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The Critical Incident Stress Debriefing process for the Los Angeles County Fire Department: automatic and effective

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Abstract

Los Angeles County Fire Department has one of the oldest Critical Incident Stress Management (CISM) programs in the country. One core component for the LACoFD has been the Critical Incident Stress Debriefing (CISD). Two important questions for the emergency managers are: 1) Do individuals find a significant difference in symptom reduction for events that were debriefed? 2) Does helpfulness of a debriefing for a specific individual correlate with recommending the process for others? A Department-wide evaluative survey was conducted in 1996 to determine the satisfaction and effectiveness of the debriefing program. Individuals reported a significant difference in the speed of symptom reduction for incidents that were debriefed versus incidents that were not debriefed. The majority of individuals would recommend the debriefing process to others regardless of whether they personally found the process helpful or not. Based on this, the recommendations are to continue the debriefing process for specific events and to make the process mandatory; furthermore, it is recommended that the term "mandatory" be changed to "automatic." By using the term "automatic," debriefings become standard operating procedures. By doing so, a method to protect the psychological welfare of emergency personnel becomes as automatic as putting on safety protection equipment [International Journal of Emergency Mental Health, 2000, 2(4), 249-257].

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... Critical Incident Stress Debriefing (CISD) was developed by Mitchell in 1983 and has since been adopted by fire, rescue, military and law enforcement organisations (Davis, 1998;Hokanson & Wirth, 2000;Sheehan, Everly, & Langlieb, 2004;Smith & Brady, 2006). Within these organisations, attendance at CISD has tended to be mandatory for individuals who have been exposed to critical incidents through their work (Bledsoe, 2003;Hokanson & Wirth, 2000). ...
... Critical Incident Stress Debriefing (CISD) was developed by Mitchell in 1983 and has since been adopted by fire, rescue, military and law enforcement organisations (Davis, 1998;Hokanson & Wirth, 2000;Sheehan, Everly, & Langlieb, 2004;Smith & Brady, 2006). Within these organisations, attendance at CISD has tended to be mandatory for individuals who have been exposed to critical incidents through their work (Bledsoe, 2003;Hokanson & Wirth, 2000). CISD is described by Mitchell (2003) as a structured process for a homogenous group of people following exposure to a crisis or traumatic event. ...
... These studies oppose the belief that the majority of people have high grief, trauma, and stress reactions to a bereavement, a belief that appears to underpin CISD (Bledsoe, 2003;Hokanson & Wirth, 2000). Whilst some may experience acute distress from which they find it difficult to recover, these studies suggest that the majority manage to endure the temporary turmoil of loss or potentially traumatic events well, with minimal disruption to functioning. ...
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Providing support to schools following a critical incident has become an established part of service delivery for many Educational Psychology Services (EPSs) in the UK. This article offers reflections on the use of Critical Incident Stress Debriefing (CISD) in schools. A review of the literature on critical incidents, trauma, resilience and bereavement suggested that studies exploring the effectiveness of psychological debriefing in general have produced mixed findings, which may be accounted for by methodological flaws and inappropriate application of the intervention. However it is also argued that the underpinning theoretical assumptions of CISD are questionable and, as a result, that Psychological First Aid, a non-intrusive evidence-informed approach, may be more appropriate in this context.
... Research has shown that programs for firefighter support should include stress management, counseling and educational campaigns regarding PTSD and should provide continuous preventive measures (Berger et al., 2012;Palmer & Spaid, 1996). However, firefighters often refuse to admit the presence of virtually any psychological problem and present a persistent but often dysfunctional need to maintain a 'macho image' (Hokanson & Wirth, 2000). ...
... Health promotion programs or interventions for firefighters have shown to be beneficial, both physically (MacKinnon et al., 2010) and mentally (Hokanson & Wirth, 2000). However, firefighters have difficulty accessing mental health services due to many reasons, including concerns regarding reputation related to career advancement and humiliation from coworkers, stringent shift-work schedules and poor working environment (e.g. ...
