Critical Incident Stress Management

Critical Incident Stress Management is an adaptive short term helping process that focuses solely on an immediate and identifiable problem to enable the individual(s) affected to return to their daily routine(s) more quickly and with a lessened likelihood of experiencing post-traumatic stress disorder. [http://www.vbgov.com/dept/ems/vgn_files/103.01.01.Critical_Incident_Stress_Mgt_Policy.pdf accessed online 9 Aug 2006]

Purpose

Critical Incident Stress Management is designed to help people deal with their trauma one incident at a time by allowing the individual to talk about the incident when it happens without judgment or criticism. The program is "peer-driven" and the people giving the treatment may come from all walks of life, but most are first responders or work in the mental health field. All interventions are strictly confidential, the only caveat to this is if the person doing the intervention determines that the person being helped is a danger to themself or to others. The emphasis is always on keeping people safe and returning them quickly to more "normal" levels of functioning.

"Normal" is different for everyone, and it is not easy to quantify. Critical incidents raise stress levels dramatically in a short period of time and after treatment a new "normal" is established, however, it is always higher than the old level. The purpose of the intervention process is to establish set the new "normal" stress levels as low as possible.

Critical incidents are traumatic events that cause powerful emotional reactions in people who are exposed to those events. Every profession can list their own worst case scenarios that can be categorized as critical incidents. Emergency services organizations, for example, usually list the "Terrible Ten" [ http://www.sgsp.edu.pl/sos/mitchel/wyklady/stress.pdf Stress Management, Jeffrey T. Mitchell, Ph.D., CTS ] . They are:1. Line of duty deaths2. Suicide of a colleague3. Serious work related injury4. Multi-casualty / disaster / terrorism incidents5. Events with a high degree of threat to the personnel6. Significant events involving children7. Events in which the victim is known to the personnel8. Events with excessive media interest9. Events that are prolonged and end with a negative outcome10. Any significantly powerful, overwhelming distressing event

Types of Intervention

There are different types of interventions for various situations. The most stressful being line of duty deaths, co-worker suicide, multiple event incidents, delayed intervention and multi-casualty incidents. [ http://www.emedicine.com/emerg/topic826.htm#section~critical_incident_stress access online 9 Aug 06 ] The type of intervention used depends on the situation, the number of people involved, and their proximity to the event. The optimum is a three-step approach that addresses the trauma at various stages of progression. A defusing is done the day of the incident before the person(s) has a chance to sleep. The defusing is designed to assure the person/people involved that their feelings are normal, tells them what symptoms to watch for over the short term and to offer them a lifeline in the form of a telephone number where they can reach someone who they can talk to. A debriefing is normally done within 72 hours of the incident and gives the individual or group the opportunity to talk about their experience, how it has affected them, brainstorm coping mechanisms, identify individuals at risk, inform the individual or group about services available to them in their community. [ http://www.csc-scc.gc.ca/text/plcy/cdshtm/253-2-cde_e.shtml#intervention sections "d", "e", and "f" accessed online 9 Aug 2006 ] The final step is to follow up with them the day after the debriefing to ensure that they are safe and coping well or to refer the individual for professional counselling.

Methodology

Defusings are limited only to individuals directly involved in the incident and are often done informally, sometimes at the scene. They are designed to assist individuals in coping in the short term and address immediate needs.

Debriefings are usually the second level of intervention for those directly affected by the incident and often the first for those not directly involved.

There are a variety of methodologies currently in use for debriefing. The most common process used is a seven step programme [ http://www.emedicine.com/emerg/topic826.htm#section~treatment accessed online 9 Aug 06 ] , although some organizations use a three step programme. The seven steps are: "introduction" of intervenor and establishment of guidelines; "details of the event" given from individual perspectives; "emotional responses" given subjectively; "personal reaction and actions"; "symptoms" exhibited since the event; "instruction phase" where the intervenor assures individuals that their responses to the event are normal; and "resumption of duty" where individuals are returned to their normal tasks. The intervenor is always watching for individuals who are not coping well and additional assistance is offered at the conclusion of the process. [http://www.emedicine.com/emerg/topic826.htm "The 7 phases of debriefing" accessed online 9 Aug 2006 ] All of the methodologies currently in use have "follow-up" as the final step. This is always done after the intervention, optimally within twenty-four hours.

Criticism

A number of studies have shown that CISM has little effect, or that it actually worsens the trauma symptoms [ [http://ccforum.com/content/6/1/88 Critical Care | Full text | Concerns about the effectiveness of critical incident stress debriefing in ameliorating stress reactions ] ] . On the other hand, Jacobs, Horne-Moyer and Jones [cite journal |author=Jacobs J, Horne-Moyer HL, Jones R |title=The effectiveness of critical incident stress debriefing with primary and secondary trauma victims |journal=Int J Emerg Ment Health |volume=6 |issue=1 |pages=5–14 |year=2004 |pmid=15131998 |doi= |url=] argue that CISM has beneficial effects when conducted with emergency services personnel, but does not work or does more harm than good with accident victims.

ee also

* Stress management
* Stress (medicine)
* Clinical psychology

References

External links

* [http://defendyourself101.ca/articles/why-you-should-talk-lawyer-talking-police Why you should talk to a lawyer before talking to the police...] A review of the effects of high stress due to violence (called either critical incident stress, CIS or Sympathetic Nervous System Stress, SNS) and how stress impacts on witness statements to police.
*http://www.icisf.org
*http://www.traumaresolution.com
*http://www.emedicine.com/emerg/topic826.htm#section~psychological_mechanisms
*http://efap.torontopolice.on.ca/pdf/dr_solomon.pdf
* [http://airforcemedicine.afms.mil/idc/groups/public/documents/webcontent/knowledgejunction.hcst?functionalarea=LeadersGuideDistress&doctype=subpage&docname=CTB_030121&incbanner=0 US Air Force Site for managing personnel in distress]
* http://www.ctsn-rcst.ca/PsyQuébecA.html
* [http://cc-cism.org Cuyahoga County (Ohio) Critical Incident Stress Management Team (CC-CISM)]