Biomedical Engineering Reference
In-Depth Information
carefully prescribed and monitored in order not
to inadvertently create an iatrogenic trade off
between immediate relief from distress and subse-
quent risk of either dependence (e.g., ongoing
use of benzodiazepines) or disruption of healthy
biological recovery processes necessary for trauma
survivors to learn that the threat or harm actu-
ally has ended. The latter outcome could increase
the risk of PTSD by blocking crucial learning and
memory processes [14].
Although replication with survivors of terrorism
and disaster are required, the scientific results
suggest several features of an acute intervention
model. Intervention as early as the first day and
in the next 1-2 weeks should focus on bolstering
natural support systems and coping resources,
and on education about post-traumatic symptoms
that teaches practical approaches to managing
expectable stress reactions. Post-traumatic coping
skills should include simple but effective cognitive
techniques for processing intrusive memories—
conceptualized as expectable stress reactions that
reflect the person's active attempts to make sense
of shocking events and the ongoing aftermath—
neither encouraging nor discouraging the recall or
disclosure of such memories so that this is viewed
as a choice rather than a therapeutic require-
ment. Guidance should be provided to victims,
families, and informal and formal role models
and caregivers about what types and degree of
symptomatic impairment is sufficient to warrant
mental health or medical professional evaluation,
and how they can use available resources to help
themselves and each other to restore reasonable
functioning.
Screening for
persistent
post-traumatic impair-
ment should not be conducted for 2-3 months,
although healthcare and social service providers,
educators, and clergy should be prepared to help
people recognize and make practical changes to
address potentially maladaptive coping strategies
(e.g., increased alcohol use), and to identify and treat
or refer individuals with severe impairment during
this period as they would ordinarily: Persons expe-
riencing persistent post-traumatic health or mental
health problems 3 months or more following a
terrorist incident or disaster should be given treat-
ment designed to enable them to: (a) shift from frag-
mented or ruminative recalling of isolated moments
or aspects of traumatic events to a coherent narra-
tive, (b) identify and manage dysphoric thoughts or
beliefs concerning symptoms that, if unchecked, can
lead to problematic attributions (e.g., mental defeat,
hopelessness) and affects (e.g., despondency, guilt,
shame, rage), and, (c) pace the recall of traumaevents
in order to prevent flooding, extreme avoidance, or
dissociation (Table 11.3).
11.2.5 Critical Incident Stress
Management with Hospital Staff and First
Responders
Although CISM has not been evaluated in
controlled research trials, it is widely used as
an approach to helping hospital staff and first
responders to recognize and effectively manage
the emotional toll that working with trauma-
tized patients, victims, or family and community
members has on them as helpers. Often, staff and
responders are directly traumatized themselves, if
they or their families are exposed to life threat-
ening danger, or if they witness extreme suffering
or death. When done optimally (Dyregrov, 1997),
CISM provides an inclusive and non-pathologizing
(i.e., everyone is included, not just those who are
particularly severely distressed) forum in which
staff and responders can construct a shared memory
of the positive as well as traumatic and stressful
aspects of their work in a crisis or disaster, and
provide mutual support that reduces the sense of
being “alone” that often occurs in the aftermath of
terrible or terrifying experiences. CISM for staff
and responders is
not
intended to be (and should
never be done as) a confrontational or emotion-
ally provocative process; indeed the focus is on
helping each person feel a greater sense of closure
and social support, rather than to “fall apart” or
“vent” emotions (which can do more harm than
good).
CISM for hospital staff or first responders
requires two types of role models, first that of
trained “peers” (i.e., staff or responders who did
not work in this incident but are experienced in this
type of work and circumstances), and second that
