1-.

 Incident Command Education:

The Incident Command System (ICS) is a standardized approach to the command, control, and
coordination of emergency response providing a common hierarchy within which responders from
multiple agencies can be effective.[1]
ICS was initially developed to address problems of inter-agency responses to wildfires in California
and Arizona but is now a component of the National Incident Management System (NIMS)[2] in the
US, where it has evolved into use in All-Hazards situations, ranging from active shootings to HazMat
scenes.[3] In addition, ICS has acted as a pattern for similar approaches internationally.[4]
ICS consists of a standard management hierarchy and procedures for managing temporary
incident(s) of any size. ICS procedures should be pre-established and sanctioned by participating
authorities, and personnel should be well-trained prior to an incident.[5]
ICS includes procedures to select and form temporary management hierarchies to control funds,
personnel, facilities, equipment, and communications. Personnel are assigned according to
established standards and procedures previously sanctioned by participating authorities. ICS is a
system designed to be used or applied from the time an incident occurs until the requirement for
management and operations no longer exist.
ICS is interdisciplinary and organizationally flexible to meet the following management challenges:

 Meets the needs of a jurisdiction to cope with incidents of any kind or complexity (i.e. it
expands or contracts as needed).
 Allows personnel from a wide variety of agencies to meld rapidly into a common
management structure with common terminology.
 Provide logistical and administrative support to operational staff.
 Be cost effective by avoiding duplication of efforts, and continuing overhead.
 Provide a unified, centrally authorized emergency organization.

2. Biological Warfare and Biological Agents

Biological warfare (BW)
—also known as germ warfare—is the use of biological toxins or infectious agents such
as bacteria, viruses, and fungi with the intent to kill or incapacitate humans, animals or plants as an
act of war. Biological weapons (often termed "bio-weapons", "biological threat agents", or "bio-
agents") are living organisms or replicating entities (viruses, which are not universally considered
"alive") that reproduce or replicate within their host victims. Entomological (insect) warfare is also
considered a type of biological weapon. This type of warfare is distinct from nuclear
warfare and chemical warfare, which together with biological warfare make up NBC, the military
initialism for nuclear, biological, and chemical warfare using weapons of mass destruction (WMDs).
None of these are considered conventional weapons, which are deployed primarily for
their explosive, kinetic, or incendiary potential.
Biological weapons may be employed in various ways to gain a strategic or tactical advantage over
the enemy, either by threats or by actual deployments. Like some chemical weapons, biological
weapons may also be useful as area denial weapons. These agents may be lethal or non-lethal, and
may be targeted against a single individual, a group of people, or even an entire population. They
may be developed, acquired, stockpiled or deployed by nation states or by non-national groups. In
the latter case, or if a nation-state uses it clandestinely, it may also be considered bioterrorism.[1]
Biological warfare and chemical warfare overlap to an extent, as the use of toxins produced by some
living organisms is considered under the provisions of both the Biological Weapons Convention and
the Chemical Weapons Convention. Toxins and psychochemical weapons are often referred to
as midspectrum agents. Unlike bioweapons, these midspectrum agents do not reproduce in their
host and are typically characterized by shorter incubation periods.[2]
The use of biological weapons is prohibited under customary international humanitarian law,[3] as well
as a variety of international treaties.[4] The use of biological agents in armed conflict is a war crime.[5]

A biological agent 
(also called bio-agent, biological threat agent, biological warfare agent, biological weapon,
or bioweapon) is a bacterium, virus, protozoan, parasite, or fungus that can be used purposefully as
a weapon in bioterrorism or biological warfare (BW).[1] In addition to these living or
replicating pathogens, toxins and biotoxins are also included among the bio-agents. More than 1,200
different kinds of potentially weaponizable bio-agents have been described and studied to date.
Biological agents have the ability to adversely affect human health in a variety of ways, ranging from
relatively mild allergic reactions to serious medical conditions, including serious injury, as well as
serious or permanent disability or even death. Many of these organisms are ubiquitous in the natural
environment where they are found in water, soil, plants, or animals.[1] Bio-agents may be amenable
to "weaponization" to render them easier to deploy or disseminate. Genetic modification may
enhance their incapacitating or lethal properties, or render them impervious to conventional
treatments or preventives. Since many bio-agents reproduce rapidly and require minimal resources
for propagation, they are also a potential danger in a wide variety of occupational settings.[1]
The Biological Weapons Convention (1972) is an international treaty banning the use or stockpiling
of bio-agents; as of February 2015, there were 171 state signatories.[2] Bio-agents are, however,
widely studied for both defensive and general medical purposes under various biosafety levels and
within biocontainment facilities throughout the world. In 2008, according to a U.S. Congressional
Research Service report[citation needed], China, Cuba, Egypt, Iran, Israel, North Korea, Russia, Syria,
and Taiwan were considered, with varying degrees of certainty, to be maintaining bio-agents in an
offensive BW program capacity.

