WHAT IS A CRITICAL INCIDENT?

A “critical incident” is any event that has significant emotional power to overwhelm usual coping methods. These include a sudden death in the line of duty, serious injury, a physical or psychological threat to the safety or well being of an individual or community regardless of the type of incident. Moreover, a critical incident can involve any situation or events faced by an individual that causes a distressing, dramatic or profound change or disruption in their physical or psychological functioning. There are oftentimes, unusually strong emotions attached to the event which have the potential to interfere with that person’s ability to function either at the crisis scene or away from it
Critical incidents produce characteristic sets of psychological and physiological reactions or
symptoms in all people.
Typical symptoms of Critical Incident Stress include:
▪ Restlessness
▪ Irritability
▪ Excessive Fatigue
▪ Sleep Disturbances
▪ Anxiety
▪ Startle Reactions
▪ Depression
▪ Moodiness
▪ Muscle Tremors
▪ Difficulties Concentrating
▪ Nightmares
▪ Vomiting
▪ Diarrhea
▪ Suspiciousness
The physical and emotional symptoms, which develop as part of a stress response, are normal
but have the potential to become dangerous to the individual if symptoms become prolonged.
Researchers have also concluded that future incidents (even those that are more “normal”) can
be enough to trigger a stress response. Prolonged stress saps energy and leaves the person
vulnerable to illness. Under certain conditions, they may have the potential for life-long after
effects. They are especially destructive when a person denies their presence or misinterprets
the stress responses as something going wrong with him
The formal Debriefing is a psychological and educational Support Group discussion that utilizes
specially trained individuals, mental-health professionals, and peer support personnel. The
main objectives of a debriefing is to mitigate the impact of a critical incident and assist the
personnel involved in returning to routine functions after the incident. Events that require a
Critical Incident Stress Debriefing includes:
▪ Line of Duty Deaths (LODD)
▪ Serious Line of Duty injuries
▪ workers suicide
▪ Disasters
▪ Significant events where the victims are relatives or friends of emergency personnel.
▪ Events that attract excessive media attention.
▪ Events that seriously threaten the lives of the staff
▪ Any event that has significant emotional power to overwhelm usual coping mechanisms.
Because overuse of Critical Incident Stress Debriefing dilutes their effectiveness, they are reserved for only those events that overwhelm the usual coping methods of staff. Before a debriefing is held, all of the coordination associated with the debriefing is done, including the announcement to those involved and the setup of the room.
In the majority of cases, a formal CISD is generally not organized for the first 24 hours because the responders are still too worked up to be able to deal appropriately with an in-depth group discussion of the incident, especially as it relates to their inner feelings. They are trained to
suppress emotional reactions during and for a brief time after an incident. Natural feelings of denial and avoidance predominate during the first 24 hours. However, the one-day time limit is only a guide. In some situations it may be desirable to conduct a formal CISD earlier than 24 hours.
Often staff attempt to intellectualize about the incident, and they run it through their minds over and over as they try to make sure that they handled their part correctly. Several hours after the incident their cognitive activities decrease and fairly intense feelings may then come to the surface. This is the time for a CISD.
Ideally, the formal CISD should be mandatory for all personnel involved in the scene. The tone must
be positive and understanding. Everyone has feelings which need to be shared and accepted.
The main rules are – no one critiques or criticizes another participant and all listen to what was,
or is, going on inside each other.
Preliminary/Prep Work
1. Facilitator
A. Someone trained in CISM.
B. Good people skills, ability to read the room and know how to keep the process moving
forward.
C. More skilled facilitators may be required for incidents that are particularly intense.
2. Time Frame
A. Optimally within 24-48 hours
B. Effectiveness diminishes when the time between the incident and CISD is offered.
There is minimal effectiveness after six weeks.
3. Ground Rules
A. Absolute confidentiality
B. Only people impacted by the traumatic event. No management or supervisory staff
should be present. If a supervisory person was part of the traumatic event,
consideration should be given to conducting an individual CISD as oppose to a group
CISD. In some cases, they might be included – but this should be the exception, not the
norm. (my wording and perception stated here)
C. No comments or criticisms regarding other’s feelings or reactions (this is not the time to
assess performance – its about what did happen and how they felt about it)
D. Positive, supportive, understanding atmosphere, based on concern
E. Active listening
F. Providing Structure
4. Establish Guidelines for expected of all participants
A. Clarify reason for the Debriefing (if you are the Facilitator)
B. Identify the event or time period the group will be discussing. Example, if PCLEC
conducted a debriefing with the first responders on the Roseville helicopter accident, the
facilitator would instruct that the debriefing would focus on the first phase of the event
(for example) – not on day two or day three of the event. Therefore only those who had
responded within the first phase would be present at the debriefing. For group
debriefings, assure the group that each person involved will have an opportunity to “tell
their story”. Reassure the group that each person’s viewpoint and contribution is
important.
i. Each person speaks for them selves, no “I heard so-and-so say, “bla, bla, bla”.
