Critical Incident Stress Research Articles

Critical incident stress and secondary trauma

Critical incident stress and secondary trauma

Evaluation of Stress Debriefing Interventions with Military Populations

Military members are frequently exposed to traumatic events. In an attempt to mitigate the psychological impact of traumatic events, formal interventions, such as Critical Incident Stress Debriefing and Process Debriefing, have been developed and implemented. Through a literature review of psychological debriefing interventions in the military, several anecdotal and research-based observations are discussed. Suggestions for clinical application and programmatic research are made based on these empirical findings.

The death of a child in the emergency department

The death of a child in the emergency department (ED) is often overwhelming to the child's community, including the health care providers involved in that child's care. Sudden death, especially of a child, induces a strong emotional response in health care providers and in the families involved. Advanced preparation by emergency staff is vital to appropriately care for the patient, the grieving family, and the ED staff. The American College of Emergency Physicians and the American Academy of Pediatrics have jointly adopted a policy statement entitled “Death of a Child in the Emergency Department Joint Statement by the American Academy of Pediatrics and the American College of Emergency Physicians.” The purpose of this article is to provide the emergency physician with information related to the management of children and their families who die in the ED. The following important issues will be discussed: a family and team-centered approach when a child dies, support for families and communities, communication within the child's medical home, identification of resources for use when a child dies, and critical incident stress management.

Disaster medicine and the emergency medicine resident

Disaster medicine and the emergency medicine resident

The role of psychological debriefing in the treatment of victims of trauma

The application of psychological debriefing has become an expected and widespread intervention following exposure to trauma. This article assesses the wisdom of such an approach and reports upon expert consensus regarding its use. Meta-analytic and narrative reviews are summarised and areas of agreement and disagreement are outlined. In sum, it was concluded that the majority of people do not become traumatised from stressful events; that generic psychological debriefing, when applied to individuals, appears to have little impact on functioning; that a specific form of debriefing called Critical Incident Stress Debriefing holds the possibility of noxious effects for some participants and that those most deleteriously affected by debriefing appear to be those most distressed by the initial trauma; that there is no randomised controlled trial evidence to support the validity of group debriefing approaches; and that early intervention using Cognitive Behavioural techniques for those with clinically significant presentations appears the most promising approach. A generic set of guidelines for intervention following trauma is provided.

Critical incident stress debriefing: implications for best practice

Critical incidents disrupt people’s lives by creating strong emotional reactions, which may range from normal stress reactions to post-traumatic stress disorders. Critical incident stress debriefing (CISD) has been used since 1983 as a component of Critical Incident Stress Management. The processes are intended to help individuals manage their normal stress reactions to abnormal events. Although used extensively, research findings to date yield mixed results. Meta-analyses of research studies are reviewed to identify the methods, results, strengths, and weaknesses of the studies that can be used for evidence-based practice.

Police Stress Interventions

In the aftermath of several high impact and high profile events within the city of Newark and the Newark Police Department, a request was made by Newark Police and a program was initiated to provide educational preventive interventions and an anonymous hotline that would afford police officers access to immediate mental health referrals and services. The program was funded by the Violence Institute of New Jersey at the University of Medicine and Dentistry of New Jersey and supported by the administration of the police department. The lectures and content of the program were well received by the police officers, reflected in their attendance and involvement in each of the program segments. During and following the presentation of the programs, a significant increase in the use of the dedicated hotline provided for the officers of the Newark Police Department was observed. Based on the favorable results of this project, a follow-up program is currently proposed to add this content to the training of recruits at the police academy, and to add another component of training in critical incident stress management. [Brief Treatment and Crisis Intervention 3:47–53 (2003)]

Effects of suicidal behavior on a psychiatric unit nursing team.

1. Suicide of a psychiatric inpatient can have significant, although diverse, effects on the emotions and behavior of both individual nurses and team functioning. 2. The majority of participants in this study felt there was a need for formal debriefing or counseling for themselves and their colleagues after a critical incident, although there was less consensus about the timing and structure of such an intervention. 3. This research highlights the need for advanced training of critical incident stress management team members and for flexibility in the application of critical incident stress management techniques.

Continuing psychological aftermath of 9/11: A POPPA experience and critical incident stress debriefing revisited.

Volunteer clinical experiences as part of the New York Police Department’s Police Organization Providing Peer Assistance (POPPA) program are described in providing critical incident stress debriefings (CISD) to NYC emergency rescue personnel. Also, there is a discussion of distinctive aspects of September 11th that both characterize and confound a successful post-9/11 recovery, to include the intertwining of personal and national reactions to global terrorism and socio-political forces. Such factors, along with concerns about the efficacy of “one-shot clinical interventions,” form the rationale for a “Phase 2 CISD intervention model” that is described.

