Las Vegas Fire & Rescue Critical Incident Stress Management Procedures PDF

530.04 Critical Incident Stress Management Page 1 of 13 Standard Operating Procedure for Critical Incident Stress ManagementCall out Procedures No: Reviewed date: Effective date: Supersedes: I. FR530.04 7/8/19 11/9/15 1/31/03 Type: Emergency Medical Service- 500 series Department: Las Vegas Fire & R...

530.04 Critical Incident Stress Management Page 1 of 13 Standard Operating Procedure for Critical Incident Stress ManagementCall out Procedures No: Reviewed date: Effective date: Supersedes: I. FR530.04 7/8/19 11/9/15 1/31/03 Type: Emergency Medical Service- 500 series Department: Las Vegas Fire & Rescue Signature: Expires: 7/8/2024 INTRODUCTION A. Purpose: 1. To provide an organized approach to the prevention and reduction of long term, damaging effects which may occur when dealing with critical incidents in the line of duty. 2. To provide continuous stress management education and resources for all department staff to address on-going, non-critical, job-related and personal stress; encourage proactive response to stress management. B. Background: Las Vegas Fire & Rescue (LVFR) recognizes the potential for its members to experience significant amounts of stress as a result of the short and long term psychological and physiological effects related to their profession. The effects of stress are best countered through debriefing personnel within a short period following exposure to extraordinary duty. First responder agencies have found this practice most successful when conducted internally from peers and professionals specifically trained for this purpose. C. Scope: 1. All department personnel are at risk for experiencing both work related and personal stress. It is up to each team member to assist the Peer Support Team (PST) and Crisis Intervention Administrator (CIA) in identifying employees who may need assistance. 2. The Fire Alarm Office (FAO), Command Officers, Company Officers, and the CIA have the responsibility of identifying critical incidents. When an incident is identified as critical, the CIA will determine the appropriate level of Critical Incident Stress Management (CISM) intervention. 530.04 Critical Incident Stress Management Page 2 of 13 D. Author: Assistant Chief of the EMS Division in accordance with the Crisis Intervention Administrator (CIA) shall be responsible for the content, review, and revision of this information. E. Objectives: F. 1. To reduce and control the harmful effects of critical incident stress on LVFR personnel. 2. To reduce the impact of a traumatic event. 3. To accelerate the normal recovery process from a traumatic event. 4. To normalize the stress response in traumatic events. 5. To provide for education in stress management and coping techniques. 6. To provide support and resources to LVFR team members and families when experiencing stress from non-critical events. Definitions: 1. Critical incident: Any event that has the sufficient emotional power to overcome the usual coping abilities of emergency personnel. 2. On-scene support services: The CIA, PST and/or LVFR Chaplain may provide on scene services by watching for acute reactions in personnel, providing support and encouragement to personnel, and serving as a consultant for the command and personnel involved in the event. 3. Defusing: A three-stage intervention implemented immediately or within 12hours of a traumatic event. It is a short process designed to help normalize the feelings and/or emotions associated with a critical incident. 4. Critical incident stress debriefing (CISD): The CISD process is a seven-stage intervention for group discussions about a traumatic event or series of traumatic events. a. A CISD should occur within 72 hours of the critical incident, but may occur up to three weeks after the incident. The CISD is designed to mitigate the psychological impact of a traumatic event, prevent the subsequent development of post-traumatic syndrome, and serves as an early identification mechanism for individuals who might require 530.04 Critical Incident Stress Management Page 3 of 13 professional mental health follow-up subsequent to a traumatic event. II. III. b. The CISD will include only those personnel directly involved in the event. Command and Company Officers not directly involved in the event will not be included in the CISD. c. NOTE: The CISD is not a form of psychotherapy, nor is it a critique of LVFR operations. Performance and logistical issues will not be discussed during the CISD. 5. Crisis Intervention Administrator (CIA): The CIA provides and administers crisis intervention services for the LVFR. The CIA is also responsible for overseeing the PST program. 6. Critical incident stress management (CISM): A comprehensive, integrated multi-component crisis intervention system. 