Critical Incident Stress Management

Critical incident stress management (CISM) is an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. It can include pre-incident preparedness to acute crisis management to post-crisis follow-up. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder (PTSD). Evidence-based reviews, however, have concluded that CISM is ineffective for primary trauma victims, and should only be used for secondary victims, such as responding emergency services personnel. CISM was never intended to treat primary victims of trauma.

CISM is designed to help people deal with their trauma one incident at a time, by allowing them to talk about the incident when it happens without judgment or criticism. The program is peer-driven and the people conducting the interventions may come from all walks of life, but most are first responders (Police, Fire, emergency medical services) or work in the mental health field. All interventions are strictly confidential, the only caveat to this is if the person doing the intervention determines that the person being helped is a danger to themself or to others. The emphasis 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.

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:

While any person may experience a critical incident, conventional wisdom says that members of law enforcement, fire fighting units, and emergency medical services are at great risk for posttraumatic stress disorder (PTSD). However, 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. Humor is used as a defense mechanism. Alcohol or possibly other drugs/medications may be used to self-medicate in "worst case" situations.

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