Article
Background There is worldwide interest in the mental health of firefighters, since they are more prone to exposure to traumatic stress and psychiatric disorders. Aims This study aimed to assess their mental health and provide individualized support to local firefighters through a mental health promotion program. Method Eighteen hundred and fifty-nine active Korean firefighters in 2015 and 2017 (502 and 1,357, respectively) participated in the ‘Visiting Counselling Centre for Firefighters’ program commissioned by the National Fire Agency. The program consisted of self-administered questionnaires, a group education session, an individual counseling session for every participant, four counseling sessions for certain participants and additional brief intensive counseling (BIC). We administered the Post-traumatic stress disorder Checklist (PCL), Beck’s Depression Inventory (BDI), Beck’s Anxiety Inventory (BAI), Beck Scale for Suicidal ideation (BSS), Insomnia Severity Index (ISI), Korean version of the Alcohol Use Disorders Identification Test (AUDIT-K) and the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) before and after the program. Additional analysis was performed to determine whether BIC participation further improved the psychopathological outcome. Results The participants showed meaningful improvement in all psychopathological scales; the PCL, BDI, BAI, BSS, ISI, AUDIT-K and WHOQOL-BREF scores all significantly improved. Meanwhile, BIC participation improved certain psychopathological symptoms at a higher degree; the BDI, BAI, BSS and AUDIT-K scores significantly improved. Conclusion The mental health promotion program improved the mental health of the participating active firefighters in Korea. Meanwhile, BIC participation improved certain psychopathological symptoms at a higher degree. A comprehensive approach for supporting the mental health of firefighters should be considered.
... One study found CISD was associated with higher levels of PTSD symptoms for fire and rescue personnel by a statistically significant amount, but the amount was not substantial (Sattler et al., 2014); in contrast, other studies have found no statistically significant relationship between CISD participation and PTSD symptoms (Harris, Baloglu, & Stacks, 2002;Hokanson & Wirth, 2000). The available research has associated CISD interventions with increased post-traumatic growth (i.e., improvements in self-perception, relationships, and outlook on life following recovery from traumatic incidents; Sattler et al., 2014), positive beliefs, and reduced negative affect (Harris et al., 2002). ...
... The available research has associated CISD interventions with increased post-traumatic growth (i.e., improvements in self-perception, relationships, and outlook on life following recovery from traumatic incidents; Sattler et al., 2014), positive beliefs, and reduced negative affect (Harris et al., 2002). Only one study found evidence that fire and rescue personnel who received a CISD intervention reported trauma-related symptom reductions sooner than personnel who did not receive the intervention (Hokanson & Wirth, 2000); however, the study design did not allow for inferences regarding causality. ...
... Employers were expected to benefit, as mentally healthy employees were thought to be better workers (Mitchell & Bray, 1990). Many organizations opted to use CISD, with some requiring attendance following exposure to critical events (Hokanson & Wirth, 2000). As a result, a cottage industry grew up around the use of CISD and similar procedures (Lewis, 2003; Gist, 2002). ...
... To date, as far as we know no study has asked firefighters which type of intervention, if any, they would prefer. One study (Hokanson & Wirth, 2000) included a survey about post-incident intervention. However, it dealt solely with CISD, and respondents were only asked whether or not they would recommend debriefings; 78.5% of respondents with previous debriefing experience, and 84.5% of those without, recommended the process. ...
Article
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The effectiveness of Critical Incident Stress Debriefing (CISD) as a tool remains, at best, inconclusive. Yet in many locales CISD is mandatory for emergency services workers, including firefighters. To our knowledge, to date no study has investigated firefighters' preferences for psychological intervention following traumatic events. To examine this, a survey was conducted with 142 members (54%) of an urban fire and rescue service in south-western Ontario, Canada. Firefighters were provided with five scenarios of varying traumatic intensity, for which they rated desirability of four voluntary post-incident interventions: CISD, individual debriefing, informal discussion, and no intervention. Firefighters expressed interest in working with post-event reactions within their peer group for all events, and an increasing interest in formal intervention as event severity increased. Individual debriefing was preferred to CISD in scenarios of low to moderate intensity. For scenarios of high intensity, ratings for all interventions were high. Expected relationships with prior CISD experience and years of service were not upheld. The essential role of informal peer-support, and the desire for meaningful intervention in severe situations, are discussed.
... Specific studies that have found CISD interventions to be at least moderately effective include applications for soldiers and peacekeepers (Adler et al., 2008;Deahl et al., 2000), robbery victims (Campfield & Hills, 2001;Richards, 2000), police officers and firefighters (Bohl, 1991(Bohl, , 1995Hokanson & Wirth, 2000), emergency medical workers (Jenkins, 1996;Wee, Mills, & Koehler, 1999), September 11th survivors (Herman, Kaplan, & LeMelle, 2002) and disaster workers (Chemtob, Tomas, Law, & Cremniter, 1997;Nurmi, 1999). Critics of the positive research cite issues of reliance on self-report data and lack 178 THE JOURNAL FOR SPECIALISTS IN GROUP WORK / June 2009 of random assignment to non-treatment control groups as methodological flaws and reasons to question the value of positive findings (Bisson, 2003;Gist & Devilly, 2002;Kenardy, 2000;McNally, Bryant, & Ehlers, 2003). ...
