International Critical Incident Stress Foundation, Inc.
International Critical Incident Stress Foundation, Inc.
By: David F. Wee, M.S.S.W., ICISF Member since 1991
During twenty-three years of experience providing Critical Incident Stress Management (CISM) while working in community mental health, I found that the CISM services were helpful and valuable both for the people who received the services and for the people who provided the services. Over the past several decades, CISM services have been provided to a wide range of people, groups, and organizations at the local, state, national, and international levels. When providing CISM services to emergency service organizations, it is important to learn and practice CISM services with a team that includes emergency service peer support personnel. CISM services include Pre-Incident Education, On-Scene Support Services, Demobilization Debriefing Services, Defusing Services, Critical Incident Stress Debriefings, and Post Incident Follow-up. It is also important to secure additional CISM support when your team needs assistance.
During my years of working in the field, I have had the privilege to provide CISM in a variety of situations beginning in 1989 to when I retired in 2012. In my position as one of the Mental Health Program Supervisors for City of Berkeley Mental Health, my responsibilities included providing CISM services and supervising mental health staff who were trained in CISM. Many of the CISM services were provided to the local police and fire departments by peer support personnel. I also held the role of Disaster Mental Health Coordinator at City of Berkeley Mental Health. The job of Disaster Mental Health Coordinator was to contribute to writing the City of Berkeley’s Mental Health Disaster Plan, train mental health staff, and participate in disaster exercise planning and disaster exercises. City of Berkeley Mental Health staff provided CISM as part of day-to-day community crisis services as well as after disasters. I also participated in California Department of Mental Health disaster planning activities, and I responded to local, regional, and California disasters when requested. My experience includes working for the Federal Emergency Management Agency in Miami, Florida, following Hurricane Andrew (search text for the incident for more information with Google or other search engine).
Critical incidents happen to a wide range of people, groups, and organizations. While working on the Mobile Crisis Team at City of Berkeley Mental Health, the Team was called to a variety of critical incidents involving citizens. Police or fire department personnel referred citizens who discovered a household member dead, experienced a traumatic event, or witnessed a traumatic accident. Groups of people could also be referred by police or fire department personnel. The types of groups of people who were referred included those who had experienced a sudden accidental loss, a small housing unit or social group that experienced an emergency, such as an accident, fire, death, or crime, or an organization such as a school, business, hotels, or other type of organizations. I’ve also provided the CISM: Basic Training Course to an international delegation from Kobe, Japan. The delegation members had survived the Hanshin earthquake in 1995 (“First Japanese CISD Team Trained in San Francisco,” (LifeNet, Summer 1996)). The course was translated into Japanese by a team of interpreters due to the length of the course. Time was needed to address the training participants’ normal reactions to an abnormal event, the Hanshin earthquake, throughout the course.
It is critically important to train and practice, before providing CISM services. CISM includes numerous important services that address the range of needs of emergency service workers and other populations following critical incidents. The services cover the time period from while the incident is happening to after the critical incident ends.
Pre-Incident Education presentations have been provided to a variety of audiences, and focus on the range of CISM services provided before, during, and after critical incidents. These presentations are done at local police and fire departments, at regional fire command meetings, and at the state level to workers with the transportation department, office of emergency services, and state psychiatric hospital.
On-Scene Support Services is another CISM service. This service was requested following the Loma Prieta earthquake in Northern California in 1989. City of Berkeley Mental Health was asked to provide On-Scene Support Services at the Cypress Structure Collapse following the earthquake. The On-Scene Support Services were provided to fire personnel, law enforcement personnel, heavy rescue personnel, transportation workers, coroner’s office employees, and the next of kin of deceased persons. Another example of On-Scene Support Services was during the Eastbay Firestorm in 1991. The Berkeley Fire Base was established during that urban/wildland interface fire. On-Scene Services were provided at the Berkeley Fire Base on a 24-hour basis until the base was demobilized.
Demobilization Debriefing Service (Demobilizations) is a CISM service that is done following a large deployment of emergency service personnel to an incident or with groups of citizens who have been affected by a large critical incident. After providing the Demobilizations, additional CISM services are offered when needed such as Defusing Services and Critical Incident Stress Debriefings. People working in CISM should be ready to provide Demobilizations when the need arises and include Demobilizations in the standard operation procedures of the emergency plan.
