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Critical Incident Stress Management (CISM)

Critical Incident Stress Management (CISM): A Comprehensive Guide to Addressing Trauma

Critical incidents, whether they occur in the workplace, schools, public settings, or during larger-scale events, can have profound psychological and emotional impacts on individuals. These incidents can range from natural disasters and accidents to acts of violence and terrorism. In response to the psychological toll such events can take, Critical Incident Stress Management (CISM) and Critical Incident Stress Debriefing (CISD) have emerged as valuable tools for mitigating the adverse effects of critical incident stress. This article explores what Critical Incident Stress is, the concepts of CISD and CISM, their applications in various settings, potential shortcomings, and the vital role of specialists with clinical expertise in addressing trauma and PTSD.

What is Critical Incident Stress?

Critical Incident Stress (CIS) refers to the psychological and emotional response individuals experience when exposed to extraordinary events that are outside their usual range of experiences. These incidents can overwhelm a person’s usual coping mechanisms, leading to distress, anxiety, and a wide range of emotional reactions. Common reactions to critical incidents include shock, anger, confusion, sadness, and even guilt.

Critical incidents can vary greatly in nature, from natural disasters like hurricanes and earthquakes to human-made tragedies such as workplace accidents, acts of terrorism, school shootings, or public emergencies. The intensity of the stress response often depends on the individual’s proximity to the incident, their personal involvement, and their resilience.

What is CISD (Critical Incident Stress Debriefing)?

CISD, or Critical Incident Stress Debriefing, is a structured and time-limited intervention designed to help individuals process their emotional reactions and cope with the psychological aftermath of a critical incident. CISD typically involves a small group of individuals who have experienced the same traumatic event. A trained facilitator guides the group through a structured debriefing process, which usually occurs within hours to a few days after the incident.

The primary goals of CISD are to:

  1. Provide a safe and supportive environment for individuals to express their thoughts and emotions related to the incident.
  2. Normalize their reactions by highlighting that their responses are typical in the aftermath of a critical incident.
  3. Educate participants about common stress reactions and coping strategies.
  4. Facilitate the sharing of experiences and emotions within the group.
  5. Help individuals identify and mobilize their own support systems.

CISD is typically conducted in several stages, including the introduction, fact phase, thought phase, reaction phase, symptom phase, teaching phase, and re-entry phase. Each phase serves a specific purpose in guiding participants through the debriefing process.

What is CISM (Critical Incident Stress Management)?

CISM, or Critical Incident Stress Management, encompasses a broader set of strategies and interventions aimed at addressing critical incident stress within organizations and communities. It includes not only CISD but also a range of proactive and follow-up interventions to support individuals and promote resilience. CISM may be applied in various settings, including businesses, schools, public institutions, and larger-scale events.

Key components of CISM include:

  1. Pre-Incident Education: Providing individuals with education and training on stress reactions, coping skills, and resilience-building before a critical incident occurs.
  2. Crisis Management Briefings: Conducting briefings immediately following a critical incident to provide essential information, resources, and initial support to those affected.
  3. Individual Crisis Intervention: Offering one-on-one support and counseling to individuals who require immediate assistance in coping with the trauma.
  4. Group Crisis Intervention: Conducting CISD sessions to help individuals process their reactions and emotions collectively.
  5. Family Crisis Intervention: Providing support to the families of individuals affected by a critical incident.
  6. Follow-Up and Resilience-Building: Offering ongoing support and interventions to ensure individuals continue to cope effectively and build resilience in the long term.

Applications of CISM in Various Settings

CISM and CISD have found applications in a wide range of settings, each with its unique requirements:

  1. Businesses: In the workplace, CISM can help employees cope with traumatic incidents, such as workplace accidents, robberies, or acts of violence. It supports the psychological well-being of employees, improves morale, and can reduce absenteeism and turnover.
  2. Schools: CISM is crucial in educational settings following traumatic events like school shootings, natural disasters, or the loss of a student or staff member. It helps students, teachers, and staff process their emotions, ensuring a safer and more supportive environment.
  3. Public Institutions: Public institutions, such as emergency services, law enforcement agencies, and healthcare organizations, rely on CISM to address the unique challenges faced by their personnel during critical incidents. It helps prevent burnout and supports the mental health of those who serve the community.
  4. Larger-Scale Events: During larger-scale events like natural disasters, terrorist attacks, or mass casualties, CISM is vital for providing immediate and ongoing support to affected individuals and communities. It facilitates the coordination of resources and interventions on a larger scale.

