Crisis Response Teams Research Articles

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Telemental Health

New Hampshire crisis units offer new tool in MH treatment

As of this month, there's a new option that mental health advocates in New Hampshire have been asking for for at least a decade: a 24/7 phone line answered by trained mental health staff and, for those who need more, a mobile crisis response team that goes to them. The hope is that a quicker response to the community will spare people emergency room waits and provide them the appropriate level of care, which can often be immediate stabilization and a next‐day appointment with a counselor. Staff from the New Hampshire Department of HHS have said they expect call center staff will resolve 80 % of cases without dispatching a crisis response team. The Rapid Response Access Point, more commonly referred to as mobile crisis response, began Jan. 1 with surprisingly little publicity by the state or the company contracted to run it. In fact, community mental health centers said their two biggest challenges are hiring enough staff and making sure the public knows how to access the new service. Run by Beacon Health Options of Boston, the 24‐hour phone and text line — 1‐833‐710‐6477 — will be staffed by master's‐level clinicians, intake workers and peer support specialists who have lived experience with mental health or substance use disorders, according to its $9.2 million contract with the state. The phone and text line will be replaced with 988, the new national suicide prevention hotline, when it goes live in July. Now, all 10 of the state's community mental health centers will have a crisis response team thanks to a $52.4 million state contract.

Crisis event dispositions following a crisis response team intervention.

We examined dispositions of crisis response team (CRT) events over 2 years in a large Midwestern city. Between January 1, 2018 and December 31, 2019, the CRT self-dispatched to mental/behavioral health-related 9-1-1 calls. Data utilized for analysis included demographic information of persons in crisis, crisis type, and crisis event dispositions. Crisis types were mental health, self-harm, and substance use related. Event dispositions included immediate detention, arrest, transport, and issue resolved. Multinomial regression models were used to predict crisis event dispositions as a function of the three crisis types, controlling for covariates. The sample included 1,426 events to distinct individuals. Most CRT events involved persons who were White (47.7%; n = 680), male (56.1%; n = 800), and an average of 39.3 years of age (SD = 16.6). Most crises were mental health (65.4%; n = 932), followed by self-harm (31.7%; n = 452), and substance use (25.9%; n = 370). Events were generally resolved at the scene (55.0%, n = 784); over a quarter resulted in immediate detention (26.9%, n = 384), followed by voluntary transport (14.0%, n = 200), and arrest (4.1%, n = 58). Crisis type was a significant predictor of event dispositions: Self-harm crises were associated with immediate detention and voluntary transport, and substance use crises with arrest. Homelessness was also a significant predictor of arrest. The findings provide a better understanding of the short-term impact of CRTs. Data highlight how crisis type indicators predict event dispositions, demonstrating potential for more efficient emergency responder utilization by dispatching units according to crisis type. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Contribution of veterinary profession to the response to COVID-19 pandemic conveyed through experiences of the Veterinary Faculty Sarajevo

The International Organisation for Animal Health (OIE), from the onset of COVID-19 pandemic, promoted One Health in global and national responses. The OIE accentuated the role of the veterinary profession due to testing capacity of animal health laboratories and expertise. Veterinary Faculty Sarajevo through its Veterinary Institute participates in the national veterinary service with diagnostic and advisory roles. It has proactively enhanced the scope and quality of laboratories, including strengthening the interdisciplinarity and internationality. Development achieved through earlier pandemic threats resulted in having laboratory and technical facilities for molecular SARS-CoV-2 detection in the wake of the unveiling COVID-19 pandemic (early 2020). From confirmation of the first COVID-19 cases in Bosnia and Herzegovina (BiH), our staff participated in crisis response teams and, so far, held over sixty media addresses promoting public awareness and science based information. Our laboratories were included in the official detection system and were the first to sequence SARS-CoV-2, then to establish the Alpha COVID-19 variant in BiH human samples and to substantiate one-way virus transmission from humans to pets. The aim of this paper is to describe our activities as a participant in the response to the COVID-19 pandemic, alongside faced challenges and gained experiences.

