FAQ about Critical Incident Stress Management (CISM)

What is a Critical Incident?

A Critical Incident is any situation that causes unusually strong emotional reactions which have the potential of interfering with an affected individual's ability to function at home, school or work. In the workplace, this may include robbery, assault with (or brandishing of) a deadly weapon by a co-worker, injury or witnessing the injury or death of another, being held hostage, and other similar out-of-the-ordinary events.

What is Critical Incident Stress Management (CISM)?

CISM is a "a comprehensive, integrated, multi-component crisis intervention system (Everly & Mitchell, 1999; Flannery, 1998). It has been recommended by the Occupational Safety and Health Administration (OSHA) ...." (Mitchell & Everly, 2001, p. 5). The components include: pre-crisis preparation, demobilizations and staff consultations, Crisis Management Briefing (CMB), defusing, Critical Incident Stress Debriefing (CISD), individual crisis intervention (F2F), pastoral crisis intervention, family CISM, organizational consultation, and follow-up and referral (Mitchell & Everly, 2001).

What is Critical Incident Stress Debriefing (CISD)?

CISD is a structured process that provides a CONFIDENTIAL group environment in which affected employees can share their experience during and after an incident. In this sense, a debriefing is NOT an operational critique; rather, participants are encouraged to share their thoughts and feelings as a first step towards recovery.

As their stories unfold, the debriefer is able to normalize the usually wide range of reactions, encourage the connection with emotional support systems (both at work and at home), instruct on appropriate self-care and assess the need for follow-up services in the days immediately following the event.

It is important to note that CISDs are *not* provided during the first 24 hours following a critical incident because affected employees will not yet know how the incident is going to impact them. During the first 24 hours, a defusing (which is a shortened version of the CISD) is provided. 

After a critical incident, what symptoms might affected employees experience initially?

After an incident, employees may experience:

• inability to concentrate
• anxiety or panic
• periods of crying
• confusion, slowness of thought
• repetitive thoughts of the event
• irritability, restlessness, agitation
• workaholism, hyperactivity
• nausea or GI upsets
• avoidance of reminders of the event
• anger, rage or blame
• difficulty returning to normal activities
• loss of judgment
• impaired decision making
• difficulty sleeping, nightmares
• depression and withdrawal
• survivor guilt
• muscles aches and pains
• increased use of alcohol/drugs
• family and relationship problems
• increased colds, flu, headaches

Each individual will have their own unique combination of symptoms -- which are NORMAL reactions to an out-of the-ordinary event. These symptoms, however, can result in reduced productivity, increased use of sick leave, failures to return to work, increased hiring expenses and the need to utilize Workman's Compensation benefits.

What is the goal of CISD (or defusing)?

The goal of CISD is to facilitate the quick return of affected employees to their pre-incident level of functioning, to mitigate the development of any long-term (chronic) psychological disabilities, and reduce absenteeism and the utilization of employee health care benefits.

Who can provide Critical Incident Stress Debriefings (or defusings)?

When responding to business and/or industry, Critical Incident Stress Debriefings are provided by licensed mental health professionals who have been specially trained in Critical Incident Stress Management (CISM)
Typically, there will be one (or, sometimes two) trained mental health professionals per debriefing group. A group may last two to three hours depending on the number of participants and the severity of impact. Follow-up services typically include a combination of individual and/or groups sessions, depending on employee needs during the first several days after the incident.