Critical Incident Stress Management
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This 1-hour presentation discusses the merit of establishing a Critical Incident Stress Management process and program for emergency responders and those that form teams and volunteers to respond to emergencies and disastrous events.
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Critical Incident Stress Management
- 1. Addressing Resilience in Mental Health for Emergency Responders (JMA Educational Services, 2016) (Early, 2013)
- 2. • Help build community resilience • Provide community support • Business organizations and continuity • Not intense • Teaches coping skills Critical Incident Management (CISM) is defined as a comprehensive, integrative, multicomponent crisis intervention system.
- 3. Traditional Responders • Police • Firefighters • Search and Rescue personnel • Emergency and paramedical teams Traditional and Non-Traditional members: Non-Traditional Responders • Truck drivers, • Heavy equipment operators, • Laborers and carpenters • Public works employees • Nurses & Physicians, • Laboratory personnel & ancillary hospital staff, etc. (Cheslow, 2018)
- 4. • Severe anxiety • Dissociation • Develops dissociative symptoms • Decrease in emotional responsiveness • May feel guilty about pursuing usual life tasks Acute Stress Disorder (ASD) • Difficulty concentrating, • Feel detached from their body, • Experience the world as unreal or dreamlike • Dissociative amnesia Responders may display a variety of symptoms of ASD to include: (Newman, 2018)
- 5. • Avoidance and nervous system arousal • Intrusive thoughts or memories • Nightmares related to the traumatic event • Flashbacks, feeling like the event is happening again • Psychological and physical reactivity to reminders of the traumatic event • Memory problems that are exclusive to the event • Negative thoughts or beliefs about one’s self or the world • Distorted sense of blame for one’s self or others, related to the event Post-Traumatic Stress Disorder (PTSD) PTSD is a serious mental illness that may be characterized by:
- 6. • Stuck in severe emotions related to the trauma • Severely reduced interest in pre-trauma activities • Feeling detached, isolated or disconnected from other people Post-Traumatic Stress Disorder (PTSD) PTSD characterizations continued: (Deloe, 2016)
- 7. • Major disaster/mass casualties • Serious injury, death, or suicide of a firefighter or police officer • Serious injury or death of a civilian resulting from emergency service Operations • Death of a child, or other incident involving profound emotional responses You might need CISM if there is: (DeRousse, 2014)
- 8. • The incident attracts unusually heavy attention of the news media • There is loss of life following an unusual, or extremely prolonged expenditure of emotional and physical energy by the emergency services personnel • The incident produces a high level or immediate or delayed emotional response • There is a probability of cumulative trauma syndromes from multiple incidents (Raghavendra, 2016) You might need CISM if:
- 9. • Extraordinary human experiences • Emotional Trauma • Shattered sense of security • Psychological First Aid Destruction of community resilience and perception of invulnerability brings heightened anxiety (Flagler Volunteer Services, 2018) (DeRousse, 2014)
- 10. • Safety • Efficacy (individual and community) • Calmness • Connectedness Work toward and achieve four key elements: (Lovewithclarity.com, 2018)
- 11. • Institute a pre-clinical, multidisciplinary team approach • Identify high-risk groups/individuals • Target mental health, resilience, distress, and risk behaviors • Identify barriers to care and services • Offer health education for prevention, assessment, and referral • Hold informational briefings (leader participation) • Offer grief leadership • Integrate family support into worker/workplace support Critical Incident Needs Assessment Team (CINAT)
- 12. • Determine the need for CISM • Call for the Critical Incident Stress Debrief (CISD) • Conduct the CISD • Defuse
- 13. • On the scene debriefing • An initial defusing • The formal CISM debriefing • A follow-up debriefing Four types of CISM Debriefings: (Elk Vallet, n.d.) (DeRousse, 2014) (DeRousse, 2014)
- 14. • Lack of efficacy in preventing symptoms of posttraumatic stress and • Lack of efficacy reducing the impact of acute stress response • Some research indicates that CISM techniques like CISD can actually increase the likelihood that trauma will have a greater psychological impact • Requires support from trained professionals
- 15. • Critical Incident Stress Management is a necessary tool for emergency responders, whether they are traditional or non- traditional members. • The resulting psychological stress of individuals that are exposed to traumatic events is well-documented. • Early and thorough intervention may be the key to preventing responders from suffering severe psychological trauma that may lead to a myriad of dysfunctional behaviors. • CISM is necessary for community resilience and organizational continuity.