7. Peer support team (PST): a group of specially trained LVFR employees who provide support to employees and their family members during times of personal and/or work related crisis. The PST members are endorsed by their supervisors and peers, and selected by a committee through a discerning process to ensure that only high quality personnel are chosen. RESPONSIBILITY A. Any department employee may contact the CIA or PST members for individual support for themselves or a family member. B. The FAO, Command Officers, Company Officers, PST members and the CIA have the responsibility of identifying critical incidents that may qualify for a defusing or debriefing. When an incident is identified as critical, a request for the CIA will automatically be initiated. C. The CIA will be responsible for management of the CISM program and level of intervention. POLICY A. Peer Support Team: Support from the PST may be requested by personnel or family members experiencing personal or work related stress. The PST also provides support during and after critical incidents that may occur in the line of duty. LVFR personnel or family members may request support from the PST member directly for non-critical incidents. PST members are designated in Telestaff with a PST next to their name. 530.04 Critical Incident Stress Management 1. B. IV. Page 4 of 13 The CIA is responsible for activating the PST when necessary during critical incidents. Critical incident support: The CIA should be notified by the FAO and Battalion Chief of all critical incidents that have sufficient emotional power to overcome the usual coping abilities of emergency personnel. The following are some examples of critical incidents capable of causing distress for emergency personnel: 1. Line of duty death. 2. Suicide of a LVFR team member. 3. Multiple-casualty incident/disaster. 4. Significant event involving children. 5. Knowing a victim of the event. 6. Serious line of duty injury. 7. Involvement in several stressful events in a short time frame. 8. Excessive media interest. 9. Prolonged incident with loss. 10. Any event that has an unusually powerful impact on fire personnel. PROCEDURE A. B. Defusing/Debriefing teams: 1. The FAO, Command Officers, or Company Officers have the responsibility of notifying the CIA when a critical incident occurs. The defusing team will be activated by the CIA when warranted and may consist of two PST members. The CIA and/or LVFR Chaplain will be present, when available. 2. The debriefing team will consist of a minimum of one trained PST member and the CIA, LVFR Chaplain, or a clinical provider. On the rare occasion that the CIA, LVFR Chaplain, and clinical provider are all unavailable, the debriefing will be conducted by two trained PST members. Activation of the Defusing process: 530.04 Critical Incident Stress Management 1. The FAO, Command Officers, Company Officers, and the CIA have the responsibility of identifying critical incidents that may qualify for a defusing. When an incident is identified as critical, a request for the CIA will automatically be made. 2. Following specific incidents, the defusing process will be automatic. The following are examples of incidents requiring an automatic defusing: a. b. c. d. C. D. Page 5 of 13 Multiple-casualty incident/disaster. Significant event involving children. Knowing a victim of the event. Serious line of duty injury. 3. Defusings will be conducted within 12 hours of the event, preferably by two trained PST members. 4. Command, Administration, and Company Officers not directly involved in the event will not be included in the defusing. A separate defusing will be conducted for these officers, as needed. Activation of the CISD process: 1. The FAO, Command Officers, Company Officers, and the CIA have the responsibility of identifying critical incidents that may qualify for a debriefing. When an incident is identified as critical, a request for the CIA will automatically be made. 2. The CIA is responsible for the activities and functions regarding Crisis Intervention, and will determine if the CISD is the appropriate CISM action based on the event and personnel affected. When the determination is made to conduct a CISD, the CIA will contact the Command Officer to schedule the CISD. All affected personnel will be taken out of service during the CISD. 3. The CIA, LVFR Chaplain, and/or a clinical provider will be present based on availability along with two trained PST members. When mass critical incidents involving large groups of the department, and/or close friends of the PST members occur, a sister agency, EAP, or outside agency may be contacted by the CIA to conduct the CISD. 4. Command, Administration, and Company Officers not directly involved in the event will not be included in the CISD. A separate CISD will be conducted for these officers as needed. Crew resource management: 530.04 Critical Incident Stress Management E. F. Page 6 of 13 1. Minimizing exposure of personnel to stressful incidents reduces the amount of stress related problems that may occur in the future. Following a critical incident, when possible, the Incident Commander should remove the initial personnel to reduce their amount of exposure to the incident. 2. The CIA, PST and/or LVFR Chaplain may provide on scene services by watching for acute reactions in personnel, providing support and encouragement to personnel, and serving as a consultant for the command and personnel involved in the event. CISM process overview: 1. Critical incident identified. 2. CIA notified. 3. Level of intervention determined by CIA. 4. Activation of PST by CIA for defusing or on scene support when appropriate. 5. CIA notifies Command Officer if CISD is indicated. 6. CIA and Command Officer schedule CISD. 7. Personnel attending the CISD will be taken out of service during the CISD. 8. CISD occurs at established location. 9. Personnel referred to outside resources as needed. 10. Follow up with personnel. Non-Critical incident support process: 1. The CIA may be contacted by any LVFR personnel or family member during normal business hours (Monday – Thursday, 0700 – 1800 hours) to request non-critical incident support for themselves, any LVFR personnel, or family members the requester has concerns about. After contacting the CIA, an appointment will be scheduled to address the non-critical incident. Scheduled appointments may occur outside of normal business hours, based on the availability of the CIA and the requester. 