Critical Stress Debriefing
Caught off guard and "numb" from the impact of a critical incident, individuals and communities are often ill-equipped to handle the chaos of such a catastrophic situation. Consequently, survivors often struggle to regain control of their lives as friends, family, and loved ones may be unaccounted for or are found critically injured, lay dying or are already dead. Additionally, the countless others who have been traumatized by the critical event may eventually need professional attention and care for weeks, months and possibly years to come. The final extent of any traumatic situation may never be known or realistically estimated in terms of trauma, loss and grief. In the aftermath of any critical incident, psychological reactions are quite common and are fairly predictable. Critical Incident Stress Debriefing (CISD) can be a valuable tool following a traumatic event.
Since the late 1970s and early 1980s, the victim assistance movement has received more positive attention than ever and has gained tremendous momentum with the passage of state and federal legislation designed to provide resources and services to those who are physically or emotionally traumatized or victimized (Young, 1994; Davis, 1993). One organization dedicated to assisting trauma survivors is the National Organization for Victim Assistance (NOVA). An important division of NOVA involves its Crisis Response Team (CRT) and emergency trauma specialists; these individuals are placed on "stand-by" for any national or international emergency considered to be a critical incident.
Directed by Marlene A. Young, Ph.D., NOVA is a highly respected non-profit organization that has responded to many "high profile" tragedies such as the Mount St. Helens' eruption in 1980, the Air Florida airline crash of 1982, the South Korean airline Flight 007 Disaster of 1983, the Mexico earthquake of 1985, and the Milwaukee Jeffrey Dahmer serial murders to name only a few (Young, 1994).
NOVAs CRT personnel are all highly trained specialists in Disaster Management, Debriefing, Victim Assistance, Victimology and Crisis Intervention in times of community crisis (man-made crisis, natural or industrial disasters). All NOVA team members are highly experienced trauma workers and crisis intervention response specialists who go as national volunteers to various disasters as a public service to the requesting community or state.
The NOVA Team is carefully selected and typically represents a cross-section of the community where it is to be deployed. Most NOVA Teams are made up to represent various disciplines to better assist the community such as Clergy, Emergency Service Providers, Media Relations, Public Safety Personnel and other professionals representing the disciplines of Education, Nursing, Psychology, Psychiatry, Victim Advocates, Law Enforcement, and Medicine.
When specifically requested, NOVAs main objective is to provide intense and immediate emergency consultation, crisis intervention services with additional follow-up during a limited period of time. Usually one team of 10 specialists will be deployed and will work up to 3-4 days. The activated team will be relieved by additional teams as needed depending upon the magnitude of the catastrophe.
What is a Critical Incident?
The author defines examples of a "critical incident" as a sudden death in the line of duty, serious injury from a shooting, 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 emergency or public safety personnel (responders) or individual that causes a distressing, dramatic or profound change or disruption in their physical (physiological) or psychological functioning. There are oftentimes, unusually strong emotions attached to the event which have the potential to interfere with that persons ability to function either at the crisis scene or away from it (Davis, 1992; Mitchell, 1983).
Clinically, traumatic events and their impact on individuals are fairly predictable. When a person has been "exposed" to a critical incident, either briefly or long-term, this exposure can have a considerable impact on their global functioning. Historically, some of the first documented cases of traumatic stress or what used to be called "transient situational disturbance" (TSD) can be traced to military combat.
In time, researchers began to find evidence that emergency workers, public safety personnel and responders to crisis situations, rape victims, abused spouses and children, stalking victims, media personnel as well as individuals who were exposed to a variety of critical incidents (e.g., fire, earthquake, floods, industrial disaster, workplace violence) also developed short-term crisis reactions.
Trauma Reactions
NOVA personnel refer to short-term crisis reactions as the "cataclysms of emotion" where feelings and thoughts run the gamut and include such diverse symptomatology as shock, denial, anger, rage, sadness, confusion, terror, shame, humiliation, grief, sorrow and even suicidal or homicidal ideation. Other responses include restlessness, fatigue, frustration, fear, guilt, blame, grief, moodiness, sleep disturbance, eating disturbance, muscle tremors or "ticks", reactive depression, nightmares, profuse sweating episodes, heart palpitations, vomiting, diarrhea. hyper-vigilance, paranoia, phobic reaction and problems with concentration or anxiety (APA, 1994; Horowitz, 1976; Young, 1994). Flashbacks and mental images of traumatic events as well as startle responses may also be observed. It is important to consider that these thought processes and reactions are considered to be quite normal and expected with crisis survivors as well as with those assisting them. Some of the described symptoms surface quickly and are readily detectable. However, other symptoms may surface gradually and become what the author calls "long-term crisis reactions." These responses can be masked within other problems such as excessive alcohol, tobacco and/or drug use. Interpersonal relations can become strained, work-related absenteeism may increase and, in extreme situations, divorce can be an unfortunate by-product. Survivor guilt is also quite common and can lead to serious depressive illness or neurotic anxiety as well (APA, 1994; Mitchell, 1983; Young, 1994).
