Critical Incident Stress Management (CISM) is an approach to preventing and treating the emotional trauma that can adversely affect emergency responders as a consequence of their duties and responsibilities that can occur in a disaster or mass casualty incident.
Components of a critical incident stress management plan include education before an incident actually occurs. Other important considerations include critical incident stress and coping strategies; field support (ensuring that staff get adequate rest, food, fluids, and rotating workloads) during an incident; and defusing, debriefings, demobilization, and follow-up care after the incident.
The basics of critical incident stress management
Defusing is a process is the first process of critical incident stress management by which the person receives education about recognition of stress reactions and management strategies for handling stress. Debriefing is a more complicated intervention; it involves a two to three hour process during which participants are asked about their emotional reactions to the incident, what symptoms they may be experiencing (eg. Flashbacks, difficulty sleeping, intrusive thoughts), and other psychological ramifications. In follow-up care, members of the critical incident stress management team will normally contact the participations of a debriefing and schedule a follow-up meeting if necessary. Individuals with ongoing stress reactions are referred to mental health specialists.
Who are the target for critical incident stress management
Critical incident stress management is a comprehensive approach to managing critical incident stress following significant and profound events that create due stress and anxiety. The provision of critical incident stress management services by specially trained and skilled health care team members can substantially help in mitigating critical incident stress symptoms with the goal of fast tracking the recovery process back to normal especially when the victims of critical incident stress are health care providers who become so overwhelmed by the disaster event and the number of victims they need to render care.
Despite the event being over, victims of traumatic disaster events may later experience a strong psychological as well as behavioral reactions to the distressing sequence of events. Everyone is at risk from these reactions. It is relatively normal for individuals to experience these after effects or reactions as a result from surviving such stressful situations. This does not imply an abnormal reaction to traumatic events but rather an indication that the trauma experienced was just too overwhelming for a normal individual to handle.
Common symptoms that critical incident stress management aim to control among health care professionals
The following incidents can result in critical incident stress; serious injury to emergency personnel, death of a medical colleague in the line of duty, mass casualty incidents, suicide of an emergency provider, terrorism and any other event that causes unusually strong reactions which can impair a health care provider in his/her duties during the initiation of an emergency operations plan.
The following are common symptoms that are associated with critical incident stress:
- Anxiety
- Headache
- Tunnel vision
- Paraesthesia
- Elevated blood pressure
- Nausea and vomiting
- Chest pain and palpitations
Although symptoms of traumatic events can greatly vary from person to person. Some individuals will experience much more pronounced symptoms while others may only experience a few. The effects can be rapid that can immediately manifest themselves immediately after the incident while others can occur weeks, months and even years which accumulates over time. Critical incident stress management can significantly help reduce and control acute stress, especially for health care workers who are at risk of becoming inefficient in their response during emergency and disaster situations.