... Some organizations make CISD attendance voluntary, while others make it mandatory. Still others have adopted an automatic protocol, wherein anyone involved in a critical incident attends a CISD as part of the protocol for responding to high magnitude events (Hokanson & Wirth, 2000). This is a source of contention is the CISD=CISM literature (Gist & Devilly, 2002;Kenardy, 2000). ...
Article
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Crisis intervention group work is routinely provided to those that have been exposed to potentially traumatizing events. The Critical Incident Stress Debriefing (CISD) has been identified as a standard format for conducting crisis groups, yet the intervention is highly debated in the literature. This article reviews the status of that debate, offers an analysis of the CISD protocols through the lens of group work effectiveness: ASGW's Best Practice Guidelines (2008), and then makes suggestions for the use of group work methodology to enhance the understanding of the benefits and limitations to CISD group work.
... Specific studies that have found CISD interventions to be at least moderately effective include applications for soldiers and peacekeepers (Adler et al., 2008;Deahl et al., 2000), robbery victims (Campfield & Hills, 2001;Richards, 2000), police officers and firefighters (Bohl, 1991(Bohl, , 1995Hokanson & Wirth, 2000), emergency medical workers (Jenkins, 1996;Wee, Mills, & Koehler, 1999), September 11th survivors (Herman, Kaplan, & LeMelle, 2002) and disaster workers (Chemtob, Tomas, Law, & Cremniter, 1997;Nurmi, 1999). Critics of the positive research cite issues of reliance on self-report data and lack 178 THE JOURNAL FOR SPECIALISTS IN GROUP WORK / June 2009 of random assignment to non-treatment control groups as methodological flaws and reasons to question the value of positive findings (Bisson, 2003;Gist & Devilly, 2002;Kenardy, 2000;McNally, Bryant, & Ehlers, 2003). ...
... Some organizations make CISD attendance voluntary, while others make it mandatory. Still others have adopted an automatic protocol, wherein anyone involved in a critical incident attends a CISD as part of the protocol for responding to high magnitude events (Hokanson & Wirth, 2000). This is a source of contention is the CISD=CISM literature (Gist & Devilly, 2002;Kenardy, 2000). ...
Article
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Critical incident stress debriefing is a highly utilized and often debated form of post-trauma exposure intervention. This article presents exploratory group process research that utilized a mixed method approach and group process research techniques. The article's findings, the emergence of therapeutic factors, support that CISD group work does yield indicators consistent with support/ psychoeducation groups with a crisis theme. Further the events that trigger the intervention yield specific therapeutic factors. CISD group work may be better understood through established group research patterns.
... Research examining effectiveness of stress and burnout reduction interventions among FFs is limited, and findings among the few studies are mixed (Halbesleben et al. 2006). Some studies of Critical Incident Stress Debriefing (CISD; Mitchell & Everly 2001), one of the most widely applied interventions for acute stress among FFs, have found improvement in post-traumatic growth (Sattler et al. 2014) and distress reduction (Hokanson and Wirth 2000); however, several randomized controlled trials, systematic reviews, and meta-analyses have concluded that CISD is ineffective (Adler et al. 2008;Forneris et al. 2013;Harris et al. 2002;Jacobs et al. 2004;Kearns et al. 2012) and may exacerbate PTSD symptoms by re-exposing patients to traumatic material (Devilly and Cotton 2003;Kenardy 2000;Regehr 2001). ...
Article
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First responders are exposed to critical incidents and chronic stressors that contribute to a higher prevalence of negative health outcomes compared to other occupations. Psychological resilience, a learnable process of positive adaptation to stress, has been identified as a protective factor against the negative impact of burnout. Mindfulness-Based Resilience Training (MBRT) is a preventive intervention tailored for first responders to reduce negative health outcomes, such as burnout. This study is a secondary analysis of law enforcement and firefighter samples to examine the mechanistic role of psychological resilience on burnout. Results indicated that changes in resilience partially mediated the relationship between mindfulness and burnout and that increased mindfulness was related to increased resilience (b = 0.41, SE = 0.11, p < .01), which in turn was related to decreased burnout (b = −0.25, SE = 0.12, p = .03). The bootstrapped confidence interval of the indirect effect did not contain zero [95% CI; −0.27, −0.01], providing evidence for mediation. Limitations and implications are discussed.