What is Critical Incident Stress Debriefing (CISD)?
Debriefing is a specific technique designed to assist others in dealing with the physical or psychological symptoms that are generally associated with trauma exposure. Debriefing allows those involved with the incident to process the event and reflect on its impact. Ideally, debriefing can be conducted on or near the site of the event (Davis, 1992; Mitchell, 1986). Defusing, another component of CISD, allows for the ventilation of emotions and thoughts associated with the crisis event. Debriefing and defusing should by provided as soon as possible but typically no longer than the first 24 to 72 hours after the initial impact of the critical event. As the length of time between exposure to the event and CISD increases, the least effective CISD becomes. Therefore, a close temporal (time) relationship between the critical incident and defusing and initial debriefing (i.e., there may be several) is imperative for these techniques to be most beneficial and effective (Davis, 1993, Mitchell, 1988).
Research on the effectiveness of applied critical incident debriefing techniques has demonstrated that individuals who are provided CISD within a 24-72 hour period after the initial critical incident experience less short-term and long-term crisis reactions or psychological trauma (Mitchell, 1988; Young, 1994). Subsequently, emergency service workers, rescue workers, police and fire personnel as well as the trauma survivors themselves who do not receive CISD, are at greater risk of developing many of the clinical symptoms the author has briefly outlined in this article (Davis, 1992; Mitchell, 1988). From the authors perspective, when applying debriefing techniques, an appropriate and effective protocol must be followed when assisting responders and crisis survivors of any critical incident.
Most approaches to CISD incorporate one or more aspects of a seven-part model. The model that the author suggests here consists of several key points that can be followed as a general guideline and applied when addressing responders and survivors who are involved in man-made, natural or industrial disasters.
An Emergency Crisis Intervention Response Specialist must lay the constructive groundwork for an initial "assessment" of the impact of the critical incident on the survivor and support personnel by carefully reviewing their level of involvement before, during and after the critical incident.
Since the late 1970s and early 1980s, the victim assistance movement has received more positive attention than ever and has gained tremendous momentum with the passage of state and federal legislation designed to provide resources and services to those who are physically or emotionally traumatized or victimized (Young, 1994; Davis, 1993). One organization dedicated to assisting trauma survivors is the National Organization for Victim Assistance (NOVA). An important division of NOVA involves its Crisis Response Team (CRT) and emergency trauma specialists; these individuals are placed on "stand-by" for any national or international emergency considered to be a critical incident.
Directed by Marlene A. Young, Ph.D., NOVA is a highly respected non-profit organization that has responded to many "high profile" tragedies such as the Mount St. Helens' eruption in 1980, the Air Florida airline crash of 1982, the South Korean airline Flight 007 Disaster of 1983, the Mexico earthquake of 1985, and the Milwaukee Jeffrey Dahmer serial murders to name only a few (Young, 1994).
NOVAs CRT personnel are all highly trained specialists in Disaster Management, Debriefing, Victim Assistance, Victimology and Crisis Intervention in times of community crisis (man-made crisis, natural or industrial disasters). All NOVA team members are highly experienced trauma workers and crisis intervention response specialists who go as national volunteers to various disasters as a public service to the requesting community or state.
The NOVA Team is carefully selected and typically represents a cross-section of the community where it is to be deployed. Most NOVA Teams are made up to represent various disciplines to better assist the community such as Clergy, Emergency Service Providers, Media Relations, Public Safety Personnel and other professionals representing the disciplines of Education, Nursing, Psychology, Psychiatry, Victim Advocates, Law Enforcement, and Medicine.
When specifically requested, NOVAs main objective is to provide intense and immediate emergency consultation, crisis intervention services with additional follow-up during a limited period of time. Usually one team of 10 specialists will be deployed and will work up to 3-4 days. The activated team will be relieved by additional teams as needed depending upon the magnitude of the catastrophe.
