Thursday, January 12th, 2012 by

Critical Incident Stress Management

Editors Note: The following is an article from Robert F. Rabe who has 38 years of Law enforcement experience, and has been involved in Critical Incident Stress Management for over 20 years.

A college professor once asked the class, “how heavy is a glass of water?”  The professor received several answers but the professor replied, “the weight doesn’t matter, it depends on long you try to hold it…the longer you hold it the heavier it becomes…that is until you put it down and rest.”  Stress is the same way.  If we carry stress especially after a critical incident the stress can become increasingly heavy, if not dealt with properly.  The stress may lead to a crisis.  According to the Chinese symbol for crisis it is made up from two other symbols which are danger and opportunity (see graphic on this page).  We can collapse under the weight of the crisis (danger) or we can learn to develop new skills (opportunity) to meet it head on.  Dr. Jeffrey Mitchell is the founder of Critical Incident Stress Management (CISM) and the International Critical Incident Stress Foundation.  In the early 1980’s, Dr. Mitchell, who was a firefighter/paramedic, found that after a critical incident, his peers demonstrated difficulty coping with the stress.  He studied their reactions and developed CISM, which is now a worldwide program. The purpose of this article is to provide to help law enforcement personnel, better understand and cope with reactions following involvement in critical incidents.

CRITICAL INCIDENT STRESS MANAGEMENT
CISM is a comprehensive, organized approach for the reduction… and control of harmful aspects of stress in the emergency service field.  It helps to develop new skills by helping to prevent or minimize incident stress reactions.  It helps to restore an individual’s ability to function.
It helps to restablize the work place.  It also includes, but is not limited to the following:

PRE-INCIDENT TRAUMATIC STRESS EDUCATION – perhaps the most important element of combating critical incident stress is pre-incident stress education.  Providing education before a critical incident strikes, helps to reduce the impact of the incident. Educating law enforcement personnel, who later become involved in critical incident, generally are better able to avoid or at least control stress reactions.  It helps personnel recover from stress reactions better because they recognize the symptoms early and seek assistance more quickly.

CRITICAL INCIDENT STRESS TEAM – is a specially trained team of volunteers from police, fire, EMS, mental health, clergy and other professions, who provide CISM services for those exposed to a critical incident.  Typically the team will meet with a group of people who have been exposed to a critical incident and ensure a confidential setting in which they can freely talk about their experience and express their reactions. An educational approach is used to inform the personnel of the normal effects of critical incident stress and to suggest ways to conquer it.

PEER COUNSELING – peer support officers are trained to recognize problems and make appropriate referrals. Officers learn basic counseling skills that builds a climate of trust through empathy, genuine concern, and an unconditional positive regard for the peer seeking help. Peer support officers do not conduct any clinical therapy, only trained and certified mental health professionals can provide the proper course of treatment Peer support officers work under the supervision of mental health professional to ensure that officers, who need help, get it.

PROFESSIONALCOUNSELING – delivering mental health care to members of the law
enforcement community is difficult. Law enforcement personnel often resist counseling for several reasons.  Frequently, they have a strong sense of self-sufficiency and insist that they can solve their own problems.  Law enforcement personnel possess great skepticism of outsiders and have difficulty trusting outsiders.  At the same time, counselors sometimes do not understand law enforcement work, nor can they easy grasp the daily stresses face by law enforcement personnel.
To counter such resistance, while still getting help for the personnel, who need it, many police departments have established peer support programs.

DEBRIEFING – is a group discussion employing both crisis intervention and an educational process, targeted toward decreasing or resolving psychological distress associated with a critical incident.  A critical incident can be a police call, during which sights, sounds and smells are so vivid as to cause the officer to feel a significant increase in stress and stress reactions – immediate or delayed.

Among the most common are:
•    SERIOUS INJURY OR DEATH
•    DEATH OR INJURY OF A CHILD
•    WORKPLACE VIOLENCE
•    SUICIDES
•    MASS CASUALTY DEATHS
•    DEATH OF A CO-WORKER

The goal of the debriefing team:
1.   Lessen impact on personnel exposed to critical incidents
2.   Accelerate recovery from critical incidents, before stress reactions have a chance to damage performance, careers, health and family………..STOP IT BEFORE IT STARTS AND CONFINE IT BEFORE IT SPREADS
3.   Provide information about critical incident stress and stress reactions that law enforcement personnel can use to help themselves and their peers.

