CISD
Clinician guided, group discussion of a traumatic event.
A discussion designed to put a bad situation into perspective.
Best if done within 24 - 72 hours of the event.
Not psychotherapy or psychological treatment, but may contain some elements of each.
Designed to:
- reduce impact of the event.
- speed up normal recovery, in normal people, who are having normal reactions to abnormal events.
Tasks:
- educate regarding stress management
- facilitate ventilation of feelings
- provide reassurance
- forewarn about possible stress reactions
- reduce fallacy of uniqueness
- reduce fallacy of abnormality
- provide positive contact with mental health professionals
- enhance group cohesiveness
- provide an opportunity for screening and referral
Critical Incident
- Any event which has a stressful impact sufficient enough to overwhelm the usually effective coping skills of either an individual or a group.
Critical Incident Stress Debriefing (CISD)
- A group meeting or discussion about a distressing critical incident designed to mitigate the impact of the incident, and assist personnel in recovering as quickly as possible.
Defusing
- A shortened version of the CISD. It has 3 parts, Introduction, Exploration and Information. Defusings always take place immediately or relatively soon after the critical incident is finished. They usually last between 20 and 45 minutes.
(Taken from Critical Incident Stress Debriefing: CISD, by Jeffry T. Mitchell and George S. Everly, Jr., Chevron Publishing, 1993.)
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FOLLOWING A CRITICAL INCIDENT
Physical
| Nausea | Upset Stomach | Feeling Uncoordinated |
| Sweating | Sleep Disturbances | Chills |
| Fatigue | Diarrhea | Shakes |
| Headache | Rapid Heart Rate | Vision Problems |
| Hyperventalation | Muscle Aches | Sex Drive/Menstruation |
| Dizziness | Dry Mouth | Tremors (lips/hands) |
Cognitive
| Flashbacks | Calculation Difficulties |
| Distressing Dreams | Poor Attention Span |
| Poor Concentration | Fear of Even Repitition |
| Blaming Someone | Intrusive Images |
| Impaired Thinking | Delayed Stress Response |
| Confusion | Personality Changes |
Emotional
| Anger | Withdrawal | Feeling Uncertain |
| Denial | Survivor Guilt | Feeling Overwhelmed |
| Fear | Identify with Victim | Feeling Abondoned |
| Depression | Anticipatory Anxiety | Feeling Loss |
| Grief | Wishing to Hide | Feeling Hopeless |
| Worried | Wishing to Die | Feeling Numb |
Behavioral
| Change in Activity | Withdrawal |
| Increased Alcohol Use | Suspiciousness |
| Increased Smoking | Change in Communication |
| Excessive/Sick Humor | Excessive Silence |
| Unusual Behavior | Change in Eating Habits |
Spiritual
| Questions Purpose of Life | Questions Higher Power |
| Questions Job/Self | Anger at Higher Power |
These symptoms are normal reactions to an abnormal event and should decrease within seven days of the incident.
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THE ROLE OF THE MANAGER
RESPONDING TO A CRITICAL INCIDENT
I. Assessment Phase:
a) What happened?
b) When
c) To whom?
d) What has been done to this point?
e) What does company need to do?
f) What resources are needed? Have they been contacted?
g) Who has been informed? (Co-workers, family, friends)
II. Action Phase:
a) Develop action plan with input from other management staff, EAP and other appropriate resources.
b) Share details of incident with management staff. (Remember that management and supervisors also need emotional support throughout the entire company response.)
c) Who will be media contact person?
d) Do not send employees home until appropriate.
e) Any reason to check on missing personnel?
f) Any "high risk" groups that need special attention?
g) Any need for individual counseling/group CISD? When? Where?
h) What are the appropriate resources? What will be the referral procedure?
i) How will other personnel be informed about incident? (i.e. large assembly, PA announcement, unit by unit) Whatever method is used, information needs to be passed as soon as possible to reduce rumors. Information should be passed in a calm, matter-of-fact manner.
j) If a death was involved, funeral plans should be announced as soon as they are known.
k) If person will not be returning, who will clean out desk/locker? When?
III. Follow-up:
a) At the end or the first day, consideration should be given to doing a review of how the day went, and what still needs to be done. (Approximately a month after the incident, a formal critique of the incident response should be done.)
b) Management needs to stay alert to possible after effects: reduced productivity, low morale, increased stress levels, various emotional reactions (e.g. guilt, anger, denial, depression.) These are greatly reduced if debriefing is done for "high risk" groups.
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Here Are the Questions Which Can Help a Manager Assess the Need for a CISD
1. What is the nature of the critical incident?
2. How long ago did it occur? Is the event ongoing?
3. Is the event of sufficient magnitude as to cause significant emotional distress among those involved?
4. Does the event fit within the definition of a critical incident?
5. How many individuals are involved in the incident?
6. If more than three, think CISD! If less, perhaps a defusing or a individual consult would suffice.
7. Are there several distinct groups of people involved or is there only one? Are the targets operations personnel, victims, witnesses or community members.
8. What is the status of the involved individuals? Where are they and how are they reaction? Some incidents may need a more immediate defusing rather than waiting for a debriefing.
9. What signs and symptoms of distress are being displayed by the participants or the witnesses of the incident?
10. How long have the reactions or signs and symptoms of distress been going on? Significant symptoms which have continued longer than a few days are a good sign that a debriefing may be necessary. If symptoms of distress are going on longer than one week after the incident, a debriefing is necessary.
11. Are symptoms growing worse as time passes? Worsening symptoms in a group may indicate a need for debriefing.
12. Are members of the group unusually fearful or anxious?
13. Are members of the group suffering sleep disturbance?
14. Are members of the group avoiding certain activities?
15. Has the behavior of the group changed significantly?
16. Is the group preoccupied with death or fear of death?
17. Are members of the group showing signs of confusion or lack of concentration?
18. Is there anyone who seems so distressed that they may be a threat to self or others?
19. Are any of the following key indicators of a need for a debriefing present: behavioral change, regression, continued symptoms, intensifying symptoms.