530.04 Critical Incident Stress Management G. Page 7 of 13 2. PST members may be contacted directly for non-critical incident support. PST members are designated in Telestaff with a PST next to their name. Off duty PST members are not required to report. 3. The following are some examples of non-critical incidents: a. Relationship problems not involving abuse or imminent danger. b. Family member issues not involving suicidal or homicidal ideations. c. Financial problems. d. Any emotional problem that does not pose an imminent risk of death or injury. e. Work problems. Confidentiality: 1. The CIA and PST members are required to keep all information discussed in individual meetings and debriefings confidential in accordance with the CISM Confidentiality Agreement. However, since debriefings are typically conducted in small groups, confidentiality is limited. Participants in the debriefing process have an ethical obligation not to disclose any information discussed by others with any outside persons to include peers not involved in the debriefing, family members, or supervisors. If there are possible legal repercussions for personnel from the events surrounding the critical incident, it is recommended that the events be discussed on an individual basis and not in a debriefing. Confidentiality issues will be discussed with the participants of the CISD by the debriefing facilitators at the beginning of every CISD. 2. During individual meetings, the information shared with PST members may only be disclosed to the CIA. However, under certain circumstances, the CIA and PST members, under the direction of the CIA, may be required to disclose specific information. The following are examples of some of the limits to confidentiality: a. Any risk of suicidal/homicidal behavior. b. Any suspected spousal, child, elder, or handicapped abuse. c. A medical emergency in which revealing information is necessary to protect or ensure health and safety of the 530.04 Critical Incident Stress Management Page 8 of 13 LVFR team member (i.e. overdose, drugs in system that may interact with emergency medication). d. Inability of the participant to perform his/her duties in a safe manner (i.e. hallucinating/delusional, severe depression, impaired by substances). e. Written and signed consent of the participant to release information to a specified entity. Note: In compliance with the Health Insurance Portability and Accountability Act’s (HIPAA) “minimum necessary” rule, only the amount of information needed to protect or insure the health and safety of the individual and/or others will be disclosed. Note: All individuals seeking one on one consults will sign a Limits of Confidentiality statement acknowledging that they have been informed of and understand the limits of confidentiality. The signed form will be maintained in accordance with HIPPA standards by the CIA (See Appendix A). Note: The LVFR CISM Confidentiality Agreement will be explained to all PST members prior to implementing their PST duties. A signed copy of the agreement will be retained by the CIA (See Appendix B). Note: Family members are afforded the same level of confidentiality as LVFR team members. H. CISM program overview: 1. On scene to provide support, observation, and consultation as needed. 2. Provide defusing within 12 hours of incident as needed. 3. Conduct CISD within one week of the incident as needed. 4. Provide confidential individual consults when requested. 5. Follow up - conducted weeks or months after incident (may be informal). 6. Knowledge of community and resources. 7. Provide stress management and resiliency education. 530.04 Critical Incident Stress Management 8. Page 9 of 13 Referral to counseling services as needed. a. This list is not all inclusive as situations will dictate needs. Note: The Critical Incident Stress Management Program is not a therapeutic intervention. The CIA and PST members DO NOT provide a counseling service for personnel or families. Critical Incident Stress Management, defusing, and debriefing are early intervention tools, designed to reduce the long term effects of stressful situations. 530.04 Critical Incident Stress Management Page 10 of 13 APPENDIX A Limits of Confidentiality Members of the Peer Support Team (PST) are bound by a code of ethics and HIPPA standards to ensure your confidentiality. However, we do have limits to what we can keep confidential. Some of the more common situations where we may have to disclose your information include: - Any risk of suicidal/homicidal behavior. - Evidence of spouse, child, elder or handicapped abuse. - A medical emergency in which revealing information is necessary to protect or ensure health and safety. - Inability of participant to perform duties in a safe manner (i.e. hallucinating/delusional, severe depression, actively impaired by mind altering substances). - Your written and signed approval to release the information to whomever you designate. - Any information may be disclosed to the Crisis Intervention Administrator overseeing the PST. If you have any questions or concerns about our limits of confidentiality, please feel free to contact the Crisis Intervention Administrator at 702-229-0068. ****Statement of Understanding**** I have read and understand that information about me will be safeguarded to the limits outlined above and in the HIPAA guidelines. _________________________ Participant Signature __________________ Date I have reviewed these limits of confidentiality with the participant. ________________________ Peer Support Team Member Comments/Notes: __________________ Date 530.04 Critical Incident Stress Management Page 11 of 13 APPENDIX B Las Vegas Fire & Rescue Critical Incident Stress Management Program Confidentiality Agreement (Peer Support Team) Peer Support Team Member _____________________________ Effective Date of the Agreement________________________________ CONFIDENTIALITY STATEMENT: I understand that in the course of my duties as a Las Vegas Fire & Rescue Peer Support Team (PST) Member, I may be privy to personal and private information about former and current personnel and/or their family members. I understand that if I do become aware of this type of information, it is to be treated as private and confidential. This includes the fact that an individual was seen or is currently being seen by any member of the PST and/or the Critical Incident Administrator (CIA), and receives (or previously received) services through the Critical Incident Stress Management (CISM) Program. Referrals made to any outside agency through the CISM program, or by any 530.04 Critical Incident Stress Management Page 12 of 13 member of an individual’s chain of command, are also confidential. This includes referrals to mental health providers, substance abuse providers or any other agency. CONFIDENTIALITY STANDARDS: The privacy and confidentiality of department personnel and their families utilizing services through the LVFR CISM program are protected under the code of ethics of mental health professionals and Federal HIPAA Regulations. Most participant information is protected and may not be disclosed without the explicit written consent of the participant. Examples of inappropriate disclosures include:  Discussing or revealing participant information to anyone without a legitimate “need to know”. This includes other PST members not directly involved in the interaction as well as friends, family members, or co-workers. Sharing stories without including Personal Identifying Information is also prohibited.  Removing any participant information from the office for any purpose (including working from home) without explicit authorization from the Critical Intervention Administrator.  Obtaining access to participant information not directly necessary for performing your job duties.  Copying participant files or other participant information onto a personal computer.  Sending any participant information via e-mail or FAX without explicit authorization from the participant or Critical Intervention Administrator.  Copying participant files or other participant information onto CD, san disk, or other electronic storage devices without explicit authorization from the participant, except when conducting authorized computer backup on a scheduled basis.  Placing participant information on the internet or into any other publicly-available forum without written consent from the participant. LIMITS TO CONFIDENTIALITY: Under certain circumstances PST members may be required to disclose specific information. The following are examples of some of the limits to confidentiality:  Any risk of suicidal/homicidal behavior.  Suspected spousal, child, elder or handicapped abuse.  A medical emergency in which revealing information is necessary to protect or insure health and safety.  Participants written and signed consent to release the information to a specified entity.  Inability of participant to perform duties in a safe manner (i.e. hallucinating/delusional, severe depression, impaired by substances)  All information may be shared with the Crisis Intervention Administrator. 530.04 Critical Incident Stress Management Page 13 of 13 Note: In compliance with the Health Insurance Portability and Accountability Act’s (HIPAA) “minimum necessary” rule, only the amount of information needed to protect or insure the health and safety of the individual and/or others will be disclosed. CONFIDENTIALITY AGREEMENT: I, ______________________________, understand that any participant information which I see or hear is considered private and confidential. I understand that confidentiality must be maintained whether the information is stored on paper, computer, communicated orally or through any other means. I understand that I am not authorized to seek or deliberately obtain access to participant information. I also understand that employee information of a private or sensitive nature must also be treated as confidential, including employment records and job evaluations. I have been informed that it would be illegal for me to access computerized participant or employee information without authorization of the Crisis Intervention Administrator and/or the participant. I understand that unauthorized disclosure of participant information, or any other confidential or proprietary information from this department, is unethical and/or illegal, and that it may be grounds for disciplinary action, up to and including the loss of my professional license, suspension and/or dismissal from employment. I understand that this duty of confidentiality and non-disclosure will continue to apply even after I am no longer working for this department or participating as a Las Vegas Fire & Rescue Peer Support Team Member. Name (Print) __________________________________________________ Signature __________________________________ Effective Date: ______ Witness Signature____________________________ Date: _____________