasting, traumatic psychological wounds to the family that do not heal on their own. Pastoral Care: This element in CISM is one that is driven by the need for spirituality by the officer or group of officers. Any major traumatic incident may cause the questioning and support of guidance from a higher power. CISM incorporates the need to address distress in spirituality.

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One-on-One Interventions: Through an individual discussion with trained peers, officers are able to process the incident through their memory and place the ramifications of the experience into its proper perspective. This element of CISM is utilized most in law enforcement because officers open up best to “one of their own.” Also, these confidential discussions result in no stigma by discussing human feelings of fear, vulnerability, anger, and sadness that may be interpreted as “weakness” by both the police and the public. Can an officer about to confront a man with a gun tell the complainant who called for help that he is too scared to confront a gunman? Therefore, the perception of “only other officers understand” creates the blue wall of silence. Departments having only a police psychologist find it very difficult to break through the “blue wall of silence” among the ranks. Referral: The referral mechanism in CISM allows the officer to continue his psychological healing through more formal counseling. Officers who would have never considered such an option find themselves going to counseling after a CISM intervention. CISM begins the process of healing and sets the mindset to “get better, not bitter.” CISM is peer driven with mental health oversight. The peers are able to break the “blue wall of silence” and allow a team of properly trained persons assist in processing the thoughts and feelings that are normal human responses to an abnormal situation. The team consists of trained law enforcement peers, mental health professionals, spouses, and clergy that are prepared to “be there when it matters.” CISM is not just about debriefings, but a comprehensive program that is utilized before the crisis happens, during the crisis, and after the crisis. Stress is a known risk in the law enforcement profession that has the capacity to debilitate an officer‟s career. Law enforcement agencies are beginning to incorporate CISM programs due to the fact that OSHA mandates that an employer is responsible to take actions to lower any known risk within the profession. Research and experience has proven that CISM lowers the emotional and psychological turmoil that officers endure across America everyday. The obligation to provide psychological and emotional assistance is no longer just a moral obligation, but it is now becoming a lawful obligation. Years ago there was no need for automatic weapons, no need for officers to wear rubber gloves, and no need for better training. Through research and experience, the profession has developed new tools to best protect an officer when involved in life-and-death situations. No municipality can completely rid all risks facing law enforcement officers, but has the ability to lower those risks as much as possible. CISM is a program that lowers the psychological and emotional toll of an officer injuring not only his mind, but also his or her heart and soul.

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Informational Documentation

Police Shootings
Captain Mike Cobb,
Richland Police Department, Washington State.

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Let me begin by way of personal introduction and brief biography. My name is Mike Cobb and I am a Captain with the Richland Police Department in Washington State. In my 20 years of experience as a police officer I have worked Patrol (17 years), K-9 (9 years), and SWAT (16 years) with 10 years as a first line supervisor and 2 years as a manager. I currently serve as the Patrol Division Commander. My involvement with Critical Incident Stress Management (CISM) began in 1992 with my introduction into the Basic and Advanced CISM courses. Our local CISM team was formed in 1993 and serves a population area of approximately 300,000 residents. I am a staff member of the International Critical Incident Stress Foundation (ICISF) and serve on their International Advisory Committee. In addition, I am a Board Certified Expert in Traumatic Stress (BCETS) through the American Academy of Experts in Traumatic Stress. Since 1992 I have had the opportunity to work with a number of officers who have been involved in shooting situations. Many have been from across Washington, and several across the United States. My experience has been that a peer based program, which provides early intervention to officers involved in any type of shooting scenario is beneficial to both the officer and the department. Some of the benefits derived by the officer include a quicker recovery time with fewer long lasting effects of the incident. Training for lethal force encounters is typically based in tactics and physical survival. One aspect that is often neglected is the psychological aftermath that may be present after such an event. Many of us enter the field knowing that this type of incident may occur, but this theory does not prepare for the harsh realities involved with taking a human life. A justification of the officer's action has not been shown to significantly decrease the emotional toll taken post-incident. In many organizations across the country, a "fitness for duty" evaluation is the only form of psychological counseling available to personnel involved in a shooting situation. The implication is that they are, by default, unfit for duty. Such testing involves little or no counseling on what the officer's concerns are, the effect this event has had upon he and his family, and how he is to incorporate this into his base of experience without significant negative side effects. For some of the more progressive agencies, mental health counseling is available for their officers and for some this is an effective intervention. The strength of a peer-based program is that it relies upon systems that are already in place. Much of what law enforcement personnel do, how they react, how selfperceptions are shaped, and even more importantly, how their worldview is impacted has traditionally been directly related to peer interaction. We rely heavily upon our peers in times of crisis, and a lethal force encounter is no different. Many officers are seeking to have their experience and reactions normalized by those who have shared similar types of incidents. In many situations the explanation of varying reactions or a forewarning of what may occur in the next few days or weeks is helpful to avoid further traumatization of the effected individuals. Many of the stress survival strategies provided will allow law enforcement officers to take back some of the control over their lives which circumstances have stripped them of. Many are much more prone to initiate the strategies because they have been provided by those with the same experiential base. These strategies have worked, for me, in the same or similar circumstances, and work with police officers.

