1. HOW TO BUILD YOUR TEAM:
THE IMPORTANCE OF SETTING UP REALITY BASED
TRAINING FOR YOUR EMERGENCY RESPONSE
TEAMS
TRAVERSE CITY, MICHIGAN
AUGUST 22, 2008
Vincent J. McNally
TRAUMA REDUCTION INC.
813 335 1143
TRAUMAREDUCTION@AOL.COM
10 STEPS FOR SUCCESSFUL REALITY BASED TRAINING©2008 vjm
REALITY BASED TRAINING REPLICATES CRISIS BEHAVIORAL
PERFORMANCE THROUGH SIMULATION OF JOB EXPERIENCES.
1. SUPPORT FROM THE HIGHEST LEVEL
-ADEQUATE BUDGET
- PROPER FACILITY
-ADEQUATE TIME
-REALISTIC EXPECTATIONS
2. THE BEST INSTRUCTOR
-EXPERIENCED
-CLEAR CUT OBJECTIVES AND PLANNING
3. CRISIS MANAGEMENT
-REACTING IN EMERGENCY AND STRESSFUL SITUATIONS
-THREAT ASSESSMENT=RECOGNIZE THREAT– RESPOND
4. INVOLVEMENT = SELF-TEACHING
-MUST WORK AT SOLVING PROBLEMS
5. TEAM WORK-----TEAM TRAINING
-BEST WITH CLASS OF 15-20 WITH 5 SUB-GROUPS
6. INTERACTIVE = NOT “TALKING AT”
-WORKING TOGETHER VS. WORKING ALONE WILL SOLVE PROBLEMS FASTER
7. SIMULATIONS
-MUST BELIEVE YOU ARE EXPERIENCING ACTUAL EVENT OF YOUR WORKING EXPERIENCE
8. EVALUATIONS –
-OF PERFORMANCE OBJECTIVES AND OBSERVEABLE TASKS
-PER COURT: TRAINING DID NOT OCCUR IF NOT DOCUMENTED
9. DEBRIEFING
-80% OF LEARNING FROM SIMULATION COMES FROM DEBRIEFING, NOT SCENERIO ITSELF:
--( KEN MURRAY)
10. TAKE CARE
-LEARN THE ROOTS OF TRAUMA AND STRESS TO PROTECT YOURSELF FROM ANXIETY,
BURNOUT AND POST TRAUMATIC STRESS DISORDER (PTSD)
REALITY BASED TRAINING FOR OUR
FUTURE EMPLOYEES:

2. ACCOMMODATING RETURNING SERVICE
MEMBERS AND VETERANS FROM IRAQ AND
AFGHANISTAN
1.7 million Americans served in Iraq and Afghanistan. Because of the Global War
on Terrorism many service members have been exposed to traumatic combat
experiences on a daily basis. The 2008 Rand Corporation study reports that 1 out
of 5 or 300,000 Afghanistan and Iraq soldiers suffer from major depression, Post
Traumatic Stress Disorder (PTSD) or anxiety. If you add problems relating to the
soldier’s family and marriage the toll reaches one million. Only ½ or 53% have
sought treatment through the Department of Veteran’s Affairs and 60,000 of
120,000 of those who served in the two wars suffer PTSD and/or depression which
are highest for woman and reservists.
Documents from the federal case of Veterans for Common Sense vs. Peake in May
2008 disclosed that the 18 veterans commit suicide each day. 1000 of those
veterans who receive care from the Department of Veteran Affairs (VA) attempt
suicide every month. As of 3/15/2008 287,790 Iraq and Afghanistan war veterans
filed disability claims with the VA. 1,467 veterans died awaiting approval of the
disability claim by the government. Those who appeal the VA decision await 4 1/2
years for an answer.
2008 American Psychiatric Association study indicates that one out of four
military on active duty did not know anything concerning mental health treatment
that might arise from their service in war zones. Those who were surveyed chose
no assistance because:
(1.) Side effects of medication,
(2.) Believed family and friends could help with the problem, and
(3.) Care would damage their career.
This stigma and the toughness emphasized by the military contribute to not
accepting assistance by the soldier or veteran.
According to a pamphlet (American Legion (American Legion. Guide for Post Traumatic Stress
Disorder (5th ed.) [Brochure]. Washington, DC) PTSD symptoms in combat veterans can
include:
1. Upsetting thoughts occurring frequently about the traumatic event.
2. Frequent dreams (in many cases, nightmares) about the event.
3. Suddenly feeling as though the event is reoccurring (flashbacks).
4. Environmental stimuli (olfactory, auditory, visual) can trigger flashbacks and
other troubling symptoms.
5. Detaching oneself physically and emotionally from other people/places,
especially large crowds.
6. A feeling of detachment from others.
7. A feeling of foreshortened future.
8. Guilt related to being a survivor - living after the trauma when many other
comrades did not. Guilt may also surface because of one's duties (having to take
another human life).
9. Sleep disturbances (usually insomnia).

