Incident Stress Research Articles

Critical Incident Stress Management (CISM) in complex systems: Cultural adaptation and safety impacts in healthcare

In complex systems, such as hospitals or air traffic control operations, critical incidents (CIs) are unavoidable. These incidents can not only become critical for victims but also for professionals working at the “sharp end” who may have to deal with critical incident stress (CIS) reactions that may be severe and impede emotional, physical, cognitive and social functioning. These CIS reactions may occur not only under exceptional conditions but also during every-day work and become an important safety issue. In contrast to air traffic management (ATM) operations in Europe, which have readily adopted critical incident stress management (CISM), most hospitals have not yet implemented comprehensive peer support programs. This survey was conducted in 2010 at the only European general hospital setting which implemented CISM program since 2004. The aim of the article is to describe possible contribution of CISM in hospital settings framed from the perspective of organizational safety and individual health for healthcare professionals. Findings affirm that daily work related incidents also can become critical for healthcare professionals. Program efficiency appears to be influenced by the professional culture, as well as organizational structure and policies. Overall, findings demonstrate that the adaptation of the CISM program in general hospitals takes time but, once established, it may serve as a mechanism for changing professional culture, thereby permitting the framing of even small incidents or near misses as an opportunity to provide valuable feedback to the system.

OS1701 ランプ入力波を用いたCFRP接着接合継手の混合モード衝撃破壊じん性評価

An experimental method was developed in order to evaluate the mixed mode (I+II) impact fracture toughness for CFRP (Carbon Fiber Reinforced Plastic) adhesive joints using ramped incident wave. The MMF (Mixed Mode Flexure) specimen was employed for the evaluation of energy release rate. The dynamic response of the specimen was studied on the basis of computational results using finite element method. In the impact fracture toughness test, the SHPB (Split Hopkinson Pressure Bar) system was used for studying the dynamic response of the specimen. When a slow gradient ramped incident stress wave was applied to the specimen, bending vibration of the specimen was suppressed, and consequently dynamic energy release rate could be evaluated more precisely. Energy release rate could be estimated more precisely with the formula based on the surface strain of the specimen, whereas vibration was overestimated with the formula based on reaction force at loading point.

Dynamic Behavior of Laminated Graphite/Epoxy Composite under High-Strain Rate Perforation Loading

A high strain rate perforation split Hopkinson pressure bar (P-SHPB) test apparatus was developed for the quantification analysis of energy expenditure in the penetration or perforation mechanics, and dynamic fracture failure processes of laminated graphite/epoxy composite. This paper described the basic features of the P-SHPB system for perforation testing, characterized of high strain rate, and single mode as well as mixed modes of fracture failures of laminated composites. The results showed that the energy expended in a perforation process depends on the thickness of the laminate samples, the impact parameters and the incident stress delivered to the composite. The failure modes in graphite/epoxy composite exhibited four regions of damage mechanism and characterized on the basis of energy absorbed, impact energy, loading force, sample stress and strain rate. Perforation limit velocity was estimated by extrapolating the (impact velocity)2 and crack length curve to a zero-damage length and determining the velocity value.

Performance evaluation of high g accelerometers

A numerical model for the split Hopkinson bar fly-away technique is presented to evaluate the performance of accelerometers measuring large amplitude pulses. Simulation results based on the numerical model indicate that the rise time of the incident stress pulse in the incident bar and the disk length are of appropriate lengths for the disk response to be accurately approximated as a rigid-body motion. Strain-time histories demonstrate that the incident strain pulse is non-dispersive. The rigid-body acceleration of the disk is derived from analytical models with stress at the incident bar/disk interface, incident strain-time data, and particle velocity on the free end of the disk calculated from numerical results. Thus, accelerations measured using the accelerometer and those derived from the models can be compared. These acceleration-time pulses show good agreement. The numerical model of the split Hopkinson bar fly-away technique can be used to calibrate high g accelerometers.

Organizational Outcomes Following Traumatic Workplace Incidents: A Practice-Based Exploration of Impact of Incident Severity Level

Traumatic workplace events (critical incidents) occur with unfortunate regularity and with significant repercussions for affected organizations. Critical incident stress management (CISM) units, often a specialty component of employee assistance programs, provide consultation and support for workplace incidents. While CISM seeks to support both individual and organizational outcomes, trauma research oriented toward individual traumatic stress dominates the literature, mirroring practitioner training that tends to emphasize clinical over organizational practice. This research contributes to less-prevalent studies that explore organizational-level outcomes. Despite the facts that social workers play a central role in critical incident response and CISM units collect massive amounts of practice data, there are no published social work studies capitalizing on the potential of existing critical incident data. Employing the methodology of clinical data mining, this practice-based, exploratory research examines the propositions that incident severity level associates with several post-incident organizational outcomes. Several findings translate into considerations for evidence-informed CISM practice in the areas of intake assessment, organizational consultation, and incident response planning.

