Critical Incident Stress Management

Overview
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.

Development
It was developed to be a peer-delivered, frontline help for emergency services personnel to help them cope with the trauma they experience every day. Every firefighter, police officer, emergency medical technician, soldier, victim, etc. who is involved in an incident is at risk of suffering from critical incident stress. Even a routine incident can cause an adverse reaction because stress is cumulative and subjective and only continues to build up if we don't take adequate actions to decrease it.

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. They are: 1. Line of duty deaths 2. Suicide of a colleague 3. Serious work related injury 4. Multi-casualty / disaster / terrorism incidents 5. Events with a high degree of threat to the personnel 6. Significant events involving children 7. Events in which the victim is known to the personnel 8. Events with excessive media interest 9. Events that are prolonged and end with a negative outcome 10. 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. 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. 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, 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. 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. On the other hand, Jacobs, Horne-Moyer and Jones 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.