Stress Management
The impact of critical incidents and work-related exposures on the health and mental health of first responders is well-known. However, there remains a level of stigma around mental health, leaving many to suffer in silence. CISM is a comprehensive holistic system aimed at addressing these exposures and consequences, best if implemented by trained professionals.
Levels and Types of Stress
The physical and psychological wellbeing of the person experiencing the stress and the future ability to function depends on stress management. In the chart on the slide, some of the common signs and symptoms that indicate critical incident stress are shown. There are also different levels. Acute stress is most common, coming from demands and pressures of the near past or near future. It is short-term and easily recognized but can be managed relatively simply. Episodic acute stress comes from lifestyles that generate continuous or episodic stress extended over time. It leads to anxiety, temper issues, tension, and ‘nervous energy, stemming from their patterns of interactions and lifestyles that are unhealthy. Finally, chronic stress is continuous grinding stress which wears away at people. It usually stems from large overarching factors that are not easy to change or from traumatic experiences, resulting in depression and changes in personality (CRMHS, 2018).
Goals and Objectives
The primary goal of a Stress Management Program for Critical Incidents in an Emergency Preparedness plan is to provide a planned, structural approach to mitigate the immediate psychological impact of a disaster or traumatic event. It offers the tools for individuals or groups in need to manage the trauma and facilitate a healthy recovery. However, while the program does have therapeutic elements, it is not a replacement for psychotherapy for those who continue to experience aftereffects of an intensely traumatic event. Instead, CISM is a system of support meant to address immediate trauma exposure, sometimes referred to as “psychological first aid.”
Vulnerable Populations and First Responders
CISM can be provided by and to many types of professionals and first responders. Virtually any first responder can provide CISM if they are trained in its implementation and are certified in critical incident stress management. However, first responders are also the ones that face traumatic events more frequently than the general public. Firefighters and police officers often face proximity to death and the possibility of trauma resulting in the development of PTSD. Healthcare workers find themselves in high-stress environments while also witnessing significant instances of morbidity and mortality, particularly in either highly destructive events or even over continuous periods of time, such as during pandemics, which severely impacts mental health.
CISM is highly flexible and can be used in the form of public interventions in the community. Such interventions can provide information, education, and guidance that contributes to the restoration of communities and families, reducing post-disaster mental health burdens stemming from distress. All kinds of vulnerable populations can benefit from stress management in critical incidents, but particularly those without a support system or with a history of mental illness are likely most susceptible to trauma.
Program Implementation
The pre-crisis phase is all about planning and preparation. The CISM model should be described in detail in the preparedness plan, and there should be trained professionals in the local first responder force to lead it alongside public health professionals. Even if the disaster has not occurred, the phase is continuous in preparing first responders in being able to respond and manage stress in order to decrease reliance on CISM if something does occur. Once a disaster occurs, the acute crisis stage interventions kick in described in the next slides.
The concept of CISM is historically grounded in crisis interventions such as Critical Incident Stress Debriefing (CISD), which is a structured group therapeutic process where people can share experiences and receive support. It is based on crisis intervention theory and has been effectively applied for decades. It is designed to accompany other components of CISM and should not be used as a stand-alone intervention (Hokanson & Wirth, 2000). The implementation of CISD will depend on the management of each respective branch of first responders or overseen by public health officials. Due to differences in perspective and experiences, it is more beneficial to separate first responders from the general public receiving this intervention.
Acute crisis stage interventions can go beyond CISD. Various techniques can be helpful as well. Demobilization and consultation allow for short sessions led by an authority person evaluating the mental health status of first responders. Defusing is similar to CISD but should occur shortly after the incident or at the end of the workday in confidential discussion groups, which promotes stabilization of emotions and preventions of traumatic stress. Finally, there are other opportunities if needed for those experiencing heavy trauma or unique circumstances. The post-crisis stage interventions are self-explanatory, focusing on long-term mental health through follow-up and referral mechanisms for those who experienced long-term effects and chronic illnesses such as PTSD.
Community Resilience
Interventions aiding people on an individual level allow for the general community resilience as bonds of camaraderie form, there is a re-established sense of community, and people have the tools to promote further resiliency from trauma. Stress management programs, such as those based on the CISM, aim to develop strategies that promote community resilience and self-efficacy in diverse populations. A holistic approach should be adopted both in interventions targeting first responders and the general public to reduce the effects of trauma subsequent mental health symptoms.
Summary
CISM is a crisis intervention that is vital to a stress management program as part of emergency preparedness. Comprised of various crisis responses components, the program addresses each phase of a crisis situation. It is flexible and can be implemented in individuals, families, groups, organizations, and the whole community. The intervention provides powerful crisis support that contributes to community resilience and individual mental wellbeing.
References
AANA. (2014). Guidelines for crucial incident stress management. Web.
Benedek, D. M., Fullerton, C., & Ursano, R. J. (2007). First responders: Mental health consequences of natural and human-made disasters for public health and public safety workers. Annual Review of Public Health, 28(1), 55–68. Web.
CRMHS. (2018). APA: 3 types of stress. Web.
Everly, G.S., Flannery, R.B., & Eyler, V.A. (2002). Critical incident stress management (CISM): A statistical review of the literature. Psychiatric Quarterly, 73(3), 171-182.
Good Therapy. (2015). Critical incident stress management. Web.
Guenthner, D. H. (2012). Emergency and crisis management: Critical incident stress management for first responders and business organisations. Journal of Business Continuity and Emergency Planning, 5(4), 298-315.
Hokanson, M., & Wirth, B. (2000). The critical incident stress debriefing process for the Los Angeles County Fire Department: automatic and effective. International Journal of Emergency Mental Health, 2(4), 249-257.
OSHA. (n.d.). Critical incident stress guide. United States Department of Labor. Web.