3. Post-Traumatic Stress Disorder    :

Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have
experienced a shocking, scary, or dangerous event.

It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second
changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response
is a typical reaction meant to protect a person from harm. Nearly everyone will experience a
range of reactions after trauma, yet most people recover from initial symptoms naturally. Those
 who continue to experience problems may be diagnosed with PTSD. People who have PTSD
may feel stressed or frightened, even when they are not in danger.

Signs and Symptoms

While most but not all traumatized people experience short term symptoms, the majority do not
develop ongoing (chronic) PTSD. Not everyone with PTSD has been through a dangerous event.
Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD.
Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they
begin years afterward. Symptoms must last more than a month and be severe enough to interfere
with relationships or work to be considered PTSD. The course of the illness varies. Some people
recover within 6 months, while others have symptoms that last much longer. In some people, the
condition becomes chronic.

A doctor who has experience helping people with mental illnesses, such as a psychiatrist or
psychologist, can diagnose PTSD.

To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

 At least one re-experiencing symptom

 At least one avoidance symptom
 At least two arousal and reactivity symptoms
 At least two cognition and mood symptoms

Re-experiencing symptoms include:

 Flashbacks—reliving the trauma over and over, including physical symptoms like a
racing heart or sweating
 Bad dreams
 Frightening thoughts

Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms
can start from the person’s own thoughts and feelings. Words, objects, or situations that are
reminders of the event can also trigger re-experiencing symptoms.

Avoidance symptoms include:

 Staying away from places, events, or objects that are reminders of the traumatic
experience
 Avoiding thoughts or feelings related to the traumatic event

Things that remind a person of the traumatic event can trigger avoidance symptoms. These
symptoms may cause a person to change his or her personal routine. For example, after a bad car
accident, a person who usually drives may avoid driving or riding in a car.

Arousal and reactivity symptoms include:

 Being easily startled
 Feeling tense or “on edge”
 Having difficulty sleeping
 Having angry outbursts

Arousal symptoms are usually constant, instead of being triggered by things that remind one of
the traumatic events. These symptoms can make the person feel stressed and angry. They may
make it hard to do daily tasks, such as sleeping, eating, or concentrating.

Cognition and mood symptoms include:

 Trouble remembering key features of the traumatic event

 Negative thoughts about oneself or the world
 Distorted feelings like guilt or blame
 Loss of interest in enjoyable activities

Cognition and mood symptoms can begin or worsen after the traumatic event, but are not due to
injury or substance use. These symptoms can make the person feel alienated or detached from
friends or family members.

It is natural to have some of these symptoms for a few weeks after a dangerous event. When the
symptoms last more than a month, seriously affect one’s ability to function, and are not due to
substance use, medical illness, or anything except the event itself, they might be PTSD. Some
people with PTSD don’t show any symptoms for weeks or months. PTSD is often accompanied
by depression, substance abuse, or one or more of the other anxiety disorders.

Do children react differently than adults?

Children and teens can have extreme reactions to trauma, but some of their symptoms may not
be the same as adults. Symptoms sometimes seen in very young children (less than 6 years old),
these symptoms can include:

 Wetting the bed after having learned to use the toilet

 Forgetting how to or being unable to talk
 Acting out the scary event during playtime
 Being unusually clingy with a parent or other adult

Older children and teens are more likely to show symptoms similar to those seen in adults. They
may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens
may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.

Risk Factors
Anyone can develop PTSD at any age. This includes war veterans, children, and people who
have been through a physical or sexual assault, abuse, accident, disaster, or other serious events.
According to the National Center for PTSD, about 7 or 8 out of every 100 people will experience
 PTSD at some point in their lives. Women are more likely to develop PTSD than men, and genes
may make some people more likely to develop PTSD than others.