Potential Shortcomings of CISM

While CISM and CISD have proven valuable in many situations, they are not without their criticisms and potential shortcomings:

  1. Lack of Scientific Evidence: Some critics argue that the effectiveness of CISM and CISD lacks solid scientific evidence. More research is needed to determine their long-term impact on individuals’ psychological well-being.
  2. Inadequate Training: For CISM and CISD to be effective, facilitators must be properly trained and experienced in trauma response. Inadequately trained facilitators can unintentionally exacerbate distress or create unhelpful dynamics.
  3. Not Suitable for Everyone: CISM and CISD may not be suitable for all individuals or cultures. Some people may prefer alternative forms of support or counseling that better align with their needs and beliefs.

The Importance of Professional Clinical Expertise in Trauma

One crucial aspect of CISM and CISD that cannot be overstated is the importance of having specialists with clinical expertise in trauma and PTSD on the team. There is no substitute for professional and clinical training and a seasoned, expert with years of experience is a game changer. This is especially true when working with victims of violence, war zone survivors, natural and man-made disasters and the rescue teams who initially responded to these calls. Here are several reasons why clinical expertise is essential:

  1. Assessment and Diagnosis: Clinical experts can accurately assess and diagnose individuals who may be experiencing PTSD or other trauma-related disorders. This ensures that those in need receive appropriate clinical treatment.
  2. Treatment Options: Clinical experts can provide a range of evidence-based therapeutic interventions for individuals with PTSD and trauma-related conditions. These interventions may include cognitive-behavioral therapy, exposure therapy, and eye movement desensitization and reprocessing (EMDR).
  3. Medication Management: In some cases, medication may be a crucial component of treatment for PTSD. Clinical experts can prescribe and manage medication when necessary.
  4. Complex Cases: Critical incidents can sometimes result in complex and long-lasting trauma. Clinical expertise is essential for addressing these challenging cases and providing ongoing support.
  5. Integration with CISM: Clinical experts can work in tandem with CISM and CISD teams to ensure that individuals with acute stress reactions receive the appropriate level of care and support. They can help bridge the gap between immediate crisis intervention and long-term treatment.
Closing Remarks

Critical Incident Stress Management (CISM) and Critical Incident Stress Debriefing (CISD) are invaluable tools for addressing the psychological impact of critical incidents in various settings, from businesses and schools to public institutions and larger-scale events. While they have demonstrated effectiveness, they are not without their potential shortcomings. To maximize their benefits, it is crucial to have specialists with clinical expertise in trauma and PTSD as part of the response team. These experts play a vital role in assessing, diagnosing, and providing appropriate treatment to individuals affected by critical incident stress, ensuring that they receive the care they need to recover and build resilience.

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Critical Incidents

Critical Incident Stress

WHAT IS CRITICAL INCIDENT STRESS?

A critical incident (or traumatic event) is any event outside the usual realm human experience that is markedly distressing (elicits reactions of intense fear, helplessness, dread, panic, horror, etc.) Critical incident stress usually involve the perceived threat to one’s physical integrity/safety or the physical integrity/safety of someone else. Most of all, critical incidents are defined by their undermining of a person’s sense of safety, security and competency in the world.

The result, critical incident stress can be a form of psychiatric injury, also known as traumatic stress. Contrary to some misconceptions out there – a person’s internal fortitude does not prevent this from happening. It is extremely important to respond quickly to a critical incident. The sooner the intervention/response – the less likely more complicated problems such as panic attacks, Post Traumatic Stress Disorder, and similar anxiety spectrum disorders are to arise, as well as a host of other challenges.

Events That May Result In Critical Incident Stress

Individual/Personal
Automobile accident, or any accident involving serious injury and/or property damage
Industrial accidents involving serious injuries or fatalities
Sudden or unexpected death of a relative, friend or colleague
Sexual assault/abuse
Robbery and violent crimes
Domestic violence
Child abuse and/or injury or death of a child
Psychological/emotional abuse
Suicide or attempted suicide
Homicide(s)
Line of duty death or injury among emergency/law enforcement personnel
Any life threatening experience
Adverse/negative publicity
Observing or being aware of unethical acts
Observing any of the individual or community critical incidents

Community/World

  • Fires
  • Floods
  • Earthquakes
  • Hurricanes
  • Tornadoes
  • Multiple injury/fatality accidents
  • Large scale environmental pollution
  • Terrorism
  • Acts of war
  • Child related traumatic events
  • Homicides in the community
  • High publicity crimes of violence or sex
  • Community disasters
  • Being an emergency worker/first responder in critical incidents and disasters*
    • (*Peace Officers, Fire & Rescue, EMT, Triage Nurses & Military)

Point Of Fact:
You do not need to be directly involved to be negatively affected by a critical incident. Generally, the closer you are to the actual event and the people involved, the more severe the impact. However, television and news media coverage, especially excessive and/or graphic depictions, may serve to increase the likelihood of experiencing traumatic impact, especially anxiety and feelings of not being safe.

