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December 13, 2017

Shielding Our Protectors

CIRS Stress Management
Updated On: Feb 22, 2012

Fraternal Order of Police, of Ohio, Inc.
Critical Incident Response Service


Deirdre Delong, Program Coordinator
222 East Town Street
Columbus, Ohio 43215-4611

Ohio Toll Free: 1-800-367-6524 (24 hours)
Office: 614-224-5700
Facsimile: 614-224-5775
Email: ddelong@fopohio.org

Critical Incident Stress Management


The Critical Incident Stress Management program, known as CISM, a multi-component crisis intervention curriculum, includes the following:

  • Pre-Incident Education,

  • On scene or near scene management,

  • One-on-One intervention,

  • Demobilization,

  • Crisis Management Briefing,

  • Defusing,

  • Critical Incident Stress Debriefing (CISD),

  • Family Support,

  • Community Crisis Response,

  • Pastoral Crisis Intervention,

  • Follow Up,

CISM: A Standard of Care

?e want to explain what our program is about, then how and why your agency might access its service.  Please use the links below to jump to a section of the page.

CRITICAL INCIDENT STRESS

THE WHO, WHAT, WHERE, OF CRITICAL INCIDENT DEBRIEFING

SYMPTOMS WHICH MAY INDICATE THE NEED FOR A DEBRIEFING/DEFUSING

WHAT LONG TERM EFFECTS ON PERSONNEL MAY OCCUR IF A DEBRIEFING IS NOT HELD?

WHAT IS THE PURPOSE OF A CRITICAL INCIDENT DEBRIEFING?

REQUESTING CISM SERVICES

CRITICAL INCIDENT STRESS

Because of the kind of work performed by emergency service workers, you are exposed to situations and events that would be considered "extraordinary" by many people's standards.

As you learn and perform your jobs you become accustomed to many of these events. There is a natural "desensitization process" that takes place, which allows you to continue working in the field. There will, however, still be events that occur which are overwhelming for even experienced emergency service personnel. Such events have been called "critical incidents".

A CRITICAL INCIDENT IS an event during which the sights, sounds, and smells are so intense that they cause you to feel a significant increase in stress and stress reaction--immediate or delayed. Events that include any of the following usually result in being identified as critical incidents.

  • Human-caused events, which elicit stronger feelings and reactions, other than natural disaster, or freak occurrences.  i.e. drunk driving accidents, abuse, terrorism etc.

  • Events with unusual sights, sounds, or smells

  • Events in which there are a large numbers of victims i.e. school bus accident

  • Events in which an emergency service personnel sense of professional competence is attacked

  • Events, which violate an employee's sense of how the world is or should be i.e. Death of infant, teenagers, freak natural occurrences involving common objects, Holiday disasters

  • Events, which draw high media coverage

  • Events that have elements that worker identifies with i.e. a child the same age as your own, same shoes as your child etc.

  • Death of a co-worker

Some events are so significant that most people exposed to the situation will have strong reactions to the event. In other cases, a work-related event might be "ordinary" for one emergency service person, but for another it may be a critical incident. In both situations, providing the involved emergency service personnel with the chance to debrief from the incident has been found to be beneficial.

*   This would probably be a good time to define, pre-incident education, defusing and debriefings.

PRE-INCIDENT EDUCATION An analogy for receiving this type of education is like receiving an immunization against disease. "Pre-Incident Preparation” may well be thought of as a form of psychological immunization. The goal is to strengthen potential vulnerabilities and enhance psychological readiness in individuals who may be at risk for traumatization. One important aspect of pre-incident preparation is the provision of knowledge. Information about CISM is power. Many traumas result from a violation of expectancy, thus setting realistic expectations serves to protect against violated assumptions.

A DEFUSING is conducted within a few hours of a critical incident and is primarily informational. They allow for initial ventilation regarding the incident. It is shorter, less formal. If only one or two people have been affected by an event, a defusing is more appropriate.

DEBRIEFINGS are most effective when conducted 24-72 hours after the incident has occurred. Debriefing sessions are confidential, non-evaluative discussions of involvement, thoughts and feelings resulting from the incident. They usually last two to three hours and everyone who was involved with the incident is invited to attend. When a whole work group is affected, a debriefing, involving the CISM Team would be utilized.

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SYMPTOMS WHICH MAY INDICATE THE NEED FOR A DEBRIEFING/DEFUSING

Critical incidents are likely to produce physical and emotional symptoms, which develop as part of a stress response and are considered normal. They may appear at several different stages:

1.         During the incident symptoms may include confusion non-directed activity, disorientation, tunnel vision, crying, muscle tenseness (clinching teeth, etc.) profuse sweating, chest pain and/or increased heart beat.