Not everyone with PTSD has been through a dangerous event. Some people develop PTSD after
a friend or family member experiences danger or harm. The sudden, unexpected death of a loved
one can also lead to PTSD.

Why do some people develop PTSD and other people do not?

It is important to remember that not everyone who lives through a dangerous event develops
PTSD. In fact, most people will not develop the disorder.

Many factors play a part in whether a person will develop PTSD. Some examples are listed
below. Risk factors make a person more likely to develop PTSD. Other factors, called resilience
factors, can help reduce the risk of the disorder.

Some factors that increase risk for PTSD include:

 Living through dangerous events and traumas

 Getting hurt
 Seeing another person hurt, or seeing a dead body
 Childhood trauma
 Feeling horror, helplessness, or extreme fear
 Having little or no social support after the event
 Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or
loss of a job or home
 Having a history of mental illness or substance abuse

Some factors that may promote recovery after trauma include:

 Seeking out support from other people, such as friends and family
 Finding a support group after a traumatic event
 Learning to feel good about one’s own actions in the face of danger
 Having a positive coping strategy, or a way of getting through the bad event and learning
from it
 Being able to act and respond effectively despite feeling fear

4. Critical Incident Stress Management:

Critical Incident Stress Management, or CISM, is an intervention protocol
developed specifically for dealing with traumatic events. It is a formal, highly
structured and professionally recognized process for helping those involved in a
critical incident to share their experiences, vent emotions, learn about stress
reactions and symptoms and given referral for further help if required. It is not
psychotherapy. It is a confidential, voluntary and educative process, sometimes
called 'psychological first aid'.

First developed for use with military combat veterans and then civilian first
responders (police, fire, ambulance, emergency workers and disaster rescuers), it
has now been adapted and used virtually everywhere there is a need to address
traumatic impact in people’s lives.

There are several types of CISM interventions that can be used, depending on the
situation. Variations of these interventions can be used for groups, individuals,
families and in the workplace.

Debriefing is a proactive intervention involving a group meeting or discussion

about a particularly distressing critical incident. Based on core principles of crisis
intervention, the CISD is designed to mitigate the impact of a critical incident and
to assist the persons in recovery from the stress associated with the event. The
CISD is facilitated by a specially trained team which includes professional and
peer support personnel. Also called Critical Incident Stress Debriefing (CISD).
Ideally it is conducted between 24 and 72 hours after the incident, but may be held
later under exceptional circumstances.

Defusing is an intervention that is a shorter, less formal version of a debriefing . It

generally lasts from 30 to 60 minutes, but may go longer and is best conducted
within one to four hours after a critical incident. It is not usually conducted more
than 12 hours after the incident. Like a debriefing, it is a confidential and voluntary
opportunity to learn about stress, share reactions to an incident and vent emotions.
The main purpose is to stabilize people affected by the incident so that they can
return to their normal routines without unusual stress. Where appropriate, a formal
debriefing also be required.

Grief and Loss Session is a structured group or individual session following a

death and assists people in understanding their own grief reactions as well as
creating a healthy atmosphere of openness and dialogue around the circumstances
of the death.
Crisis Management Briefing is a large, homogeneous group intervention used
before, during and after crisis to present facts, facilitate a brief, controlled
discussion, Q & A and info on stress survival skills and/or other available support
services. May be repeated as situation changes.

Critical Incident Adjustment Support provides multi-faceted humanitarian

assistance to individual, families or groups for coping with the aftermath of an
incident and overcoming the ongoing impact of a death or injury.

Pre-Crisis Education provides a foundation for CISM services. It includes incident

awareness, crisis response strategies and develops stress management coping skills
that can prevent major problems should an incident occur. It takes the form of an
employee handbook, e-book and/or workshops and training seminars.

5. Debriefing
Debriefing is a report of a mission or project or the information so obtained. It is a structured
process following an exercise or event that reviews the actions taken.[1] As a technical term, it implies
a specific and active intervention process that has developed with more formal meanings such as
operational debriefing. It is classified into different types, which include military, experiential, and
psychological debriefing, among others.

