Incident Support Tool User Guide

About the Incident Support Tool

PURPOSE:

Further evaluate and delineate the need for incident support such as the 3-3-3 exposure tool following incidents.

The incident support tool was developed to support decision making after incidents, improve incident stress appraisal and team and self awareness following incidents.

Its purpose is to establish common language and objective approach for decision making, to allow for an operational metric for stress exposure following an incident to determine if traumatic levels of stress were involved, either on an individual or team basis.

Ultimately, this tool is designed to operationalize appraisal to objective factors, allowing commanders, clinicians and responders to evaluate the incident rather than the individual, decreasing stigma and de-personalizing the process.

Target Audience:

This tool has been designed for use by responders and Incident Commanders, leaders and clinicians who support them. It is designed to be used in collaboration with teams that ideally have a framework for the 3-3-3 Exposure Protocol.

Training for use:

It is suggested that a brief onboarding process, which includes a review of the PTE’s on the scoring card and indications for use (to be determined by the agency or TIPS).

The Incident Support Online Module describes the use of the tool.

Target User Groups:

Incident Command Use:

This tool is designed to support appraisal of incidents for components of incident stress. For the incident commander, using the Incident Appraisal following a major incident to assign a score of 0-50 offers an opportunity to objectively view the incident for potentially traumatizing events.

Incident Commanders may use this tool internally to determine, based on the score above, if more support, ie, Debriefing, Gathering, or e-mail is warranted, or whether appropriate to get a clinician or TIPS member to follow up.

FEEDBACK: Does this include a need for an incident score?

Have the incident commander AND responders score the incident. Allow for shared numbers and discrepancy, which fuels communication and dialogue. Each Responder can then complete their own numerical appraisal, and share if desired.

Individual Rescuer Use:

Individual Responders can fill out this IST following each incident, and keep a log of the total incidents throughout the year, either with score pad sheets, or whiteboard/erasable markers with photos.

Any incidents incurring a score in the red are strongly encouraged to follow with a 3-3-3.

Team Use;

1). Score the incident by color and ask responders to the event to add the incident score to the individual score to determine a color, then anonymously poll the group for incident colors. If there are a significant number of reds in the group, consider a 3-3-3 for team or individuals

2) Repeat above, asking for self-appraisal of the responders, without sharing a color. If responders feel, following the incident and appraisal (yellow or red) that

they would benefit from a 3-3-3, this should be offered. Individual 3-3-3 may be offered for anyone in the red, or feels it would be supportive.

Clinician Use:

Clinicians supporting teams may consider reflecting on the PTE’s and the score as a means to normalize stress reactions and offer educational and support opportunities.

Clinicians could also be asked to support those who identify the incident as red for individuals and teams, or when the preponderance of the team identifies in red.

PEER SUPPORT (TIPS) Use:

Responder: The IST can be a supportive tool for Peer Support following up with responders and incident commanders following incidents to determine whether to embark on the 3-3-3 process.

Rationale: Asking to share a numerical finding or color finding may feel more comfortable in the emotional space for responders than asking about the PTE’s. This allows individual responders to share their cards, thus their 3-3-3, with established structure for the conversation. Responders in the yellow or red may choose to proceed with the 3-3-3, where those scoring in the green, it may be an opportunity to note that every incident is impactful, or necessitating peer support.

A word about incident commanders: Many incident commanders are left out of the 3-3-3 and PTE appraisal process given their sense that they were not in the field and thus do not have a right to be impacted. This can be far from the truth. The Peer Supporter, particularly beneficial if they have also played a role in incident support or leadership, may identify that ‘duty to act, conflict, complexity of the mission and family contact’ are often particularly impactful to incident supporters. Additionally, incident commanders who feel that involved responders on ‘their watch’ were

injured either physically or psychologically, may experience mission injury personally.

For example:

Personal Identification: Responders who personally identify with those they support are at higher risk of traumatic stress, because the association cues the brain to feel the event could happen to them or someone they love. This may raise survival cues for the responder.

Example: Rescuer responds to a climbing accident on route he or she recently climbed.

Example: Flight medic responds as first on scene to a climber wearing a jacket that a partner wears.

Example: The rescuer determines on scene that he recognizes the patient or the deceased as a teacher in the small town where he or she works.

Guidelines for Scoring

5-

Recommendations for teams and individuals should be customized to the individual team culture and resources used. Please see a example below of the potential use of each color area of for individual rescuers who have identified the rescue by color:

INDIVIDUAL:

Connect:

< 4 0

● Revisit Resources & Stress Mitigation Tools

● Monitor Stress Levels

Portland Mountain Rescue:

● Briefly Review IRP & Green Choices

● Stress Continuum Check in

● Encourage Green choices

Consider:

● Implement Mitigation Tools

● 3-3-3 Protocol

● Follow Up Gathering

Recommend:

> 7 0

● After Action Review

● 3-3-3 Protocol for Individuals

● Follow Up Social Gathering

Portland Mountain Rescue:

● Encourage green choices 4 07 0

● Stress Continuum Check in

● Consider 3-3-3 if rescuer feels it would be supportive

● Consider planning green choice

Portland Mountain Rescue:

Initiate 3-3-3 protocol

Offer support for green choices and stress reduction

Normalize processing of unusual events

TEAM:

Consider team culture and current practices customized to team culture and vision.

