International Critical Incident Stress Foundation, Inc.
International Critical Incident Stress Foundation, Inc.
By: Veronica Sites D. Min CCISM
Crisis response demands the ability to approach uncertain situations with adaptability and preparedness to pivot as the situation demands. Most disasters are short-lived with the sequence of aftermath protocols that last longer. That is until now. COVID-19 has resulted in a prolonged disaster. It has yet to see its end and continues a wavering impact with a high incident of burnout and fatigue. It is for that reason I invested time in writing this article. Both presently and historically, what Critical Incident Stress Management (CISM) stands to mitigate is what is at risk of compromise if practitioners of CISM do not realize the mitigative role psychological first aid has in a continuum of maintaining mental health. We will look at lessons learned from disaster response during a world of lockdown and social distancing and how Personal Protective Equipment (PPE) contributed to the teachable moments leading to this article.
Critical Incident Stress Management’s (CISM) practicalities and its adaptable yet consistent model, today, offer ever-increasing opportunities to help others as the prolonged period of fluidity continues in this pandemic. The general public is demonstrating hyper stress, and one can only operate in the fight or flight survival mode for so long before there is a potential compromise in good mental health. It only takes someone well equipped and ready to serve, skilled, and aware of the benefits that CISM offers in maintaining mental health to make a difference in someone else’s future.
In twenty-fives years of serving on CISM teams as part of the Texas State Guard, Crisis Response Ministry, and alongside various agencies in the past several months have been unique. As the last quarter of 2020 wrapped up, teachable moments continue to produce on the job training that draws strength in the fundamentals of CISM.
Remember that CISM is a toolbox. There are various ways according to a situation that calls for a particular or sometimes augmented application. Know that work done contributes to mitigating a total compromise in mental health down the road. When the education component is seized as a time of informative trauma empowerment, I tell others that we all have mental health just as we have a unique role in maintaining, neglecting, or empowering our wellness. I see lightbulb moments that communicate that they have been helped, given hope, and know-how to take charge of their mental wellness in light of current circumstances. Mitigating any compromise in mental health is essential. Most people do not know the value of psychological first aid. What the general public knows is that they don’t want to lose it or be perceived as someone crazy. Giving people space and permission to realize that common reactions to very abnormal circumstances are to be expected is empowering to the person impacted at the core of being human. The key is to follow up and refer. Other lessons include the importance of a growing network. I prefer to have resources vetted in advance of the need. That is not always possible, but intentionally pursuing good connections with professionals in mental health can go a long way in how equipped a person is launched beyond a Critical Incident Debriefing (CID). Knowing professionals, organizations, and where one can turn to when a one-stop shelter environment is not available helps you as a provider and the individual as a survivor.
I am a crisis chaplain and prefer to remain on the frontline serving as a preliminary crisis counselor to those impacted by the tragedy. I provide coaching, not therapy. An increasing network is critical if the impact is to be as effective as possible. We all have a mind that no one wants to lose. CISM empowers the recipient to regain control of one thing when their world may be upside down; that is a well-learned lesson to remember.
Until disaster relief during a pandemic, coupled with social-distancing, became a simultaneous protocol, there was no need to address the challenges that might arise. In fact, it may be that we did not know what to consider as a possibility until the need arose. Now the need exists to navigate pandemic restrictions. People need stability; social distancing takes a toll, while personal protective equipment (PPE) pose unforeseen challenges.
Disaster response during a world of lockdown and social distancing continues to present teachable moments. The following are only a few of an ever-increasing list of lessons learned recently. There was no need to imagine what would happen during a hurricane that displaced thousands while everything was shut down. It happened. Multiple times and each time, a hurricane pounded southern shores presented with different challenges, especially for those displaced. Social distancing showed its most significant challenge to elderly persons who had never evacuated before that instance, let alone being sent away from home. At the same time, their adult kids stayed to weather storms. The challenge for practitioners was limited access to those impacted. A second challenge was maintaining a safe, CDC-compliant environment in hotels predominantly filled with evacuees, of which the elderly found it most difficult to isolate in rooms and wanting to assemble for conversation. That is where individual CISM became possible and useful for guests highly traumatized. The elderly struggled most partially because understanding that a cell phone may reach a loved one stuck back home without power and water did not mean it was a reasonable option to have mom or dad come home. In such cases, stress manifested common to the circumstances but beyond what was easily processed by seniors.
Since those particular instances involved evacuees that found their stay extended and, in some cases, included multiple changes of venue in where they were to shelter, instability exacerbated already very highly stressed individuals. For many, only weeks later, the cycle repeated when a second, then a third time a hurricane threatened to ravage what little remained. Lessons learned have already been reported as part of after-action reports. I have learned the importance and seen the outcome as improvements when we do share insight from the frontline to decision-makers and curriculum writers.
The most insightful lesson was birthed from what I call the PPE challenge. I did not need to think that impaired hearing and visibility would be part of a personal challenge. Masks are of the devil when it comes to PPE protocol that requires six-foot distance and face-covering for a CID. How did we pivot, what was the challenge, and how did we all grow? A quick pivot and use of clear shields seemed the best solution. It worked well on the visual scale; the problem resulted in a recommendation I will now make as a lesson learned. Shields reverberate sound back to the one speaking. Shields wrap far enough around the face and prevents sound from crossing the barrier into the airwaves to those listening. The challenge to listen is hard enough. Add to that, the inability to hear and the after-action evaluation resulted in realizing that PPE may need to be modified to comply with the purpose of wear and not hinder the purpose a CID is conducted. A shield can be modified by keeping the front a “u-shape” in front of the face and reducing what obstructs sound and hearing capability. It won’t be perfect, but is it better than speaking more loudly only to blow yourself out in doing so and not reaching the one that needs to hear what is said.
The pivot was in allowing more time for words and emotions to regain composure, so that needed repetition created an opportunity for the one processing to hear the disconnect in what they were thinking according to how they felt. Seeing the transition unlock an unhealthy perspective to release false guilt and embrace that there were limitations to what could be done was like watching a door open for a person stuck in a prison cell. It actually became less frustrating when we all realized the outcome was not only an effective CID but that individuals departed having processed further as a result of the need to wait and work through the challenge of limited hearing.
While a pandemic poses uncertainty, CISM’s foundational model is sure to help mitigate what could potentially be some of the outcomes of this prolonged disaster. By helping others to anchor and establish solid footing to better know from where to pivot and navigate toward stability, we are part of a continuum in mental health. This sums up a great need for the year 2020. We have historical lessons to consider as daily opportunities for individual CISM continue to increase until we reach a recovery phase in this COVID disaster. What do we need to consider? What are some historical considerations? More importantly, how can CISM be a catalyst in a mitigative role in suicide prevention?
While not at all the same kind of disaster, it is prudent to consider studies following the attacks of 911 and current similar operational demands of first responders. A residual impact can be mitigated and improved when we better collaborate proactively using the SAFE-R model to refer often and refer well. The study conducted called “The Ripple Effect” captured insight we must pay attention to in this prolonged situation. Mitigation of which CISM is a significant key in suicide prevention is imperative. My greatest joy as part of active CISM teams is to know that frontline intervention makes a difference.
References:
[1] Pulido, M.L. The Ripple Effect: Lessons Learned About Secondary Traumatic Stress Among Clinicians Responding to the September 11th Terrorist Attacks. Clin Soc Work J 40, 307–315 (2012). https://doi.org/10.1007/s10615-012-0384-3
Copyright © 2025 International Critical Incident Stress Foundation, Inc
International Critical Incident Stress Foundation, Inc is a 501(c)3 Non Profit