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AIM Psycho-Social Crisis Response Team (CISM-IASC Aligned) Operational Guidelines

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1. PREAMBLE & MISSION

The Association for Integrative Medicine (AIM) has established the AIM Psycho-Social Crisis Response Team (CISM-IASC Aligned) to provide immediate, short-term psychological support during critical incidents, natural disasters, and mass casualty events.

These guidelines serve as the global standard operating procedure (SOP). While specific therapeutic modalities may vary based on local cultural needs and practitioner expertise, all interventions must be evidence-based, legally compliant, and strictly adhere to the protocols defined herein.

It is imperative to adhere to these guidelines in their entirety. Any violation of these ethical, safety, or operational standards will result in the immediate revocation of AIM-CRT membership and potential legal referral.

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2. COMPLIANCE & LEGAL FRAMEWORK

2.1 Local Legal Sovereignty
It is imperative that all AIM-CRT chapters operate strictly within the legal framework of their respective jurisdictions.

The definition of "allowable psychological interventions" must comply with the regulations established by local medical and mental health licensing boards.
In instances where a particular technique is legally restricted to medical doctors, non-medical AIM members must resort to alternative stabilization techniques that are legally compliant.

2.2 Zero-Tolerance Policy
The following protocol shall be observed in the event that a member is found to be acting beyond the scope of their legal practice or in violation of the "Do No Harm" principle. In such an instance, the member in question will be permanently expelled from the Association.

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3. OPERATIONAL FRAMEWORKS

All AIM-CRT interventions are required to be structured around two non-negotiable international frameworks:

3.1 Critical Incident Stress Management (CISM)
It is imperative that members employ the CISM model (Mitchell & Everly) as the foundational framework for intervention.

• Target: The primary objectives of treatment are stabilization, reduction of impairment, and facilitation of return to function.

• Prohibition: It is imperative to refrain from conducting "psychological debriefing" (CISD) on individuals who are still in a state of high acute shock or dissociation. The primary objective is to defuse and stabilize.

3.2 IASC MHPSS Guidelines (2007)
According to the 2007 Inter-Agency Standing Committee (IASC) MHPSS Guidelines, adherence to the aforementioned guidelines on mental health and psychosocial support in emergency settings is mandatory for all members.

• Core Principle: Do No Harm.

• The coordination process is as follows: It is imperative to avoid working in isolation. In order to ensure an integrated response, it is essential to coordinate with general health services and community supports.

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4. MEMBERSHIP QUALIFICATION & VETTING

To ensure the highest standard of care, the "Volunteer" status does not exempt members from professional rigor. Candidates are required to successfully complete the following three-stage assessment:

1. Written Knowledge Exam: The course material encompasses the CISM theory, IASC guidelines, psychotraumatology, and local legal statutes.

2. Crisis Intervention Exam: The practical simulation necessitates that the candidate exhibit the capacity to implement rapid stabilization techniques, meticulously adapted for crisis scenarios, under observation.

3. Resilience Test: A psychological evaluation is necessary to ascertain whether the candidate possesses the emotional fortitude to function in high-stress environments without becoming a secondary casualty (vicarious trauma).

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5. CLINICAL BOUNDARIES: PFA & THERAPY

5.1 Distinct Roles
It is imperative that members clearly distinguish between Psychological First Aid (PFA) and Clinical Psychotherapy.

• Psychological First Aid (PFA)

  • The objective is threefold: immediate stabilization, safety, and comfort.

  • The timeframe for this process is measured in minutes to hours post-event.

  • Action:The reduction of arousal is imperative to ensure that fundamental physical needs are met.

• Clinical Psychotherapy:

  • The objective of the treatment is threefold: first, to facilitate profound processing; second, to promote resolution of trauma; and third, to effect change in personality.

  • The temporal framework encompasses a period ranging from weeks to months following the occurrence of the event within a clinical setting.

  • Action:Regression analysis and restructuring.

5.2 Operational Restriction
According to the fifth section of the AIM-CRT protocol, members of the organization are strictly forbidden from conducting deep clinical trauma processing in the field. The objective of the treatment is limited to the alleviation and stabilization of symptoms.

5.3 Disclaimer Requirement
It is imperative that each member explicitly articulates the following to recipients (or guardians) prior to engagement:

The techniques delineated herein are intended for the provision of psychological first aid and the immediate stabilization of emotional states. It is imperative to note that these measures are intended to provide supplementary support and do not supersede critical medical interventions, law enforcement negotiations, or prolonged psychiatric treatment.

