IRAQ WAR CLINICIAN GUIDE

Iraq War Clinician Guide 135 Appendix F
which cmotion>Uy alicnt a: inadvrrcenlly innilninlling
erprrirnru nc1111red for rome.
Another cnncmm rholit how ClSD is implmmenrnple, orrii ind
$!long aiippon fmna ~vp~zvbon and =dminirm%or. nny
lnnprn rlrcirionr rbosc priliciprlion (t.g.. Gin 61 \Vood-
XU. 2WO).A rcherrbyno individwl (orgmup ofindividsaid
is found8obcappioprLic fax CISU.&in, lomlly.
ClSD ir dcriacd only for me %\.i~ltemrrgcnry wwivt
,r.o,ken (6. tigbrul. rocus pcna.nc1. micrgwr.cy roo",
prnonnel, police oi6mn. err.). dillough the ClSD mining
alrn drwibcr ClSD u npptoptirfc far wimtlws to
~-tiriialc~~niu mdb~7tmdm~vl~o$uddcnlg bccomelhclp-
cn by vinueufrl,cirbcingii>r p~rticulrpl~ccinapnticulrr
timc. 'lhc lircnturs cniphziri, 1bac diwf victim? of
c~itinl inddcn~. 6ndy membcn of ,ha* $mowsly
ilqurrd or killed. asid chorc wriourly injurcd in qing to
-$pond lo an i~iciclrntrrguire n?ors~xcnrirc mnmmi
aiid 4iauLI ner zncsd r CISD. Thcrero-nUcd dirrrt virtim
an lhmdled in empcofied w~ys wirhin tile brordrr
tsltntenr &mework of CISM. I-lotvc\rr, ir is unclclr
tvhrrhrr (how who pnctir~ ClSD apply ,he inrcrcntion
only to individlnbrccondrriiy cxpmcd ro mumr (Dyrram.:
1994. For crm>plc, loUmuing the turamr hnrk
on chi UUoild Tndc Cemci. chouvn& ofofice $%,orkcrr
2nd arhtr yeaplc dirrcdy iiivolrcd in the izxiden~ \YEIC
rpparmlly pr6vided with vrriri~o ofCISD.
Oili oflhe pmiadaly amrti\,s fcriurcr afllic ClSD
hmic\+ock is chr q~~cid arestion ~ nid to ihe $miquc
n.c& of \volkrrr a risk for rxpolvre to othcn' dlmrl
,mlman?d,ulfc"ng. rrrgcdllg the inie,l,c',ninlndsr",
of ",,>erp,ydalogiol bunicn of
such wrk ir conridanble and ihc CISD G~tnovorkliu
providcd r qsrunair rmcrurc lo xddica d ~r cmo!ion~l
trccllr oihilyen in o~~tliv~ion~ such a ihc Ilcd Crorr.
Ilowrvcr,xam~hzvcrrycdU~apiopone,~nofd~bticfing
biltoiciognlicrufiiicndy ihc r~tunlrc~ilirncyufrt~~rrpcy
re workor acid tllc>r mpxity la find id2pri.c
indsriduaLixrd and pmnnzl w y ofm3nlging ~ lhrii xzc-
rion,ro ihcrmafuldemrndr ofihrir duricr (e.5. Girt&
Woodd, 2W).
In illc ClSD hn>s$i,ork, the rper oferrnu 1x1 conciituse
ctiriill i~xridcna \~.~rnntingClSD h isvlc%i. and
iris unrriuin hmv, $withina girrn upat at ion or work
r)%ccm.diicd vktim ofuauml arc accudly irircncd. The
muintr in wllirh d,r foinul d'icinition brrwrnptinwy
or direct. 2nd indiicct rxp>iimilro remsim anicruin.
Thr we oian indiddarli mlein the mumriic cantrxcrr
dc role ioilwsioruq crirrrion for CISD nuy comti~urc
m arlrimry didnccion. For insunre. cmcqcnry \%,orken
tnvy lx crl,oscd to rcvwc WE dirmdy and wtondarily
by \imieofohseningodiriinttimgicady Wlictherrurh
iodiuiduzlr \\,auld hconriducd inxppiopti~!r candid=tcr
for ClSD rcmaim unclni.
Ilxc CISD model nsurncl llur dirrrt or primacy uic
ILN rrc inlpproprialc foi CISD bxaurc romc mc>runblc
pL)-Gnl. rogiitivc, or rmotional q~lality ofrhc "victim"
cx)xriri~rc nlrkcs tlxs CISD pia hniawork
hitngc, xup~ifidrlly on $shcrhci ihm is ph~inl
injury niir is inrppraprixa, giiw ~hr vrrc lilcarua
rltslo~~g-trrmconrcqonrsr alp%y).rhological mumr.\Vc
~rgt:, rhx r~enlpoto cacgoricallydi~UnpuYl diica (primay)
nld isdixra (scrondzq) rioioa wiU Lu diiflrtsli if
chc intrrrsntion hi~~toidid~orddr~np~y).doprlliolagical
rrrpann:r, If early isicrrcntios b ro zlfonl indi\idurl>
wllo liu cinolly rI~~U~,~gi~,g e>ncsp>~. wvzk n>
oppofltmiry to nilinrain gmup rohcriorl, a \vcll s rhxc
md receirr ii~bimaiinn >bow jdrplivc coping, cllcn
iocmiilg or? rrncrl:mry unrkcic icsin* ~n ipproprixc
~ - x . - ~ . ~ . . L A * * ~ ~....L.-L-~x---...,.. , - -=>>..~~~=---- -=,.-
DEPARTMEkT OF VETERANS AFFAIRS
NATIONAL CENTER FOR PTSD