As human beings, we share the trait of being able to experience extreme fear A variety of events can bring about this level of distress, some of which occur naturally and others that are caused by human action. One such event, terrorism, results from human action. In recent times, there has been a shift from conventional weapons for war and terrorism to a type of weapon of mass destruction (WMD) that includes chemical, biological, radiological, nuclear, and high yield explosives (CBRNE) weapons These types of weapons, in addition to their obvious effects, may be particularly capable of causing widespread fear, confusion, and stress that may alter the long-term health of affected communities and the larger community's sense of well-being.
[Show abstract][Hide abstract] ABSTRACT: Critical incident stress management (CISM) has become a common practice in modern emergency services. Described in 1983 as critical incident stress debriefing (CISD), CISM was originally marketed to help emergency personnel deal with ostensibly stressful situations they would encounter as a part of their work.
To review the status of the medical and psychological literature regarding the efficacy and safety of CISM.
Several pertinent databases were accessed and searched for scientific articles pertaining to CISM. These were subsequently analyzed for methodology and pertinence to the study topic.
Numerous scientific articles were found concerning CISM. Several high-quality studies were identified, but many other studies lacked adequate methodology sufficient for use in an evidence-based medicine approach. Others were from trade magazines, non-refereed journals, and obscure mental health journals. Several meta-analyses and randomized controlled trials (RCTs) were found. Overall, these studies show that, at best, CISM has no effect on preventing psychiatric sequelae following a traumatic event, particularly post-traumatic stress disorder (PTSD). Furthermore, several studies report possible paradoxical worsening of stress-related symptoms in patients and personnel receiving CISM.
Despite the limitations of the existing literature base, several meta-analyses and RCTs found CISM to be ineffective in preventing PTSD. Several studies found possible iatrogenic worsening of stress-related symptoms in persons who received CISM. Because of this, CISM should be curtailed or utilized only with extreme caution in emergency services until additional high-quality studies can verify its effectiveness and provide mechanisms to limit paradoxical outcomes. It should never be a mandatory intervention.
Prehospital Emergency Care 04/2003; 7(2):272-9. · 1.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Research on the prevalence of traumatic exposure has tended to focus on younger populations, limiting our knowledge about trauma and its effects in older adults. In this study, lifetime trauma exposure was assessed in a sample of 436 male military veterans of World War II and the Korean Conflict (age 59–92). A clinician-administered screening measure, the Brief Trauma Interview, was developed to assess lifetime exposure to 10 categories of trauma using DSM-IV criteria. PTSD was assessed in interview and questionnaires. Despite a high prevalence of trauma exposure, symptom levels were relatively low. Few men met criteria for current or lifetime PTSD. Secondary analyses found that lifetime symptom severity was higher in men who met the DSM-IV A.2 criterion, in contrast with men who did not meet A.2. Findings indicate that trauma is highly prevalent among older men, although many may be asymptomatic.
Journal of Clinical Geropsychology 01/2002; 8(3):175-187. DOI:10.1023/A:1015992110544
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