여성 119구급대원의 폭력 경험과 이직 의사

Purpose : The purpose of this study was to provide an appropriated direction for fire service organizational management by analyzing the violence experiences and turnover intention of female 119 emergency medical technicians (119 EMT) in Korea. Methods : The questionaries were obtained from 415 female 119 EMT in Korea from April 27 to March 8 in 2009. The collected data were analyzed with SPSS WIN 19.0 program. Results : Female 119 EMTs experienced 94.9%-verbal insults, 57.1%-violence aggression, 62.89%- potential violence, 32.5%-physical assault. About 76.4% of the subjects experienced to feel shame about the verbal insults. They had a stress level (mean 5.47 out of 10) and about 41.2% was more than seven points. About 39.3% of the subjects responded turnover intention. Conclusion : We proposed the preventive program against violence as well as critical incident stress debriefing. These results are expected to be useful in making human resource management plans to lower turnover intention.

소방공무원의 지각한 현장출동 충격경험과 외상 후 스트레스가 신체증상 및 대처방식에 미치는 영향

본 연구는 소방공무원들의 지각한 현장출동 충격 경험과 외상 후 스트레스가 신체증상 및 대처방식에 미치는 영향을 규명하기 위하여 강원도 소재 소방안전센터에 근무하고 있는 소방공무원 남녀 362명을 대상으로 조사하였다. 수집된 자료는 Windows용 SPSS 19.0과 AMOS 19.0을 사용하여 빈도분석, 타당도와 신뢰도 분석을 위한 요인분석과 Cronbach's <TEX>${\alpha}$</TEX> 분석, 기술통계와 상관관계를 실시하였고, 가설 검정을 위해 구조방정식 모형을 이용한 분석을 실시하였다. 모든 통계분석은 유의수준은 p<.05로 설정하였다. 결과는 다음과 같다. 첫째, 지각한 현장출동 충격 경험은 외상 후 스트레스에 영향을 미치는 것으로 나타났다. 둘째, 지각한 현장출동 충격 경험이 신체증상에 영향을 미치는 것으로 나타났다. 셋째, 지각한 현장출동 충격 경험은 대처방식에 영향을 미치는 것으로 나타났다. 넷째, 외상 후 스트레스는 신체증상에 영향을 미치는 것으로 나타났다. 다섯째, 외상 후 스트레스는 대처방식에 영향을 미치는 것으로 나타났다. 여섯째, 신체증상은 대처방식에 영향을 미치는 것으로 나타났다. 이러한 결론으로 볼 때 충격적 스트레스를 해소하기 위한 제도적 방안으로 전 세계적으로 검증이 되어 실제 운영되고 있는 위기상항 스트레스 해소법(Critical Incident Stress Debriefing : CISD)을 소방서의 실정에 맞게 도입하여 운영하는 것이 필요할 것이다. The purpose of this study was to closely examine the influence of field-shock experience and post traumatic stress perceived by fire officials upon somatic symptoms and coping methods. A survey was carried out targeting 362 male and female fire officials who are working at fire safety centers where are located in Gangwon-do Province. The collected data were used SPSS 19.0 and AMOS 19.0 for Windows. It carried out frequency analysis, factor analysis for validity and reliability, Cronbach's <TEX>${\alpha}$</TEX> analysis, descriptive statistics and correlation. For hypothesis verification, an analysis was carried out by using structural equation modeling. All the statistical analyses were set for the significant level in p<.05. The results are as follows. First, the perceived field-shock stress was indicated to have influence upon post traumatic stress. Second, the perceived field-shock stress was indicated to have influence upon somatic symptom. Third, the perceived field-shock stress was indicated to have influence upon a coping method. Fourth, the post traumatic stress was indicated to have influence upon somatic symptom. Fifth, the post traumatic stress was indicated to have influence upon a coping method. Sixthly, the somatic symptom was indicated to have influence upon a method of coping with stress.

„Second victim“

Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.

