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Critical Incident Stress Management

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Published on November 10, 2016. Last modified on April 12, 2019

BH logoMonterey County Health Department

Critical Incident Stress Management (CISM) Team

Strategic Response to Crisis

I. What is Critical Incident Stress?

  1. Critical Incident Stress (CIS) is a state of intensified arousal accompanied by strong cognitive, physical, emotional, behavioral, and spiritual reactions as a result of the exposure to the critical incident. CIS is a normal survival response; Post Traumatic Stress Disorder (PTSD) is a pathologic end result of unresolved CIS.
  2. Critical Incident Stress for Emergency Responders
    1. Emergency responders play a unique role in our society. These professions require specific personal skills. Most individuals who select these professions are action oriented, with a high tolerance for stress. They are willing to take risks, prepared to make sacrifices, reluctant to give up, and able to suppress emotions in spite of the depth of their caring.
    2. An emergency responder’s job can be a tremendous source of satisfaction, leaving them feeling invigorated, elite because of the specialized knowledge and skills required, and rewarded for having contributed to the community by saving lives, providing compassionate care or helping rebuild lives.
    3. It can also be emotionally draining, taking its toll on the responder and their family. It may produce an occupational hazard know as Critical Incident Stress. Their response to traumatic events or to a long term series of events (cumulative stress) may be very distressing if they do not understand that such reactions are normal. Regardless of their personal training, ALL emergency responders are susceptible to Critical Incident Stress.

II. What causes critical incident stress?

  1. Research has indicated that certain situations are more likely to cause Critical Incident Stress: Not everyone reacts the same way to the same emotional event. One may find themselves reacting to an event while another worker does not. An event may pass by without much reaction one time, yet a similar event a year later may provoke a strong reaction. Responses to emotional situations are the result of many different factors.
    1. Death or serious injury of a co-worker
    2. Death of a child
    3. Death of a patient/victim after a lengthy rescue
    4. Suicide of a fellow worker
    5. Mass casualty incidents
    6. Situations in which one’s life is in danger
    7. Unreasonable expectations of being able to confront any situation without being affected
    8. Past experiences that have not been adequately handle
    9. Events with sensational media coverage
  2. Not everyone reacts the same way to the same emotional event. One may find themselves reacting to an event while another worker does not. An event may pass by without much reaction time, yet a similar event a year later may provoke a strong reaction.

III. Who does the MCCISM Team respond to?

  1. The Monterey County Critical Incident Stress Management Team responds to citizens and first responders in Monterey County.

IV. How does the MCCISM Team receive notification to respond?

  1. In order to respond to an event, first responders and citizens call the Monterey County Crisis Team at Natividad Medical Center at (831) 755-4111. The crisis workers will notify the on-call MCCISM dispatcher.
  2. In large scale incidents, MCCISM will request mutual aid from other CISM teams in the Bay Area.

V. What interventions does the MCCISM use?

  1. Rest Information Transition Services (RITS)/ Respite Centers – ongoing support centers that are established near the disaster site. These centers provide food, rest, shelter, materials, supplies, news, message boards, therapeutic massage and even sleeping quarters for emergency personnel and other disaster workers.
  2. Crisis Management Briefings – structured large group community/organizational “town meetings” designed to provide information about the incident, control rumors, educate about symptoms of distress, inform about basic stress management, and identify resources available for continued support, if desired. May be especially useful in response to community violence/ terrorism. May be utilized with a traumatic event of any size that impacts a large number of people. Applicable to schools, business, church, industrial, organizational and community based populations. Has military and emergency services applications, as well.
  3. Defusings – a small group discussion following a critical event. Typically provided within 8-12 hours of the event (i.e. end of shift). The goals are to normalize reactions, lower tension, set expectations, provide information, discuss coping methods, and identify those who need additional support.
  4. Critical Incident Stress Debriefing – a structured group discussion concerning a critical incident. The goals are to mitigate the impact of the traumatic event by lowering tension, facilitate the recovery process for normal people who are having normal reactions to an abnormal event, and to identify individuals within the group who might benefit from additional support, or, in a few cases, a referral for EAP, psychotherapy, etc. Typically provided within 72 hours of the event, but may be scheduled up to 10 days from the event if the event is ongoing.
  5. Peer support (1:1’s) – most crisis intervention is done individually, one-on-one. Peer support stabilizes the individual, acknowledges the crisis event and reactions, facilitates understanding and normalization of reactions, encourages effective coping and facilitates access to continued care.

VI. Why is CISM helpful?

  1. CISM can reduce burnout, sick leave, stress leave and post traumatic stress disorder from developing in emergency personnel.

VII. How does MCCISM Team fit into the Incident Command System (ICS)?

  1. Most CISM Teams fit under the Operations, Planning or Logistics sections of the ICS structure.
  2. Depending on the target populations, the types of interventions needed, and the scale of the incident, a Chief of Crisis Intervention would work closely with the plans, operations and command sectors.

Monterey County CISM Team Coordinators

Lead Coordinator
Melanie Rhodes, LMFT, LPCC
(Office) 831-796-1742
Kelly Molton, LCSW
(Office) 831-647-7704
Program email: 415-CISM@co.monterey.ca.us 

24-Hour line Natividad Crisis Team: 831-755-4111

Additional Information on Critical Incident Stress

  • Factors that heighten stress:
    • Sensory triggers: sights, sounds, smells, places, textures, sensations
    • Suddenness/unexpected surprise
    • Intensity
    • Duration
    • Identification with victim
    • Holiday season or nighttime
    • Personal involvement with victim
  • The signs of Critical Incident Stress:
    • Reactions to an event may be immediate (beginning at the scene), delayed (hours, days or months later), or cumulative
    • Some reactions that may occur within the first few days:
      • Nausea, sweating, tremors, chest pain, elevated heart rate and blood pressure
      • Disorientation, slowed thinking and decision making, poor concentration, confusion, and decreased attention span
      • Anxiety, fear, grief, depression, withdrawal, irritability, resentfulness, and feelings of being overwhelmed
      • Insomnia, flashbacks, vivid dreams and excessive alcohol or drug use
    • Delayed reactions may include:
      • Increasing depression and flashbacks
      • Decreasing sex drive, excessive or too little sleep, change in appetite
      • Loss of emotional control (excessive crying, anger, humor, etc.)
      • Loss of interest in family or recreational activities
      • Poor job performance, re-evaluation of career, or fear of job-related activities
  • Cumulative Stress
    • Not caused by a specific event, but is a state of chronic fatigue and frustration. It is the result of too many stressful events, and the signs include:
      • Depression and withdrawal
      • Fatigue, irritability, and apathy
      • Disillusionment
      • More frequent illnesses
      • Family Problems