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 likely hood of experiencing Post-traumatic stress disorder.

It was developed to be a frontline help for emergency services personnel to help them cope with the trauma they experience every day. Every firefighter, police officer, ambulance attendant, 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.

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 programme 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 isn’t easy to define but each of us knows what our normal level of stress feels like. When you suffer a critical incident your level of stress rises dramatically and when you finally do come off of the rush your body returns to a lower level of stress which then becomes the new normal. Stress is cumulative so the new normal is always higher than the old level was. That’s why we need to decompress after traumatic incidents because we want to make the new normal as low as possible.

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.

Normally large groups are broken into manageable sizes along the lines of primary/secondary victims and according to the role they played at the scene. Usually supervisors and their staff are dealt with separately. These interventions are not designed to critique job performance or to lay blame, these interventions are solely designed to decompress individual reactions to stressful situations.

Frontline assistance for an individual can be given directly at the incident, at the hospital, or any other quiet place in which the person/people involved feel comfortable. Group sessions are a little more complicated but even then the physical requirements are few and easily available. Seating is generally arranged in a circle and a refreshment table is normally available at the back.

The sooner the intervention happens the more effective it is. The optimum is to do the first intervention at the trauma scene, the second within 72 hours of the event and follow up within one day of the defusing. The same timeframe is also optimum for groups, however it may not always be practical to do so. The emphasis then would be on isolating the individuals who had the closest proximity to the trauma and deal with their issues right away and to do a debriefing with those who were less affected later (within 72 hours).