The Role of Managers in Critical Incident Stress Management Programmes: A Qualitative Study of New Zealand Social Workers

This paper reports part of a larger exploratory research study of social workers' preferred models of critical incident stress management and experiences of critical incident stress debriefing. Social workers were invited to contribute to the research through an advertisement in the national association's newsletter for Aotearoa New Zealand Association of Social Workers. Using a qualitative methodology involving in-depth interviews with 13 social workers, participants were asked about their experiences of critical events encountered within their workplaces over the last five years. Interviews were recorded by audiotape with consent and analysed using thematic analysis. Four main themes emerged: the importance of preparation for critical incidents, the role of relationship between line managers and social workers, specifically the line manager's support immediately after the critical incident, and the availability of peer/colleague networks. An unexpected finding was that social workers interviewed noted that the pre-existing relationship with the line manager influenced their experience of the debriefing process itself. The more engaged and emotionally aware the manager was seen, the more the social worker claimed the debriefing process had been successful from their perspectives. The implications for social workers and their employing agencies are discussed.

Group critical incident stress debriefing with emergency services personnel: a randomized controlled trial

Although single-session individual debriefing is contraindicated, the efficacy of group psychological debriefing remains unresolved. We conducted the first randomized controlled trial of critical incident stress debriefing (CISD) with emergency workers (67 volunteer fire-fighters) following shared exposure to an occupational potentially traumatic event (PTE). The goals of group CISD are to prevent post-traumatic stress and promote return to normal functioning following a PTE. To assess both goals we measured four outcomes, before and after the intervention: post-traumatic stress, psychological distress, quality of life, and alcohol use. Fire brigades were randomly assigned to one of three treatment conditions: (1) CISD, (2) Screening (i.e., no-treatment), or (3) stress management Education. Controlling for pre-intervention scores, CISD was associated with significantly less alcohol use post-intervention relative to Screening, and significantly greater post-intervention quality of life relative to Education. There were no significant effects on post-traumatic stress or psychological distress. Overall, CISD may benefit broader functioning following exposure to work-related PTEs. Future research should focus on individual, group, and organizational factors and processes that can promote recovery from operational stressors. Ultimately, an occupational health (rather than victim-based) approach will provide the best framework for understanding and combating potential threats to the health and well-being of workers at high risk for PTE exposure.

Understanding of the Scattering of Incident Stress Waves by Defects on the Blind Side of Fuel Vent Hole

This paper reports on findings that extend previous work for the purpose of in-situ structural health monitoring of defects on the blind side of open holes using plate waves. A series of computational studies is presented to understand how and why the ultrasonic scattered wave field can be detected on the accessible surface. The uniqueness of these findings is that the length-scale of the defect and the incident waves are comparable. The combination of the experimental-computational-analytical approach gives rise to new insights and guidance for the quantification of defects located in hard-to-inspect regions of future unitised metallic and composite structures. The outcomes advance the knowledge base of inspection of hard-to-access regions with actuators and sensors placed in easily accessible locations.

Alleviating Stress In Police Agencies

Police stress has been examined in many studies, many of which have focused upon the development of prevention and treatment programs for the police officers (Maslach, 1982; Maslach & Jackson, 1979; Mitchell, 1983; Mitchell & Everly, 1993). The trend of combating stress began with the police agencies using employee assistance programs, funding conferences, conducting research, and establishing prevention programs, but the fact remains that the health of police officers and their families becomes a large concern as most officers tend not use free counseling due to concerns regarding confidentiality and the competence of the counselors. An example of one program is the New Jersey COP-2-COP confidential hotline for police officers and their families (Ussery & Waters, 2006). COP-2-COP was a volunteer program and its usefulness was seen post-September 11, 2001, in its response to the needs of the survivors of the World Trade Center disaster and also after the New Orleans disaster in the Critical Incident Stress Debriefing process after Hurricane Katrina. Police stress can have a bad influence on police performance and can cause many problems such as poor job performance, increased accidents, sleep disturbances, marital discord, domestic violence, posttraumatic stress disorder, depression, suicide, alcohol and other drug abuse, ulcers and other digestive disorders, respiratory ailments, and cardiovascular disease.

