Critical incident stress management

CISM was 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 was peer-driven (often by people with less than a week of training, and no formal mental health or counseling training or credentials[14][15]) and the people conducting the interventions may have come from all walks of life, but most were first responders (Police, Fire, emergency medical services) or worked in the mental health field. A major CISM training source appears to deliberately legally distance themselves from the training they provide by issuing a "certificate of attendance" and specifically stating: "We do not offer a certificate that specifically states you are CISD/CISM trained."[15] Another training source that does offer certificates also legally distances themselves from their own training, stating that they do "not represent, warrant or guaranty that the certificant is properly prepared or equipped to perform CISM or any of its components".[16] 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 themselves or to others. The emphasis was 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.[17] 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.[18] They are:

1. Line of duty deaths
2. Suicide of a colleague
3. Serious work related injury
4. Multi-casualty / disaster / terrorism incidents
5. Events with a high degree of threat to the personnel
6. Significant events involving children
7. Events in which the victim is known to the personnel
8. Events with excessive media interest
9. Events that are prolonged and end with a negative outcome
10. Any significantly powerful, overwhelming distressing event

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 post-traumatic stress disorder (PTSD). However, less than 5% of emergency services personnel will develop long-term PTSD symptomatology.[19] 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%,[20] 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.[19] Humor is used as a defense mechanism. Alcohol or possibly other drugs/medications may be used to self-medicate in "worst case" situations.

The type of intervention used depended on the situation, the number of people involved, and their proximity to the event. One form of intervention was a three-step approach, whereas different approaches include as many as five stages. However, the exact number of steps is not what is important for the intervention's success. The goal of the intervention is to address the trauma along the general progression: defusing, debriefing, and followup.[21]

The overwhelming preponderance of peer reviewed, published research found that CISM was ineffective and/or harmful.[4][29] Several meta-analyses in the medical literature either found no preventative benefit of CISM,[6][8][9] very low quality evidence of benefit,[7] or negative impact for those debriefed.[10][11][12][13][24][30][23][31] Research evidence linking debriefing to harm had been identified as early as 2002 where Rose Et. al identified increased rates of PTSD one year after a psychological debriefing like those used in CISM[2] leading to a rejection of the practice of debriefing by many US Government Agencies that year[3] under the medical ethical principle of "do no harm".[32] Twenty years later, the evidence against CISM/debriefing had strengthened with a January 2022 peer-reviewed evidence synthesis stating, "current evidence is consistent in not endorsing it as a form of treatment or prevention of post-traumatic symptomatology", "clinical guidelines for managing post-traumatic stress recommend not to practice psychological debriefing" and "psychological debriefing and associated interventions should be avoided in the management of acute trauma".[4]

• Clinical psychology
• Incident stress
• Stress management
• Stress (medicine)