3. 10. Mood swings and anger outbursts.
11. Cognitive/memory difficulties.
12. Excessive vigilance and survival-related behaviors.
13. Hyperarousal - a person may seem "jumpy," especially in the presence of
unexpected noises.
It is important to note that not all veterans that experience combat will develop
PTSD; employers and coworkers must not assume that someone who is returning
from the Middle East is having these difficulties. Furthermore, those who do
develop this condition may not experience all of the symptoms and behaviors
listed above. In some cases, it may take years for PTSD to develop. Employees
who are veterans of previous military conflicts may benefit from this information
as well.
ACCOMMODATION INFORMATION
Below are some suggestions for accommodations. It is important to remember
that not all veterans with PTSD will need these accommodations, if any. This is
not an all-inclusive list:
Lack of Concentration: People with PTSD may have difficulty concentrating on job
tasks.
Reduce distractions in the work environment
Provide space enclosures or a private space
Allow the employee to play soothing music using a headset
Increase natural lighting or increase full spectrum lighting
Divide large assignments into smaller goal oriented tasks or steps
Plan for uninterrupted work time
Coping with Stress: People with PTSD may have difficulty handling stress.
Allow longer or more frequent work breaks as needed
Provide backup coverage for when the employee needs to take breaks
Provide additional time to learn new responsibilities
Restructure job to include only essential functions during times of stress
Allow for time off for counseling
Assign a supervisor, manager, or mentor to answer the employee's questions
Working Effectively with a Supervisor: Managers could supervise people with
PTSD using alternative supervisory techniques.
Giving assignments, instructions, or training in writing or via e-mail
Provide detailed day-to-day guidance and feedback
Provide positive reinforcement
Provide clear expectations and the consequences of not meeting expectations
Develop strategies to deal with problems before a crisis occurs
Interacting with Co-workers: People with PTSD may have difficulty working with
others.

4. Encourage the employee to walk away from frustrating situations and
confrontations
Allow employee to work from home part-time
Provide partitions or closed doors to allow for privacy
Provide disability awareness training to coworkers and supervisors
Dealing with Emotions: People with PTSD could have difficulty exhibiting
appropriate emotions or controlling anger.
Refer to employee assistance programs (EAP) and veterans centers
Use stress management techniques to deal with frustration
Use of a support animal
Allow telephone calls during work hours to doctors and others for needed
support
Allow frequent breaks
Sleep Disturbance: People with PTSD may have disruption in sleep patterns that
could affect workplace performance.
Allow the employee to work one consistent schedule
Allow for a flexible start time
Combine regularly scheduled short breaks into one longer break
Provide a place for the employee to sleep during break
Absenteeism: People with PTSD could have absenteeism or tardiness issues or
have difficulty maintaining reliable attendance.
Allow for a flexible start time or end time, or work from home
Provide straight shift or permanent schedule
Count one occurrence for all PTSD-related absences
Allow the employee to make up the time missed
Panic Attacks: People with PTSD could experience panic attacks at home or at
work which could affect workplace performance.
Allow the employee to take a break and go to a place where s/he feels
comfortable to use relaxation techniques or contact a support person
Identify and remove environmental triggers such as particular smells or noises
Allow the presence of a support animal
Helping to ease the transition back to the workplace
The Disability Management Employer Coalition and several large insurers teamed
up with military and veteran advisers to examine the challenges and opportunities
facing returning veterans and to identify employer-based resources and strategies

