Mass Casualty Response Resilience/Post Action Strategic Debriefing 

Amy Morgan

[00.41] *Note: There are no graphic images included in this event, knowing that such images may be a trigger to viewers/attendees.

[01.05]

Agenda:

• What is wellness/health?
• What is Trauma
• Mass casualty incident is trauma for the responder
• Resilience v recovery
• Using the PASD method of debriefing

[01.33]

Definition:

Mass Casualty Incident (MCI), also known as a Multiple-Casualty Incident or Multiple-Casualty Situation, is any incident in which emergency medical services resources, such as personnel and equipment are overwhelmed by the number and severity of the casualties.

Most agencies have a preparation plan for a mass casualty event.

• What to do when you get the call?
• Who will respond?
• In what order?

All the logistical plans necessary to have most efficient response possible and save the most lives.

[02.30]

Examples:

• Building collapse in Mexico City leaves 6 Dead, 9 Injured
• Multiple people Injured in School Shooting in San Bernardino
• Apartment Building Collapses in Poland
• 26 Killed, 36 injured in Bus Accident in Nepal

[03.12]“The potential for emergency personnel to be called to respond to a mass casualty incident is far more likely than we like to think about.”

What happens to those after the event and the rescue attempts are over with?

[03.47] “Only by allowing for healing, recovery and acknowledging the potential for lingering emotions can these responders get back to a full state of wellness and good health.”

[04.05]

What is Wellness and Health?

3 Main Factors of Health:

• Mental health
• Emotional health
• Physical health

Other types of health include:

• Social – good relationships and social support network
• Spiritual – Faith, their values beliefs principles and morals
• Financial – a sense of security, or little worry with regard to finances.
• Environmental – surroundings, your home and where you spend most of your time.
• Occupational – safety in someone’s workplace, prevention of injuries at work
• Cultural – perception of general acceptance or based on someone’s background
• Intellectual – creative, mentally stimulating activities, learning potential
• Relational – closer relationships (parents, spouse, kids, close friends)

[05.45]

Three Primary Areas of Health are interconnected.

“These three areas reciprocally affect each other. If one area is weakened, the other two areas also have the potential to be compromised. To be at your best, all three areas need to be in a state of wellness. Approaching all three together is taking a whole-istic approach.”

[7.20]

Good Emotional Health:

• In control of emotions and behavior
• Able to handle life’s challenges
• Able to build and maintain strong relationships
• Able to quickly recover from setbacks
• Self-confident, self-aware and able to find meaning in difficult situations
• Manage anger, guilt, sadness, shock, disappointment and hurt

Poor emotional health:

• Full of worry or stress
• Hold grudges
• Brood or ruminate over bad situations
• Self-defeating behavior
• Depression, anxiety, poor anger management
• Addiction

[8.35]

Good mental health:

• Cope with normal stressors
• Make a contribution to the community
• Think clearly and make decisions
• Perform daily life tasks and take care of yourself
• Problem solve and adapt to change

Poor mental health

• Disability
• Unable to function well
• A diagnosed mental illness or mental disorders

[9.35]

Good physical health

• Absence of illness
• Good vitals
• Resistance to illness or disease
• Fast recovery from illness
• Healthy heart, lungs and digestion
• Good sleep patterns, healthy diet and exercise
• Physical strength
• Free from addictions (drugs, alcohol, tobacco)

Poor physical health:

• Frequent Illness, chronic pain
• Long recovery time
• Exhaustion, weakness, fatigue

[10.17]

Audience Poll: How would you rate yourself on these three areas of wellness:

15% Excellent

65% Good

20% Fair

0% poor

[11.47]

What is Trauma?

What causes trauma for one may not cause trauma for another.

Events or incidents that can cause trauma:

• Feared for life or safety
• Watched or heard about such an incident
• Had a close relationship with someone involved
• Shocking or unexpected
• Against social expectations
• Any situation faced that causes a distressing, dramatic or profound change or disruption in physical or psychological function

[12.57] “If you’re a responder seeing those situations first-hand, you have the potential for post-incident trauma. There are both short-term and long-term reactions to crisis or trauma that can happen.”

[13.05]

Trauma

Short term crisis or trauma reactions

• Insomnia
• Anxiousness
• Agitation

Long term trauma reactions or PTSD:

• Overwhelming fear
• Sense of loss of personal control over the environment
• Memory or stimuli may trigger the same emotional reaction felt during the incident

[13.49]

Following a traumatic event, a persona may experience these reactions:

• Shock
• Denial
• Anger
• Rage
• Sadness
• Confusion
• Terror
• Shame
• Humiliation
• Sorrow
• Suicidal or homicidal ideation
• Restlessness
• Fatigue
• Frustration
• Fear
• Guilt
• Blame
• Grief
• Sleep disturbance
• Eating disturbance
• Muscle tremors
• Reactive depression
• Nightmares
• Profuse sweating episodes
• Heart palpitations
• Vomiting or diarrhea
• Hypervigilance
• Paranoia
• Phobic reactions
• Problems concentrating
• Anxiety
• Flashbacks and mental images of traumatic events
• Startle responses

[15.09] “The more of these reactions a person has, the deeper their trauma is affecting them.

