Crisis intervention in the rescue service
The crisis intervention in the emergency service care uninjured participants and members in acutely mentally traumatic accidents, emergencies and disasters.
The help should start immediately after the event (peritraumatic phase) or at the latest when an acute stress reaction occurs. The early intervention gives those affected space for their grief, makes them able to act again and thus prevents the development of post-traumatic stress disorder (PTSD). The psychiatric care of confused or psychotic persons is not one of the tasks of crisis intervention.
Specifically for crisis intervention trained helpers are experienced forces of the rescue service or civil protection, which is usually about the rescue coordination center will be alerted.
Such services are mostly offered by aid organizations , fire brigades or in the form of independent associations, albeit under different names, such as peers .
Terms
The designation crisis intervention in the rescue service and the abbreviation KIT as well as the KIT logo are protected trademarks or word marks of the Arbeiter-Samariter-Bundes Regionalverband Oberbayern eV The term "KIT" (or "KID") is now a pars pro toto Term used in rescue services .
The name Crisis Intervention Service (KID) serves as a generic term for this activity in the sense of a specialist service or an organizational classification in an aid organization. The Crisis Intervention Team (KIT) describes the whole unit (and is often part of its name, as far as permitted by the trademark protection described), but the operation is usually approached with "only" two helpers - at KIT-Munich often also as a "single team" with only one rescuer. The term emergency pastoral care (by church / religious organizations) is closely related, but is not only used in the area of care for those affected, but also in follow-up care for the emergency services.
Other common names are crisis intervention in the emergency services (KED), emergency aftercare and emergency care (NFB).
The term crisis helper or crisis intervention helper (KIH) is commonly used to designate the emergency services trained in crisis intervention ; theologians of emergency pastoral care are called emergency pastors .
The critical incident stress management (SBE), however, is intended for emergency responders who are affected in a different way and react. However, many crisis helpers are also trained in SbE, and in some places both services are offered together.
history
The emergency medical rescue service has the task of restoring vital functions, maintaining them and ensuring the proper transport of injured or sick people to a facility providing further care. The care of affected relatives is not primarily one of them, although the employees of the emergency services are very often confronted with it. In the past, however, they had to leave those involved who were mentally troubled and not in need of emergency medical treatment to themselves in order to do their own job.
A serious traffic accident with a tram , in which a child was killed and the uninjured parents had to stay behind at the scene without professional care, was the occasion for the paramedic and deacon Andreas Müller-Cyran on March 9, 1994 in the Arbeiter-Samariter-Bund Munich to establish the world's first crisis intervention team to deal with such situations in an organized manner.
The role of crisis intervention is no longer contested, after initial doubts in the art, now it is in many areas an integral part of the emergency services, the basics were also under the slogan based crisis intervention in the curriculum of the German paramedics training received.
The KIT Munich of the Arbeiter-Samariter-Bund helped set up other German cities and districts, for example KIT Stuttgart , KIT Leipzig , KIT Erding / Freising / Ebersberg / Landkreis Traunstein , soon also outside Germany in Luxembourg ( Unité de Support Psychologique , USP) and South Tyrol . For this purpose, a separate training and further education facility was founded, the KIT Academy in Munich. Today the KIT Academy offers numerous basic, advanced and advanced training courses, such as B. as a crisis intervention helper, for private individuals at their own expense - but without guarantee that they will then also be allowed to volunteer at the KIT-Munich of the Arbeiter-Samariter-Bund.
Not to be confused is the KIT-Munich of the Arbeiter-Samariter-Bund with the KID of the Munich Red Cross, which is also active in the Munich rescue service. While the helpers of both teams have a similar training according to the guidelines agreed between all aid organizations nationwide, the Arbeiter-Samariter-Bund has employed volunteer members (2017: approx. 55 active members) as well as a full-time management and full-time administrative staff. The KIT Munich of the Arbeiter-Samariter-Bund ensures 24/7 readiness. Like the vast majority of teams in Germany, the BRK-KID consists exclusively of volunteer members.
A crisis intervention is now available across the board in Austria ; the last one was installed in the province of Burgenland in summer 2009 .
In Switzerland there are plans to set up a crisis intervention service based on the German and Austrian models.
Use of crisis intervention
Occasions
The most common indication is the care of relatives in the event of a death, especially in special circumstances, for example in the stressful situation of an unsuccessful attempt at resuscitation , the unexpected death of a relatively young patient, suicide , death in public or in the event of (social) isolation of the bereaved. A clear indication is the death of a child, be it as a result of an accident, acute illness or sudden infant death syndrome (SIDS).
In cooperation with the police, the crisis intervention service also delivers reports of death. For the police officers this often means a great deal of relief, the trained crisis helpers are often better able to cater to the needs and reactions of relatives.
