Critical Incident Stress Syndrome 3

SARBC

Search and Rescue Society of British Columbia

As a result of the interest shown in his three-part series (in EHS Mirror) on C.I.S., Toby Snelgrove added this article on C.I.S. debriefing. - Editor, SARNEWS

Critical incident stress is the emotional, behavioural and physiological reaction to an emergency worker when confronted with acute trauma. Specifically, when there is unexpected mission failure, excessive human suffering or unusual sights or sounds (eg. grotesque victims), or when there is a threat to the life of the worker, emergency personnel can experience a traumatic stress response. Critical incident stress (C.I.S.) has the potential to affect one's ability to function either at the scene of an incident or later.

The most effective way to minimize the negative effect of C.I.S. is through a C.I.S. debriefing facilitated by a trained mental health professional. However, there may be times when there is no professional debriefer available or when the incident is of a minor nature and unit chiefs or managers may wish to provide some form of debriefing service. In these situations you may wish to conduct a MINI DEBRIEFING.

If you find yourself in situation where you feel a mini-debriefing is necessary, here are some guidelines to consider.

1. Not everyone can conduct mini-debriefings.

Those best suited have good interpersonal skills, know from experience that C.I.S. is real and a normal reaction to acute trauma, are comfortable with the expression of emotion in themselves and others and are trusted by those they plan to assist. Knowledge of crisis intervention, grief and loss is a definite plus.

2. You must be seen as an ally to the crew you plan to debrief.

Sometimes even the warmest supervisor cannot lead a debriefing due to the attitude some may have towards management or an existing climate between groups and management. It is recommended that debriefers be at the peer level. If there is no one else, simply put your cards on the table right away. Inform the group (or individual, if that is the case) that your role here is as a supportive friend, not as a boss. If you feel your position would get in the way of a debriefing, get someone else to lead the process.

3. Make the rules clear. This is to be a debriefing, not a critique.

The purpose of the session is to share your feelings about a difficult call, not to criticize others. Also make sure participants agree that the proceedings will be confidential.

4. Pick a time and a place that is comfortable and where there will be no interruptions.

The debriefing should be a continuous process with no one else wandering in and out.

5. Do not assume how participants are feeling.

Explain why you have initiated the debriefing and your knowledge about C.I.S. Then simply invite participants to individually respond to how the call has impacted them. Listen and watch for signs of emotional vulnerability. If there is none, fine, you have done your job. If there is, let it flow and the group will establish its own emotional level. Remember, the expression of extreme emotion is a healthy, normal process that emergency workers have learned to suppress.

6. Don't force the group process, but do get each individual to contribute at least once.

One suggestion is to follow the traditional debriefing steps and have participants discuss what they actually said and heard at the scene. If individuals have been traumatized, it normally shows through their tone of voice. When this happens, let them express themselves. Affirm that what they are experiencing is normal given the circumstances.

7. STOP CRITICISM OF OTHERS.

A critique can come later, but if individuals start complaining about others behaviour, stop it by saying something like: "Bob, we will be doing a critique later this week. The purpose of this session is to share our feelings about the call. Tell us how you felt during the call when things started going wrong." Being criticized by others before you are debriefed can be more traumatic than the incident itself.

8. Do not permit tough, insensitive comments or any gallows humor.

This will quickly put an end to the expression of personal feelings.

9. Watch for the non-participant especially the one who is visibly shaken.

Touch base with him/her later in private to make sure he/she is not simply reluctant to talk in a group setting.

10. If the mini-debriefing becomes emotional, do not stop until all the grief and pain is out.

You may go through the entire group without any expression of feelings and finally the last person shares some emotional pain. Make sure you allow time to go around the group again allowing others to do the same.

11. End the session with some form of "Where do we go from here?" question.

After an emotional session there is a need for a transition. Talking about action plans gives time for individuals to internalize what has happened and get ready to return home or to work.

12. Finally, after the session is over, you should contact a trained debriefer and debrief yourself.

Doing this will release any pent-up stress and build your confidence about further debriefings.

Remember, the worst thing you can do when others have experienced C.I.S., is to criticize them before they are emotionally debriefed. The second worst thing you can do is not to facilitate some form of psychological debriefing.

If you ever find yourself in a situation where the emergency workers around you may be in emotional pain, I urge you to take action. If it means doing your first mini-debriefing, "go for it". Remember, all you can be is yourself and all you can do is your best. If your colleagues know you are sincere in your intentions, they will support you in what you are attempting to do.

Toby Snelgrove, M.Ed. Stress Consultant