Inner strategies of coping with operational work amongst SAPS officers

Orientation: Identification of the inner coping strategies used by South African Police Service (SAPS) officers who do operational work is something the SAPS should consider to ensure the officers’ management of trauma and efficiency at work.Research purpose: The objective of this study was to describe inner coping strategies used by officers in the Vhembe district (South Africa) to reconstruct stressful and traumatic experiences at work.Motivation for the study: Most studies on coping amongst SAPS officers focus on organisational stress and not on the impact of the officers’ operational work.Research design, approach and method: An exploratory design was used and 20 SAPS officers were selected through purposive sampling. In-depth face-to-face and telephone interviews, as well as diaries were used to collect data, which were analysed using content thematic data analysis.Main findings: The results showed that the main categories of coping strategies that led to management of the impact of operational work amongst the selected sample were centred around problem-focused and emotion-focused strategies, with some use of reappraisal and minimal use of avoidance. Considering the context of the officers’ work, the list of dimensions of inner coping strategies amongst SAPS officers should be extended.Practical/managerial implications: Intervention programmes designed for the SAPS, including critical incident stress debriefing, should take the operational officers’ inner strategies into account to improve the management of the impact of their work.Contribution/value-add: This study contributes to the body of knowledge on the inner coping strategies amongst SAPS officers, with special reference to operational work in a specific setting.

Importance of debriefing following critical incidents

Working in emergency departments (EDs) is inherently stressful, and stress caused by events such as witnessed death, elder or child abuse, and aggression and violence can have profound effects on staff. One strategy that can be effective in helping staff deal with such events is critical incident stress debriefing but, as the literature suggests, this is poorly established in ED settings. This article reports the results of a study in three EDs in Ireland of nurses' and doctors' perceived needs for debriefing and makes recommendations to improve this area of practice.

Effect of industrial explosions on the stability in rock mass with cavities

The paper substantiates the conditions of seismic stability in the rock mass with cavities, on which protected objects are located, under constant seismic effects of mass explosions in quarries. Based on the ray-tracing method, a mathematical model of the interaction between longitudinal and transverse waves with a spherical cavity has been developed. An algorithm has been elaborated for determining the total static and dynamic loads along the spherical cavity perimeter from seismic explosion waves falling on the interface. The regularities of joint action of static loads have been determined, when located above the objects cavity, with allowance for the effect of the mass of cavity ceiling, the mass of the protected object above it and dynamic loads in the rock mass, and under the plane wave front fall on the cavity from different directions. The dependences of the change of total stresses referred to the incident wave stress at the interface of the rock mass and the cavity depending on the coordinate on its surface have been set. It has been established that the most dangerous points of cavity surface, in which destruction is likely to occur, are the cases when the seismic wave front falls on the cavity from the bottom directions typical for blasting operations in deep quarries. Under the arbitrary angles of the wave incidence on the cavity the stresses rearrange along the perimeter, which under different circumstances might lead to the mass breach and the fall of the protected objects, located above it, under the ground

Three-Dimensional Laser Scanning Vibrometry as a Visualisation Tool for Structural Health Monitoring Research

The application of three-dimensional scanning laser vibrometry for visualising stress wave propagation in a specimen with a non-surface penetrating defect is presented in this paper. The aim of this paper is to demonstrate the use of this measurement technique to achieve a good insight of the propagation of the stress wave over a given region on a test specimen. An investigation into the interaction of the various wave modes with the defect in the structure can be enhanced with this knowledge. The ability to acquire the time series at an array of measurement points in a given region on the structure provide for an excellent means for visualising the propagation of the incident stress and how they interact with the defect present. In addition to the visualisation aspect, the data acquired can also be transformed to assess the modal content of the various wave modes present within the structure. For the purpose of this paper, a flat aluminium test plate with a non-surface penetrating defect will be used. The application of this form of non-contact measurement technique for the stress wave visualisation work will be illustrated. It will be shown that this measurement technique can be used to establish the modal content and the time-development of the incident and the scattered wave modes in the test specimen.

Cross-sectional study of critical incident stress and mental health among firefighters dispatched to areas affected by the Great East Japan Earthquake

Cross-sectional study of critical incident stress and mental health among firefighters dispatched to areas affected by the Great East Japan Earthquake