... proper debriefing after stressful events is recommended (see Hokanson & Wirth, 2000). (Caldwell & Caldwell, 2003, p15). ...
Article
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This report was prepared for WHO Patient Safety’s Methods and Measures for Patient Safety Working Group. It provides a basic description of major topic areas relating to human factors relevant to patient safety, with some indication of possible tools that can be used in a healthcare workplace for measurement or training of these topics. First an explanation of the human factors approach is provided. An organizing framework is presented to provide a structure for the discussion of the topics, by categorizing them as follows: i) Organizational/ Managerial, ii) Team, iii) Individual, iv) Work environment. Wider social factors and the central role of the patient are also acknowledged but these aspects of the healthcare system are not explicitly covered. Ten topic areas within these four categories are described: organizational culture, managerial leadership, communication, teamwork, team leadership, situation awareness, decision making, stress, fatigue, work environment. A selection of tools for education, measurement or training these human factors topics is described. Some of these may be suitable for application in developing, as well as developed, countries.
... Crisis interventions following traumatic events have been utilized for many years (Boudreaux & McCabe, 2000; Kaplan et al., 2001; Mitchell, 2004). However, the effectiveness and safety of these interventions following these events have been debated (Castellano, 2003; Flannery & Everly, 2000; Hokanson & Wirth, 2000; Jacobs, Horne-Moyer, & Jones, 2004; Kaplan et al., 2001; Luna, 2002; Mitchell, 2003). Nevertheless, group crisis interventions are commonly recommended following traumatic events (Flannery & Everly, 2004; Mitchell, 2004). ...
Postdisaster crisis interventions have been viewed by many as the appropriate and immediate approach to enhance psychological well-being among persons affected by large-scale traumatic events. Yet, studies and systematic reviews have challenged the effectiveness of these efforts. This article provides the first rigorous scientific evidence to suggest that postdisaster crisis interventions in the workplace significantly reduced mental health disorders and symptoms up to 2 years after the initial interventions. Until now, studies have neither focused on the effectiveness and safety of brief mental health services following disasters, or traumatic events generally, nor examined the long-term impact of these interventions across a spectrum of outcomes using a rigorous research design. The focus of this study was to examine the impact of brief mental health crisis interventions received at the worksite following the World Trade Center disaster (WTCD) among a random sample of New York adults. The data for the present study come from a prospective cohort study of 1,681 adults interviewed by telephone at 1 year and 2 years after this event. Results indicate that worksite crisis interventions offered by employers following the WTCD had a beneficial impact across a spectrum of outcomes, including reduced risks for binge drinking, alcohol dependence, PTSD symptoms, major depression, somatization, anxiety, and global impairment, compared with individuals who did not receive these interventions. In addition, it appeared that 2-3 brief sessions achieved the maximum benefit for most outcomes examined. Implications for postdisaster crisis interventions efforts are discussed.
... Using these procedures, a number of investigators have found from moderate to very high degrees of satisfaction with PD (21,25,28,33,35,36,39,41). In addition, 11 category B studies have assessed the perceived helpfulness. A high to very high degree of satisfaction is found in all of these research papers (7,(59)(60)(61)(62)(63)(64)(65)(66)(67)(68). ...
Article
To identify literature concerning the effectiveness of psychological debriefing (PD) and analyse results according to different criteria of success and different uses of the intervention format. Literature search was made in databases PubMed, PsycInfo and Psychlit. Twenty-five studies were selected for a thorough description. Forty-two studies provided additional information. Results indicate that, in general, debriefing does not prevent psychiatric disorders or mitigate the effects of traumatic stress, even though people generally find the intervention helpful in the process of recovering from traumatic stress. The intervention holds potential as a screening procedure, and there may be economic arguments for continued use. When used with adherence to traditional descriptions of treatment group, events, group format, leadership and time spent, a preventive effect emerges. No tendency according to timing was found. Current uses of PD are problematic. The concept needs to be redefined, and the scope of application must be revised. The objectives for use need to be clarified.
