Critical Incident Stress Management

Purpose

Purpose The purpose of any Critical Incident Stress Management (CISM) programme is to mitigate the potential psychological impact of a serious incident or accident on the individual. It works by putting into practice some tactics that when linked together alleviate the reaction to such traumatic experience. The success of any CISM programme depends on the qualification of the peers and the support and understanding of the management. This IFATCA CISM Guidance Material aims to assist Member Associations in successfully implementing a CISM programme.

What will you find here?

  • KEY TERMS & CONCEPTS: setting the scene
  • PHASE I - PLANNING AHEAD: what do you need?
  • PHASE II - IMPLEMENTATION: going for it!
  • PHASE III - EVALUATION & QUALITY MANAGEMENT: how are we doing?
  • References and supporting documentation

KEY TERMS & CONCEPTS

For a better understanding of the programme and in order to increase awareness, some key terms and concepts relevant to CISM are briefly explained. Should further information be needed, please refer to the supporting documentation chapter.

Crisis

A crisis can be defined as an acute emotional reaction to a powerful stimulus or demand. Four characteristics:

  • The balance between thinking and emotions is disturbed
  • Coping mechanisms fail
  • There is evidence of distress, impairment or dysfunction in those involved in the crisis
  • Exposure alone does not create a crisis. Exposure plus the intense personal relevance of the event may increase the chances of developing a crisis reaction.

Stress

Stress has a different meaning for different people under different conditions but a generic working definition could be “a condition in which an individual is aroused and made anxious by an uncontrollable aversive challenge” . Stress leads to a feeling of fear and anxiety and depending on the circumstances the fear response can lead to either fight or flight.

Critical Incident

A critical incident can be defined as any powerful traumatic event that initiates a crisis response and can overwhelm the usual coping mechanisms of individuals. It is typically accompanied by cognitive, emotional, physical and behavioural manifestations of stress.

Critical Stress Incident

A state of cognitive, physical, emotional and behavioural arousal that comes together with the crisis reaction. If not managed and properly resolved, it may lead to several psychological disorders such as acute stress disorder, post-traumatic stress disorder, panic attacks, depression, drugs abuse, etc. It is a normal reaction to abnormal events. It is important to point out that it is the incident that is abnormal, and that the stress reaction to such an event is a normal human reaction. A group of people experiencing the same incident may reveal patterns of critical stress reactions of different qualities and intensities. Critical Incident Stress reactions can manifest either immediately after the exposure to the incident or up to several weeks later.

Crisis Intervention

Emotional first aid, active and supportive, for individuals or group of individuals during a period of extreme distress. It is NOT psychotherapy nor a substitute for psychotherapy.

Main goals:

  • Mitigate the impact of an event
  • Facilitate normal coping and recovery processes
  • Restore individuals or groups to adaptive functions

Primary principles of crisis intervention:

  • Proximity: Crisis work should be provided in those surroundings that are familiar to the people who need support.
  • Immediacy: Help should be provided as soon as possible after the exposure to a traumatic exposure.
  • Simplicity: In the midst of a crisis, complexity is not very well handed. The crisis support provider should focus on solutions that are easy for a distressed person to apply.
  • Brevity: Actions to assist people should be brief but not so much as to compromise the final goal.
  • Expectancy: The provider of the crisis intervention should instil some hope that it is possible to manage and resolve the situation.

Critical Incident Stress Management

CISM methods are preventing measures consisting on discussions about the incidents in the form of structured individual or group debates so as to help the person to regain its ability to apply coping strategies. It’s defined as a "comprehensive, integrated, systematic and multi-tactic crisis intervention approach" to manage critical incident stress after traumatic events.

Critical Incident Stress Management Peers

CISM methods are based on peer-supported crisis interventions. The particular strength of the peer concept lies not only in the physical proximity to those who need help but in the professional proximity. They share the same professional understanding of job-related processes so they can deeply understand how someone feels after a job-related critical incident. In order to provide assistance, peers need to follow initial as well as refresher training.

CISM General Information

  • CISM deals with the human reaction to a critical event and shall be treated in confidence. CONFIDENTIALITY and PRIVACY is vital in order to build up trust. Confidential information should not be made available to company’s management nor Civil Aviation Authorities. All conversations within the programme are confidential and not meant to be shared with no one beyond the CISM programme.
  • Accident/Incident investigations have nothing to do with CISM and therefore CISM peers shall not be involved in any incident/accident investigation. Such investigations shall be dealt with separately.
  • CISM is an “emotional first aid”. If the goal of restoration to independent functioning seems not to be reached, then the services from a mental health professional (MHP) are required.

CISM INTERVENTIONS

There are several Crisis Intervention techniques that can be included in a Critical Incident Stress Management (CISM) programme:

Individual crisis interventions are provided by peer team members and are used to support, stabilize and provide stress management education. The need for a formal Debriefing session is assessed. A follow up is essential and a referral might be needed afterwards.
Critical Incident Stress Defusing is the immediate response right after a critical incident has occurred. The main goals are to curb intense reactions to the incident and to assess the need for a follow up with a Critical Incident Stress Debriefing (CISD). It is provided to small groups of individuals that were more directly affected by the event.
Critical Incident Stress Debriefing (CISD) is a specific, 7-phase, small group, supportive crisis intervention process. It is usually organized between 24 and 72 hours after the incident has occurred. The individuals that were most exposed to the critical situation are called to a confidential group intervention led by a specially trained mental health professional and assisted by employee peers. The main goals are to mitigate the impact and accelerate the recovery from the distressful event.
Demobilization is a group process in which a set of peers conduct, on a rotating basis, at the beginning or end of work shifts, a series of staff meetings to provide facts about the recent incident or stress education information. This technique is generally used on deeply distressing events that can spread their effects over a large group of employees.
Crisis Management Briefing (CMB) is a large group crisis intervention. It is most appropriate for large scale events. It may be supported by peer support personnel, mental health professionals, management and union representatives or operational experts both from within the organization or by third-party agencies.
Follow up/Referral Following a CISM intervention of any kind, it is necessary to provide follow up by a peer in the programme or a referral for professional assistance in case the assigned peer feels the individual in distress needs further help.