The critical incident can be much different than you usually face.  Although law enforcement personnel are well trained; a critical incident is something they may not be prepared for.   Personnel may be confronted by reactions and feelings rarely reported or discussed by their peers.  Just as you allow yourself time to recover from a physical injury, it is important to accept your reactions after a critical incident.  Allow time to recover from the incident and remember time will vary with each individual.  Every year hundreds of law enforcement personnel experience critical incidents, that can have serious long-term consequence for themselves and their departments. Law enforcement personnel may not suffer any physical injuries, but the emotional trauma can be just as painful.

In order to better understand your reactions, consider the critical incident in which you have been involved, to be like the initial splash, when a stone is thrown in the water.  Your reactions are like the ripples, which may continue long after the stone penetrates the water surface.  Being aware of the fact that your responses are not unusual may help lessen the level of anxiety these reactions might cause you.  There are certain predicators that will also influence how well one responds to critical incidents.  The severity of the incident, prior reaction to similar incidents, level of stress in ones
life at the time of the incident and the response of others to the incident itself and you.

POST-INCIDENT TRAINING – what to expect after a critical incident. After being exposed to a critical incident, law enforcement personnel may experience noticeable changes in the way they feel, think and behave.  This may occur now or later in the days, weeks or months to come.  These changes are simply normal reactions that normal people have to an abnormal event.

Here are some common signs and symptoms of the stress reactions triggered by a critical incident:

PHYSICAL
Stomach upset
Diarrhea
Dizziness
Sleep disturbance

THINKING
Disorientated
memory problems
confusion
distressing dreams

EMOTIONAL
Anxiety
Fear
Guilt
Grief

Research has shown that critical incident stress, affects up to 87% of all emergency service personnel, at least once in their careers.

Each of us experiences trauma in our life.  It isn’t just the incident itself that determines our level of victimization, but how we prepare and react to it, that is crucial.

ABOUT THE AUTHOR:
Bob Rabe, is a Vietnam Veteran (military police), with 38 years of Law enforcement experience.  He has been involved in Critical Incident Stress Management for over 20 years.  He developed stress Seminars – 14 years.  He has volunteered his time to over 50 debriefings Involving law enforcement.

1. T.Pierson C.I.S.   Article:  A SERIOUS LAW ENFORCEMENT PROBLEM
The Police Chief Feb. 1989 pp32-33

Image: The dao of strategic maneuverability. (2009, March 29). Retrieved from http://collaboration360.blogspot.com/2009_03_01_archive.html

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7 Comments

  • Bob,
    Really good article. The opening example is fantastic way to say, “we can only handle so much exposure without some debriefing”. I will definitely send to my son, who will trust what you have to say because of your background, a little more than his dad. Glad you decided to write. You have lots to offer…Bill

  • We are very fortunate, in the Denver-Metro area, to have the Mayflower Crisis Support Team. In 1985, the Mayflower Team was among the first to deliver certified Critical Incident Stress Management (CISM) services in North America. The Mayflower Team is often consulted, world-wide, because of 26 consecutive years of experience in CISM.
    The Mayflower Team can be contacted through a dispatcher at 303-788-6889.
    Other teams, in Colorado, include Centennial (Greeley) at 970-350-9600; Southern Colorado (Colo Springs) at 719-576-1200; High Country (Frisco) at 970-668-8301; San Luis Valley (Alamosa) 719-589-5807; Triad (Glenwood Springs) at 970-920-5310; and Arkansas Valley (Pueblo) at 719-553-2502.

  • Hi Bill,

    Thank you for your comments!

  • Hi Danny,

    Thanks for the great resources!

  • Bob,

    Great article. My experiences as a career military officer discovered that the preparation and debriefings are instrumental in keeping massive stressful encounters at bay. In short, your article transcends law enforcement and EMS, and is equally applicable to the Department of Defense apparatus. Thanks for sharing.

  • I thought it was a great article. The public safety community does a good job addressing their physical issues that are the direct result of performing their jobs(ie injuries, occupational and communicable diseases).We do a poor job addressing psychological  injuries( that can lead to physical ones) due greatly to failure to detect the cause of the issue and also many times because of a character built on a recipe primarily comprised of ego, machesmo , and bravado.

  • Bob,
    Even though I didn’t know much about the topic before I read your article, I feel I have a better understanding of the impact of people’s experiences on the job to their overall well being. As a Manager I wish we had more of planned program like this to deal with stress. Great job on the article! Enjoyed reading it very much.
    Cheryl

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