Together telling: reconciling information equivocality in crisis response

Information is essential during crises. In a crisis response operation, information is usually shared among autonomous relief agencies to facilitate collective understanding and action. However, this may evoke the problem of equivocality, the presence of multiple competing or contradicting interpretations of the same information. The aim of this study is to offer pragmatic means of managing equivocality so collective understanding within and among groups can ensue in order to improve crisis response efforts. The primary theoretical constructs underlying this study are sensemaking, sensegiving, and storytelling. Sensemaking activities seek, process, create and use the information to come up with plausible understandings by assigning one meaning out of many plausible meanings in a situation, which is then communicated to others through the sensegiving efforts. Storytelling, as a communication tool, helps with the building of narratives in which open and negotiated conversations can lead to share understandings and coordinated actions. Built on the case of a garment factory fire incident in Pakistan that led to the death of 289 workers, the study adopted a Design Science Research approach by combining both existing theoretical understandings and relevant empirical data collected in two related settings. The data collection phase in Pakistan included analysis of investigation reports that examined the contributing factors and challenges faced by the first responders in handling the fire incident at the factory. Interviews with different actors of the factory fire incident, including survivors, victims’ family members, and emergency responders, were conducted. The second data source came from fieldwork conducted at Illinois Fire Service Institute (IFSI) in the United States. This was reinforced with reports retrieved from the National Institute for Occupational Safety and Health (NIOSH) database investigating the common causes of firefighter fatalities. The data were analyzed using content analysis and validated through the member-checking process. Based on the theoretical and empirical data, this study developed and introduced the concept of Together Telling (TT). By using storytelling exercises adopted from the theatre ensemble, TT addresses the information-sharing issue of equivocality by enhancing the dialogic competencies of the crisis handlers so they can collectively understand the situation and move towards action. This study has important theoretical and practical implications. Theoretically, it facilitates episodes of collective sensemaking by improving sharing of information among team members and the application of storytelling techniques in the context of crisis response as this has been largely used in pre-crisis and post-crisis settings. TT provides practical incremental steps towards achieving common understandings while managing misunderstandings and confusions among the crisis response teams which is crucial in moving forward jointly. It also allows new form of leadership to emerge where everyone contributes to developing the larger narrative of the ongoing situation.

Nevada lawmaker seeks funds to expand MH programs

Nevada Sen. Catherine Cortez Masto met with first responders and mental health professionals at Desert Parkway Behavioral Healthcare Hospital in Las Vegas following her introduction of a new bill designed to provide funding for and break down barriers to behavioral services for those suffering from a mental health crisis, the Las Vegas Review‐Journal reported June 2. Cortez Masto spoke with members of the Las Vegas Fire Department's crisis response team, a pilot program funded by one state and one federal grant in partnership with Desert Parkway that sends a team of emergency medical technicians, paramedics and a licensed social worker — instead of police or firefighters — to handle 911 calls related to mental health crises. The team can transport a patient directly to Desert Parkway, whereas traditional first responders are required to first take the patient to a medical hospital. Cortez Masto, a Democrat, and Sen. John Cornyn (R‐Texas) announced the introduction of the Behavioral Health Crisis Services Expansion Act on June 1. Cortez Masto said the bill would provide more grant funding for the expansion of programs like the Las Vegas crisis response team, with local oversight in place to account for the different needs of each local government.

San Francisco expands civilian response to mental health 911 calls

San Francisco is expanding a new program to the Bayview neighborhood that aims to be an alternative to policing by having a team of behavioral health professionals and paramedics respond to certain 911 calls, the San Francisco Examiner reported April 5. The Street Crisis Response Team will respond to nonviolent reports of people in mental health crisis in the Bayview every day of the week beginning April 5 from 11 a.m. to 11 p.m., according to Mayor London Breed's office. The Bayview team is the third to be deployed in San Francisco. Officials first launched a team in the Tenderloin last November, followed by a second team serving the Mission and Castro in February. Each team includes a paramedic from the Fire Department, a behavioral health clinician with the nonprofit HealthRight 360 and a peer specialist with Richmond Area Multi‐Services, a nonprofit mental health agency. Staff also includes people to coordinate care for those encountered on the street. While officials are praising the expansion, the rollout falls short of the goals Breed laid out last November when she announced San Francisco would have at least six teams available 24/7 across the city by the end of March. “The process of hiring behavioral health clinicians is a challenge in normal times, but it has been especially difficult during the pandemic because of the demands that COVID‐19 has placed on the public health system,” Breed's spokesperson Andy Lynch said. “Additionally, the city is looking for clinicians with experience handling these types of interactions.” Lynch said Breed is still committed to establishing all six teams for 24‐hour‐a‐day coverage and “are optimistic we can do this by the end of summer 2021.”