2.         After the incident symptoms may begin to appear within hours after the incident and may include blurred vision, loss of memory, confusion, non-directed activity disorientation, or restlessness.

3.         Delayed post incident stress symptoms may occur weeks or months after the incident and may include restlessness, irritability, chronic fatigue, sleep disturbances, anxiety, depression, moodiness, muscle tremors, difficulties concentrating, increased substance abuse, nightmares, headaches, vomiting, diarrhea and/or suspiciousness.

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WHAT IS THE PURPOSE OF A CRITICAL INCIDENT DEBRIEFING?

The purpose of a debriefing is to offer emergency service personnel the opportunity to come together as a group and to identify their own personal reactions to the event.

Being involved in a critical incident:

-           can make a person feel isolated

-           trigger responses that are unfamiliar and frightening.

A debriefing:

-           provides information about normal human responses to abnormal events,

-           helps emergency service personnel understand what they are experiencing,

-           accelerates the normal recovery of normal people with “normal reactions to abnormal events”,

-           helps emergency service personnel develop strategies for coping with their reactions to the event.

There is a lot of evidence that having strong social supports after a traumatic event helps people reestablish a sense of psychological well being and regain equilibrium.

Emergency service personnel say that it is difficult to share these events with friends and family who weren't there and wouldn't understand. They don't want to expose them to the details of these situations.

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THE WHO, WHAT, WHERE, OF CRITICAL INCIDENT DEBRIEFING

WHO LEADS A CRITICAL INCIDENT DEBRIEFING?

Mental health professionals and peer debriefers trained in crisis intervention and traumatic stress reactions, make up the CISM team, which facilitates a debriefing. Team members are selected by an application and review process and have completed a CISM training program. 

WHAT HAPPENS IN A DEBRIEFING?

1. HOW LONG DO THEY LAST?

When you participate in a debriefing, you will be asked to stay for the entire length of the   debriefing (2-3 hours). It is important not to "box yourself in" with other appointments, since it is difficult to determine ahead of time exactly how long a debriefing will last. If  you carry a pager you should make arrangements to have your calls forwarded.

2. AM I REQUIRED TO ATTEND?

Any emergency personnel who were involved in the incident should be invited to attend the debriefing. This includes supervisory staff. To exclude them produces an "us and them" atmosphere within the organization.

It is the nature of the human response to events of this magnitude to experience some shock and denial. This means that people often don't realize immediately that they are having reactions.

Certain events simply will precipitate reactions in almost everyone: what these reactions are will vary among people; but everyone will have some reaction.

In our experience, it is often the person who thinks they need a debriefing the least that has found the debriefing to be the most beneficial.

Understanding the experience of your co-employees during a critical incident is also important. You will need to be working with them and depending on them soon. We have found that debriefing are helpful in reestablishing the effective functioning of work groups.

3. WHAT ABOUT CONFIDENTIALITY?

One of the main reasons that debriefings are helpful is our requirement that confidentiality is essential.

  • There is not rank at a debriefing. If managers are present, they are there because they participated in the event.
  • No notes or records are taken during the debriefing.
  • Participants are told that they may share their own experiences of the incident and their own reactions to the debriefing process with people who did not participate in the debriefing, but they may not talk about anyone else's experience or comments during the debriefing.

4. SHOULD MANAGERS ATTEND?

Managers who were involved in the incident should attend. However, they are there because they participated personally and also need the opportunity to explore their own personal responses.

5. WHAT IF I AM UNCOMFORTABLE TALKING ABOUT MY EXPERIENCES DURING A DEBRIEFING?

Most people find that they will want to contribute some information about their experience during a critical incident during a debriefing. Participants are invited to share their experiences to the extent that you feel comfortable doing so. No one is "forced” to talk if they choose not to.

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WHAT LONG TERM EFFECTS ON PERSONNEL MAY OCCUR IF A DEBRIEFING IS NOT HELD?

The long-term adverse effects of the stress response syndrome, although normal, have the potential to become dangerous to the employee’s health, if symptoms become prolonged. Departments may experience increased absences, moral problems and increased employee health care costs over the years following the incident. Any costs incurred for overtime to allow employees to attend a debriefing will most certainly be saved over the long term in avoidance of these potential costs through the course of emergency service personnel careers.

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REQUESTING CISM SERVICES

Anyone can identify or recognize significant incidents that may require debriefings. A debriefing should be requested as soon as possible after the event. The best policy is to have a plan for personnel to request CISM intervention.

The Critical Incident Response Service can help your department when needed. Services are free of charge and can be arranged by contacting, Critical Incident Response Service at 1-800-367-6524, 24 hours a day. Be prepared to provide a contact person’s name, the location of the scene, and a brief description of the critical incident. The CISM Team will evaluate the need for a debriefing. If a debriefing is needed, contact will be made with the department to set up a convenient time and location.



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