In the case of serious traffic, rail or work accidents, the basic use of crisis intervention makes sense, as stressful circumstances can often be expected here. Eyewitnesses, work colleagues or the driver of the vehicle involved in the accident are also looked after. Some transport companies even have crisis helpers here themselves (for example Deutsche Bahn AG). In this context, a frequent cause of crisis intervention operations is attempted suicide by rolling over the train. In Vienna and Munich pilot studies were carried out in cooperation with the mass media , which are no longer supposed to report on such suicides in order to reduce the imitator effect ( Werther effect ). As a result, the overall frequency of this suicide method has already decreased in Vienna .
Organized crisis intervention also makes sense for other missions in which psychological trauma is to be expected of the physically uninjured. Examples are fires with seriously injured or dead people and situations with massive experience of violence or personal threat ( bank robberies , hostage-taking or rape ).
The need to call in a crisis intervention service is usually decided by the on-site personnel from the police, fire brigade and rescue service. In the case of certain message images, the emergency call centers alert the emergency call center to the emergency service in parallel, so that, in the event of accidents in the public area, you can be at the scene early and also be able to reach eyewitnesses. In some control center areas, such as in Munich, however, there is still a great deal of uncertainty about the alerting channels of the PSNV emergency services. Thus, the responsible integrated control center does not always alert or post-alarm support, but this often takes place on the short official channel via (unsecured) cell phone connections. Not only in a control center area does this lead to obstructive competition situations between the aid organizations involved, emergency pastoral care and BOS. Even when coordinating large-scale incidents (such as the killing spree in Munich on July 22, 2016), when a PSNV leader is alerted, a PSNV task force is not always set up at the responsible supervisory authority. Partly delegated to private aid organizations.
Major disaster situations
Crisis intervention is also important in the event of major incidents and mass casualties . The first major operation for crisis intervention and emergency pastoral care with great media interest was in 1998 with the ICE accident in Eschede . Supraregional and international deployments of local crisis intervention teams are now common (examples are the Concorde crash in Paris 2000 , the mountain railway accident in Kaprun 2000 , the terrorist attacks on September 11, 2001 in New York City , the rampage in Erfurt and Freising in 2002, the Bus accidents in 2003 in Siófok / Hungary , Lyon / France Vicenza / Italy , a hostage-taking at Munich Airport in 2004, the catastrophic flood after the seaquake in the Indian Ocean in 2004 and the collapse of the ice rink in Bad Reichenhall in 2006 ).
Operations abroad are generally requested by the Federal Foreign Office , while national operations are carried out on behalf of the Ministry of the Interior or the locally responsible operations management . The Bavarian Red Cross has included crisis intervention as an integral part of its supraregional task forces.
If the situation arises, we work closely with the care service .
Procedure and methods
The operational sequence during a crisis intervention in the rescue service can be divided into phases in which different aspects and methods are in the foreground:
- Preparation and organization phase: This phase begins before the contact with the client with the collection of information about the event and enables the employee to be able to provide information to the client later (what happened? Who is to be looked after?).
- Convey security and support : At the beginning of the care, the crisis intervention helper should ensure that the person affected is in an environment (setting) in which he can allow emotions and is protected from disturbing influences from the environment. An important principle of crisis intervention is the continuity of the care situation in order to avoid additional stress from repeated changes of the caregiver.
- Creating structure : Since the person being cared for has mostly experienced the stressful situation from a passive victim role, regaining the ability to act is a short-term goal of crisis intervention. The possibility of saying goodbye to the deceased may play an essential role, and information about organizational processes for the next few hours and days (post-mortem inspection, burial, registry office) should enable the person concerned to leave the victim role.
- Bridging function : At the end of the crisis intervention, the handover to the social network should take place. An activation of family or friendly reference persons of the client, if possible by the client himself, ensures further care of the person concerned, also information about professional help offers (advice centers, self-help groups) belongs to this point.
The intervention by a crisis worker usually takes a few hours, but there are, albeit rarely, missions in which employees are on site for up to 8 hours.
In contrast to emergency pastoral care, crisis workers do not perform liturgical acts. Should this be desired by the client, there is often a cooperation with the local emergency pastoral care or the religious communities (standby pastoral care).
Principle of uniqueness
No return visits are usual after the initial and outpatient crisis intervention. The reason for this is the changed relationship structure between the person being cared for and the caregiver, which occurs when contact is made again. As a result, the methods of crisis intervention in the rescue service would no longer be easily applicable and optimal care for the client would not be guaranteed. In addition, this time limit is intended to reduce the burden on the employee.
education
The training is uniformly regulated nationwide by the "Common quality standards and guidelines on measures of psychosocial emergency care for survivors, relatives, bereaved, witnesses and / or missing persons in the field of psychosocial acute care" of February 21, 2013. Thus, both the requirements for participation, the quality assurance, as well as the curriculum for the training to become a crisis intervention helper (KIH) and the qualification of the trainers deployed, are uniformly regulated. In addition, following the consensus conference, which was controlled by the Federal Office for Civil Protection and Disaster Aid ( BBK ), the "Quality standards and guidelines Part I and II" were adopted. These are valid nationwide and, in accordance with the joint approval of all PSNV participants, are also binding.
