Critical Incident Stress Research Articles

Investigating the “rescue personality”.

Mitchell and Bray use the term rescue personality as a way of describing characteristics of individuals who serve in the emergency services and describe emergency service workers as inner-directed, action oriented, obsessed with high standards of performance, traditional, socially conservative, easily bored, and highly dedicated.This rescue personality has provided an important foundation for the controversial Critical Incident Stress Management model; however, little empirical evidence is available demonstrating its existence.Previous literature has primarily considered emergency service personality characteristics as predictors of posttraumatic symptoms and/or effective job performance. Consequently, a gap in the literature exists with respect to research investigating the existence of a particular personality type for emergency service workers, as compared with those working in nonemergency occupations. The present project compared a group of paid professional firefighters (n = 94) with a comparison gr...

Can Compassion Fatigue?

Journal of Palliative MedicineVol. 12, No. 8 Personal ReflectionCan Compassion Fatigue?Lisa MarrLisa MarrSearch for more papers by this authorPublished Online:7 Aug 2009https://doi.org/10.1089/jpm.2009.9577AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Can Compassion Fatigue?." , 12(8), pp. 739–740FiguresReferencesRelatedDetailsCited byMindfulness and compassion-oriented practices at work reduce distress and enhance self-care of palliative care teams: a mixed-method evaluation of an “on the job“ program6 July 2017 | BMC Palliative Care, Vol. 17, No. 1Interventions Following a Critical Incident: Developing a Critical Incident Stress Management TeamArchives of Psychiatric Nursing, Vol. 26, No. 1Compassion Fatigue: An Application of the Concept to Informal Caregivers of Family Members with DementiaNursing Research and Practice, Vol. 2011 Volume 12Issue 8Aug 2009 InformationCopyright 2009, Mary Ann Liebert, Inc.To cite this article:Lisa Marr.Can Compassion Fatigue?.Journal of Palliative Medicine.Aug 2009.739-740.http://doi.org/10.1089/jpm.2009.9577Published in Volume: 12 Issue 8: August 7, 2009PDF download

Disaster mental health: A critical incident stress management program (CISM) to mitigate compassion fatigue

This article presents a critical incident stress management program (CISMP) that is designed to anticipate and mitigate the emotional impact of external and internal critical incidents upon individuals and groups who deliver disaster recovery services. This comprehensive program provides for immediate and sustained responses to assist disaster workers in effectively minimizing the emotional detriment of stressful incidents, resulting from interactions with disaster victims. Disaster workers have the potential to experience compassion fatigue as they listen to the disaster survivors’ stories of pain and losses, and work long work hours over extended work periods. The program is a structured, peer-driven, clinician-guided, and supported process designed to provide interventions to address disaster-related mental health issues. Emphasis is placed on individual peer support for immediate action, and specialized individual and group support, assessment, and referral is provided by a stress management clinician. Peer partners participate in a training program, which includes: (1) an overview of stress assessment and management; (2) critical/intervention orientation; (3) identification and utilization of peer support techniques; (4) event preplanning, event briefings, defusings, and debriefings; (5) protocol for responding to an incident; and (6) basic information on workplace violence.

ASGW Best Practice Guidelines as a Research Tool: A Comprehensive Examination of the Critical Incident Stress Debriefing

Crisis intervention group work is routinely provided to those that have been exposed to potentially traumatizing events. The Critical Incident Stress Debriefing (CISD) has been identified as a standard format for conducting crisis groups, yet the intervention is highly debated in the literature. This article reviews the status of that debate, offers an analysis of the CISD protocols through the lens of group work effectiveness: ASGW's Best Practice Guidelines (2008), and then makes suggestions for the use of group work methodology to enhance the understanding of the benefits and limitations to CISD group work.

What makes an incident critical for ambulance workers? Emotional outcomes and implications for intervention

Ambulance workers use the term “critical incident” to refer to a category of workplace stressor. Developing an evidence-based approach to critical incident stress begins with identifying what makes incidents critical. The aim of this qualitative study was to characterize critical incidents as well as elicit suggestions for interventions. We interviewed 60 ambulance-based workers, both front-line and supervisors, and analysed interview transcripts. Having presented their suggestions for interventions more fully elsewhere (Halpern et al, 2009), here we characterize the incidents that emerged as critical and the emotional responses evoked by them. We found they suffered considerable distress from critical incidents and would welcome interventions. Incidents that were identified as critical commonly involved patient death, often combined with poignancy. These events appeared to evoke vulnerable feelings of inability to help and intense compassion, which led to further emotional, cognitive, and behavioural responses. Difficulty in acknowledging distress and fear of stigma presented significant barriers to accessing support. These barriers may be overcome by educating both ambulance personnel and their supervisors to recognize and tolerate the vulnerable feelings often evoked by critical incidents. While gender and length of service did not seem to impact on evoked emotions, recent recruits may be more open to this type of education.

