Primary Principles Of Crisis Intervention:
- Proximity: Crisis work should be provided in those surroundings that are familiar to the people who need support.
- Immediacy: Help should be provided as soon as possible after the exposure to a traumatic exposure.
- Simplicity: In the midst of a crisis, complexity is not very well handed. The crisis support provider should focus on solutions that are easy for a distressed person to apply.
- Brevity: Actions to assist people should be brief but not so much as to compromise the final goal.
- Expectancy: The provider of the crisis intervention should instil some hope that it is possible to manage and resolve the situation.
What Can Cism Do For You
Debriefing – A debriefing, usually held 24-72 hrs after an event, is intended for the first responders after a horrific event for your and other participating organization members who were on scene to discuss the event and help them deal with the emotions they are feeling including sadness, grief, fear, wanting to quit, etc. Please note: dispatchers are presumed to be on scene.
Defusing – A meeting for first responders immediately following a horrific event and sometimes during a long lasting event to “unload” emotions and or frustrations of what has or is unfolding.
Training – Informative training events to help you deal with stressors, manage your life, and recognize warning signs and symptoms of mental exhaustion.
What Are Considered Critical Incidents
Critical incidents are unusually challenging events that cause a powerful emotional reaction and have the potential to create significant human distress and potentially overwhelm one’s usual coping mechanisms. The pandemic presents an unusually challenging event contributing to increased stress in the workplace.
During the COVID-19 pandemic, CISM support may be required if any of the following scenarios apply:
- Evidence of cumulative stress in your staff
- Anticipatory anxiety/fear
- Events where staff are threatened for feeling threatened
- Any distressing situation
- Knowing or being related to a patient
- Prolonged incidents
- Events with excessive media interest or
- Events involving children or other vulnerable populations.
How Do You Debrief
How to Conduct a Debrief
Common Reactions To Critical Incidents
Each person’s experience is different, however there are some common reactions among people caught up in a critical incident. It can be reassuring to know that these reactions are not unusual.
Some common reactions and feelings are
- Disbelief at what has happened.
- Numbness – the event may seem unreal, like a dream.
- Of death or harm to yourself or your family.
- Recurrence of the event.
- You may experience panic or anxiety.
- Outrage at what has happened or at who “caused it, or allowed it to happen”.
- Anger at the injustice and senselessness of it all.
- Anger at other emergency service personnel or the public for not acting quickly enough.
- The feeling of helplessness because of the inability to prevent some things from happening.
Shame or Guilt
- For having been exposed as helpless, emotional and needing others.
- For not having reacted as you would have wished.
- For not having reacted as others have.
- If you have made a mistake.
- For the loss of the belief that the world is safe and predictable.
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The Components Of Crisis Intervention
The CISM package includes integrated, multi-component crisis intervention strategies that are useful in the aftermath of a traumatic event. The type of intervention used depends on the situation, the number of people involved, and their proximity to the event. One form of intervention is a three-step approach, whereas different approaches include as many as seven steps. The exact number of steps is not what is important for the intervention’s success, however. The goal of the intervention is to address the trauma.
The Importance Of Vetting Mental Health Professionals
One of our main efforts, and challenges is ensuring that every firefighter is referred to a qualified mental health professional who understands the culture of the job.
The fear of someone being unfamiliar with the culture is the main reason firefighters tend to avoid seeking a mental health professional.
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Impacts Of Traumatic Stress On An Agency
Besides taking a toll on the individual, traumatic stress has an impact on the agency. The effects of traumatic stress on organizations often include:
- Communication breakdowns
- Increased healthcare costs including increased workers compensation and disability claims
These financial and morale costs can cause long-term damage to an agencys community support, resource budget and recruiting opportunities.
It is important that agencies address the cognitive, emotional, physical and behavioral symptoms associated with traumatic stress by implementing CISM interventions. Such implementation often includes one-on-one sessions, debriefings and defusing sessions that are co-facilitated by mental health professionals and peers to combat traumatic stress. Agencies need to take proactive steps to help officers heal and recover from traumatic-stress incidents.
Carrie Kahn Courtney, RCSWI, wears many hats as a grant writer, social worker, disaster behavioral health specialist for adults and children, addictions professional, cadre trainer for the Disaster Technical Assistance Center, Vice President of Volusia Interfaith Networking in Disaster, Outgoing Chair for the Mental Health Association of East Central Florida, and Advanced Responder for the Florida Crisis Consortium.
To contact the authors, please send an email to .
Incidents That Might Result In A Cism Response
- Major disaster/mass casualties
- Serious injury, line of duty death or suicide of fire department personnel.
- Serious injury or death of civilian resulting from fire department operations.
- Death or serious injury of a child.
- Multiple fatality incidents
- Any incident which attracts large scale media attention.
- Loss of life following unusual or extremely prolonged expenditure of emotional and physical energy from Fire department personnel.
- Any unusual incident in which the potential for an immediate or delayed emotional response is high.
- Accumulating stress reactions over long periods of time, after involvement in many previous critical incidents.
