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CRITICAL INCIDENT STRESS MANAGEMENT (CISM)

The Seven Core Components

1. Pre Incident Prepartation

2. Demobilization or Group Info Briefing

3. Defusing

4. Critical Incident Stress Debreifing (CISD)

5. Individual Intervetnion (1:1)

6. Family CISM

7. Follow-Up Referral

A DEBRIEFING

A debriefing is, formally, a seven stage process used in a group meeting for those involved in a critical incident to help "mitigate the psychological impact of a traumatic event, prevent the subsequent development of a post-traumatic syndrome, and serve as an early identification mechanism for individuals who will require professional mental health follow-up" (Mitchell JT, Everly GS, Critical Incident Stress Debriefing: The Basic Course Workbook, 1995).

The debriefing is ideally held within hours of the incident. A "defusing" is somewhat of a shortened version of a CISD that includes only three stages and may be implemented immediately after the event or shortly thereafter. It may eliminate the need for a full debriefing. A "demobilization" is a "quick informational and rest session applied when operations units have been released from service at a major incident which require over 100 personnel" (Mitchell and Everly, 1995). The demobilization allows for the team of workers to rest and eat. It also allows for identification of individuals who may need additional assistance.

Basics of a Debriefing The seven stages of a debriefing are identified below and are adapted from Mitchell and Everly (1995).

Stage Phase Objectives 1. Introduction To introduce intervention team members, explain process, set expectations.

2. Fact To have each participant describe the nature of their participation, from a cognitive perspective.

3. Thought Reaction To solicit cognitive response to: "What aspect held the most negative impact?" or, "What aspect was the worst for you?" Then, transition from cognitive to emotional processing.

4. Emotional Reaction Given the response to Stage 3, to solicit emotional reactions or consequences.

5. Reframing To transition from emotional domain back to cognitive. "What lessons could be learned from this experience?" and, "What is something positive that you will take away from this experience?"

6. Teaching To educate as to normal reactions and teach basic stress management, if applicable.

7. Re-Entry To summarize experience with emphasis on positive or learning aspects.

During the debriefing the group is guided through the seven stages by the debriefing team. The team must always include a mental health worker who is capable of identifying individuals who may need or want further assistance. The process is not meant to be some kind of psychotherapy. It is simply meant to "mitigate" the effects of the critical incident and provide a means for further assistance as some may require.

DEFUSING

The defusing process is typically a three stage intervetnion. It may be considered a shortened version of CISD. Defusings are designed to be: a) implemented immediately, or within 8 hours of a traumatic event; b) shorter in length than a formal CISD (about 1 hour compared to a 2-3 hour CISD); c) more flexible than a CISD (greater latitude in the three stage fromat); and, d) used to either eliminate the need for a fromal CISD, or enhance a subsequent CISD.

Stages of Post-Trauma Defusings

Stage One Introduction

To introduce intervention team members, explain the process, set expectations.

Stage Two Exploration

To discuess the traumatic experience via participants' disclosoure of facts, cognitive and emotional reactions, and finally symptoms of distress related to the traumatic event.

Stage Three Information

To cognitively normalize and educate with regard to stress, stress management and trauma.