Biomechanical Risk Factors for Lower Extremity Stress Fracture

Objectives:Stress fracture injuries disproportionately affect athletes and military service members and little is known about the modifiable biomechanical risk factors associated with these injuries. The purpose of this study was to prospectively examine the association between neuromuscular and biomechanical factors upon entry to military service and the subsequent incidence of lower-extremity stress fracture injury during four years of follow-up.Methods:We analyzed data from the JUMP-ACL cohort, an existing prospective cohort study of military cadets. JUMP-ACL conducted detailed motion analysis during a jump landing task at the initiation of each subject’s military career. We limited our analyses to the class years 2009-2013 (i.e., subjects who completed baseline testing in 2005-2008). There were 1895 subjects available for analysis. Fifty-two subjects reported a history of stress fracture at baseline and were excluded from further analysis leaving 1843 subjects. Incident lower extremity-stress fracture cases were identified through the Defense Medical Surveillance System and the Cadet Injury and Illness Tracking System during the follow-up period. The electronic medical records of each potential incident case were reviewed and each case was confirmed by an adjudication committee consisting of two sports medicine fellowship trained orthopaedic surgeons. The primary outcome of interest was the incidence rate of lower-extremity stress fracture during the follow-up period. The association between incident stress fracture and sagittal, frontal, and transverse plane hip and knee kinematics during the jump-landing task were examined at initial contact (IC), 15%(T15), 50%(T50), 85%(T85) and 100%(T100) of stance phase. Descriptive plots of all biomechanical variables along with 95% confidence intervals (CI) were generated during the stance phase of the jump landing task. Univariate and multivariable Poisson regression models were used to estimate the association between baseline biomechanical factors and the incidence rate of lower-extremity stress fracture during follow-up.Results:Overall, 94 (5.1%, 95%CI: 4.14, 6.21) subjects sustained an incident stress fracture during the follow-up period. The incidence rate for stress fracture injuries among females was nearly three times greater when compared to males (IRR=2.86, 95%CI: 1.88, 4.34, p<0.001). Compared to those with greater than 5° of knee valgus, subjects with neutral or varus knee alignment experienced incidence rates for stress fracture that were 43%-53% lower at IC (IRR=0.57, 95%CI: 0.29, 1.11, p=0.10), T50 (IRR=0.47, 95%CI=0.23, 1.00, p=0.05), and T85 (IRR=0.53, 95%CI: 0.29, 0.98, p=0.04). Subjects with greater than 5° of internal knee rotation exhibited rates for stress fracture that were 2-4 times higher at T15 (IRR=2.31, 95%CI: 1.01, 5.27, p=0.05), T50 (IRR=3.98, 95%CI: 0.99, 16.00, p=0.05), and T85 (IRR=2.31, 95%CI: 0.86, 6.23, p=0.10), when compared to those with neutral or external knee rotation alignment.Conclusion:Several potentially modifiable biomechanical factors at the time of entry into military service appear to be associated with the subsequent rate of stress fracture. It is possible that injury prevention programs targeted to address these biomechanical movement patterns may reduce the risk of stress fracture injury in athletes and military service members.

In search of the “Rescue Personality”. A questionnaire study with emergency medical services personnel

The construct of the “Rescue Personality” as claimed by Mitchell (1983) in the course of Critical Incident Stress Debriefing was investigated in a sample of 173 Emergency Medical Services (EMSs) personnel. As hypothesized EMS personnel scored lower on neuroticism and openness but higher on conscientiousness and risk and competition seeking compared with a norm sample. By contrast, EMS personnel showed lower scores for agreeableness and no differences for extraversion. Duration of EMS service was not associated with personality except for extraversion preliminarily supporting a predisposition model. Furthermore, EMS volunteers did not differ from EMS professionals regarding personality, again except for extraversion. These results provide first evidence for most of Mitchell’s assumptions concerning the “Rescue Personality”. Implications for vocational choice, prevention and crisis intervention are discussed.

Atypical Femur Fractures: 81 Individual Personal Histories

An online voluntary association of individuals who had incurred one or more atypical femur fractures (AFFs) while taking bisphosphonates for prevention or treatment of osteoporosis provided an opportunity to collect long-term histories. Individuals from a nationwide general community completed an anonymous survey documenting their history. Within a larger cadre, cases were selected where the documentation, including fracture radiographs, verified the diagnosis based on published standards. Eighty-one of this group responded to the anonymous survey. We describe passively collected observational data only. The incidence of a large number of potential variations was determined. The mean duration of bisphosphonate treatment was 9.5 yr. Prevention was the initial indication in 68% of the subjects; 94% started on alendronate, 77% reported prodromal pain, only 16% of these were diagnosed with incident stress fractures, and 39.5% experienced a contralateral AFF from less than 1 month to 49 months after the first. Of 71 subjects with a completed first AFF, 38% reported delayed healing, 11% had a complete contralateral AFF, and 22% underwent prophylactic rodding for a contralateral stress AFF. Forty-four percent of subjects with complete AFFs were continued on a bisphosphonate after the fracture. Thirty-five percent incurred a metatarsal fracture. AFF patients experienced delayed healing, prodromal pain, and persisting risk of a contralateral and/or other fracture. Femur pain evaluation in patients on long-term bisphosphonates may facilitate early diagnosis of stress AFFs, permitting intervention, thus reducing completed and/or contralateral or other fracture risk. The details of these histories will assist in counseling regarding prognosis after an initial AFF.