TFD Officers and supervisors are responsible for identifying/recognizing significant incidents that may qualify for debriefing. A significant incident may include any incident where the probability is high for a negative stress reaction to the incident by one or more members. When an incident is identified, a request for debriefing consideration should be made through the CISM Team as soon as possible.
Any member who believes an individual has further needs after meeting with the CISM team may initiate the process of contacting the City of Topeka EAP program.
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Concerns Limitations And Contraindications Of Cism
Critical incident stress management has often been criticized for its lack of efficacy in preventing symptoms of posttraumatic stress and reducing the impact of acute stress response. According to a literature review published in Prehospital Emergency Care the official journal of the National Association of EMS Physicianssome research indicates that CISM techniques like CISD can actually increase the likelihood that trauma will have a greater psychological impact.
Defenders of CISM insist that many of the studies that portray CISM as ineffective are scientifically flawed. Additionally, CISM supporters argue that these research studies incorporated techniques improperly or used non-CISM techniques such as single-session debriefings. Single-session debriefings are not sanctioned or encouraged by the developers of CISM or the International Critical Incident Stress Foundation.
Overall, conflicting research on the efficacy of CISM may be cause for caution. As with all interventions, therapies, and treatments, it is paramount that individuals seek support from trained professionals. In general, people on both sides of the CISM debate agree that CISM techniques should be delivered appropriately, by certified personnel, and with the utmost care.
- Client referrals
The Cism Team May Respond To The Following:
- Death of a city/county service worker, i.e. law enforcement, firefighter, social worker , or emergency personnel in the line of duty: during an incident, en route to an incident, or during a training exercise.
- Serious line of duty injury to city/county employees or first responders.
- Suicide or other unexpected death of a co-worker.
- Mass Casualty Incidents.
- Serious injury or death of a civilian resulting from emergency services operations, i.e. auto accident, etc.
- Officer related shooting
- Events that seriously threaten the lives of responders/service personnel.
- Loss of life of a patient following extraordinary and prolonged expenditure of physical and emotional energy during rescue efforts by emergency/ services personnel.
- Personal identification with the victim or the circumstances. Events where the victims are relatives or friends of county, city or service personnel.
- Any incident in which the circumstances were so unusual or the sights and sounds so distressing as to produce a high level of immediate or delayed emotional reaction.
- Natural disasters in the county. i.e. floods, fire, etc.
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Critical Incident Stress Management Peers
CISM methods are based on peer-supported crisis interventions. The particular strength of the peer concept lies not only in the physical proximity to those who need help but in the professional proximity. They share the same professional understanding of job-related processes so they can deeply understand how someone feels after a job-related critical incident. In order to provide assistance, peers need to follow initial as well as refresher training.
Support Given By Critical Incident Stress Management Response
Critical Incident Stress Management Response offers structured social support following a critical incident
The service aims to:
- prevent harmful effects by working with you at the time of a critical incident
- provide you with social support, and coping and self-management techniques
- help you to return to normal team working
- identify if you need a referral to the Employee Assistance Programme
The Employee Assistance Programme will:
- assess the impact of the critical incident
- identify appropriate CISM supports
- provide follow-up support
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How Critical Incident Stress Management Interventions Help Heal Responders
Agencies need to take proactive steps to help responders heal and recover from traumatic-stress incidents
By Dr. Chuck Russo, Program Director, Criminal Justice at American Military University, and Carrie Kahn Courtney
First responders are trained to utilize tactical strategies in crisis situations, so they can quickly protect lives and property. However, high-crisis incidents can overwhelm normal coping mechanisms and trigger traumatic-stress disorders for first responders.
Officer-involved shootings, line-of-duty deaths and injuries, child victims, employee suicide and mass-casualty incidents are all events that can trigger traumatic-stress disorders for first responders. Common effects of traumatic stress include:
Is Cism Used With Other Treatments Or Services
Critical incident stress management can be used in conjunction with various types of crisis intervention. If the critical incident occurs at the workplace, CISM might be used as a part of the employer’s employee assistance program . Additionally, CISM can be used as a precursor to psychotherapy.
Although CISM has therapeutic elements, it should not be mistaken for psychotherapy. People seeking help for mental health issues beyond an immediate response to a traumatic event should be directed to find a therapist or a similarly qualified mental health professional. An article in Psychiatric Quarterly outlines the differences between psychotherapy and CISM. CISM is short-term and focused on the here-and-now, whereas psychotherapy can be long-term and focused on the past, present, and future. Psychotherapy is always delivered by a mental health professional, but CISM can be provided by trained professionals of all kinds. The goal of CISM is to manage immediate trauma response and reduce distress, whereas psychotherapy involves a varied spectrum of short and long-term goals toward growth and change.
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Topeka Fire Department Cism Team Members
- 2 Topeka Fire Department Chaplains
- 1 Topeka Fire Department Battalion Chief
- 5 Topeka Fire Department members.
All members are trained to national standards. The focus of this service is to minimize the harmful effects of our job, particularly in crisis or emergency situations. The highest priority of the team is the confidentiality and respect for the feelings of the individuals involved. It is not the function of the team to replace on-going professional counseling, but to provide stress management education and immediate crisis intervention.