... Using these procedures, a number of investigators have found from moderate to very high degrees of satisfaction with PD (21,25,28,33,35,36,39,41). In addition, 11 category B studies have assessed the perceived helpfulness. A high to very high degree of satisfaction is found in all of these research papers (7,(59)(60)(61)(62)(63)(64)(65)(66)(67)(68). ...
Article
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Diagnostic criteria for stress reactions and adjustment disorders are summarized. Existing psychological treatments are outlined with a focus on evidence-based methods, and recommendations for treatment are described. The conclusion is that there is no evidence for the effect of psychological debriefing or other professional treatment in the immediate aftermath of traumatic events. On the other hand, cognitive behavioural therapy, EMDR and similar methods with focus on exposure can be recommended, both as a preventive strategy and for patients with post-traumatic stress disorder.
... It also causes posttraumatic stress disorder, dissatisfaction, anxiety among the survivors of terrorism (Franklin.C.G., 2002). Hokinson & Wirth (2000) argued that shocking events affect the learning capacity of people. If a person retained the traumatic incident in his mind, he is unable to follow communication. ...
... Although physical fitness programs are common in the fire industry, few departments offer specialized training aimed at improving and enhancing cognitive, psychosocial, and psychological well-being (Rodriguez, 2001). Researchers have found that various psychological interventions including mindfulness (Kaplan et al., 2017), cognitive behavioral therapy (Difede et al., 2007), critical incident stress debriefing (Hokanson & Wirth, 2000), and relaxation techniques (Mitani et al., 2006) are beneficial for the fire population. However, research on these techniques (e.g., critical incident stress debriefing, cognitive behavioral therapy, etc.) were used to reduce rather than prevent symptoms. ...
Article
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This study aimed to assess the psychometric properties of a modifiedsport psychology instrument in firefighters and explore the associations betweenpsychological skills and coping strategies. Career firefighters completed an onlinesurvey assessing psychological skills and coping strategies. Confirmatory factoranalyses (CFA) were performed on the modified Athletic Skills Coping Inventory(ACSI) and the Brief Cope (BC). Subsequent exploratory factor analysis (EFA) andcovariance modeling were performed on the ACSI and bivariate correlationsbetween the refined ACSI and BC were assessed. The refined ACSI included four factors and model fit exceeded fit recommendations. Nine significant relationships between the modified ACSI and BC were found. Excellent psychometric properties of the refined ACSI instrument provide preliminary evidence of the appropriateness,meaningfulness, and usefulness of the instrument in firefighters. However, modifications should be made that address the scale weaknesses before implementation.
... Most firefighters have periods of down time and web access at their fire station, making the web a feasible source of health information and independent learning. Further, since firefighters resist acknowledging the need for psychological help [20], the availability and anonymity of seeking health information online is especially attractive for health conditions that might have negative connotations [21]. ...
... Also known as the Mitchell Model, CISD was originally used in response to the Washington Air Crash, which resulted in 76 fatalities. The firefighters, police, disaster managers, and paramedics who attended the voluntary debriefings reported that they were helpful (Hokanson & Bonnita, 2000). ...
... Individuals exposed to a PTE are invited, within days, to participate in a three to four hour session in which the "incident" is reviewed. Personnel are invited to attend a CISD regardless of the degree of their acute symptoms or functional impairment (e.g., Hokanson & Wirth, 2000). The assumption of the CISD approach is that everyone exposed to a PTE is at risk for a stress reaction/PTSD and that everyone could benefit from an opportunity to share their experience and learn about trauma and adaptive coping. ...
Article
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In August 2003, an international expert panel was convened by the U.S. Department of Health and Human Services and the U.S. Department of Veterans Affairs in Bethesda, Maryland, to discuss outreach and intervention for behavioral health needs following disasters and mass violence. This document is the outgrowth of a paper prepared by the working group on individual interventions that was formed at the roundtable. In this document, we discuss basic considerations regarding individual post-disaster interventions and outreach strategies. We then provide brief overviews of the research base and recommendations concerning interventions for different time periods in the aftermath of mass violence or disaster. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Working under adverse conditions may increase the amount of stress that firefighting personnel experience while they are performing emergency work on scene. For example, the Cerritos air crash of 1986 was a mass casualty event that caused extreme stress and psychological distress among the firefighting personnel who responded to the scene (Hokanson & Wirth, 2000). ...