A “Mental Health PPE” model of proactive mental health support for frontline health care workers during the COVID-19 pandemic

We summarize in this article the development, roll out, and preliminary outcomes of a large-scale proactive mental health support model for frontline healthcare workers during the early stages of the COVID-19 pandemic, specifically during New York City's initial case surge in March through June of 2020. This paper summarizes the program design and output for two types of dedicated teams of behavioral health clinicians: 1) Mental Health Liaisons, who provided preventative support to COVID-19 hospital units and Emergency Departments, and 2) Mental Health Crisis Response Teams, who staffed 24/7 crisis response lines to support and mitigate staff crises as needed. In addition to the specifics of this model, we discuss the strategies, rewards, and difficulties of rapidly staging and evaluating such a model in the context of an ongoing disaster situation. We also offer recommendations for how this multi-dimensional model may be replicated in other settings.

Multiple-criteria Evaluation Model for Medical Professionals Assigned to Temporary SARS-CoV-2 Hospitals

Hospitals around the world, as health institutions with a key role in the health system, face problems while providing health services to patients with various types of diseases. Currently, those problems are intensified due to the pandemic caused by SARS-CoV-2 virus. This pandemic has caused an extreme spread of the disease with constantly changing needs of patients which impacts the capacities and overall functioning of hospitals. In order to meet the challenge of the COVID-19 (COronaVIrus Disease- 2019) pandemic, health systems must adjust to new circumstances and establish separate hospitals exclusive for patients infected with SARS-CoV-2 virus. In the process of creating COVID-19 hospitals, health systems face a shortage of medical professionals trained for work in COVID-19 hospitals. Using this as a starting point, this study puts forward a two-phase model for the evaluation and selection of nurses for COVID-19 hospitals. Each phase of the model features a separate multiple-criteria model. In the first phase, a multiple-criteria model with a dominant criterion is formed and candidates who meet the defined requirements are evaluated. In the second phase, a modified multiple-criteria model is formed and used to evaluate medical professionals who do not meet the requirements of the dominant criterion. By applying this model, two groups of medical professionals are defined: 1) medical professionals who completely meet the requirements for working in COVID-19 hospitals and 2) medical professionals who require additional training. The criteria for evaluation of medical professionals in this multiple-criteria model are defined based on research conducted on medical professionals assigned to the COVID-19 Crisis Response Team during the COVID-19 pandemic in the Republic of Serbia. The model was tested on a real example of evaluating medical professionals assigned to the COVID-19 hospital in Sombor. The model for evaluating medical professionals presented in this paper can help decision makers in hospitals and national policy makers to determine the readiness level of hospitals for working in the conditions of the COVID-19 pandemic, as well as underline the areas in which hospitals are not ready to meet the challenges of the pandemic.

Filling the gap: Mental health and psychosocial paramedicine programming in Ontario, Canada.

Paramedics respond to acute medical and trauma emergencies in the community and transport patients to emergency departments (ED). In some cases, paramedics are not only attending calls for mental health and psychosocial care but are also connecting individuals with more appropriate services to address their needs. This study qualitatively explores to what extent there are promising practices to be learned from paramedic services that are connecting patients to mental health and psychosocial programming. The study is organised as follows. In terms of the methods, we conducted a critical ethnographic case study of mental health and psychosocial care within paramedic services in Ontario, Canada. Interviews were conducted with frontline paramedics (n=31), paramedic services management (n=5), educators at paramedic college programmes (n=5) and Base Hospital physicians/directors (n=5). Work observations were also performed in three paramedic services, with multiple crews across different shifts (n ~90hr). The study findings outline three promising practices: diversion programmes that transfer patients to a destination other than the ED; crisis response teams that attend calls identified as involving mental health and community paramedicine programmes including referral programmes. We outline the social, political and economic conditions in which these programmes were established and are provided. We also describe the conditions required to enable connecting patients to non-ED supports. The benefits of implementing specific programming for mental health-related calls within paramedic services are discussed, as well as the importance of reaching beyond the prehospital and mental healthcare system to comprehensively and preventatively address mental health needs. Tensions are explored related to running programmatic interventions for mental health by paramedic services. We conclude by noting some public policy-level challenges including the need to focus more broadly on prevention and address the social determinants of health to aid the de-escalation of distress.