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Law enforcement personnel, as a profession and as a culture, have often not availed themselves of other clinical resources that are available in the community. A strong sense of "you must have walked in my shoes to understand me" prevails in our professional culture. The moments following a crisis are not the appropriate time in which to reshape this belief system. Some clinicians are viewed as too "warm and fuzzy" for the comfort levels of police officers, and some have difficulty speaking the same language. It is not uncommon for mental health providers to be overwhelmed by an officer's experiences and some find the stories or descriptions too graphic. Many of the in-house or "department psychologist" resources available are viewed as being arms of supervision or administration and there are significant trust issues involved with the process. For many, the stereotype or stigma attached to seeking out assistance is a strong obstacle blocking the way. Whether these perceptions are based in fact or not is irrelevant to the officers involved. The beliefs are simply there and will probably not be altered in time of distress. Peer-based intervention systems rely upon clinical oversight and supervision. The clinician is there for referral when a higher level of care is required. This is what is described as "psychological first aid". As paramedics in the field may treat many of the wounds that they encounter, so may the peer in the field work with many emotional or psychological injuries. Some will require follow up by a medical doctor, some by a therapist or counselor, some not at all. In cases where referral is required, the peer acts as the conduit to the higher level of care. The peer facilitates contact with clinical staff and insures that this vital step in recovery is accomplished. Having the opportunity to exchange thoughts, feelings, reactions and concerns with another police officer, without judgment, is a process that works successfully in countries across the world. It is also a system that is called upon by the officer in crisis much more reliably and consistently that mental health based systems. An officer or group of officers involved in a lethal force encounter is living an incident that is outside the range of normalcy for most of the population. Most officers never discharge their weapon in the course of their careers. The need to have assistance provided in order to cope with the after effects of this type of experience is common, as is the possibility of developing severe trauma symptomologies. Often the officer(s) feel isolated, misunderstood, alienated from their support systems. Some focus on the incident as the defining moment in their adult lives and everything else pales by comparison. Both reactions are unhealthy and may be indicators of unrelieved distress. In some cases, post traumatic stress disorder (PTSD) is manifested and requires significant resources to be treated effectively. A proactive CISM program is designed to help prevent the onset of PTSD and in most cases accomplishes that goal. A determination on whether CISM services are provided before or after an officer issues a statement to investigators will rest upon several different variables. The first is department policy. Policies vary from agency to agency. These policies should be adhered to, but modifications addressed when appropriate. The next concern is the ability of the officer at the time to formulate a written account of what has occurred. During the aftermath of a critical incident, a syndrome known as cortical inhibition may occur. This will impact an individual in a variety of different ways. One of them is in the ability to write, recall details before or after an event, the ability to speak, and other

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physiological responses. Often an inability to communicate, verbally or in writing, is perceived as deception. This may not be the case, and in most circumstances is not. Timely crisis intervention is able to aid in the reduction of cortical inhibition and allow a person to function at a state much closer to their norm. In this sense, the availability of a trained CISM peer to contact the officer as soon as possible after a traumatic event will assist in achieving the goals of the agency as well as the individual. Certain issues of confidentiality or privileged communication must be taken into account, but reactions are the important feature as well as working with the impact the event has had upon the person. In some cases it may be possible to leave out details which may be extremely significant to an ongoing investigation and still facilitate working with the emotional and psychological impact of the event. As important, is assistance to officers who witness or are otherwise involved in police shootings. The threat to life presented to the team or unit is significantly distressing to those who share each other's professional lives. We are taught to care for our own while performing tasks and this becomes essential in our world view. To do otherwise is unconscionable and, for many, not being able to assist their co-workers in the time of a significant event may bring forth overwhelming emotions. Guilt is often present, as well as grief, anger, and a myriad of other reactions. Peer based crisis intervention programs, when utilized quickly, are able to significantly mitigate the impact of this type of critical incident and facilitate quicker recovery time for those involved. The specific intervention protocols utilized under the ICISF model of crisis intervention are termed on-scene support, one-on-one support, and defusing for small groups. Though much of what I have spoken of in the above paragraphs address issues surrounding law enforcement shootings, it should not be mistaken that this is only one small facet of the total continuum of care provided by a trained CISM team. Much of what our personnel experience during the course of their careers does not involve a shooting scenario. These thousands of significant events, and their impact, need to be addressed as they arise. The effect of cumulative stress is debilitating and has been shown to shorten careers and is the leading reason why trained and valuable employees leave the field. Critical incident stress management is a standard of care in many communities consisting of an integrated, multi-component system of intervention strategies. Beginning with preincident education there are individual and group interventions designed for a multiplicity of applications. For emergency responders, the success of the system is the peer-based application with support and guidance of clinical staff. A successful CISM program will enable law enforcement officers to provide a high level of care to our communities and to function in a much more healthy and positive fashion. When viewed as part of a comprehensive officer survival program, CISM is literally able to save lives. This same program enhances any number of quality of life issues for our personnel as well. CISM has a dramatic positive impact upon police families, shows a reduction in instances of alcohol or substance abuse, and is often translated into an increase in morale, productivity and performance. A brief summary of the mission statement of a successful CISM program is: "Our team keeps your team on the job".

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