Table of Contents
Critical incident stress (CIS) management is the process of managing the response after a critical incident at work that causes employee stress. (Caine, & Ter-Bagdasarian, 2003) In a 911 communications environment this could be hearing a call where you’re not able to respond before someone dies of a medical injury, listening to a suicide or homicide in progress, or other events that have the potential to overwhelm an individual’s coping skills.
After an initial traumatic event or critical incident, an acute stress disorder may develop. If these symptoms (numbing, reduced awareness, derealization) continue for more than 4 weeks a client may meet the definition for PTSD. (Gibson, 2016) Approximately 20% of individuals who experience a trauma will go on to develop PTSD. (Norris, et. al., 2002)
The goal of CIS Maangement (CISM) is to short-circuit this process in people exposed to secondary trauma in order to ensure the best outcome for the individual. For primary victims of trauma CISM is ineffective. (Jacobs, Horne-Moyer & Jones, 2004)
CISM is generally broken into three categories (Guenthner, 2012):
- Primary Interventions, which focus on promoting health and resilience in employees in the absence of any critical incident
- Secondary Interventions, which focus on the immediate steps after the crisis
- Tertiary Interventions, for individuals who are experiencing symptoms of PTSD
Critical Incident Stress Management (CISM) Process
Blacklock (2012) identified the steps of the CISM process. The first step of the CISM process is diffusing. Diffusing is limited to individuals who were directly involved in the trauma (e.g. the first responders at an accident scene) so that they can begin the process of ventilating emotion. Individuals are provided with a telephone line to call or other resource they can reach out to and make sure they will be okay for the remainder of their shift.
The second step in the CISM process is debriefing. This should be done within 72 hours with all staff directly or indirectly involved being allowed to attend. Mitchell (1983) identified seven steps to the CISM Debrief which are listed in the next section.
Critical Incident Stress Debriefing (CISD)
The following table comes from Blacklock (2012) who cited it from Mitchell (1983):
Other CISM Interventions
Pulley (2005) identifies additional activities including:
- Crisis management briefing, where large groups of individuals affected by a trauma are brief on the crisis
- Family support – Providing the family of an emergency worker with practical supports to assist in the CISM process
- Assessment/consultation – On an organizational level, additional support is provided by larger organizations (such as the Tema Conter Memorial Trust) to help identify appropriate referrals
- Follow-up and referral – The organization follows up with affected individuals to identify any unmet needs and performs case management to help them access new supports.
- Mutual aid – Finally, other individuals who have previously experienced trauma provide peer support to help everyone work through their symptoms.
The Canadian Critical Incident Stress Foundation provides individual and group training that meets the requirements of the International Critical Incident Stress Foundation (ICISF). Online CISM Training is also offered online through the ICISF.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association.
Blacklock, E. (2012) Interventions Following a Critical Incident: Developing a Critical Incident Stress Management Team. Archives of Psychiatric Nursing. 2-8.
Caine, R., & Ter-Bagdasarian, L. (2003). Advanced practice. Early identification and management of critical incident stress. Critical Care Nurse, 23(1), 59-65 7p.
Gibson, L.E. (2016) Acute Stress Disorder. U.S. Department of Veterans Affairs, National Center for PTSD. Accessed electronically on Sun May 22, 2016 from http://www.ptsd.va.gov/professional/treatment/early/acute-stress-disorder.asp
Guenthner, D. H. (2012). Emergency and crisis management: Critical incident stress management for first responders and business organisations. Journal Of Business Continuity & Emergency Planning, 5(4), 298-315.
Jacobs, J. Horne-Moyer, H.L., Jones, R. (2004) The effectiveness of critical incident stress debriefing with primary and secondary trauma victims. International Jounal of Emergency Mental Health. 6(1):5-14
Norris, F.H., Friedman, M.J., Watson, P.J., Byrne, C.M., Diaz, E. & Kaniasty, K (2002). 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981–2001. Psychiatry 65, 207–239.
Pulley, S.A. (2005) Critical Incident Stress Management. Accessed electronically on May 28, 2016 from http://web.archive.org/web/20060811232118/http://www.emedicine.com/emerg/topic826.htm