Beyond ‘knee jerk’ reaction: CISM as a health promotion construct

This grounded theory research explores UK firefighter perceptions of stress and coping, and describes the outcomes firefighters see as evidence of successful coping. Results of this study reinforce outcomes of similar research with Canadian firefighters who also reported that their levels of distress post–incident are decreased or mitigated through talking to others about their reactions and coping strategies. Both studies explicated social support, personal coping, and meaning–making as necessary components to firefighter coping, and critical incident stress management (CISM) as a vehicle to support firefighters in developing and maintaining those strategies. This study confirms that CISM ‘works’, not because it is a medical intervention, but because it is a health promotion concept embedded in the culture and coping of the fire service. Health promotion philosophy and practice are explicated, and implications of a health promotion model for firefighter stress are outlined.

Editorial: Psychology and the Fire and RescueService

Provides an introduction for the articles in the special issue on Psychology and the Fire and Rescue Service (FRS). The seven papers in the issue make theoretical and empirical contributions to the psychological literature on fire and the FRS, and collectively form a compelling case for others to share their focus on this important topic area. Papers included in the issue consider diverse topics including the positive impact of fire through religious ritual, smoke alarm utility for special populations, the positive role of Critical Incident Stress Management, the unique situation offirefighters becoming victims of fire, the panic myth in disaster evacuations, industrial dispute in the FRS, and the experiences ofthose who love and live with firefighters.

Psychological interventions following terrorist attacks

Psychological reactions to terror attacks have been documented as ranging from no symptoms to transient behavioural symptoms to more serious posttraumatic stress. A review of representative studies is presented, with a critical analysis of the salient points of the various psychological intervention strategies for terrorist attacks. Common aspects of both most intervention approaches include multifaceted models that foster social support and include a preparatory phase, a phase of 'psychological first aid' and a follow-up phase of referral for more severe cases. The notion of intervention for all who may show some symptoms is not universally accepted. Where treatment or intervention is used, the debriefing aspect of CISM (Critical Incident Stress Management) remains highly disputed, with the focus on intrusively revisiting the trauma appearing to have questionable value at best. Some data questions whether formal treatment or intervention is necessary or even desirable. For many who choose not to seek out any help following a trauma, clinical data shows no negative results. Moreover, the preponderance of data shows that conventional 'debriefing' is not recommended. If the debriefing mechanism is refined so that intrusive emotional rehashing of the traumatic event is eliminated, the resultant interventions resemble resilience based approaches. Further defining when intervention is called for and refining the mechanisms of intervention in multi-stage intervention.

Interventions for critical incident stress in emergency medical services: a qualitative study

AbstractControversy over the use of Critical Incident Stress Debriefing leaves Emergency Medical Services (EMS) organizations with little direction in preventing sequelae of Critical Incident Stress (CIS) in their employees. Objectives of the study were to explore and describe Emergency Medical Technicians' (EMTs) experiences of critical incidents and views about potential interventions, in order to facilitate development of interventions that take into account EMS culture. We interviewed 60 EMT practitioners and supervisors, and examined interview transcripts using ethnographic content analysis. EMT practitioners want emotional support in their workplace soon after a critical incident, and welcome interventions that would enhance this. They also experience a brief timeout as important in preventing sequelae of CIS. Exchanges with supervisors and peers that are experienced as supportive are illustrated. Barriers to support are described, as well as ways to address them. Educating supervisors and front‐line practitioners to recognize and respond supportively to critical incidents is acceptable to them. However, an organizational culture that stigmatizes vulnerability is the most insidious and challenging barrier to accessing support after a critical incident. Addressing the issue of stigma is critical to developing appropriate interventions. Copyright © 2008 John Wiley & Sons, Ltd.

Apprehended Without Warrant

The practice of professional psychology was founded on empirical science. Subsequent development of the profession reveals a gap that is partially the result of the popularization of junk science in legal and judicial domains. A greater threat comes from pseudoscience, which presents serious professional issues for those who work in trauma-related emergency services and law enforcement. The most widely promoted service is Critical Incident Stress Debriefing and Management, but scientific evidence does not justify its application. The authors describe the promotion and implementation of these services within the FBI and the professional difficulties that ensued. They also provide suggestions as to how such difficulties could have been avoided and apply them to other domains of law enforcement.

Helping the helpers: debriefing following an adverse incident

A significant proportion of healthcare workers will experience some degree of critical incident stress following adverse events. Individuals’ responses range from common, uncomplicated stress‐related reactions to the more complex post‐traumatic stress disorder. Under‐reporting of clinical incidents results mainly from fear of litigation and disciplinary action. Debriefing should be an essential component of critical incident stress management. Learning objectives: To be aware of how healthcare staff can be supported effectively following an adverse incident. To learn about the seven phases of the Mitchell debriefing model. Ethical issues: Disclosure of adverse events all too often results in disciplinary action: this ‘blame culture’ is to the detriment of patients and staff. Please cite this article as: Vaithilingam N, Jain S, Davies D. Helping the helpers: debriefing following an adverse incident. The Obstetrician & Gynaecologist 2008;10:251–256.

