 |
 |
 |
 |
 |
By Dr Hazel Pilgrim |
CRITICAL INCIDENT STRESS MANAGEMENTIt is now well recognised that individuals may suffer from emotional reactions following traumatic experiences, such as recurrent nightmares, intrusive thoughts or memories of the incident. These tend to be accompanied by strong emotional reactions like fear, distress, grief and anger. Individuals with these reactions often find themselves avoiding reminders of the incident and being unable to talk about their memories or their feelings. For most people these reactions tend to be relatively short term, but for some, the reactions may persist and become seriously debilitating, a disorder known as Post Traumatic Stress Disorder. People with PTSD may withdraw from others, start to drink heavily or experience what seems like a personality change. All these problems can put a great strain on the person’s relationships and impair their ability to function at work and at home. Fire fighters are more likely to experience traumatic incidents than the general population, because that is the nature of the job, and although training may help fire fighters to prepare for certain types of incidents it is extremely difficult to prepare anyone for the emotional reactions described above. However, it is now recognised that the sooner an individual is able to access help, after developing symptoms of PTSD, the less likely they are to develop chronic long term problems which could lead to medical retirement. Many organisations are now taking the mental welfare of their personnel very seriously, and this is also true of the fire service. In line with this policy some Regional Services such as Cumbria and Manchester are looking at the whole picture in terms of managing personnel after a difficult incident. In addition to the Occupational health Services and access to confidential counselling, they are training facilitators to run Critical Incident Stress Management meetings, and training senior personnel to recognise when help may be required. Critical Incident Stress Management originates from ideas introduced by Dr Jeffrey Mitchell in 1983, a former fire fighter/paramedic. He developed the concept of having a structured meeting for personnel in emergency services, in which they could discuss and understand their reactions after a traumatic incident. He called this meeting Critical Incident Stress Debriefing, and the facilitators of the meeting Debriefers. It was initially thought that such meetings would prevent the development of PTSD, however, this has now been shown by research to not be the case. At the same time these meeting shave been shown to have other benefits to personnel and to an organisation. Over time the structure of the meetings has evolved and the aims modified in line with research. In order to avoid confusion with Operational Debriefing many organisations now prefer to call these meetings Critical Incident Stress Management meetings and call the facilitators, Facilitators. Currently the aims of CISM meetings are to reduce the emotional impact of events and to accelerate the ‘normal recovery of normal people who are suffering through normal but painful reactions to abnormal events’. Other benefits of CISM meetings are to provide facts about the incident and give personnel a chance to ventilate their feelings, at the same time understand what normal reactions are. The meetings also provide a chance for personnel to gain mutual support, enhancing group and organisational cohesiveness. In addition the meetings reduce stigma and allow personnel to access professional help sooner than otherwise, which is particularly relevant when PTSD type symptoms develop. The Facilitators of CISM meetings are not health professionals but members of the same emergency service, who volunteer for the training and are prepared to give their time to help others. Many organisations offer time in lieu for the time given up. The idea of using facilitators from the same organisation as those being debriefed is that they are more likely to understand complexities of the job. They are also less likely to be seen as threatening mental health workers and the meeting is more likely to keep within the boundaries of its aims and less likely to become a group therapy session. Training takes place over two to three days, depending on how many CISM Facilitators are being trained at the same time, and is carried out by Mental Health Professionals who are experienced in this area. Facilitators are usually screened initially to ensure that they are not themselves suffering from emotional problems. A good Facilitator tends to be someone who has good coping resources and understands their own reactions, also able to communicate well and fairly experienced within the organisation. Individuals who get too emotionally involved with others are likely to become personally affected by others difficulties, and Facilitators who are too rigid in their thinking may be judgemental of others. Once trained a Facilitator needs to able to rely on the support of the organisation and refresher training. One of the first things a Facilitator is taught is who attends a CISM meeting and when it occurs. A CISM meeting will only involve those personnel who were directly involved in a traumatic incident. Participants are assured of usual confidentiality and the focus of the meeting is about a shared experience, with rank being irrelevant It occurs between 24 and 72 hours after a critical incident, whilst individual’s memories and emotional reactions are still fresh. A critical incident is any incident which has sufficient emotional impact to reduce usual coping abilities. On the course Facilitators are taught how a CISM meeting can be called, which varies across organisations and the Trainers need to be fully familiar with the policies of the organisation. In Cumbria Fire Service some incidents, e.g. one involving two fatalities or more, lead to a CISM meeting automatically being called, although attendance is voluntary. Other CISM meetings can be called at the discretion of the Fire Station. After a meeting has been called for a venue and time are arranged and a ‘lead’ Facilitator would work with Brigade Control Staff Department regarding this. The Facilitators would not be directly involved in the incident. Facilitators are taught about normal reactions and coping strategies. They are also taught the process and management of a CISM meeting. The Structure of the meeting involves seven distinct stages. These are:- • The Introduction, which involves the Facilitators introducing themselves, telling participants the aims and introducing some basic rules such as respecting each others point of view and right to speak. Each person is encouraged to contribute, at least by giving basic details. After a meeting has ended the Facilitators will stay for half an hour in case anyone has any personal concerns, and then the Facilitators will discuss amongst themselves, their own reactions to what has been said, and give each other support. Typically three Facilitators will manage a CISM meeting, and prior to the meeting will decide which one will take a lead role. CISM meetings have been shown to be most useful to organisations when they are part of a full package of Critical Incident Stress management, including teaching senior personnel to recognise symptoms of distress during incidents and when to call a CISM meeting. Also providing follow up help and support services. For further information on Critical Incident Stress Management please contact Dr Pilgrim at Pilgrim Psychology Services, 01745 888 297
|
Home | About Us | Therapy Explained | Services | Bookings | Contact Us |