5. to help ease the transition. The group, calling themselves the Workplace Warrior
Think Tank, has produced a useful guide for employers: The Corporate Response
to Deployment and Reintegration Highlighting Best Practices in Human Resources
and Disability Management.
The following are among the group's most important best practice
recommendations:
 Establish a Military Leave and Return Policy covering employees who are
members of the Reserves or National Guard. A key component of that
policy is to communicate the range of benefits and programs that apply,
including provisions of the federal Uniformed Services Employment and
Re-Employment Rights Act of 1994 (USERRA), which requires job
protection for all employees who are deployed regardless of the size of the
employer.
 Evaluate the effectiveness of the Employee Assistance Program (EAP) and
behavioral health services to help returning employees (including members
of the military and civilian employees assigned overseas) who have been
diagnosed with or who are exhibiting symptoms of major depression,
generalized anxiety or post traumatic stress disorder (PTSD).
 Use good general disability management practices that apply, including:
- maintaining communication during absences;
- celebrating employees’ return to work;
- giving employees adequate information about benefits prior to
deployment;
- allowing time to reintegrate after an extended absence;
- considering accommodations to assist the employee’s return to
productivity;
- recapping changes while employees were gone;
- establishing red flags to help supervisors identify potential problems; and
- obtaining commitment from senior management to ensure that programs
are given strong support and a cultural presence.
 Offer sensitivity training to managers, supervisors and co-workers on
issues and challenges faced by civilian soldiers during deployment and
post-deployment.
 Provide mentoring programs to link returning civilian soldiers with
veterans in the workforce. The commonality of military experience may
forge bonds among colleagues to support the successful reintegration of
returning workplace warriors.
Employee Assistance Programs (EAP) identified as a vital resource
The Workplace Warrior Think Tank stressed the importance of employers having
not just an EAP, but one that is well equipped to address the full spectrum of

6. behavioral health issues that are common to re-acclimating veterans, particularly
PTSD and depression. According to a November 14, 2007 article in the Journal of
the American Medical Association, U.S. Department of Defense clinicians
identified that 20.3 percent of active and 42.4 percent of reserve component
soldiers required mental health treatment. This incidence rate was identified
through either an initial post-deployment health assessment or re-assessment
that occurred approximately six months later. “Estimates indicate that three out
of five veterans probably have PTSD to some degree. We need to educate
companies about traumatic brain injury and PTSD so people can understand and
be aware of the issue.” Bill Dozier, Assistant Director, National Veterans Outreach Services, Veteran of
Foreign Wars (VFW)
In addition, the EAP must be poised to address the many family problems and
stresses that can surface both during and after deployment. According to
congressional testimony by Todd Bowers, Director of Government Affairs for Iraq
and Afghanistan Veterans of America, 27% of soldiers now admit they are
experiencing marital problems, and 20% of deployed soldiers say they are
currently planning a divorce. And a CBS investigation points to a veteran suicide
rate that is twice that of average Americans.
Employers must train supervisors and HR staff to spot warning signs for
problems early and must have resources in place for referrals to
appropriate help and support services. For employers who will have
returning citizen soldiers, the next EAP renewal might be a good time to
kick the tires and ensure that it is up to providing the serious support and
mental health services that will be needed. The transition will not be a
once-and-done matter, but a long-term issue that America's employers will
be dealing with over the next few decades. (HR WEB CAFÉ, Employers' best practice
guide for helping veterans reacclimate to the workplace”, ESI Employee Assistance Group, Wellsville,
NY, 2006)
Compiled by: Vincent J. McNally, MPS, CEAP
Trauma Reduction Inc.
TRAUMAREDUCTION@AOL.COM