Critical Incident Stress Management
Thank you as always for your questions. This post is in response to how I got started on my journey as a trauma therapist.
This journey started a long time ago, when I was only 19 years old. My first two serious boyfriends were first responders – a policeman who is now a homicide detective and then later a fireman, who is now a fire chief. Being involved in their worlds and seeing the impact of what they did first hand, was an eye opening experience.
During this time I was introduced to Critical Incident Stress Management (CISM) and started training in this field. I will also preface the rest of this post to say that CISM is intended for those who have not directly experienced the trauma i.e.: the person who was hurt or in the fire, as this is an entirely separate issue. CISM is intended to deal with vicarious trauma, experienced by those who are helping others, who have experienced the trauma. That said, what is seen, heard & experienced by first responders is at times horrific & traumatic and can produce PTSD.
CISM is designed to help people deal with their trauma one incident at a time, by helping first responders to talk about the incident when it happens without judgment or criticism. All interventions are strictly confidential, with the typical caveat of being honoured unless danger to self or others is determined. The priority is always on keeping people safe and returning them quickly to more normal levels of functioning.
Normal is different for everyone, and it is not easy to quantify. Critical incidents raise stress levels dramatically in a short period of time and after treatment a new normal is established, however, it is always higher than the old level. The purpose of the intervention process is to establish or set the new normal stress levels as low as possible. (This is where I also add in my somatic training to help the trauma release from the nervous system. )
Critical incidents are traumatic events that cause powerful emotional reactions in people who are exposed to those events. The most stressful of these are line of duty deaths, co-worker suicide, multiple event incidents, delayed intervention and multi-casualty incidents. Every profession can list their own worst-case scenarios that can be categorized as critical incidents. Emergency services organizations, for example, usually list the Terrible Ten. They are:
- Line of duty deaths
- Suicide of a colleague
- Serious work related injury
- Multi-casualty / disaster / terrorism incidents
- Events with a high degree of threat to the personnel
- Significant events involving children
- Events in which the victim is known to the personnel
- Events with excessive media interest
- Events that are prolonged and end with a negative outcome
- Any significantly powerful, overwhelming distressing event
While any person may experience a critical incident, it makes sense that members of law enforcement, fire fighting units, and emergency medical services are at greater risk for post traumatic stress disorder (PTSD). That said, less than 5% of emergency services personnel will develop long-term PTSD symptomatology.
That percentage increases when responders endure the death of a co-worker in the line of duty. This rate is only slightly higher than the general population average of 3–4%, which indicates that despite the remarkably high levels of exposure to trauma, emergency workers are resilient, and people who join the field may self-select for emotional resilience.
Emergency responders tend to portray themselves as “tough”, professional, and unemotional about their work. They often find comfort with other responders, and believe that their families and friends in other professions are unable to completely understand their experiences.
This is where CISM makes all the difference. If handled immediately issue by issue there is usually no long term fall out or repercussions. If however CISM is not undertaken, this is where the trouble can start, coping mechanisms come into play. Humour is a safe one, however drugs / medications or alcohol may be used to self medicate in the worse case situations, leaving the first responder open to numerous outcomes.
Well, I think that is it for now, but as always, if I haven’t answered your question I will try to do so in my next post.