Keep things in the first person.
ii. Important that each person talk about the crisis event.
C. Location
i. Private
ii. Comfortable
D. Systematic Approach (as outlined in the formal CISM training)
Phase 1: Introduction Phase
The CISD begins with an introduction from the CISD team members at which point they state
that the material to be discussed is strictly confidential. It should also be emphasized that the
CISD is not an operation critique. Attendees are then told what to expect during the debriefing
and assured that the major concern of the CISD team is to restore p eople to their routine lives
as soon as possible with minimal personal damage to the individual. The basic rules of the
debriefing are explained before the team members move into the next phase.
Phase 2: Fact Phase
The second phase of the CISD is the fact phase in which people are asked to describe what
happened at the scene. This is a relatively easy phase for law enforcement and emergency
personnel who are used to talking about the operational aspects of an incident. Once the
incident is described, th e debriefing team leader will lead the discussion into the thought phase
of the process.
Phase 3: Thought Phase
The usual question asked in this phase is, “Can you recall your first thought once you stopped
functioning in an automatic mode at the scene?” This helps people to “personalize” their
experiences. The events are no longer a collection of facts but an individual, meaningful
recollection of how they personally experienced the incident.
Phase 4: Reaction Phase
The fourth phase of a debriefing is the reaction phase, the point at which people can describe
the worst part of the event for them and why it bothered them. If a critical incident has any
significant emotional content attached to it, it will usually be discussed during this phase. It can
occasionally become a heavy emotional phase of the debriefing but is not necessarily intense.
It is not the objective of a CISD team to promote emotional behavior but, instead, to foster
discussion so that recovery is as rapid as possible. The reaction phase allows people to
discuss the worst parts of an incident in a controlled environment that enhances venting
thoughts and feelings associated with the event and prepare them for useful stress reduction
information.
Phase 5: Symptom Phase
The fifth phase of the CISD process is the symptom phase. The group is asked to describe
stress symptoms felt at three different times: The first being those symptoms experienced
during the incident; the second are those that appeared three to five days after the incident; and
the last being symptoms that might still remain at the time of the debriefing. Changes, increases
and decreases of symptoms are good indicators for the mental-health person of the need for
additional help for some attendees.
Phase 6: Teaching Phase
The next phase of the CISD process is the teaching phase. The CISD team members furnish a
great deal of useful stress-reduction information to the group. They also incorporate other
information, such as the grief process, promoting communication with spouses and suggesting
how to help one another through the stress.
Phase 7: Re-Entry Phase
The seventh phase of the debriefing process is called the re-entry phase, when personnel may
ask whatever questions they have. A summary is given by the team and the CISD is concluded.
After the debriefing, the CISD team remains at the debriefing center to talk with those needing
additional individual assistance. Referrals are made for counseling if necessary. Finally, the
CISD team holds a post debriefing meeting to quickly review the debriefing and discuss ways
to improve their functions for future debriefings. However, the main reason for meeting is to
make sure that everyone on the team is okay before going home – hearing the pain that others
experience may bring about some pain for the debriefers.
PTSD may occur if the victim hasn’t had the opportunity to work through their crisis.
There are three distinct phases of acute post-trauma reactions: the shock phase, the impact
phase and the recovery phase. Following, is a short description of each phase:
The Shock Phase
A. Can last a few days or several weeks
B. Common emotional responses
i. Immobilization – confusion, disorganization, and inability to perform simple, routine
tasks. (Example, during an armed robbery, the store clerk may have difficulty
following the direction to open the cash register – almost feeling like everything is
happening in slow motion. Tunnel vision, which causes the victim to focus on one
area of the trauma, is also not uncommon. In the store clerk example, the clerk
may focus on the weapon to the point that they do not know what the robber
looked like or anything else going on in the store.
ii. Denial – refusing to believe that the trauma is actually happening.
C. Not all victims experience the shock phase. People trained to deal with trauma on a
regular basis, such as police, m ilitary, medical emergency workers, may initially bypass
the shock phase, though elements of the shock phase may be evident.
The Impact Phase
A. Anger and/or extreme anxiety
i. Trembling
ii. Crying
iii. Subjective feelings of tension
iv. Anxiety
v. Outrage
vi. Displacement (Store clerk example – may become extremely angry with the store
owner or the police as oppose to the perpetrator).