Types of debriefings
Military debriefing

Debriefings originated in the military. This type of debriefing is used to receive information from a
pilot or soldier after a mission, and to instruct the individual as to what information can be released to
the public and what information is classified. Another purpose of the military debriefing is to assess
the individual and return him or her to regular duties as soon as possible.[3]

Experiential learning debriefing

Ernesto Yturralde, experiential trainer and researcher, explains: "In the field of experiential learning
methodology, the debriefing is a semi-structured process by which the facilitator, once a certain
activity is accomplished, makes a series of progressive questions in this session, with an adequate
sequence that let the participants reflect what happened, giving important insights with the aim of
that project towards the future, linking the challenge with the actions and the future." It is analogous
to "providing feedback" as it constitutes a vital component of any simulation intervention or any
educational intervention, involving a process of explanation, analysis, and synthesis, with an active
facilitator-participant interface.[4]
"Emotional Decompression" is one style of psychological debriefing proposed by David Kinchin in his
2007 book by that name.
Experiential learning debriefing is the basis for debriefing in Medical Simulation, used widely within
healthcare.[5]

Crisis intervention
Trauma-exposed individuals often receive treatment called psychological debriefing in an effort to
prevent PTSD, which consists of interviews that are meant to allow individuals to directly confront
the event and share their feelings with the counselor and to help structure their memories of the
event.[6] However, several meta-analyses find that psychological debriefing is unhelpful and is
potentially harmful.[6][7][8] This is true for both single-session debriefing and multiple session
interventions.[9][needs update] As of 2017 The American Psychological Association assessed psychological
debriefing as No Research Support/Treatment is Potentially Harmful.[10]
Critical Incident Stress Debriefing (CISD) is a crisis intervention program that is used to provide
initial psychosocial relief to rescue workers. It is generally conducted in a group session and held
between 24 and 72 hours of the disaster. Each debriefing session follows seven phases: (1)
introduction to set rules; (2) fact phase to establish what happened; (3) cognition phase to discuss
thoughts about what happened; (4) reaction phase to discuss emotions associated with what
happened; (5) symptoms phase to learn the signs and symptoms of distress; (6) educational phase
to learn about post traumatic stress disorder (PTSD) and coping strategies; and (7) re-entry phase to
discuss any other issues and to provide any additional services (Carlier et al., 1998). The goal of this
type of debriefing is to stop the individuals from developing PTSD. Although this debriefing is widely
used, there is uncertainty how it effects an individual.
Researchers Mayou, Ehlers and Hobbs (2000), were interested in evaluating the 3-year results of a
randomized controlled trial of debriefing for consecutive subjects admitted to the hospital following a
traffic accident. The patients were assessed in the hospital using the Impact of Event Scale (IES),
Brief Symptom Inventory (BSI) and a questionnaire, and were then reassessed at 3 years and 3
months. The intervention used was psychological debriefing. The results showed that the
intervention group had significantly worse psychiatric symptoms, travel anxiety, physical problems,
and financial problems.
In another study conducted by Carlier et al., (1998), they looked at the symptomatology in police
officers that had been debriefed and not debriefed following a civilian plane crash. The results
showed that the two groups did not differ in pre-event or post event distress. Furthermore, those who
had undergone debriefing had significantly more disaster-related hyper arousal symptoms.
Overall, these results showed that caution should be used when using CISD. Studies have shown
that it is ineffective and has adverse long-term effects, and is not an appropriate treatment for
trauma victims.

Psychological research
In psychological research, a debriefing is a short interview that takes place between researchers and
research participants immediately following their participation in a psychology experiment. The
debriefing is an important ethical consideration to make sure that participants are fully informed
about, and not psychologically or physically harmed in any way by, their experience in an
experiment. Along with informed consent, the debriefing is considered to be a fundamental ethical
precaution in research involving human beings.[11] It is especially important in social
psychology experiments that use deception. Debriefing is typically not used in surveys, observational
studies, or other forms of research that involve no deception and minimal risk to participants.
Methodological advantages of a debriefing include the ability of researchers to check the
effectiveness of a manipulation, or to identify participants who were able to guess the hypothesis or
spot a deception. If the data have been compromised in this way, then those participants should be
excluded from the analysis. Many psychologists feel that these benefits justify a post experimental
follow up even in the absence of deception or stressful procedures.[12][13]