In an admission interview, personal motivations and skills are clarified. Only then is it possible - in some teams - to do an internship under the guidance of experienced employees in the field service. Some teams only allow employees who have successfully completed theoretical training to work.
In the next step, the theoretical training takes place, which comprises 16 teaching units (TU) in a basic course and 80 TU in a subsequent specialist course.
Content are u. a. the introduction to the basics of psychology, basics of communication, organizational structures of the PSNV and the BOS, special subject topics (culture and religion, suicide, special target groups, law and administration, mental hygiene) and above all the structure of an intervention with extensive exercise on the learning plan . The training usually lasts 12 weeks, which is then concluded with a theoretical, oral and practical exam. In a subsequent practical phase, the duration of which is individually agreed, the candidate is only on duty within the framework of an appropriate practical support (observation). The length of the practical phase depends on the individual entry requirements and the actual operational situations. Theoretical and practical training should be completed after 3 years at the latest.
At the end of the practical phase, a final interview is held, based on the results of which a decision is then made as to whether the trainee will be employed as a "fully operational" employee. For the first few months he is then assigned a mentor .
financing
The crisis intervention in the emergency service can not handle the in Germany currently health insurance are billed. The client will not be billed. Funding comes from donations , sometimes from public grants and the sponsor's budget. In view of this situation, the service always remains voluntary, which can be a relief for the crisis intervention helpers deployed in view of the potentially stressful work, but is also a strong obstacle with regard to the creation of clear structures analogous to the fire brigade, police and disaster control, which is a major obstacle to the above. Problems e.g. B. leads to alarms.
Emergency vehicle
Many crisis intervention services have their own emergency vehicle to get to the scene , some use the private vehicles of the helpers or vehicles from the rescue service, the fire brigade or the police. In Germany, the use of special rights and rights of way for crisis intervention is regulated differently from region to region.
In order to create a calm support atmosphere ( setting ) and to be able to shield clients from prying eyes, but also from the media, minibuses are usually sought as emergency vehicles.
literature
- Carl-Heinz Daschner : Crisis Intervention in the Rescue Service (KIT). Stumpf & Kossendey, Edewecht 2003, ISBN 3-932750-88-8 .
- Carl-Heinz Daschner: case study. Crisis intervention in the rescue service. In: Ambulance Service. Stumpf & Kossendey, Edewecht 1997, p. 17ff.
- Bernd Ready, Hanjo von Wieterheim (ed.): Human support and crisis intervention in the rescue service. Stumpf & Kossendey, Edewecht 1997, ISBN 3-923124-68-6 .
- Andreas Müller-Cyran , Birgit Petrol: A vacation trip that is endless. KIT Munich in action. In: Ambulance Service. 07/2003. Stumpf & Kossendey, Edewecht 2003.
- Birgit Richter, Regina Karl: Crisis intervention in the rescue service. KIT Munich. An exploratory study on the KIT working method. Thesis. LMU Munich, Munich 2000.
- Peter Zehentner: When the nightmare becomes reality, the unthinkable catastrophe. In: Civil Protection. 4/2007. Federal Office for Civil Protection and Disaster Assistance of the Federal Ministry of the Interior.
- Peter Jaeggi : First aid for the soul. How suffering can be alleviated with rapid crisis intervention. In: Neue Zürcher Zeitung . July 13, 2004, p. 9 ( online ).
- Annette Ramelsberger : First aid for the soul. When death comes home - out and about with people who bring terrible news. In: Süddeutsche Zeitung . 27./28. March 2004, p. 3 ( online ).
- Peter Zehentner: The course to the crisis. A socio-pedagogically oriented course to prepare employees for work in the field of preclinical crisis intervention. Thesis. KSFH Munich, 2000.
- Peter Zehentner: The Crisis Intervention Team (KIT) Munich. In: Lasogga, Gasch (ed.): Emergency psychology. Textbook for practice. Jumper. Heidelberg 2007, ISBN 978-3-540-71625-9 .
- Sebastian Roth: Crisis education - training and further education of crisis intervention helpers. Kovac, Hamburg 2008, ISBN 978-3-8300-3537-4 .
- Werner Reiners-Kröncke, Manuela Dette and Ines Haas: Trauma and overcoming trauma. Recommendations for action for psychological first aid. TARGET. Augsburg 2013, ISBN 978-3-940562-82-1 .
Web links
- Psychosocial emergency care: Quality standards and guidelines Part I and II [1] , Federal Office for Civil Protection
Individual evidence
- ↑ Common quality standards and guidelines on measures of psychosocial emergency care for survivors, relatives, bereaved dependents, witnesses and / or missing persons in the field of psychosocial emergency care from February 21, 2013 . Berlin / Bonn / Kassel / Cologne February 21, 2013.
- ↑ Emergency psychosocial care: Quality standards and guidelines Part I and II ". (PDF) (No longer available online.) Federal Office for Civil Protection and Disaster Assistance, July 2012, archived from the original on January 16, 2017 ; accessed on June 18, 2017 .