Development of a Multi-Criteria Model for Sustainable Reorganization of a Healthcare System in an Emergency Situation Caused by the COVID-19 Pandemic

Healthcare systems worldwide are facing problems in providing health care to patients in a pandemic caused by the SARS-CoV-2 virus (COVID-19). The pandemic causes an extreme disease to spread with fluctuating needs among patients, which significantly affect the capacity and overall performance of healthcare systems. In addition, its impact on the sustainability of the entire economic and social system is enormous and certain sustainable management strategies need to be selected. To meet the challenges of the COVID-19 pandemic and ensure sustainable performance, national healthcare systems must adapt to new circumstances. This paper proposes an original multi-criteria methodology for the sustainable selection of strategic guidelines for the reorganization of a healthcare system under the conditions of the COVID-19 pandemic. The selection of an appropriate strategic guideline is made on the basis of defined criteria and depending on infection capacity and pandemic spread risk. The criteria for the evaluation of strategic guidelines were defined on the basis of a survey in which the medical personnel engaged in the crisis response team during the COVID-19 pandemic in the Republic of Serbia participated. The Level-Based Weight Assessment (LBWA) model and Measuring Attractiveness by a Categorical-Based Evaluation Technique (MACBETH) method were used to determine the weight coefficient criteria, while a novel fuzzy Ranking of Alternatives through Functional Mapping of Criterion Subintervals into a Single Interval (RAFSI) model was used to evaluate the strategic guidelines. The proposed multi-criteria methodology was tested in a case study in the Republic of Serbia. The validity of the proposed methodology is shown through the simulation of changes in input parameters of Bonferroni aggregation functions and through a comparison with other multi-criteria methodologies.

Defund and Replace the Police: A Model Act for a Behavioral Health Crisis Response Team

NOTE: Model law is located in the Appendix. Too many Black persons and other persons of color are dying at the hands of law enforcement, leading many to call for the defunding of police. These deaths were directly caused by excessive use of force by police officers, but were also driven by upstream and institutional factors that include structural racism, institutional bias, and a historic culture of racialized violence. Public outcry against racial inequities has increased as the authority of police departments has expanded to include not only the authority to respond to and investigate criminal activity, but also to respond to calls regarding behavioral health issues and houselessness. Defunding police raises questions about how budget cuts should affect the types of services provided by police departments and what new and improved responses may look like. While advocates may have identified model programs that they hope will be the answer to defunding the police, many community organizers lack the legal training necessary to fully develop these models into policy proposals that institutionalize their visions in ways that protect against law enforcement co-option and make their visions a reality. This article proposes model Act (the Model Behavioral Health Response Team Act) that can be tailored to meet the needs of local and state policymakers endeavoring to create a new institution to replace the police in responding to mental health, substance use, and housing crisis. The institution created by this model act is evidence-based, person-centered, and community-driven. It is informed by empirical evidence on crisis response, federal guidelines, and a case-study of political activity motivated by the use of police excess of force that resulted in the death of a Black man in Greensboro, N.C. IF YOU WOULD LIKE TO SEE THIS ACT ADOPTED BY POLICYMAKERS IN YOUR NEIGHBORHOOD, SIGN-ON TO OUR LETTER OF SUPPORT: https://forms.gle/7q1LztNfBECLPLKe7

114. DESIGNING AND EVALUATING A NOVEL MENTAL AND BEHAVIORAL HEALTH CURRICULUM

Background Pediatric mental and behavioral health disorders are a growing public health concern with immediate and long-term impacts for children, families, and society. Pediatricians are uniquely positioned, but often inadequately trained, to identify and address childhood mental and behavioral health needs. Design/Methods Two major learning domains were identified for a 2-week rotation in senior year: 1) screening, diagnosis, and treatment of depression, anxiety, and ADHD in outpatient pediatric settings; and 2) evaluation, de-escalation, and triage of children in acute mental health crises. Residents participate in repeated sessions in integrated behavioral health clinics, conduct screenings with social workers, perform intakes supervised by a child psychiatrist, and evaluate patients with acute mental health concerns in the emergency department with child psychiatrists, in the community with Boston Emergency Services Team, and in inpatient settings with the hospital's Behavioral Response Team. Self-directed learning activities provide individualized experiences tailored to residents’ interests. By random selection, half of senior residents will participate in the rotation during its first year. All senior residents were invited to complete a baseline survey at the beginning of the year evaluating their satisfaction with their behavioral health training thus far. Results Fourteen of 29 (48%) eligible seniors completed the baseline assessment, showing that residents were least satisfied with their training in titrating/initiating medications to treat depression and anxiety, and most satisfied with their training in agitation management (Figure). Thus far, 11 senior residents have participated in the rotation. Conclusions Many senior residents have received limited training in behavioral and mental health competencies. We developed a novel 2-week rotation that leverages hands-on experiences with child psychiatrists, social workers, and crisis response teams, as well as individualized self-directed learning, which we will follow-up with surveys to assess efficacy as our next steps.