B. “What-if-and-maybe” stage
i. Self Doubt
a. Invents different scenarios – ignoring the actual fact and outcome of the
trauma.
b. “If only I’d been five minutes earlier”
c. “If only I had reacted more quickly”
ii. Self Blame (Common in police and ambulance crews)
d. Guilt can last indefinitely if not dealt with
C. Depression
i. Irritable
ii. Misunderstood
iii. Helpless
iv. Isolation which leads to a loss of hope for the future
v. Prevailing attitude: “Leave me alone, there’s nothing wrong with me.”
D. “Mad/Sad” Cycle. If the v ictim fails to face the trauma at this point, they will continue in
an anger/anxiety and depression cycle and will be unable to progress to the recovery
phase. PTSD becomes chronic.
The Recovery Phase
A. If the trauma is dealt with right away, the chances of getting stuck in the Impact Stage
are slim. If a victim sees a crisis counselor at the scene or soon afterward, and the
counselor explains what they’re experiencing, why they are experiencing it, and what to
expect next, the victim will feel reassured that what they are feeling is “normal”.
B. Once the person resolves the guilt and returns to a relatively symptom-free mode of
functioning, they may remain there for sometime. A new disturbance or a reminder of
the original trauma can cause recurring symptoms.
C. Similarly, an accumulation of the stresses of daily life, such as financial problems,
employment difficulties, or ill health, may also cause the trauma survivor to regress.
With effective treatment, survivors can learn to control many of the symptoms of anxiety and
depression which will allow them to function more productively. Victims who haven’t worked
through their trauma and don’t understand what they are experiencing may become trapped in
the anxiety / depression cycle.
Demobilization
A demobilization is intended to assist staff to make the transition from the state of
high arousal associated with the incident to a more normal one. It does not attempt
to explore or analyze the experience itself.
When conducting a demobilization, it has been found that the following
sequence enables staff needs to be met in a safe and effective way:
1. Gather the group and summarize what has happened.
2. Ask staff if they have any questions. This leads to discussion, clarification
and personal expression.
3. Decide what will happen next in relation to the incident and make interim
arrangements for the work responsibilities.
4. Present the support arrangements for staff until the next shift (this should
include contact arrangements after hours if required).
5. Provide information on reactions and assistance available, defusing,
debriefing and so on, and the mechanisms for activating these.
6. Assess the staff members ‘immediate needs for personal support and
practical help.
7. Give advice on what to do next and how staff can take care of themselves
(including handouts and contact numbers).
Defusing
A defusing is intended to terminate the incident psychologically, bring the experience of the incident to a conclusion, allow opportunity to express immediate concerns, and clarify what is possible in relation to the events or actions involved
When conducting a defusing, a trained debriefer will need to:
1. Introduce themselves, work with the manager, ensure confidentiality and
explain the purpose of the meeting.
2. Ensure the event is summarized (usually by the manager or involved team
member).
3. Discuss issues arising from this account including questions and clarification.
This time is used to identify issues and needs, and encourage reflection.
4. Summaries what has been said and frame the event, reactions and recovery
process.
5. Provide advice on what to do until the next contact, self-management overnight, and the availability of assistance.
6. Give advice on follow-up plans, arrangements for debriefing, referrals and
other support needs. Handout material is provided.
7. Liaise with the manager after defusing to ensure all requirements are met
Debriefing
Debriefing is a process to assist people to use their abilities to overcome the effects
of critical incidents by:
•Forming a clear idea of the events.
•Taking stock of the thoughts and reactions they have experienced.
•Identifying current or likely CIS symptoms.
•Providing information about normal stress responses to abnormal experiences.
•Helping to mobilize problem-solving strategies.
•Supporting personal needs
When conducting a debriefing, a trained debriefer will need to:
1. Introduce the session and outline the rules of confidentiality, non-judgment
and freedom to talk.
2. Invite the group to give an account of the incident, which is then clarified and
completed.
3. Invite participants to share their thoughts at the time of the incident or in the
time since it occurred. These indicate important meanings that will be
significant factors in the development of stress.
4. Review staff reactions at the time. These often indicate other aspects of the
meaning and significance of the events, and account for the development of
symptoms.
5. Review stress symptoms as these form the basis for the following stage.
6. Provide focused education, advice and information to assist in understanding
and managing the symptoms.
7. Undertake problem solving for issues arising in the course of the session and prepare for the recovery process or return to work. Requirements for continuing the integration of the incident are discussed. This may include assessing the need for follow-up sessions.
Demobilization re-establishes management of the staff group, stabilises the situation and sets the basis for a return to normality.
Defusing stabilizes the situation in the minds of the participants and helps them make a break from it and begin to unwind (that is, to prepare them to rest).
Debriefing systematically works through the event to gain a thorough idea of it and participants’ reactions, and participants gain the information necessary to manage their recovery.

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