Critical Incident Stress Management

1.3 Critical Incident Stress Management

 

 

PURPOSE

Critical Incident Stress Management (CISM) is a comprehensive, integrated, multicomponent, systematic program of crisis intervention. Its purpose is to provide education, support, assessment, and intervention for emergency ser-vice personnel who are often exposed to and/or affected by critical incidents. CISM was born out of emergency services and has become a world standard of care for first responders. Formulated and standardized by the International Critical

Incident Stress Foundation (ICISF), CISM has proven to be effective in mitigating many of the common symptoms of critical incident stress. The goal when applying any of the CISM components is to assess, educate, and intervene as necessary and return individuals to their work with the tools and support needed to reduce the effects of a critical incident. The benefits of the intervention include a reduction in symptoms of post-traumatic stress, quicker return to normal productive functioning, increased job satisfaction, reduced worker's compensation claims, reduced absenteeism and presenteeism, reduced errors, enhanced group cohesion, increased personal confidence and extended longevity.

OVERVIEW

The Broward County CISM Team (Broward Region X CISM) is made up of trained and credentialed members of law enforcement, fire/rescue, corrections, communications, and others, as well as trained, credentialed, and licensed mental health professionals, all of whom have completed at least three (3) of the core ICISF courses. Broward's CISM Team is independent of any other organization or department in Broward County. The team is designed and organized to respond to any incident that occurs in any emergency services department or agency in Broward County on a 24 × 7 × 365 basis, within a maximum of two (2) hours after a critical incident has occurred and CISM ser-vices are requested. The team meets on a periodic basis for additional training and information.

CONFIDENTIALITY

Florida Statute 401.30(4) (e) protects the discussions held during a CISM intervention as being "confidential and privileged communication under section 90.503." Therefore, all information shared during any part of a CISM intervention is held in the strictest of confidence.

CISM SERVICES

The following types of services can be provided by the Broward CISM Team.

  1. Pre-event planning and preparation.
    1. Educational and informational programs about CISM.
    2. Pre-incident planning and education.
  2. Strategic planning and assessment.
    1. Pre- and post-incident assessment of needs.
    2. Development and implementation of a strategic plan for major events.
  3. Individual intervention.
    1. One-on-one services with a qualified CISM team member.
    2. Individual support and follow-up.
  4. Small group defusing.
    1. Recommended within the first 12 hours after a critical incident occurs.
    2. Best delivered as soon as possible after a critical incident.
    3. Homogeneous groups.
    4. Assessment and education with possible referral and follow-up.
  5. Small group debriefing.
    1. 12-72 hours post-critical incident.
    2. Prior to demobilization from extended deployment or upon return home from extende deployment.
    3. Events of significant personal loss (expanded-phase defusing within first 12 hours).
  6. Crisis management briefing.
    1. Appropriate for large incidents, incidents with high media involvement, respite/rehab centers, and demobilizations.
    2. Best for large groups or mixed groups.
    3. Primary focus on assessment and information.
  7. Family crisis intervention.
  8. Organizational consultation.
  9. Assessment of organizational needs.
  10. Development and recommendation for coordination and delivery of services.
  11. Pastoral/spiritual crisis intervention.
  12. Referral and follow-up.

CISM CALL-OUT BASIS

A critical incident is any situation that is either out of the norm or that challenges or would appear to challenge a person's normal coping mechanisms. Examples include the following situations:

  • Pediatric injury or death
  • Multiple youth fatalities
  • Events with severe operational challenges
  • Line-of-duty death or line-of-duty injury
  • Officer involved in a shooting
  • Off-duty death, suicide, homicide, or injury
  • Events with multiple or mass casualties
  • Prolonged events with loss of life
  • Events when the victim(s) is (are) known
  • Events with excessive media interest
  • Any incident that could perceivably cause emotional impact

Emergency responders work under stressful conditions and situations. Training and continuing education about stress management contribute to the development and maintenance of improved emotional health, stress resistance, and resilience. Statistics demonstrate significantly higher instances of drug and alcohol abuse, marital and family strife, intimate-partner and domestic violence, heart attack, and suicide rates among emergency services personnel compared to the general population. These facts underscore the need for CISM services in any situation similar to those in the preceding list. Because one of the positive benefits of a group intervention is stronger group cohesion, all members of the group are encouraged to be present.

CISM ACTIVATION PROCESS EXAMPLE (BROWARD COUNTY)

  1. Requesting agency officer contacts the Communications Captain on duty at Broward Regional Communications Center, requesting CISM Team response.
  2. Communications Center number: 954-765-5100.
  3. Requesting agency shall supply the following information:
    1. Agency name.
    2. Type of incident.
    3. Number of members involved.
    4. Call-back contact number or pager number.
  4. The Communications Captain shall page out the on-call CISM Team Leader.

CISM CALL-OUT PROCEDURE

  1. When a critical incident event occurs or when an on- or off-scene command determines that an incident may or could have an emotional impact on the responding personnel, department, or agency, any person authorized to do so contacts the Broward Sheriff's Office (BSO) Communications at 954-765-5100 and requests a CISM response, giving a brief description of the event, the caller's name, and his/her contact information.
  2. BSO Communications contacts the on-call CISM Team coordinator and, at the same time, pages and/or sends a text message to all members on the CISM Team list.
  3. The CISM Team Coordinator contacts the CISM Team Clinical Director or designee and provides the incident contact name and number. The CISM Team Coordinator then begins assembling peer team members for a response. No team member from the affected department, agency, or organization will be part of the responding CISM Team.
  4. The CISM Clinical Director contacts the site or incident contact person, receives details about the incident, and advises the contact of the appropriate type and timing of the response.
  5. Once the type, timing, and location of the response are determined, the Clinical Director contacts the Team Coordinator with the information necessary to conduct the appropriate intervention. The Clinical Director then contacts mental health members for the intervention as needed.
  6. Upon arrival at the determined site, the CISM Team members assemble for a briefing with the Team Leader and then meet with the contact person or designee.
  7. Personnel are assembled according to type, in a quiet and secure location. All personnel shall be either off-duty or out of service for the duration of the intervention and related services.
  8. In the case of a critical incident stress defusing or debriefing, personnel are assembled according to rank, involvement in the incident, proximity to the incident, as determined by the responding Team Leader.
  9. No written, audio, or video recording of the intervention shall be permitted.
  10. The CISM Team consults with the contact person to provide general recommendations or for possible follow-up.
  11. The CISM Team gathers for a team debriefing