From Neutral to High Gear: Critical Implementation Drivers for PREPaRE School Safety and Crisis Response in Practice

School safety and crisis prevention, preparedness, and response initiatives have become standard operating procedures in schools throughout the USA. PREPaRE, a comprehensive curriculum developed by school-employed mental health professionals for school-based safety and crisis response teams, has been adopted by many schools in support of such initiatives. While research has supported consumer satisfaction with the training and materials associated with PREPaRE, anecdotal observations and conversations indicate considerable challenges with broad-scale implementation of the strategies and skills embedded in the curriculum. A possible explanation for this phenomenon may be found in the implementation science literature. We propose how implementation drivers such as leadership, organization, and competency connect to various elements of PREPaRE and how they can be used to increase the probability of taking the model from neutral to high gear by school-based safety and crisis teams. Specific potential driver ideas and related resources for implementation are included.

When psychologists take a stand: Barriers to trauma response services and advocacy for American Indian communities

ABSTRACT American Indians and other Indigenous groups face numerous traumas resulting from civil rights infractions. Often, these infractions began in historical contexts and continue into modern experiences. The Dakota Access Pipeline (DAPL) and subsequent activist response at Standing Rock are a prime example of how movements asserting human rights are met with resistance from dominant majority groups. Generally, this resistance turns violent as police and security responses from the dominant culture escalate despite the peaceful nature of demonstrations. This impacts mental health among oppressed populations. As #NoDAPL progressed, Indigenous psychologists felt moved to “Stand with Standing Rock” by supporting Water Protectors in need of trauma services. This was met with institutional and systemic barriers to treatment and lack of support from key professional organizations. This article addresses barriers faced by mental health professionals providing services on the frontlines and lists potential resolutions including the development of a crisis response team, infrastructure for communication with individuals onsite, culturally congruent healing, community-building, and prayer. The article serves as a case study for trauma provision among American Indian communities in crisis and is a reminder of the resilience and empowerment that occurs when Indigenous peoples from all over the world come together for a shared cause. This case study format can be a guiding example for service providers choosing to take a stand with marginalized communities asserting social change.

Measuring and optimising the efficiency of community hospital inpatient care for older people: the MoCHA mixed-methods study

BackgroundCommunity hospitals are small hospitals providing local inpatient and outpatient services. National surveys report that inpatient rehabilitation for older people is a core function but there are large differences in key performance measures. We have investigated these variations in community hospital ward performance.Objectives(1) To measure the relative performance of community hospital wards (studies 1 and 2); (2) to identify characteristics of community hospital wards that optimise performance (studies 1 and 3); (3) to develop a web-based interactive toolkit that supports operational changes to optimise ward performance (study 4); (4) to investigate the impact of community hospital wards on secondary care use (study 5); and (5) to investigate associations between short-term community (intermediate care) services and secondary care utilisation (study 5).MethodsStudy 1 – we used national data to conduct econometric estimations using stochastic frontier analysis in which a cost function was modelled using significant predictors of community hospital ward costs. Study 2 – a national postal survey was developed to collect data from a larger sample of community hospitals. Study 3 – three ethnographic case studies were performed to provide insight into less tangible aspects of community hospital ward care. Study 4 – a web-based interactive toolkit was developed by integrating the econometrics (study 1) and case study (study 3) findings. Study 5 – regression analyses were conducted using data from the Atlas of Variation Map 61 (rate of emergency admissions to hospital for people aged ≥ 75 years with a length of stay of < 24 hours) and the National Audit of Intermediate Care.ResultsCommunity hospital ward efficiency is comparable with the NHS acute hospital sector (mean cost efficiency 0.83, range 0.72–0.92). The rank order of community hospital ward efficiencies was distinguished to facilitate learning across the sector. On average, if all community hospital wards were operating in line with the highest cost efficiency, savings of 17% (or £47M per year) could be achieved (price year 2013/14) for our sample of 101 wards. Significant economies of scale were found: a 1% rise in output was associated with an average 0.85% increase in costs. We were unable to obtain a larger community hospital sample because of the low response rate to our national survey. The case studies identified how rehabilitation was delivered through collaborative, interdisciplinary working; interprofessional communication; and meaningful patient and family engagement. We also developed insight into patients’ recovery trajectories and care transitions. The web-based interactive toolkit was established [http://mocha.nhsbenchmarking.nhs.uk/(accessed 9 September 2019)]. The crisis response team type of intermediate care, but not community hospitals, had a statistically significant negative association with emergency admissions.LimitationsThe econometric analyses were based on cross-sectional data and were also limited by missing data. The low response rate to our national survey means that we cannot extrapolate reliably from our community hospital sample.ConclusionsThe results suggest that significant community hospital ward savings may be realised by improving modifiable performance factors that might be augmented further by economies of scale.Future workHow less efficient hospitals might reduce costs and sustain quality requires further research.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 8, No. 1. See the NIHR Journals Library website for further project information.