Continuing Psychological Aftermath of 9/11: A POPPA Experience and Critical Incident Stress Debriefing Revisited

Continuing Psychological Aftermath of 9/11: A POPPA Experience and Critical Incident Stress Debriefing Revisited

Supporting the Federal Emergency Management Agency Rescuers: A Variation of Critical Incident Stress Management

The purpose of this article was to document the efforts of two military installations in facilitating Critical Incident Stress Management teams for Federal Emergency Management Agency Rescue and Recovery Units following the attacks on the World Trade Center on September 11, 2001. McGuire Air Force Base accepted the mission to support the rotating task forces with emotional support, and Fort Dix offered temporary lodging while the teams were in-bound and out-bound to the "Ground Zero" site. A team, comprised of staff from both installations due to the configuration of professional and support staffs, does the Critical Incident Stress Management work. Both installations are within commuting distance of New York City and could provide adequate safety, security, and logistics to the teams. The classic crisis management models were not called into play, as that service was not asked for; however, it was clear to the McGuire Air Force Base/Fort Dix Critical Incident Stress Management team members that the rescue and recovery teams needed their physical presence. Many rescue organizations have their own "debriefing teams," yet it is believed that "outside teams" may be helpful as interim measures to demonstrate the universality of the process of coping with traumatic stress and grief management. It is hoped that this article honors the workers who came together to help in a very difficult time for our country. This article documents the interim measures that were taken for a group of people moving through crisis.

Work stress and posttraumatic stress disorder in ED nurses/personnel (CE)

Introduction: Work-related stress in the emergency department previously has been linked to depression and burnout; however, these findings have not been extended to the development of anxiety disorders, such as posttraumatic stress disorder (PTSD). Three sets of factors have been shown to contribute to stress in ED personnel: organizational characteristics, patient care, and the interpersonal environment. The current study addressed whether an association exists between sources of workplace stress and PTSD symptoms. Method: Respondents were 51 ED personnel from a hospital in a large Canadian urban center. The majority of respondents were emergency nurses. Respondents completed questionnaires measuring PTSD and sources of work stress and answered a series of questions regarding work-related responses to stress or trauma. Results: Interpersonal conflict was significantly associated with PTSD symptoms. The majority of respondents (67%) believed they had received inadequate support from hospital administrators following the traumatic incident and 20% considered changing jobs as a result of the trauma. Only 18% attended critical incident stress debriefing and none sought outside help for their distress. Discussion: These findings underscore the need for hospital administrations to be aware of the extent of workplace stress and PTSD symptoms in their employees. Improving the interpersonal climate in the workplace may be useful in ameliorating PTSD symptoms.

Early Identification and Management of Critical Incident Stress

Everyone experiences stress. That stress may be related to work (internal), community (external), or family; it may be cumulative or related to a particular critical incident. The cost related to treating acute stress is staggering, both to individuals and to organizations. Critical care nurses are well educated in the physiological responses to the stress of acute illness. Recognizing the emotional impact of stress and the techniques to manage it in themselves and in those with whom they work is equally as important. CISD is widely advocated as an intervention after critical incidents. Although debriefing in and of itself is effective, a single-session semistructured crisis intervention will not prevent posttraumatic stress; thus, the use of CISD as part of a comprehensive multifaceted approach to the management of acute stress related to a critical incident is recommended.

C RITICAL I NCIDENT S TRESS M ANAGEMENT (CISM): B ENEFIT OR R ISK FOR E MERGENCY S ERVICES ?

Background. Critical incident stress management (CISM) has become a common practice in modern emergency services. Described in 1983 as critical incident stress debriefing (CISD), CISM was originally marketed to help emergency personnel deal with ostensibly stressful situations they would encounter as a part of their work. Objective. To review the status of the medical and psychological literature regarding the efficacy and safety of CISM. Methods. Several pertinent databases were accessed and searched for scientific articles pertaining to CISM. These were subsequently analyzed for methodology and pertinence to the study topic. Results. Numerous scientific articles were found concerning CISM. Several high-quality studies were identified, but many other studies lacked adequate methodology sufficient for use in an evidence-based medicine approach. Others were from trade magazines, non-refereed journals, and obscure mental health journals. Several meta-analyses and randomized controlled trials (RCTs) were found. Overall, these studies show that, at best, CISM has no effect on preventing psychiatric sequelae following a traumatic event, particularly post-traumatic stress disorder (PTSD). Furthermore, several studies report possible paradoxical worsening of stress-related symptoms in patients and personnel receiving CISM. Conclusions. Despite the limitations of the existing literature base, several meta-analyses and RCTs found CISM to be ineffective in preventing PTSD. Several studies found possible iatrogenic worsening of stress-related symptoms in persons who received CISM. Because of this, CISM should be curtailed or utilized only with extreme caution in emergency services until additional high-quality studies can verify its effectiveness and provide mechanisms to limit paradoxical outcomes. It should never be a mandatory intervention.