What is a Critical Incident?
The author defines examples of a "critical incident" as a sudden death in the line of duty, serious injury from a shooting, 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 emergency or public safety personnel (responders) or individual that causes a distressing, dramatic or profound change or disruption in their physical (physiological) or psychological functioning. There are oftentimes, unusually strong emotions attached to the event which have the potential to interfere with that persons ability to function either at the crisis scene or away from it (Davis, 1992; Mitchell, 1983).
Clinically, traumatic events and their impact on individuals are fairly predictable. When a person has been "exposed" to a critical incident, either briefly or long-term, this exposure can have a considerable impact on their global functioning. Historically, some of the first documented cases of traumatic stress or what used to be called "transient situational disturbance" (TSD) can be traced to military combat.
In time, researchers began to find evidence that emergency workers, public safety personnel and responders to crisis situations, rape victims, abused spouses and children, stalking victims, media personnel as well as individuals who were exposed to a variety of critical incidents (e.g., fire, earthquake, floods, industrial disaster, workplace violence) also developed short-term crisis reactions.
Trauma Reactions
NOVA personnel refer to short-term crisis reactions as the "cataclysms of emotion" where feelings and thoughts run the gamut and include such diverse symptomatology as shock, denial, anger, rage, sadness, confusion, terror, shame, humiliation, grief, sorrow and even suicidal or homicidal ideation. Other responses include restlessness, fatigue, frustration, fear, guilt, blame, grief, moodiness, sleep disturbance, eating disturbance, muscle tremors or "ticks", reactive depression, nightmares, profuse sweating episodes, heart palpitations, vomiting, diarrhea. hyper-vigilance, paranoia, phobic reaction and problems with concentration or anxiety (APA, 1994; Horowitz, 1976; Young, 1994). Flashbacks and mental images of traumatic events as well as startle responses may also be observed. It is important to consider that these thought processes and reactions are considered to be quite normal and expected with crisis survivors as well as with those assisting them. Some of the described symptoms surface quickly and are readily detectable. However, other symptoms may surface gradually and become what the author calls "long-term crisis reactions." These responses can be masked within other problems such as excessive alcohol, tobacco and/or drug use. Interpersonal relations can become strained, work-related absenteeism may increase and, in extreme situations, divorce can be an unfortunate by-product. Survivor guilt is also quite common and can lead to serious depressive illness or neurotic anxiety as well (APA, 1994; Mitchell, 1983; Young, 1994).
What is Critical Incident Stress Debriefing (CISD)?
Debriefing is a specific technique designed to assist others in dealing with the physical or psychological symptoms that are generally associated with trauma exposure. Debriefing allows those involved with the incident to process the event and reflect on its impact. Ideally, debriefing can be conducted on or near the site of the event (Davis, 1992; Mitchell, 1986). Defusing, another component of CISD, allows for the ventilation of emotions and thoughts associated with the crisis event. Debriefing and defusing should by provided as soon as possible but typically no longer than the first 24 to 72 hours after the initial impact of the critical event. As the length of time between exposure to the event and CISD increases, the least effective CISD becomes. Therefore, a close temporal (time) relationship between the critical incident and defusing and initial debriefing (i.e., there may be several) is imperative for these techniques to be most beneficial and effective (Davis, 1993, Mitchell, 1988).
Research on the effectiveness of applied critical incident debriefing techniques has demonstrated that individuals who are provided CISD within a 24-72 hour period after the initial critical incident experience less short-term and long-term crisis reactions or psychological trauma (Mitchell, 1988; Young, 1994). Subsequently, emergency service workers, rescue workers, police and fire personnel as well as the trauma survivors themselves who do not receive CISD, are at greater risk of developing many of the clinical symptoms the author has briefly outlined in this article (Davis, 1992; Mitchell, 1988). From the authors perspective, when applying debriefing techniques, an appropriate and effective protocol must be followed when assisting responders and crisis survivors of any critical incident.
Most approaches to CISD incorporate one or more aspects of a seven-part model. The model that the author suggests here consists of several key points that can be followed as a general guideline and applied when addressing responders and survivors who are involved in man-made, natural or industrial disasters.
An Emergency Crisis Intervention Response Specialist must lay the constructive groundwork for an initial "assessment" of the impact of the critical incident on the survivor and support personnel by carefully reviewing their level of involvement before, during and after the critical incident.