Critical Incident Stress Management Team
The Utah Critical Incident Stress Management Program has been established to assist emergency service workers throughout the State. The CISM Team comprises mental health professionals and peer support personnel who are trained to assist emergency responders in dealing with the stress of their profession.
The main objective of CISM is to provide crisis intervention during or after critical incidents in order to minimize stress-related injuries to emergency personnel. CISM is both a psychological and educational group process designed to:
Some examples of critical incidents are suicide, death, or serious injury of an emergency service worker high media interest in an event a prolonged event injury or death of a child a mass casualty incident threats to an emergency service worker’s safety a natural disaster or any event that troubles an emergency worker who participated in the event.
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Critical Incident Stress Management
Critical incident stress management is a type of crisis intervention designed to provide support for those who have experienced traumatic events. CISM is comprised of multiple crisis response components that attempt address each phase of a crisis situation. It can be implemented with individuals, families, groups, organizations, and communities. Although some research has found CISM to be ineffective and even harmful, defenders of CISM argue that, when implemented properly, this intervention offers powerful crisis support.
A Primer On Critical Incident Stress Management
George S. Everly, Jr., Ph.D., C.T.S. and Jeffrey T. Mitchell, Ph.D., C.T.S.The International Critical Incident Stress Foundation
As crises and disasters become epidemic, the need for effective crisis response capabilities becomes obvious. Crisis intervention programs are recommended and even mandated in a wide variety of community and occupational settings . Critical Incident Stress Management represents a powerful, yet cost- effective approach to crisis response which unfortunately is often misrepresented and misunderstood.
What is CISM? CISM is a comprehensive, integrative, multicomponent crisis intervention system. CISM is considered comprehensive because it consists of multiple crisis intervention components, which functionally span the entire temporal spectrum of a crisis. CISM interventions range from the pre-crisis phase through the acute crisis phase, and into the post-crisis phase. CISM is also considered comprehensive in that it consists of interventions which may be applied to individuals, small functional groups, large groups, families, organizations, and even communities. The 7 core components of CISM are defined below and are summarized in TABLE 1.
1. Pre-crisis preparation. This includes stress management education, stress resistance, and crisis mitigation training for both individuals and organizations.
5. One-on-one crisis intervention/counseling or psychological support throughout the full range of the crisis spectrum.
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How Do I Debrief My Staff
Here’s Level One on how to break it down when you’re using debriefing techniques:
Some Signs And Symptoms Of Concern
|Cognitive Poor Concentration Difficulties with calculations Poor attention span Memory problems Difficulty making decisions Slowed problem solvingEmotional Guilt Depression Grief Anger Feeling lost Overwhelmed Anxiety Fear Loss of emotional ControlPhysical Muscle tremors Chest pains Gastrointestinal distress Difficulty breathing Headaches Elevated blood pressure||Behavioral Excessive Silence Sleep disturbances Extreme Behavioral change Changes in eating habits Withdrawal from contact Change in work habits Anger at Deity Anger at Clergy Sense of isolation from Deity Questioning basic beliefs Loss of meaning or purpose Faith practices seem empty Withdrawal from place of worship Uncharacteristic religious involvement|
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Peers Selection And Recruitment
The following activities are advisable:
- Define the number of peers required. The adequate number will depend on the location of the team, number of ATCOs served, types of call out procedures and availability of resources. It is important to keep in mind that a failure in call out procedure and intervention has the effect of deteriorating confidence in the CISM team ability to respond to a crisis.
- Define the number of Mental Health Professionals required.
- Detail peers required skills.
- Consider the selection of local CISM coordinators.
- Consider the support of external professional resources .
- Select team/peers members.
At this stage, focus should be on:
- Defining the contents of modules and developing training documentation
- Defining by which means the training is to be delivered
- Ultimate timetable including venues for the training to take place
- Planning of not only initial but also refresher training
- Planning of succession for leaving CISM peers
Cism And Employee Assistance Program
While Employee Assistance Programs services include response to crisis and trauma, EAP cannot provide peer support which is the foundation of the ICISF intervention models we utilize in wildland fire.
The Peer Support Program can be seen as the connecting link between the employees and EAP services. The Peer Support Program and Employee Assistance Programs often complement each other to help employees, especially for follow-up care after crisis interventions services.
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What Is A Critical Incident
Emergency services personnel may be exposed to critical incidents at any time during their careers. A critical incident is any event that has a stressful impact sufficient enough to overwhelm your usual coping strategies. Critical incidents can be sudden, shocking and outside the range of ordinary human experience. However, it may also be an event that has a specific personal significance to the individual and may result in strong emotional and/or physical reactions.
These reactions are relatively normal and commonplace. In fact, up to 87% of all emergency service personnel are affected at some time during their careers by a critical incident. Work experience, years of service or experiencing similar incidents do not necessarily make emergency service personnel immune to the impact of critical incident stress.
There is a range of strong emotional effects associated with traumatic events which are common. Learning to recognise these reactions and emotions that occur following an abnormal event can help you to understand and feel more at ease with these feelings. This in turn can help you adjust to what has happened.