PHASE I – PLANNING AHEAD

What do you need?

CISM TEAM

  • Peers: Colleagues, voluntarily trained in CISM techniques, play the most active and effective role in CISM programmes since they benefit from immediate credibility among their fellow co-workers. They need to be adequately trained to lead CISM interventions after critical incidents. Basic training as well as refresher training are to be foreseen. The peer role is to provide short-term support as an emotional first aid, but peers shall have the ability to identify the need for a further skilled intervention (MHP).
  • Coordinators: Role also assumed by peers, but with additional training, to handle administrative tasks and organise additional support measures such as “debrief the debriefer” sessions aiming to help with the distress that interventions might have caused upon peers. Coordinators shall also be very aware of any potential secondary traumatization, that is, any situation faced by peers that causes them to experience unusual strong emotional reactions and feelings of countertransference, which have the potential to interfere with their ability to function in their prescribed role.
  • Mental Health Professionals (MHP): It is advisable to count on the support of mental health professionals to handle deep-seated psychological problems. These professionals may include psychiatrists, psychologists and social workers.
  • CISM Manager: Ideally, to guarantee independence and credibility of the programme, the latter should be ran by a manager independent from the company management.

FINANCING

Any organisation involved in the implementation of a CISM programme needs to consider the following:
  • Resource requirements, personnel, internal and external support services
  • Cost-analysis of the project including meetings, travelling, training (basic training, refresher training, regular peers meetings, etc.), communication
  • Financial approval and local process of financing

TIMETABLE

CISM programme implementation shall be organised following local rules or guidelines. Project’s milestones shall be:
  • Policy statement on CISM from the CEO
  • Awareness information package
  • CISM peers’ selection, call for applicants, nomination and election
  • CISM peers training
  • Initial evaluation and quality management
  • Feedback provision

DOCUMENTATION

Documents for administration, promotion, information, training and evaluation shall be developed. For example:
  • Terms of reference, Guidelines, Confidentiality agreements
  • Flyers, awareness information, keynote presentations
  • Manuals for training, CBT documents and programmes if needed
  • Management manual, quality assurance documents, feedback forms

PLANNING THE TRAINING

Training for CISM peers and supervisors shall start at an early stage because it requires many resources and a lot of development work. Following items are to be considered:
  • Summary of the module(s)
  • Types of training: initial, refresher, for managers, for peers
  • Training documentation and certification
  • Recruitment and selection of peers
  • Selection of venues
  • Travel planning

PHASE II – IMPLEMENTATION

Going For It!

COMMUNICATION

  • Benchmarking and feedback from organisations already running CISM programmes
  • Achievement of formal agreements with organization’s management (General Management as well as Operational Management) and also staff associations
  • Consider providing a call-centre phone number or contact details and availability of CISM peers at the local level
  • Consider different ways of communication such as online publications, flyers, posters, staff magazines, briefings, etc.

 

Peer Selection and Recruitment

 The following activities are advisable:

  • Define the number of peers required. The adequate number will depend on the location of the team, number of ATCOs served, types of call out procedures and availability of resources. It is important to keep in mind that a failure in call out procedure and intervention has the effect of deteriorating confidence in the CISM team ability to respond to a crisis.
  • Define the number of Mental Health Professionals required.
  • Detail peers’ required skills.
  • Decide and inform upon the selection board and peers selection process. Staff and staff associations should have a voice in the selection otherwise the programme could be less successful.
  • Consider the selection of a National CISM manager.
  • Consider the selection of local CISM coordinators.
    Consider the support of external professional resources (CISM experts).
  • Select team/peers members.

 

Providing The Training

 At this stage, focus should be on:

  • Defining the contents of modules and developing training documentation
  • Defining by which means the training is to be delivered (Computer-based training, on-line courses, in-class courses, etc.)
  • Ultimate timetable including venues for the training to take place
  • Planning of not only initial but also refresher training
  • Planning of succession for leaving CISM peers

PHASE III – EVALUATION & QUALITY MANAGEMENT

After implementation, all personnel involved in the programme shall be informed about:

  • Status of the programme
  • Feedback about CISM interventions (make sure information is deidentified) and benefits the programme yielded
  • Deidentified statistical reports in order to evaluate the effectiveness of the programme

REFERENCES AND SUPPORTING DOCUMENTATION

Everly G.S. and Mitchell, J.T. (1997). Critical Incident Stress Management: A new era and standard of care in crisis intervention, Ellicott City, Maryland: Chevron Publishing Group. Farberow, N.L., Frederick, C.J., et al. (1978). Training Manual for Human Services Workers in Major Disasters. National Institute of Mental Health, Publication DHEW (ADM) 777-538, 1978, U.S. Government Printing Office Stock #017-024-00685-8. Mitchell, J.T. Ph.D, Everly, G.S. Ph.D. (1993). Critical Incident Stress Debriefing: CISD An Operations Manual for the Prevention of Traumatic Stress Among Emergency Service and Disaster Workers. Ellicot City, Maryland: Chevron Publishing Corporation. Mitchell, J. T. Ph.D. (s.d.) Critical Incident Stress Debriefing (CISD) Diplomate American Academy of Experts in Traumatic Stress and Clinical Professor of Emergency Health Services University of Maryland. Selye, H. (1975). Confusion and Controversy in the stress field, Human Stress.