Traumatic Events, Critical Incident Stress and CISM

What are CISD and CISM?

Critical Traumatogenic Exposure and CISM Incident Stress Debriefings (CISDs) are a specific tool of Critical Incident Stress Management designed to help individuals, groups, or entire organizations cope with the often difficult, overwhelming and stressful emotions associated with critical incidents or traumatic events.

What Employers Should Know About CISM

CISDs helps mitigate post-traumatic symptoms, assess the need for follow-up, and often provides a sense of closure. If prompt trauma intervention is provided at the onset of the crisis, damaging long term effects can be minimized and employees will be better equipped to return to the daily work routine and productivity.

Professional Consulting/CISM for Traumatic Exposure and Critical Incident Stress

Professional consulting and Critical Incident Stress Management (CISM) are not the same thing as psychotherapy or counseling. These are specialized, focused services that are used very specifically for individuals who have been involved in or exposed to unnatural events or conditions. Sometimes exposure occurs while fulfilling the duties of their profession, sometimes due to unforeseen accidents or disasters and even sometimes as a victim of an aggressive crime.

These services are not the same as therapy and in no way are they meant to replace therapy. These services are most effective when used as soon as possible after the event to help normalize the situation and prepare the individual for some other issues that may arise in the short term as a result. CISM is intended to be used promptly to reduce the risk of further distress and more detrimental outcomes later on such as Post-Traumatic Stress Disorder (PTSD).

Critical Incident Stress and Other Issues that may be addressed by CISM include;

Critical Incident Stress Debriefing, Anxiety & Anger Problems, Stress Management, Traumatogenic Exposure, PTSD, Survivor’s Guilt, Grief and Loss, Family Conflict, Significant Life-Change Adjustment, Work/Life Balance, Spiritual/Philosophical Conflicts and Substance Abuse/Dependence.

These services are typically used for :
First Responders
Peace Officers
Fire Department
Nurses
EMT
Hazardous Professions
Oil (Rig/Refinery) Professionals
Industrial Plant Professionals
Airline / Airport
Maritime / Off Shore
Railroad
Professional Environment
Death in the Workplace
Violence in the Workplace
Crisis Event in the Workplace
Victims & Survivors
Accidents
Aggressive/Assaultive Crime
Robbery/Random Crime
National Crisis
Natural Disaster

The Top 7 Reasons Your Company Should Use a Licensed and Experienced CISM;

The Top Reasons Your Company Should Use Critical Incident Stress Management
(What Every CEO, Human Resources Manager and Internal EAP Should Know About Critical Incident Stress Management.)

  1. Meet OSHA requirements for General Duty Clause 29 USC 1900 5(a) and for S.E.M.P. Compliance. (Structured Emergency Response Program)
  2. Provide Risk Management for adversarial situations and help decrease litigious responses.
  3. Help prevent job stress and burnout problems and worker injuries/errors and associated costs.
  4. Decrease bottom line expenses for employers. (Studies have shown realized savings of $7 for every $1 spent on CISM).
  5. Promotes employee wellness and decreases utilization of sick time and benefits.
  6. Stabilize crisis situations quickly & effectively when they do occur.
  7. The visible and appropriate action of a company taking care of its employees in a crisis.

Professional Consulting/CISM for Critical Incident Stress

Professional consulting and Critical Incident Stress Management (CISM) are not the same thing as psychotherapy or counseling. These are specialized, focused services that are used very specifically for individuals who have been involved in or exposed to unnatural events or conditions. Sometimes exposure occurs while fulfilling the duties of their profession, sometimes due to unforeseen accidents or disasters and even sometimes as a victim of an aggressive crime.

These services are not the same as therapy and are in no way meant to replace therapy. These services are most effective when used as soon as possible after the event to help normalize the situation and prepare the individual for some other issues that may arise in the short term as a result. CISM is intended to be used promptly to reduce the risk of further distress and more detrimental outcomes later on such as Post-Traumatic Stress Disorder (PTSD).

For Corporate CISM Services, please contact Ben Carrettin at (346)-493-6181

Ben Carrettin is a Nationally Board Certified Counselor (NCC), Licensed Professional Counselor-Supervisor (LPC-S) and Licensed Chemical Dependency Counselor (LCDC). He is the owner of Practice Improvement Resources, LLC; a private business which offers an array of specialized counseling, evidenced-based clinical consultation, Critical Incident Stress Management (CISM) and targeted ESI-based services to individuals and businesses.