Critical Incident Stress Management

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM
MISSION STATEMENT To minimize the potentially
harmful stress- related symptoms associated with
critical incidents affecting emergency service
personnel and their families through timely
confidential crisis intervention that is
empathic and respectful toward all involved.
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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• TEAM MISSION - Expanded
• The mission of the team is not to debrief the
  public or victims
• of disasters. However, the mental health members
  may make appropriate referrals. Exceptions will
  be discussed with the clinical or program
  coordinator.
• CISM Teams provide debriefing following
  critical
• incidents to any emergency response agency
  requesting
• assistance. The focus of this service is to
  minimize the
• harmful effects of job stress, particularly
  in crisis or
• emergency situations.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM
THE CONCERN Emergency services personnel have
become increasingly aware of the toll that
unique occupation- related stressors may have on
their quality of life. The very nature of
emergency service jobs may expose these
individuals routinely, or periodically, to
stressful events which they may or may not be
able to work through satisfactorily on their
own. Factors which cause stress to one
individual may not be stressful for another.
worker or group of emergency workers.
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CRITICAL INCIDENT STRESS MANAGEMENT TEAM (CISM)
TEAM
THE CONCERN (Continued) It has been
demonstrated that certain events, such as the
death of a child, the death of a co-worker, high
rise fires or multiple casualty incidents, are
particularly stressful for emergency workers. It
has been demonstrated that certain events, such
as the death of a child, the death of a
co-worker, high rise fires or multiple casualty
incidents, are particularly stressful for
emergency workers. Any of these events, plus a
host of others may cause or contribute to a
critical incident for an emergency worker or
group of emergency workers.
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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM
THE CONCERN (Continued) Research has shown
that a very small percentage of emergency service
personnel are not actually affected by stress. Of
those who do demonstrate symptoms related to
stress, one-half can resolve these alone, while
the other half continue to be affected.
Responses to stress may be immediate and
incident specific, may be delayed for a period of
time after an incident, or may be cumulative,
building up after a long period of time and may
include many incidents.
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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM
THE CONCERN (Continued) Multiple factors
affect an individual's response to stress and
include factors specific to the stressor, such as
the individual's personal qualities, past
experiences and the resources available to him
or her.
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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM
A CRITICAL INCIDENT A critical incident is a
traumatic event, in an institution or in the
community, that is outside the range of usual
human experience and that may cause unusual
psychological distress and has sufficient
emotional power to affect a person's ability to
cope with the consequences of the event.
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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM
A CRITICAL INCIDENT Jeffrey Mitchell, founder
of the International Critical Incident Stress
Foundation (ICISF), has defined a critical
incident as "any situation faced by emergency
service personnel that causes them to experience
unusually strong emotional reactions which have
the potential to interfere with their ability to
function either at the scene or later. All that
is necessary is that the incident, regardless of
the type, generates unusually strong feelings in
the emergency workers."
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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• CRITICAL INCIDENT EXAMPLES
• Death of an emergency services worker, i.e.
  law
• enforcement, fire fighter or other emergency
• personnel in the line of duty, including
  during the
• incident, enroute to or following the scene,
  or
• during a training exercise.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• CRITICAL INCIDENT EXAMPLES (Continued)
• Serious line of duty injury.
• Suicide of a crew member or other unexpected
  death.
• Mass casualty incidents.
• Serious injury or death of a civilian
  resulting from
• emergency services operations, i.e. auto
  accident, etc.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• CRITICAL INCIDENT EXAMPLES (Continued)
• Police shooting.
• Events that seriously threaten the lives of
  responders.
• Death of a child or violence to a child.
• Loss of life of a patient following
  extraordinary and
• prolonged expenditure of physical and
  emotional
• energy during rescue efforts by emergency
  services
• personnel.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• CRITICAL INCIDENT EXAMPLES (Continued)
• Incidents that attract excessive media
  coverage.
• Personal identification with the victim or the
• circumstances.
• Events where the victims are relatives or
  friends of
• emergency personnel.
• Any incident that is charged with profound
  emotion.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• CRITICAL INCIDENT EXAMPLES (Continued)
• 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.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM
A SOLUTION The CISM Team has been established
to provide a form of crisis intervention
specifically designed to assist emergency workers
to reduce the number of psychological casualties
among their ranks. Through critical incident
stress debriefing, emergency personnel are
provided a tool to potentially alleviate
overwhelming emotional feelings and physical
symptoms.
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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• THE TEAM
• The CISM Team consists of a multidisciplinary
  group of certified ICISF-trained professionals.
  Debriefers are volunteers who are familiar with
  emergency services. They are carefully selected
  from the following groups
• Mental health professionals
• Fire service personnel
• Chaplains
• Law enforcement
• Emergency Medical Services
• Field personnel from various agencies

