Critical Incident Stress Management
Delta Training, Atlanta 04./10.2000 Walter Gaber, MD Medical Director Frankfurt Airport
Critical Incident Stress Management (Mitchell) In the evolution of crisis intervention , CIRM represents a new generation of collective intervention technologies. More specifically CISM represents an integrated, comprehensive multicomponent crisis intervention program spanning the complete crisis continuum. (Mitchell 1997) The notion that crisis intervention should be multidimensional is not new (Bordow 1979). But is was Mitchell (1983),who first suggested that a multicomponent crisis program should be utilized with the potential secondary victims of crisis and trauma, e.g. emergency services personnel.
Initially , this multicomponent approach to crisis intervention was generically referred to as CRITICAL INCIDENT STRESS DEBRIEFING and collectively included interventions such as individual crisis support techniques, •pre- crisis education, •a 3-step immediate small group discussion called defusing, • a 7-step more structured group discussion called formal CISD (debriefing), and •follow-up psychological services.
Demobilization Mitchell (1988) later expended the multicomponent crisis intervention approach to include mental preparation and a psychological decompression technique called demobilization for very large groups which is used after mass disasters.
Demobilization Goal: ✈Assess well-beeing of personnel after major incident ✈Migitate impact of event ✈Provide stress management information to personnel ✈Provide an opportunity for rest and food before returning to routine ✈Assess need for debriefing and other services
Critical Incident Stress Management Is there an need for CIRM ???? ò car accident ò family member is dying ò suicide ò rescue teams, police men, security ò tranfering the “death information” ò “Little Rock”, shooting in school ò Ramstein ò Airline crash (Lockerbie,Halifax e.g.)
Potential Traumatizing Events ● ● ● ●
Individual Sexual assault Robbery Serios physical injury Homicide Injury or death to a child
● ● ● ● ● ●
Copmmunity Flood Hurricans Fire Terrorism High publicity crime Community wide disaster
Common Symptoms ● ● ●
Cognitive Disorientation Confusing in thinking Problems to decide Behavior Change in eating Decreasing personal hygiene
● ● ● ● ● ● ● ● ●
Emotional Anger Helpless Hopeless Physical Sweating Breathing Heart rate Blood pressure
Critical Incident Stress Management (Mitchell)
CIRM is no therapy !!!!! Take it like a “Band Aid” (Mitchell 04.00 in ATL)
CIRM´s aim is simple ☛Maintain health and productivity ☛Prevent traumatic stress effects ☛Migitate stress effects ☛Restore personal to normal functions ☛Speed recovery from stress ☛Enhance to overall enviroment in which the person works and lives
Traumatic Stress Trauma:
Any event outside the usual realm of human experiencethat is markedly distressing.
Post Traumatic Stress:
Very intense arousal subsequent to a traumatic stressor (trauma).Traumatic stress overwhelms coping mechanisms leaving individuals out of control.
Post Traumatic Stress Disorder (PTSD) The PTSD is characterized by symptoms of: ☛excessive excitability and arousal ☛numbing withdrawal , and avoidance and ☛repetive , intrusive memories or recollections of the trauma and events related to the trauma ☛duration of at least one month Mitchell,Atlanta 04.00
Post Traumatic Stress Disorder (PTSD) By many estimations, PTSD represents the more severe and disabling variation of occupational stress known (Everly,1989). Yet at this time there exists no generelly agreed upon “treatment of choise” for PTSD (Mitchell, 2000, ATL). More recently the Israeli Defense Forces began to utilize group and ind. psych. support after fire fights .They concluded that the incidence of psychiatric disturbance was trimmed ba as much as 60% since the inception of this service (Breznitz ,1980)
Critical Incident Stress Management (Mitchell)
Key Concept: ☛All aspects of the organization should be involved ☛Adminitrative support is vital ☛CISM needs to be taught in all types of training within the organization ☛CISM is support !!! ☛CISM is becoming a standard of care
Critical Incident Stress Management (Mitchell) ➨ Demobilization
➨Defusing within 8 hours ➨Debriefing 24 - 72 hours
Defusing Defusing process is typically a three stage intervention. It may be considered a short version of the CISD. Defusings are designed to be: ☛ implemented immediatly or within 8 hours ☛more flexible than CISD (greater latitude in the 3 stage format) ☛used to either eliminate the need for a formal CISD, or enhance CISD
Defusing ☛ Stage
1 Intoduction ☛Stage 2 Exploration ☛Stage 3 Information
Defusing Goal: ✈Migitate the impact of the event ✈Accelerate the recovery process ✈Assesment of the need for debriefings or other services ✈Reduce cognitive, emotional and psychological symptoms
Critical Incident Stress Management (Mitchell) The Seven Core Components: ò Pre - incident Preperation
òDemobilization (Large group) òDefusing ( Small group) òDebriefing (CISD) Small group òIndividual Intervention (1:1) òFamily CISM òFollow-up Referral (Individual,Famliy)
Critical Incident Stress Management (Mitchell) The core 7 elements are listed in the table, but CISM as a programmatic intervention may encompass even more components: ò Pre- incident traumatic stress education òContinuing stress education òSupervisor stress program òOrganizational consultation òFamily support services òPeer counseling òOn scene support services !!! òChaplain services òResearch and development òOther support services as required