 

6. MECHANISMS OF ACTION & PFA APPLICATION

6.1 The Neuropsychological Mechanism
Interventions are predicated on the assumption that during a crisis:

• The experience of high emotional arousal has been demonstrated to be a catalyst for the activation of the fight-or-flight response.

• The aforementioned factors result in the suspension of the critical faculty, otherwise known as the conscious filter.

• Individuals exhibit a heightened susceptibility to suggestion. Consequently, the AIM-CRT member is tasked with the role of "External Regulator," employing authoritative yet soothing directives to circumvent panic and reestablish a sense of safety.

6.2 The PFA Principles in Context
Members are expected to implement the standard PFA model through specialized communication.

• LOOK (The initial phase of the process is observation and triage):

  • A comprehensive evaluation should be conducted to ascertain the presence of any indications of dissociation, characterized by a vacant stare. Additionally, the manifestation of hysteria or shock should be closely monitored.

  • Application:These signs should be used as entry points for "Utilization" techniques.

• LISTEN (Pay close attention to the following list of validation points):

  • It is imperative to engage in active listening, prioritizing the immediate concerns of the individual.

  • Application:Pay close attention to the "key words" that the survivor employs and subsequently offer them suggestions that will facilitate the establishment of a rapport.

• LINK (Resource Connection):

  • The establishment of a connection with individuals or services is imperative.

  • The application of the survivor's internal connection to their own past resources of strength and calmness, also known as anchoring, is a crucial aspect of the intervention.

 

7. EMOTIONAL COMPETENCE & PROTOCOLS

7.1 Emotional Knowledge and the Inner Child
It is imperative that members operate from the understanding that all emotional reactions, including hysteria and freezing, are inherently beneficial.

• Concept: The concept of the "Inner Child" or Subconscious Mind has been postulated as a factor in eliciting such reactions, which are believed to serve a protective function.

• Technique: It is imperative to refrain from resisting the emotional response. First, it is essential to acknowledge the protective intent behind this behavior, as illustrated by the following statement: "I know part of you is trying to keep you safe/alert." Following this acknowledgment, a more adaptive approach to safety should be proposed, such as conserving energy.

7.2 Consent and Legal Handling in Chaos
In situations characterized by chaos, where the provision of written informed consent is impracticable, the principles of consent and legal handling are of paramount importance.

• Implied Consent: This assertion is only valid in circumstances involving life-saving or acute stabilization when the subject is unable to communicate.

• Verbal Consent: It is imperative to seek this whenever possible.

• The Two-Person Rule, also known as the Buddy System, is mandatory. It is imperative to note that no member of the AIM-CRT is permitted to engage with a survivor in a secluded area independently. It is imperative to always work in pairs. One individual is tasked with facilitating the process, while the other focuses on observing and documenting the proceedings. This measure is designed to safeguard the interests of both the survivor and the member by preventing the emergence of allegations against either party.

 

8. FIELD SAFETY & SELF-PROTECTION

8.1 Environmental Awareness
According to the most recent research, members are responsible for their own safety first. It is imperative to establish a clear distinction between the concepts of "heroism" and "negligence."

• Structural Safety: It is imperative to refrain from entering structures that have been damaged by natural disasters, such as earthquakes, fires, or floods, for the purpose of providing psychological support. It is imperative to await authorization from the pertinent Fire and Rescue authorities.

• The Sanctuary Rule: It is imperative to ensure that the location designated for intervention is shielded from the direct view of carnage or immediate danger.

8.2 Health & Evacuation
The following section will address health and evacuation protocols.

• The following is a discussion of disease prevention strategies. In regions affected by disasters, such as floods, it is imperative to assume that all water and surfaces are contaminated. The utilization of PPE (Personal Protective Equipment) is imperative in scenarios where physical contact, such as a handshake, is deemed to be unavoidable.

• Escape Route: Prior to engaging any survivor, it is incumbent upon the member to identify the nearest Exit Strategy.

• Hostile Environments: In the event that a location becomes subject to violence, such as riots or looting, AIM-CRT members are required to promptly remove their identification vests and evacuate the area. It is imperative to acknowledge that our role does not entail the maintenance of peace.