- 16. Benedek, D.M., Fullerton, C., & Ursano, R.J. (2007). First responders: mental health consequences of natural and human-made disasters for public health and public safety workers. Retrieved from https://online.columbiasouthern.edu/CSU_Content/Courses/Emergency_Services/MSE/MSE5301/14D/Unit%20III_Mental%20Heal th%20Workers.pdf Bressert, S. (2017). Acute Stress Disorder Symptoms. Psych Central. Retrieved on May 9, 2018, from https://psychcentral.com/disorders/acute-stress-disorder-symptoms/ Cheslow, D. (2018, January 31). Power, to the people. Retrieved from https://pv-magazine-usa.com/2018/01/31/power-to-the-people/ Deloe, J. (2016, February 11). 10 things people with PTSD want you to understand. Retrieved from https://www.healthyplace.com/blogs/traumaptsdblog/2016/02/10-things-people-with-ptsd-want-others-to-understand DeRousse, J. (2014, November 9). Critical incident stress management: not a one size fits all concept. Retrieved from https://medium.com/homeland-security/critical-incident-stress-managment-c-i-s-m-f8d41e2fa819 Early, J. (2013, January 24). PTSD and Police Officers at the Newtown Massacre. Retrieved from https://ncworkcompjournal.com/category/first-responders/
- 17. Elk Valley Critical Incident response Team. (n.d.). Critical incident stress management. Retrieved from http://www.evcirt.org/cism/ First Responder. (2018). In Dictionary.com. Retrieved from http://www.dictionary.com/browse/first-responder?s=t Flagler Volunteer Services. (2018, February 26). Psychological first aid workshop. Retrieved from https://allevents.in/bunnell/psychological-first-aid-training-workshop/121694865244908 GoodTherapy.com. (2015, August 13). Critical incident stress management. Retrieved from https://www.goodtherapy.org/learn- about-therapy/types/critical-incident-stress-management Guenthner, D.H. (2012, January 3). Emergency and crisis management: critical incident stress management for first responders and business organisations. Retrieved from https://online.columbiasouthern.edu/CSU_Content/Courses/Emergency_Services/MSE/MSE5301/14D/Unit%20III_Emerge ncy%20and%20Crisis%20Management.pdf JMA Educational Services. (2016). ACT for First Responders. Retrieved from http://jmarlinandassociates.com/lunch-and- learns/act-for-first-responders/ Lovewithclarity.com. (2018, May 1). Emotional safety: the main ingredient of healthy living. Retrieved from http://www.lovewithclarity.com/emotional-safety-one/
- 18. Newman, J. (2018, January 2). After a trauma acute distress disorder. Retrieved from http://borssakingdom.com/after-a-trauma-acute- stress-disorder/ Raghavendra, K.S. (2016). The crystal ball approach. Retrieved from http://www.kumartalks.com/2016/09/the-crystal-ball-approach.html Sonoma County Fire & Emergency Services. (2011, February 10). Procedure manual Safety Program: Critical Incident Stress Management. Retrieved from http://www.sonoma-county.org/fire/pdf/fire/sop/2_8_13_critical_incident_stress_management.pdf Staggs, S. (2018). Posttraumatic Stress Disorder (PTSD) Symptoms. Psych Central. Retrieved on May 11, 2018, from https://psychcentral.com/disorders/ptsd/posttraumatic-stress-disorder-ptsd-symptoms/
Editor's Notes
- CISM consists of multiple crisis intervention components and spans the length of the crisis The realization of Critical Incident Stress (CIS) and its impact on responders, the community, and business does not usually come until after a crisis strikes. The traditional approach to address CIS (i.e. talking through or reliving the event) failed. Clinicians and researchers are now starting to take the approach of Psychological First Aid (PFA), which is much less intense and teaches coping skills. Research has shown that PFA is the most appropriate intervention methodology to help manage critical incident stress during and after a disaster or crisis. (Guenther, 2012)
- First Responder – a certified, often volunteer, emergency, medical, or law enforcement officer who is first to arrive at an accident or disaster scene (Dictionary.com, 2018) Non traditional First responders augment the roles of traditional first responders. In regards to identifying who should receive CISM care, these non-traditional role players highlight the need to expand the definition of “first responder” and may also suggest an expanded definition of “public health worker.” (Bendeck et al, 2007)
- As a response to the traumatic event, the individual may develop dissociative symptoms and decreased emotional responsiveness CISM Team members must be trained to observe and identify characteristics of individuals that may be suffering from ASD And may have a feeling as if he/she is experiencing the world as if it is unreal or dreamlike (Bressert, 2017)