Seeking help through a professional counselor is the best first step for preventing these reactions or managing them once they occur. They may not even show up after a particular event, they may show up later.”

[15.49]

MCI can Cause Trauma

“Those who respond—those who go in to the incident, often as it’s still happening or who see the immediate aftermath of a scene—have a very high potential for experiencing trauma reactions.”

[16.57] Specific Incident Trauma vs. Cumulative Trauma

Trauma is trauma. Incident trauma is one event, while cumulative is a collection of events. Each event by itself is traumatic, but they pile up.

[18.19]

Biological responses to a traumatic encounter:

• Shaking
• Stomach knots or butterflies
• Tunnel vision
• Tunnel hearing
• Amnesia

[21.06]

Long lasting consequences of trauma:

• Noises
• Smells
• Weather
• Situations/triggers
• Hyper-vigilance

[21.49]

Important Note:

Expecting everything to go back to the way it was before is probably an unrealistic expectation. It will change you, but if you will give yourself the gift of using resources….you can heal. While things may never look the same to you, it can still look hopeful and positive.

[22.30]

Audience Poll Question:  Have you experienced either a traumatic event or mass casualty incident:

MCI 5%

TE 44%

Both 30%

Neither 21%

[24.01]

Resiliency v Recovery

Resiliency is the ability to bounce back or heal, to resume normal activities, an be at usual level of strength and wellness

Resilience is a process, not an end result or trait

Resilience in all three areas should be a continuous goal

“Wherever there is the potential for injury, there is the potential for healing.”

Recovery is getting back to a state of wellness after a period of not being in that state (illness or injury).

[26.20]

Important Note:

• If you are the leader of a team who may find themselves needing these resources, it is in your best interest to give them all the help you can possibly give them.
• Team leaders should create an environment where resources are offered and encouraged, for the strongest and most ready team.
• There are way too many leaders in public safety who want or expect their team members to just “suck it up” and “get over it” and move on, without needing resources or having any issues. This is an unrealistic expectation and helps no-one.
• If you’re telling your team members to not have emotional reactions to the things they will experience in an MCI, you’re basically telling them that you want them to be more like a psychopath than a caring human being.
• Psychopath = callus, lack of empathy, unable to feel emotions deeply, emotionally high thresholds for disgust
• Dissocial personality disorder = callous unconcern for the feelings of others
• Your team members = empathetic, concerned for others, able to feel emotion and able to make sound ethical decisions

[28.42]

The Post Action Strategic Debriefing Method:

A combination of techniques:

• Therapeutic techniques (narrative, reframing, etc.)
• Crisis intervention methods
• After Action Review (military AAR)
• Critical incident stress management (CISM)

[30.30]

Strengthening mental and emotional wellness

• Achieve balance
• Lower stress
• Increasing positive activities (exercise, fun, hobbies, good deeds etc)

Positive activities and positive thinking:

• Releases endorphins
  • Blocks pain
  • Allows controlled emotions
  • Creates feelings of pleasure
  • Self-regulating

• Neurotransmitters can be trained
• Connect better
• Stronger emotionally

• The more endorphins released the better neurotransmitters connect, the more mentally and emotionally healthy the individual.

• Strengthening emotional and mental health
  • More resilient
  • Better able to cope with stressors
  • Less unpredictability
  • Better focus

[34.40]

Mental and Emotional Fatigue Or Compassion Fatigue

Those in giving careers, including public service careers where the job is to constantly take care of other people, often experience something called compassion fatigue, which is growing weary from giving of themselves because they’re not taking care of their own needs equally.

[35.41]

The Process of the Post-Action Strategic Debriefing

• Gather together – have a neutral facilitator
• Expectations v Reality – what was the plan for how things were supposed to happen compared with what actually happened.
  1. What worked well? What would you want to happen next time?
  2. What challenges were encountered? What could have been done better?
  3. What were the immediate reactions and thoughts on the experience
• Discuss after incident reactions – list the potential reactions so the team can know what to look out for in themselves and each other
• Positive Reframing – take a healing, more positive perception of the incident and reduces blame and resentment within the team
• Getting Back to Center – being one team unit, sharing the same experience, and new normalcy together
• Follow up plan – name resources to use in the future and promote the importance of watching for and getting help for signs of distress

[42.45]

Potential Resources

• 800-273-8255 (TALK) – the National Suicide Prevention Lifeline
• Counselor
• Clergy/Chaplain
• Supportive Friends and Family
• Physician
• Coworker/Peer
• Supervisor

[43.49]

Excellent Resource:

National Alliance on Mental Illness (NAMI) document – Preparing for the Unimaginable: How Chiefs can safeguard officer mental health before and after mass casualty events.

[46.40]

Audience Question: What should I watch for in a peer who may be struggling?

• Hopeless
• Angry
• Apathy
• Isolating themselves
• Agitation

Contact Amy Morgan, MSC at AMorgan@AcademyHour.com or www.AcademyHour.com for more information