Critical incident stress debriefing: Application for perianesthesia nurses

THE HALLMARK QUALITY of perianesthesia nurses—what sets experts apart—may well be the management of emergent, unexpected incidents with numerous patients in rapid succession.We care for vulnerable patients, frequently without the benefit of patient history, a chart to review, or a knowledgeable resource for pertinent information. We move on to the next patient, the next challenge, smoothly and automatically. Our focus on real or potential problems, with assessment skills and critical care competencies, assists us to ease the transitions patients undergo while in our units. We handle stressful situations for our patients and ourselves. We are constantly challenged with critical issues such as preempting emergencies and recognizing subtle and overt signs of patient instability. At the same time, we deal with patient flow issues such as “turnover time” and “unavailable postoperative beds” in critical care and clinical nursing units. We also deal with colorful personalities and interesting communication styles from professional colleagues.

Air Force Critical Incident Stress Management Outreach with Pentagon Staff after the Terrorist Attack

This article describes the Critical Incident Stress Management outreach to Pentagon staff conducted after the terrorist attack by a team of Air Force mental health and chaplain personnel. Also discussed are lessons learned from the author's experience while leading the mental health component and working in a larger tri-service outreach. Finally, the observed impacts of the outreach effort are examined along with recommendations for future postcritical incident outreach efforts.

A Perspective on the Air Force's Mental Health Response to the Pentagon

This article describes efforts to coordinate the Air Force mental health response to the Pentagon disaster of September 11, 2001. The successes and challenges of Air Force teams that provided Critical Incident Stress Management and outreach efforts at both the Pentagon and Family Assistance Center will be discussed. Lessons learned from this experience and recommendations for future Department of Defense responses to large-scale disasters follow.

Single session debriefing after psychological trauma: a meta-analysis

Despite conflicting research findings and uncertain efficacy, single session debriefing is standard clinical practice after traumatic events. We aimed to assess the efficacy of this intervention in prevention of chronic symptoms of post-traumatic stress disorder and other disorders after trauma. In a meta-analysis, we selected appropriate studies from databases (Medline Advanced, PsychINFO, and PubMed), the Journal of Traumatic Stress, and reference lists of articles and book chapters. Inclusion criteria were that single session debriefing had been done within 1 month after trauma, symptoms were assessed with widely accepted clinical outcome measures, and data from psychological assessments that had been done before (pretest data) and after (post-test data) interventions and were essential for calculation of effect sizes had been reported. We included seven studies in final analyses, in which there were five critical incident stress debriefing (CISD) interventions, three non-CISD interventions, and six no-intervention controls. Non-CISD interventions and no intervention improved symptoms of post-traumatic stress disorder, but CISD did not improve symptoms (weighted mean effect sizes 0.65 [95% CI 0.14-1.16], 0.47 [0.28-0.66], and 0.13 [-0.29 to 0.55], respectively). CISD did not improve natural recovery from other trauma-related disorders (0.12 [-0.22 to 0.47]). CISD and non-CISD interventions do not improve natural recovery from psychological trauma.

Psychological Intervention with Mortuary Workers after the September 11 Attack: The Dover Behavioral Health Consultant Model

Numerous descriptive as well as prospective studies have indicated that mortuary workers, body handlers, and those tasked to work with human remains are at risk for symptoms related to post-traumatic stress disorder and other psychological sequelae. There have been no controlled studies outlining psychological interventions to prevent or minimize the impact of being assigned to perform such duties. In this article, we describe a method of psychological intervention with mortuary workers mobilized as a result of the September 11 attack on the Pentagon. The intervention included the use of Critical Incident Stress Teams and was based on a behavioral health consultant model that has been demonstrated to be effective for behavioral interventions in primary care settings. The model incorporated knowledge from previous studies on mortuary workers and individuals tasked to work with human remains. Qualitative analysis indicated that the behavioral health consultants were well received, recommendations were implemented, and few personnel were removed from duty as a result of psychological factors leading to impaired performance. Implications related to popular models of critical incident intervention and directions for future controlled research are discussed.

Best practices: terrorism and mental health: private-sector responses and issues for policy makers.

Best practices: terrorism and mental health: private-sector responses and issues for policy makers.