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• THE TEAM (Continued)
• The highest priorities of the team are to
  maintain
• confidentiality and to respect the feelings
  of the individuals
• involved.
• It is not the function of a team to replace
  on-going
• professional counseling, but to provide
  immediate crisis
• intervention. Through the CISM process, a
  team provides
• emergency personnel tools to potentially
  alleviate stress
• related symptoms.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• THE TEAM (Continued)
• CISM Teams also provide education regarding
  critical
• incident stress to emergency services
  workers. CISM
• Teams provide services to emergency/first
  responder
• personnel, hospital personnel, and spouses.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• GROUPS SERVED BY THE CISM TEAM
• Fire services - paid or volunteer
• EMS service - paid or volunteer
• Law enforcement personnel
• Search and rescue personnel
• Ski patrol organizations
• Hospital personnel
• Others

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM
TYPES OF INTERVENTIONS Several types of
interventions may be conducted depending upon
the circumstances of a particular incident.
Intervention may be on an individual one-on-one
basis or, ideally, in small groups. The following
types of interventions, singularly or in
combination, are most commonly utilized

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• TYPES OF INTERVENTIONS
• Pre-Incident Education
• On-scene support services
• Demobilization/de-escalation/decompression
• Defusing
• Formal debriefing
• Individual consults
• Significant other support
• Specialty debriefing
• Informal discussion
• Follow-up services

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Pre-Incident Education
• Pre-incident education regarding stress,
  stress recognition
• and stress reduction strategies is an
  essential part of the
• CISM process.
• Educational programs for line and command
  staff also
• include information on critical incident
  stress debriefings,
• how to contact a team, and on-scene
  considerations.
• Programs should be provided for recruits,
  refresher training,
• and veteran personnel.
• Programs for spouses and significant others
  may also include
• stress recognition and management.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• On-Scene Support Services
• Three types of services for prolonged or large
  scale
• incidents may be provided
• One-on-one sessions with rescuers exhibiting
  signs of
• obvious distress
• Consultation to the Incident Commander or
  command
• officers
• Assistance to victims of the incident as
  needed

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Demobilization/De-escalation/Decompression
• Utilized during or following a large scale
  incident as units are released from the scene to
  determine if all personnel are accounted for,
  make announcements, etc.
• A mental health professional or experienced peer
  takes 15 minutes to provide information on the
  signs and symptoms
• of stress reactions that may occur. Lasts a
  maximum of 30 minutes.
• Unit may be released from duty or return to the
  station in
• service. Incident Commander may require
  that all personnel
• go through a demobilization session before
  they are released
• from the scene.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Defusing
• Defusing is a shortened version of the
  debriefing.
• Defusings take place immediately or relatively
  
• soon after the critical incident is finished
  and
• typically last less than one hour.
• The leader of a defusing may be a peer support
  
• person or one of the mental health support
  people
• on the critical incident stress management
  team.
• Defusings are designed to either eliminate
  the
• need to provide a formal debriefing or to
  enhance
• the debriefing if it is still necessary to
  provide one.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Defusing
• A mini-debriefing for a small core or working
  group
• (such as an engine company) conducted at the
  station
• shortly after the incident, usually within
  3-4 hours.
• Provides information about the incident and
  general
• information and advice on stress reactions.
  In some
• circumstances a defusing may involve a more
  in-depth
• discussion of participants feelings and
  reactions.
• May be led by an experienced peer debriefer. A
• defusing may eliminate the need for a formal
  debriefing.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• DEBRIEFING
• A debriefing is a group meeting or discussion
  about a
• distressing critical incident.
• Based upon the core principles of education
  and crisis
• intervention, the critical incident stress
  debriefing is
• designed to mitigate the impact of a
  psychologically
• traumatic event (a critical incident) and to
  assist personnel
• in recovering as quickly as possible from
  the stress
• associated with the event.
• The formal critical incident stress debriefing
  is a structured
• group meeting using a seven-stage
  intervention process.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Formal Debriefing
• Ideally conducted within 24-72 hours of the
  incident.
• Confidential non-evaluative discussion of the
• involvement, thoughts, and feelings
  resulting from the
• incident.
• Also provides discussion and education
  regarding
• possible stress-related symptoms.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Individual Consults
• One-on-one counseling for concerns related to
  the
• incident.
• May require a mental health professional.
  Providing
• individual counseling is not a function of
  the CISM
• Team. However, team clinicians may be
  utilized for
• referrals.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Significant Other Support
• Includes the following services
• Educational programs for significant others,
• Debriefings for significant others,
• Bereavement support,
• Grief and crisis counseling, and
• Family support