Defusing Services is another CISM service that is provided after a critical incident. Defusing Services are provided to persons impacted by a critical incident after the incident ends. For example, Defusing Services were provided to the former hostages after the Henry’s Bar hostage incident in 1990. The Defusing Services were provided at the Berkeley Police Department to individual former hostages and with small groups of former hostages after the death of the hostage taker was confirmed. Support services were also provided to police personnel. Defusing Services were followed by City of Berkeley Mental Health and University of California Berkeley, University Health Service staff providing Critical Incident Stress Debriefing with the former hostages. Follow-up meetings with former hostages and mental health professions were available.
Critical Incident Stress Debriefing (CISD) with peer support personnel was also provided after the emergency search and rescue phase of the Cypress Structure collapse. CISD was offered to all the mutual aid response departments and coroner’s office personnel that responded to the Cypress Structure collapse operation. One of the very helpful events during this time was when one of the Deputy Chiefs at City of Berkeley Fire Department appeared at the reception desk at City of Berkeley Mental Health with a copy of an article by Dr. Jeffrey Mitchell that appeared in the Journal of Emergency Medical Service (1983). This article was very useful in helping us meet the request for CISDs using peer support personnel to assist mutual aid responders.
All CISM services provided should have Post-Incident Meetings following the services. Post-Incident Meetings are held following CISM services to review the service provided, identify what went well with the service provided, to review lessons learned for the next time the service is provided, and to identify any additional tasks that needed to be completed. The mental health team member or designated peer support person will be assigned to report that the service was provided and to note any additional CISM service the CISD team recommends. The confidentiality of the persons participating in the CISM intervention is always protected.
Provide CISM services to the target group using the most appropriate personnel based on training background and experience. Rotating the assignment of CISM activities is important not only to distribute the work load among team members but also to mitigate the impact of CISM activities on compassion fatigue. Additional considerations for providing CISM services include obtaining information about the incident from both line staff and command staff, obtaining information about the specific roles of the individuals and groups of people involved in the incident, and securing the best possible setting for providing the CISM service. Before the CISM services are provided, brief the CISM members on the information that has been obtained about the incident and any issues that may emerge while providing CISM service, plan a time and place to meet to discuss the services provided, and plan for follow-up that is needed. Addressing cultural and language needs for the CISM service is critical. For example, a CISD was done for monolingual Spanish-speaking staff of a restaurant with a Spanish language interpreter following a robbery. The CISD could not have been done in English. In another case, a CISD was done following a nighttime rescue in the San Francisco bay near a municipal pier. A group of young people were socializing on the pier when a young woman fell off the pier into the water and a young man jumped in to rescue her. As they drifted out in the darkness, he struggled to stay afloat and she sank below surface. He was pulled by the current out into the bay. A rescue boat found the young man later in the night, and the young woman was found deceased several days later. The EMT referred the young man and all the survivors of the incident for CISM services. The CISD was done by two mental health professionals, one of whom had experience working with young people.
Learn the resources that are available to provide CISM. Local resources to provide Critical Incident Stress Management may include local law enforcement, fire departments, and emergency medical resources. Emergency service worker organizations often have CISM training and peer support personnel available. Educational institutions at the elementary, junior high, and high school, and levels of higher education may have CISM teams or resources. Community agencies such as mental health clinics, family service agencies, and youth service agencies may have CISM resources. Regional resources may be present in your area and may require some research to identify the resources. For national and international CISM resources, ICISF is the best source to identify resources at the national and international levels.
There are many important lessons I have learned about using CISM. The beginning of the learning process is having an understanding of what you and your CISM Team can do in relation to Critical Incident Stress Management. Identify the range of essential CISM services that are available to meet the requests for CISM services in your area. Crucial to implementing and providing CISM services is to identify the range of incidents and populations that can be impacted by critical incidents in your area. Identification and knowledge about the CISM resources in your area will enable you and your team to focus on the populations that are the focus of your CISM services. Secure CISM services by planning and hosting required CISM training. Disasters that exceed your ability to respond to the CISM needs in your area will happen, so learn about the outside resources that are available. Above all else, continue to learn about crisis intervention and CISM so that the services you provide will continue to be helpful and be a valuable experience for both the people you help and the people who provide the services.
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