- PTSD is most often experienced by people who have been in combat situations but it is also seen in traumas associated with emergency situations with injuries and devastation and abuse. There is no longer a requirement that someone has to have an intense emotional response at the time of the event. (Staggs, 2018)
- More often than not, the individual suffering from PTSD must have had the characteristics for at least a month and these characteristics seriously affect one’s ability to function. The characteristics also cannot be associated with substance use, medical illness, or anything else except for the event itself (Staggs, 2018) CIS Disorders are not limited to ASD and PTSD. Affected individuals may show other characteristics and signs such as: burnout depression substance use disorder (SUD) Suicide (Guenthner, 2012)
- Usually large, multi-faceted, significant events bring a high potential for psychological distress in otherwise healthy, normal people. (Sonoma County, 2011)
- The CISM team’s responsibility is to provide an organized approach to management of stress responses for first responders and public safety and health workers, and non-traditional workers so that they may discover coping mechanisms. (Sonoma County, 2011)
- The psychological and behavioral consequences for individuals and communities of public health workers affected by disaster are needed in any plan for interventions before, during, and after a disaster. Many disastrous or less disastrous emergency events that fall outside the range of what we may call “ordinary human experiences” often provoke a strong emotional feeling(s) in the individuals who experience it When this occurs, the psychological needs of the person who experienced the event must be addressed. Previously, Critical Incident Stress (CIS) was dealt with traditionally in that the distressed person was urged to talk through the traumatic experience. However this proved to be ineffective with this type of traumatic experience The result was using the Psychological First Aid (PFA) approach which is not as intense and incorporated coping skills (Guenthner, 2012).
- Safety: Develop a physically safe environment; identify safe areas and behaviors Efficacy (individual and community): Maximize individuals’ ability to care for self, family, and others through measures, clear policies, guidance (e.g., evacuation or shelter-in-place procedures; mechanisms for obtaining food, shelter, vaccination, medical care) Calmness: Teach and encourage relaxation and calming skills and maintenance of natural body rhythms (e.g., nutrition, sleep, rest, exercise) Connectedness: Maximize and facilitate connectedness to family and other social supports to the extent possible Foster hope and optimism without minimizing ongoing risks (Benedek et al, 2007)
- Other components the CINAT must strive for: Facilitate social connectedness Foster optimism Decrease arousal Restore self-efficacy through psychoeducation Basic relaxation training Cognitive reframing Assist in the implementation of psychological first aid in the workplace, Identify at-risk individuals and groups, Provide consultation to leadership around risk communication Champion grief leadership Establish psychological consequence mitigation strategies within the work place (Benedek et al, 2007)
- As soon as feasible during the incident the designated Safety Officer or Incident Commander initiates the CISM process and the CISD Whenever possible, the defusing shall take place immediately following the incident or within 48 hours of the incident. Only those involved in the incident and members of the Fire Department’s Critical Incident Stress Management team members shall attend the defusing. If a responder (s) needs additional debriefing and or therapeutic treatment, the CISM program should identify all measures that assist the member in receiving what is necessary
- On scene – CISM team members response to the scene and observe for CIS triggers. Initial defusing – This is an informal process occurring shortly after the incident and encourages an open, free expression of feelings without a critique of the incident or the personnel's response. Formal CISM debriefing - led by a qualified mental health professional from the CISM team, and will take place approximately 24 to 48 hours after the conclusion of the incident. Follow-up debriefing – Performed several weeks or months after a critical incident, may be held, if necessary (Sonoma County, 2011)
- Defenders of CISM insist that many of the studies that portray CISM as ineffective are scientifically flawed. Conflicting research on the efficacy of CISM may be cause for caution. Individuals should seek support from trained professionals. CISM techniques should be delivered appropriately, by certified personnel, and with the utmost care. (GoodTherapy.com, 2015)