Spruce Mountain Rescue:

< 4 0

4 07 0

Connect:

● Revisit Resources & Stress Mitigation Tools

● Monitor Stress Levels

● Encourage Green choices

Consider:

● Implement Mitigation Tools

● 3-3-3 Protocol

● Follow Up Gathering

Recommend:

> 7 0

● After Action Review

● 3-3-3 Protocol for Individuals

● Follow Up Social Gathering

● AAR/E-mail review of mission and highlight areas of strength

● Encourage individual or buddy Stress Continuum Checks

● Encourage corporate connection

Spruce Mountain Rescue:

● Consider AAR/Gathering

● Encourage individuals to use 3-3-3 protocol

● Team reminders of resilience practices

Spruce Mountain Rescue:

● Schedule AAR or Gathering (first 3)

● Encourage Clinician involvement for support

● Encourage team to utilize optional collective 3-3-3 gatherings

Final word:

Remember that most responders who participate in rescue incidents will not be injured by them. In fact, incidents provide both responders and teams the opportunity to achieve mission satisfaction, enhance skills, serve others and learn from mistakes.

In the beginning of use, teams may chose collectively to use this tool with more frequency then necessary to aclimatize to the use of the tool, and fit it into team culture, as well as become familiar with the scoring and recommendations. Over time the tool will be successful if it is used with less frequency and more precision to support impactful events, but continue the cultural norm of resilience after events, rather than pathologizing each event as one that may be harmful.

The spirit of this tool is to increase awareness about incident stress, enhance communication following incidents, screen for those who may be impacted, particularly individuals, and provide structure for decision making. This tool can and should be used for regular incident ‘hygiene’ much like After Action Review and cleaning and putting gear away. It is not meant to ‘pathologize’ responses, meaning assume that responders are injured at each rescue. In fact, this may serve as the opposite, an opportunity for responders to notice how often they respond to an incident and experience mission satisfaction without impact.

Please fill out this survey if your team is using the tool:

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it?usp=sharing

Future considerations:

How to train on this tool

Breakdown of each score on the score card

Pleaseseethebelowagendaforthisquarterandmeeting:

Finalize Incident SupportTemplate and plan for Utilization

Discuss 3-3-3 Stress Continuum & resources for family & partner support

Discuss Incident Support planning (3-3-3 for teams from theTIPS angle)

Responder PFR vs. Bystander PFR

Pre-work(ifyou'reable) IST

Pleasereviewattacheddocument:IncidentSupportTool(IST)UserGuide

IbelieveImadeallthechangesyousuggestedtotheactualcardandhavedevelopedauserguide.It wouldbegreattoreviewandcustomizetoTIPS.

WillalsodiscussbestmethodfortrainingIncidentCommandtousethetools,aswellasintroducing ittoteamsifwedecideonitsuse.

PFR-R

ForthoseofyouwhohadthechancetoreviewthePFR-Rcoursepriortoourmeeting,we'lldiscuss nextstepsforutilization.

Public facing:

Wehavediscusseda'ContinuityofCare'formorhandoutsothatrescuerscanbrieflybuildorshare resourcesoraplanwiththosetheycontactonamission,withJacksonbasedsupportcustomizedon thedocument Rescuer facing:

PleaseconsiderhowPFRskillsmaybesupportiveofTIPSlateralsupport,andwhethersharingthe trainingwithyourownorganizationswouldbesupportivevs.incorporatingitintoTIPSrelated responsetootherrescuersandrescueteams

3-3-3forfamilysupportvs.TeamSupport

Pleaseconsiderwhetherfamiliesoftherescuersyousupportwouldbenefitfrom3-3-3training.We willtiethediscussionof3-3-3forteamsintotheISTguidancedocument.

Pleasesendmeanyquestions/conundrumsyou'dlikemetodiscussorcoverwhilewe'retogetheror individuallytwodaysbeforewemeet.

Future considerations:

Rituals of mutual support - food, card, support

Next steps: Digital vs. notepad options.

How will the tool be used.

Cards

Can it be incorporated in the onboarding process

Smaller size- for uniform pocket-

GCS- if less than 8, innovate..

IC and the crew doing it.

If incident commanders feel it’s their ultimate responsibility to care for their people

Create the tools

Create the training and support mechanism

Beta test: Google form