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Specialty Debriefing
• Providing debriefing interventions for groups
  not
• directly involved in emergency services or
  otherwise
• outside the realm of the CISM Team.
• May be requested if services are not available
  in the
• mental health community.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Informal Discussion
• An informal leaderless discussion of the event
  by
• individual crews following return to
  quarters.
• Initial discussion occurs spontaneously in
  many
• groups and is not structured.
• It may be facilitated by a team peer member
  who is
• present.
• The focus of the discussion should be the
  groups
• reaction to the event rather than a
  critique.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Follow-up Services
• Conducted following individual consults,
  defusings,
• debriefings, demobilizations, and
  significant other
• support in the weeks or months after an
  incident.
• May include an informal debriefing session,
  phone
• or personal follow-up.
• Concern with detecting delayed or prolonged
  stress
• syndrome.
• May also be used to evaluate debriefing
  services
• offered.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• THE DEBRIEFING PROCESS
• Emergency services personnel, command staff,
• emergency management, medical control
  authorities
• (e.g., Public Health, Hospital, Nursing,
  etc.) are
• responsible for identifying and recognizing
  significant
• incidents that may require debriefing.
• When an occurrence is identified as a
  critical
• incident, a request for debriefing should
  be made as
• soon as possible.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• THE DEBRIEFING PROCESS (Continued)
• The team is activated by a call to the
  dispatch center in
• the Sheriffs Office.
• Appropriate call information is obtained and
  relayed to
• the CISM Team.
• CISM interventions are coordinated by a
  designated
• team member to promote the quality of the
  services
• and to ensure appropriate procedures are
  followed.
• The team member also schedules requests for
• education/in-service presentations.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• THE DEBRIEFING PROCESS (Continued)
• A team member contacts the agency requesting
  services to
• Assess the need for a formal debriefing, a
• defusing, or a referral.
• Determine the nature of the incident.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• THE DEBRIEFING PROCESS (Continued)
• Team members should coordinate a time and
• location to meet prior to and following the
• debriefing to discuss the incident, available
• resource information, and the approach to be
• used during and after the debriefing.
• At times, they may wish to visit the incident
  site before
• the debriefing.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• THE DEBRIEFING PROCESS (Continued)
• Arrange a time and location if a formal
  debriefing
• is indicated.
• Debriefings are optimally conducted within
  24-72 hours of
• the incident, and should not generally extend
  beyond one
• week.
• A 24 hour normalizing period following the
  incident is
• recommended.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• THE DEBRIEFING PROCESS (Continued)
• If large numbers of personnel are involved,
  debriefing
• begins with those most involved with the
  incident.
• A defusing may be appropriate within 24 hours
  of the
• incident.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Debriefing Process Considerations
• The location selected for the debriefing
  should be
• free of distractions.
• Other potential sites include schools,
  churches or
• other meeting facilities. Crew quarters or
  station
• may also be utilized if appropriate to the
  circumstances.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Debriefing Process Considerations (Continued)
• All emergency personnel involved in the
  incident
• should be invited to the debriefing and
  encouraged
• to attend. This includes, but is not limited
  to fire, law
• enforcement, dispatch, EMS personnel, and
  hospital
• emergency department personnel.
• A time for the debriefing should be selected
  that is
• most convenient for as many responders as
  possible
• and for the team members.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Debriefing Process Considerations (Continued)
• Agency management or command officers
• should be encouraged to relieve personnel
  from
• duty during the debriefing.
• The environment should be free of
  interruptions,
• phone calls, radios, and pagers. Turn off
  pagers,
• cell phones, radios, and other communication
• devices.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Debriefing Process Considerations (Continued)
• The team member contacted selects a debriefing
• team from available members.
• To assure the quality of the process, the team
• must consist of at least one mental health
• professional and two to three team members.
• The average team consists of 3 members.
• The mental health professional is the
  designated
• team leader.
• Team members who have responded to the
• incident should not be debriefers.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Guidelines For Debriefings
• Strict confidentiality must be maintained. All
• information regarding agencies involved,
• situation debriefed, and issues discussed
  shall
• not be divulged before or after a debriefing
• except with team members or as part of the
  team
• continuing education process.
• No mechanical recordings or written notes will
  be
• made during a debriefing. It is up to the
  team to
• enforce this rule during the debriefing.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Guidelines For Debriefings (Continued)
• No media personnel (TV, radio or newspapers)
• will be allowed to attend a debriefing.
• In the event that these individuals are
  present
• without team knowledge, phrases such as
• Everything said here is off the record may
  be
• helpful.
• This does not guarantee, however, that
• information will not be reported.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Guidelines For Debriefings (Continued)
• Participants in the debriefing may speak to
  the
• media either before or after the debriefing.
  It is
• important for team members to explain that
• individuals speak only for themselves and NOT
  
