Critical Incident Stress Management

Health care workers in emergency medical services and critical care are everyday exposed to stresses not normally encountered by the lay public. While we share the happiness of patients and families who get better because of our efforts, we also share in the frustration and sorrow of those who don't. Part of the job is maintaining a critical balance between empathy and a certain desensitization that allows us to effectively perform our jobs. Sometimes, however, situations or crises occur that have us experience emotions that are overpowering and can actually interfere with our ability to function. Situations, such as these, are known as "Critical Incidents".

It's easy to understand that a terrorist bombing and it's aftermath of destruction would easily qualify as a critical incidents, but there are other, more common events that are just as devastating. These include the suicide of a co-worker, the sudden death of a child, treating a victim of child abuse or treating a friend who is critically injured in an accident. Sometimes critical incidents are less well defined; basically a critical incident is any incident that the individual worker feels is critical to them.

Healthcare and EMS workers who are exposed to the stress created by critical incidents are proven to be much more prone to developing professional burn-out. They may develop symptoms of post traumatic stress disorder: difficulty sleeping, depression, recurrent nightmares, "flashbacks", and a general inability to continued functioning effectively in their chosen occupations.

The result of this is that every year we lose some of the best trained and most experienced emergency workers to the effects of chronic critical incident stress.

In recent years the emergency medical services, in conjunction with mental health professionals, developed a program known as Critical Incident Stress Management or CISM. When a critical incident occurs, a debriefing should take place within 24 to 72 hours of the incident. During the debriefing, the individuals involved in the critical incident meet with a team of peer counselors and mental health professionals to discuss the incident and begin processing and working through it.

A CISD is held in 7 phases;

  • Introduction: Individuals are assured that everything discussed during the debriefing will be kept confidential. Nothing said in the debriefing will affect their job in any way.
  • Facts: Individuals get to go over actual details of the critical incident.
  • Reactions: The group members discuss their reactions about what happened.
  • Symptoms: The members are encouraged to discuss any mental, physical or emotional symptoms they experienced during the incident.
  • Teaching: The debriefers help the members sort out their feelings and the symptomsthey described. They help them to see that their reactions are normal.
  • Re-entry:The debriefers evaluate information discussed in the meeting and offersuggestions as to how the participants can deal with the stresses and actually help them form a plan for returning to their job. If needed, plans are made for follow-upactivities or treatments.
  • Follow-up: Follow-up can be held weeks or months later if needed to address any unresolved issues

    A debriefing should include everyone involved in the incident; nurses, police, EMS workers, fire and rescue personnel. In some case it may even be appropriate to include spouses, as they are the ones who are so frequently exposed to the after effects of critical incident stress.

    Another specialized version of CISD is known as "Defusing". Defusing is an abbreviated, earlier form of CISM that usually involves only the people who were the most directly involved in the incident. It usually last less than an hour and sets the stage for later full debriefings. In the Oklahoma City bombing, as emergency workers finished their shifts, they attended defusings and later debriefings.

    CISM works by helping individuals vent their reactions rapidly. This aids in the more rapid processing and assimilation of the experiences and emotions that occurred in response to the critical incident. When CISM is properly utilized it drastically reduces the subsequent development of symptom's of posttraumatic stress and professional burn-out.

    CISM Texts and Study Guides:

    (to order click on the book title)


    Critical Incident Stress Management (CISM) : A New Era and Standard of Care in Crisis Intervention ~

    by George S.,Jr Everly, Jeffrey T. Mitchell, Published 1999
    Price: $27.00

    Critical Incident Stress Debriefing : CISD : An Operations Manual for the Prevention of Traumatic Stress Among Emergency and Disaster Workers ~

    by George S.,Jr Everly, Jeffrey T. Mitchell, Published 1995
    Price: $32.00

    • Critical Incident Stress Debriefing : CISD : An Operations Manual for the Prevention of Traumatic Stress Among Emergency and Disaster Workers ~

    by George S.,Jr Everly, (editor), Published 1996
    Price: $29.00

    Human Elements Training for Emergency Services, Public Safety and Disaster Personnel: An Instructional Guide to Teaching Debriefing, Crisis Intervention and Stress Management Programs ~

    by Jeffrey T. Mitchell, George S. Everly, Published 1994
    Price: $32.00

    Critical Incident Stress Management Internet Links:


    ICISF - International Critical Incident Stress Foundation

    START - Surface to Air Response Team (Air-Medical) CISM Team

    ISTSS - International Society for Traumatic Stress Studies

    Traumatology

    SARBC Search and Rescue of British Columbia (has CISM specific areas)

    FMBA - Fireman's Mutual Benevolent Association CISM Network

    Granite State CISD Team

    Athens, Ohio CISM Team

    Australian Critical Incident Stress Management and Peer Support

    Hocking Valley, Ohio CISM Team

    Kenawha, Ohio CISM Team

    Michigan Crisis Response Association

    North Dakota CISM System

    San Luis Valley, Colorado Critical Incident Team

    South Teir Regional EMS CISM Team, Elmira, New York

    Texas Critical Incident Stress Network

    Victoria, Australia Emergency Services CISM Team

    E-mail comments Here! Or return to the Seaox Air-Medical Homepage

    Last modified on 30 November 1999.