Critical Incident Stress Management

What is Critical Incident Stress Management?
Who and what are the CISM team?
How it works
Who's affected by CIS?
Can CIS affect your home life?
Symptoms of CIS
Coping with CIS
What Family and Friends Can Do

What is CISM?

CISM stands for Critical Incident Stress Management which was developed to help mitigate the effects of critical incident stress common to emergency service workers.

What is a Critical Incident and Critical Incident Stress

A Critical Incident is any situation faced by emergency personnel that causes them to experience unusually strong emotional reactions which limit their ability to adjust and negatively impacts the work and home environment. Tragedy, trauma, gruesome injuries, fatalities, serious incidents involving children, line of duty deaths - these are just some of the incidents that have the potential to cause Critical Incident Stress. How well you handle any one of these situations will depend upon your mental and emotional state at the time of the incident. Whatever is happening in your personal life may impede your ability to cope with situations that in your opinion, you always "handled well" in the past. Because each incident affects us in a unique way, do not measure your reactions to a critical incident against the reactions of your peers. Remember that CIS symptoms are a "normal reaction to an abnormal situation".

What is Critical Incident Stress Management?

Critical Stress Management is comprised of techniques and steps that can be used to help mitigate the effects of Critical Incident Stress. Through education and support service developed specifically for emergency service workers and their families, the goal is to address the issues early on to reduce the negative effects the stress can cause.

Who and what are the CISM team?

Your CISM Team is comprised of peers, Mental Health Professional(s) and Clergy who are sincere in their desire to offer assistance in helping manage and ease these symptoms through support and education. The team places the highest value on respect and confidentialty when providing this service. Confidentiality has to be respected by everyone involved in the process for this service to be successful.

How it works.

Upon being notified their assistance is required the team will respond to a level that is determined by the nature and scope of the incident. Sometimes only a diffusing is necessary. This may involve one or two team members responding to speak to those potentially impacted by the incident. A larger response, known as a debriefing, is used when it is obvious that the magnitude of the call and/or the number of people affected make a larger response necessary. Anyone can initiate the process if they feel it is needed by contacting their supervisor.

Who's affected by CIS?

CIS can affect anyone on the job from the recruit just starting out to the thirty year veteran. Needing some type of assistance does not mean that you are not good at what you do. The next time you feel the urge to say something judgemental about the way a peer has been affected by an incident, remind yourself that it could be you at a future incident.

Can CIS affect your home life?

Have you ever heard someone on the job say they don't take the job home - their family doesn't need to be exposed to what they do? Chances are family and friends may bear the brunt of your reaction to the incident. The symptoms of CIS may be more obvious to the people who care about you, than they are to you.

CISM does work, and even though you may not think that you are experiencing stress or feel the need to attend a defusing/debriefing we encourage you to participate. Your presence may help someone else in the debriefing or defusing. Coming together and talking about the incident is the first step in dealing with it, and may often be the only step required.

Here are some very common symptoms of CIS:

PHYSICAL	THOUGHTS	FEELINGS	RESPONSES
Chills	Confusion	Fear	Withdrawal
Weakness	Poor abstract thinking	Intense anger	Hyper alert to environment
Visual difficulties	Nightmares	Guilt	Antisocial acts
Thirst	Poor concentration	Apprehension	Increased alcohol consumption
Chest Pain*	Uncertainty	Grief	Inability to rest
Profuse sweating	Poor memory	Emotional shock	Change in usual communications
Fatigue	Hypervigilance	Panic	Intensified pacing
Headaches	Poor decisions	Emotional outbursts	Erratic movements
Difficulty breathing*	Suspiciousness	Denial	Change in social activity
Nausea	Disorientation	Feeling overwhelmed	Change in speech patterns
Elevated blood pressure*	Intrusive images	Anxiety	Loss or increase in appetite
Fainting	Difficulty identifying people/objects	Loss of emotional control	change in menstrual cycle
Rapid heart rate	Blaming someone	Agitation	etc.
Twitches	Increased/decreased awareness	Inappropriate emotional response
Muscle tremors	Poor problem solving	Irritability
Vomiting	Heightened alertness	Depression
Shock symptoms	Lowered alertness	etc.
Dizziness	etc.
Grinding of teeth

* A definite indicator for medical evaluation

Coping

Physical Exercise.
Relaxation.
Structure Time - Keep Busy.
Talk to people - don't clam up.
Avoid alcohol and drugs - they can complicate the problem.
Spend time with others.
Try to keep up a normal schedule.
Reach out to people- they do care (family, friends, clergy, co-workers etc.)
Give yourself permission to feel rotten.
Do things that make you feel good and you enjoy.
Eat a well balanced diet and eat regular meals.
Rest
Don't make any life changing decisions, but do make daily decisions to give you a feeling of control.
Share feelings with co-workers and check to see how they are doing.
Recurring thoughts, dreams or flashbacks are normal - try not to fight them - they'll decrease over time, and become less painful.

What Family and Friends Can Do

Listen Carefully.
Spend time with them.
Offer your care and concern - even if they don't ask you for help.
Give them private time.
Reassure them they are safe.
Don't take their anger or moods personally.
DON'T tell them they are "lucky it wasn't worse" - traumatized people are not consoled by these statements. Tell them you are sorry this incident occurred, and you want to try to understand and help.

CIS can happen to anyone and the symptoms can be different from person to person. Remember, don't compare yourself to others. These are normal reactions to an abnormal situation and incidents affect us all at a different level, depending on our mental, physical, and emotional state, as well as our unique personalities. Never feel afraid or embarrassed to seek help. The CISM TEAM is here for all of us - feel free to contact a member at any time for information or assistance, as well as making use of our EAP program.