31.4 CRISIS/BEHAVIORAL INTERVENTION TEAMS IN ACTION ON CAMPUSES AND UNIVERSITIES

Suicide is prevalent in the college-age population, and mental health treatment often is delivered exclusively on campus. College campuses are unique environments, and the impact of a student suicide is felt across campus in the student’s residential, academic, and social communities. Participants will learn about the following: 1) the role of crisis response teams on college campuses; 2) the relationship of these teams with counseling centers; and 3) the issue of confidentiality on campus.

A WEB PLATFORM FOR CRISIS MANAGEMENT BASED ON VOLUNTARY DATA AND FREE TOOLS IN CASE OF NATURAL DISASTER

Abstract. An effective intervention of emergency based on good management of resources such as road, can limit the damage in practice. The road network can be easily damaged by a natural disaster which makes it partially or completely unusable. Also, it would be crucial to quickly map the most affected areas and associate them with a list of the necessary aids, or even indicate the places probably in danger to ensure the safety of the nearby population. Currently, web mapping and especially voluntary web mapping (such as the famous OpenStreetMap) are presented as a key tool for the management of crisis response teams, thanks to their mobility and simplicity for the wider public, the latter can play a vital role in creating and sharing real-time data from disaster areas to better manage emergency services. A web platform will allow the contribution of anyone wishing to provide support from its location using mobile devices, and enrich the crisis cells with the largest amount of geospatial information. Our work consists of implementing a web platform based on free tools and existing data. This platform will be accessible in case of natural disaster by everyone in order to supply its database. A global methodology for structuring and the implementing will be presented and discussed.

Crisis management training using discrete-event simulation and virtual reality techniques

Conducting emergency drills in an actual environment is workforce and resources intensive. Hence, organisations often hesitate to conduct emergency exercises frequently. Because of the limited number of opportunities to conduct drills in a year, the content of the emergency drills can only focus on common cases and exclude rare cases. This constraint also restricts the members of crisis response teams from exploring and verifying new methods for tackling a crisis. Therefore, this research uses information and communication technology (ICT), virtual reality (VR) and discrete-event simulation (DES) technologies to develop a hazard simulation system with the capability to recreate large scale and multi-agency emergency incidents that would be otherwise too costly, complex and dangerous to reproduce in the actual system. With this system, organisations can conduct emergency drills inside a virtual world having a close correspondence with their real physical apparition. This training method is called virtual collaborative simulation-based training (VCST). Two laboratory-based studies were conducted to examine user perceptions about the VCST method. A total of 60 university students majored in managerial-related subjects were enrolled, and the results showed that the proposed method appears to be a feasible approach for practising crisis management training. Further research is needed to verify the findings in larger samples and different populations.

Sensemaking questions in crisis response teams

Purpose When a crisis strikes, responders need to make sense of it to gain an understanding of its origins, nature and implications. In this way, crisis sensemaking guides the implementation of the response. The purpose of this paper is to focus on the sensemaking questions that responders need to address for achieving effective and efficient crisis management. Design/methodology/approach Data are drawn from six exercises, in which teams of professionals from different crisis organizations were confronted with two terrorist attacks. Just like in real incidents, these professionals convened in tactical response teams and formulated their response collectively. Findings The exercises demonstrate that crisis responders do not just have to make sense of the crisis, but also of their own roles and actions. They raise and address three sensemaking questions: What is happening in this crisis? (i.e. situational sensemaking), Who am I in this crisis? (i.e. identity-oriented sensemaking) and How does it matter what I do? (i.e. action-oriented sensemaking). Practical implications Crisis preparation tends to focus on plans and systems that accelerate or improve the construction of a situational understanding, while this study suggests the need of more preparatory attention for crisis responders’ roles and actions. Originality/value The research extends crisis sensemaking literature beyond the restricted focus on the incident itself by showing that responders are also trying to grasp their own role and how their actions matter when they are engaged in crisis response.