• for anyone else in the debriefing.
• Debriefers may speak to the media, but only to
• educate about the process of CISM and to
• discuss the effects of stress. All other
  inquiries
• should be referred to a Team Coordinator or
  other
• designated individual.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Guidelines For Debriefings (Continued)
• Debriefings are not a critique of the
  incident. The
• team has no evaluation function of tactical
• procedures.
• The debriefing process provides a format in
• which personnel can discuss their feelings
  and
• reactions and thus reduce the stress
  resulting
• from exposure to critical incidents.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• CISD GOAL
• The goal of the CISD is to encourage
  ventilation of
• emotions and a re-balancing of the
  individual and
• the group, and to educate group members
  regarding
• normal stress reactions.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• General Format For Formal CISD
• Introductory Phase
• Introduction of the CISM Team, description
  of
• the debriefing process, establish ground
  rules.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Fact Phase
• Self introduction of participants, description of
  
• what the participants heard, saw, and did during
• the incident. Each participant is included in
  turn
• by completing the circle.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Thought Phase
• At what point did the participants realize this
  was
• an unusual situation? Content question What
• did you think at the time?

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Reaction Phase
• Sharing of feelings at the scene, now, and in
  past situations, if applicable. Content question
  What
• was the worst part for you?

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Symptom Phase
• Perceived unusual experiences at the time of
• and/or since the incident. Expression of
  participants
• stress response syndromes. Content questions
• What symptoms let you know that this was
• different from other situations? What was your
• most intense reaction at the scene? What were
• your reactions later? Whats not going away?

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Teaching Phase
• Team discusses stress response syndrome and
• normal signs, symptoms, and emotional reactions.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Re-entry Phase
• Wrap up loose ends, answer additional questions,
  provide
• final reassurances, establish a plan of action.
  Content
• questions What was your moment of strength?
  What
• did you feel good about in yourself? What was
  positive
• about your response? What will be valuable in
  the future?

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• REMINDERS
• Referrals are made at the discretion of the
• debriefing team clinician.
• The CISM Team should follow-up with the
• debriefed agency in an appropriate period
• of time. The team leader and peer members
• may also provide appropriate follow-up.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• REMINDERS (Continued)
• The potential need to debrief the debriefers
  must
• be considered by the debriefing team.
• Following the death of an emergency services
• worker in the line of duty, two debriefings
  are
• indicated. The first should ideally occur on
  the
• day of the death if possible. The second
  should
• occur as soon as possible after the funeral.
• Postponing the second debriefing for a week
  is
• probably too long.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• ACCESSING THE TEAM
• The CISM Team is available for any emergency
  service requesting the team services. Any agency
  requiring assistance may contact the CISM Team by
  calling 1-307-399-4818, seven days a week. Be
  prepared to give information to the following
  questions
• Your agency's name, address and chief officer
• The nature and location of the incident
• Date and time of the incident
• The urgency of the situation
• The number of persons expected to attend the
  debriefing
• Your name and telephone number

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• ACCESSING THE TEAM (Continued)
• For optimal effectiveness, a formal debriefing
  should be
• conducted 24 to 72 hours following an
  incident. It should
• generally not be postponed for longer than
  one week.
• Because of Wyoming's rural population, special
  circumstances
• are often encountered, and debriefings must
  be contoured to
• each individual situation.
• All information during the debriefing is
  strictly confidential and
• will not be discussed with those not at the
  session. Only
• general information will be released.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• AGENCY RESPONSIBILITIES
• Your agency will be asked to cover the
  debriefers'
• expenses such as travel, meals, and lodging,
  if needed.
• At the present time, all the services of the
  debriefing
• sessions are on a volunteer basis.
• Your agency should strongly encourage
  attendance at
• the debriefing session by all personnel
  involved in the
• incident from your agency as well as others
  affected by
• the incident.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Training
• All Teams shall follow the training outlines and
  schedules.
• All teams must receive training from an approved
  trainer. New/additional members must also
• receive training from an approved trainer.

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

• Training (Continued)
• New member team training shall be a 16-hour
• basic training program plus field ride-along
  time
• for clinicians.
• New team members must complete the training
• session before being scheduled as active
• debriefing team members.

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SNOWY RANGE ASSIST CISM TEAM

• Training (Continued)
• Instructors in the training programs shall be
• experienced CISM Team members and approved
• as basic trainers.
• Team training will be scheduled annually to
• provide new member training.
• The Network members will provide or assist
• Member Teams in providing continuing
  education
• offerings

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CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM

1-307-399-4818