Firefighter preferences regarding post-incident intervention

The effectiveness of Critical Incident Stress Debriefing (CISD) as a tool remains, at best, inconclusive. Yet in many locales CISD is mandatory for emergency services workers, including firefighters. To our knowledge, to date no study has investigated firefighters’ preferences for psychological intervention following traumatic events. To examine this, a survey was conducted with 142 members (54%) of an urban fire and rescue service in south-western Ontario, Canada. Firefighters were provided with five scenarios of varying traumatic intensity, for which they rated desirability of four voluntary post-incident interventions: CISD, individual debriefing, informal discussion, and no intervention. Firefighters expressed interest in working with post-event reactions within their peer group for all events, and an increasing interest in formal intervention as event severity increased. Individual debriefing was preferred to CISD in scenarios of low to moderate intensity. For scenarios of high intensity, ratings for all interventions were high. Expected relationships with prior CISD experience and years of service were not upheld. The essential role of informal peer-support, and the desire for meaningful intervention in severe situations, are discussed.

Introduction to the Special Issue

Within policing there is widespread promotion and use of questionable psychologically rooted practices as well as the acceptance of erroneous beliefs about police work. For instance, the articles composing this special issue show that dubious practices—hypnotic interviewing, polygraph examination, criminal profiling, critical incident stress debriefing, and detecting of deception solely on the basis of nonverbal cues—are routinely used by police agencies. Similarly, policing is pervaded by erroneous beliefs about confession evidence, eyewitness memory, lineup identification procedures, police behavior, and criminal behavior. The tie that binds these practices and beliefs is their lack of strong scientific support. In fact, these aspects of policing, and numerous others that are not covered in this special issue (e.g., psychic detection, authorship analysis, psychological autopsies), contain many characteristics that are indicative of pseudoscience (Lilienfeld, Lynn, & Lohr, 2003; Shermer, 2002; Stanovich, 2004). This is highly disconcerting because of the potential for severe consequences (e.g., miscarriages of justices) when pseudoscientific practices are employed by the police or when erroneous beliefs guide the consequential decision making that is inherent in police work. Tavris (2003) noted that there is a growing gap between the reliance on various practices in applied domains (e.g., clinical psychology, medicine, and engineering) and the amount of empirical evidence supporting those practices. Law enforcement does not appear to be immune to this widening scientist–practitioner gap. Concerns about the divide between psychological science and police work ultimately lead to questions about how police agencies, and other institutions within the criminal justice system, fall prey to such spurious practices and what can be done to help reduce their reliance on them. Concern about this schism, and the need to address these fundamental questions, stimulated this special issue. The specific goals of this special issue are to (a) identify a range of questionable practices and erroneous beliefs within law enforcement, (b) subject those practices and beliefs to incisive scientific scrutiny, (c) explain why law enforcement personnel use those unsubstantiated practices and form erroneous beliefs, (d) enhance the scientific foundation of the police profession, and (e) reduce the scientist–practitioner gap by arming law enforcement officers, police agencies, and other legal professionals with the knowledge required to identify pseudoscientific practices. Accordingly, each of the invited articles in this special issue contributes to the accomplishment of one or more of these goals.

Occupational and Organizational Issues in Emergency Medical Services Behavioral Health

SUMMARY Recent advances in research and understanding of the behavioral health impacts of an emergency medical service (EMS) career have necessitated reconceptualization of previous approaches to prevention, mitigation, and intervention. Approaches modeled on critical incident stress debriefing have fallen into disfavor due to a growing body of research indicating little if any efficacy for these techniques while suggesting the potential for paradoxical impacts on the recovery of some recipients. Current recommendations focus on supporting personal and organizational foundations that help to bolster resilience while ensuring that processes are in place to provide access to intervention utilizing evidence-informed best practices where indicated.

A group randomized trial of critical incident stress debriefing provided to U.S. peacekeepers

In a group randomized trial of critical incident stress debriefing (CISD) with platoons of 952 peacekeepers, CISD was compared with a stress management class (SMC) and survey-only (SO) condition. Multilevel growth curve modeling found that CISD did not differentially hasten recovery compared to the other two conditions. For those soldiers reporting the highest degree of exposure to mission stressors, CISD was minimally associated with lower reports of posttraumatic stress and aggression (vs. SMC), higher perceived organizational support (vs. SO), and more alcohol problems than SMC and SO. Soldiers reported that they liked CISD more than the SMC, and CISD did not cause undue distress.

Debriefing after failed paediatric resuscitation: a survey of current UK practice

Objectives:Debriefing is a form of psychological “first aid” with origins in the military. It moved into the spotlight in 1983, when Mitchell described the technique of critical incident stress debriefing....

Occupational Therapists’ Role on U.S. Army and U.S. Public Health Service Commissioned Corps Disaster Mental Health Response Teams

Occupational Therapists’ Role on U.S. Army and U.S. Public Health Service Commissioned Corps Disaster Mental Health Response Teams

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Review of Traumatic incident reduction and critical incident stress management: A synergistic approach.

Review of Traumatic incident reduction and critical incident stress management: A synergistic approach.

Katrina's MH Sequelae Hit New Orleans Residents Hardest

Katrina's MH Sequelae Hit New Orleans Residents Hardest