Article
The purpose of this study was to identify the effectiveness of the coping strategies and resources that firefighters use to deal with personal and workplace stressors. One hundred and fifteen firefighting personnel from 4 fire departments in Illinois and Indiana participated. The Coping Resources Inventory for Stress (CRIS) Scale measured stress levels and coping strategies. The results showed that firefighters who were not physically fit, who lacked social support, and who were unable to control tension and structure daily activities experienced feelings of low confidence. The findings from this study can provide fire department administrators and company officers with ways to address stress in the ranks of the fire department. Future research should be conducted to identify the workplace and personal stressors of firefighting personnel and develop interventions to combat these stressors.
... Since many physical assault incidents in health care settings do not require treatment [7], this suggests that the subsequent episodes of missed work are only partially due to the direct consequences of physical assault (e.g., the injury inflicted by an attack). Maintaining physical and emotional well-being is essential to the functioning of an emergency service [8]. The finding that the frequency of exposure to abusive and violent situations was among the top three stressors identified by EMS personnel [4] highlights the need for prehospital providers to have access to counseling and psychological services for stress and support. ...
Article
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Previous studies on violence against prehospital personnel have mainly reported on “verbal” and “physical” violence. This study explored how provider demographic and work-related characteristics were associated with five different forms of workplace violence (being cursed or threatened; being punched, slapped, or scratched; being spat upon; being stabbed/stabbing attempt; and being shot/shooting attempt). A cohort of nationally registered United States Emergency Medical Services professionals was surveyed to determine the experience of each of these types of patient initiated violence by these providers and their partners. Multivariable logistic regression analyses indicated gender was significantly associated with both being cursed/threatened and being stabbed or experiencing a stabbing attempt (odds ratio (OR) = 0.65, CI = 0.44-0.96; OR = 0.27, CI = 0.09-0.75, resp.). Level of EMT practice was significantly associated with being cursed/threatened, being spat upon, and being punched, slapped, or scratched (OR = 0.17, CI = 0.11-0.27; OR = 0.30, CI = 0.21-0.43; OR = 0.31, CI = 0.22-0.44, resp.). Both community size and experience were significantly associated with all the types of violence investigated. EMS workplace violence research is at its infancy; thus this study adds to a limited but growing body of knowledge.
Article
The impact of work related stressors on emergency clinicians has long been recognized, yet there is little formal research into the benefits of debriefing hospital staff after critical incidents, such as failed resuscitation. This article examines current models of debriefing and their application to emergency staff through a review of the literature. The goal being, to outline best practice, with recommendations for guideline development and future research directives. An electronic database search was conducted in Ovid and Psychinfo. All available abstracts were read and a hand search was completed of the references. Included articles were selected by a panel of two experts. Models and evidence relating to their efficacy were identified from the literature, and detailed evaluation included. The reviewed literature revealed a distinct paucity regarding the efficacy of debriefing of clinicians post CI and in particular randomized controlled trials. Despite this debriefing is perceived as important by emergency clinicians. However evidence presents both benefits and disadvantages to debriefing interventions. In the absence of evidence based practice guidelines, any development of models of debriefing in the emergency healthcare setting should be closely evaluated. And future research directives should aim towards large randomized control trials.
Article
Psychological debriefing uses brief unsystematic exposure, and is ineffective for posttraumatic stress symptoms and disorder. Systematic exposure alone and cognitive restructuring alone are each effective. Other approaches too may be useful. The treatment of 3 posttraumatic stress disorder (PTSD) patients is detailed in which there was no exposure to the main traumatic event. There was exposure to related cues in case 1, exposure to related and other cues followed by well-being therapy (WBT) in case 2 and WBT in case 3. The 3 patients improved enduringly, confirming earlier findings that exposure to the main trauma is not essential for PTSD to improve. A study is needed of therapeutic mechanisms in PTSD and of the value of WBT in a randomized controlled trial.
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Many 21st century operations are characterised by teams of workers dealing with significant risks and complex technology, in competitive, commercially-driven environments. Informed managers in such sectors have realised the necessity of understanding the human dimension to their operations if they hope to improve production and safety performance. While organisational safety culture is a key determinant of workplace safety, it is also essential to focus on the non-technical skills of the system operators based at the 'sharp end' of the organisation. These skills are the cognitive and social skills required for efficient and safe operations, often termed Crew Resource Management (CRM) skills. In industries such as civil aviation, it has long been appreciated that the majority of accidents could have been prevented if better non-technical skills had been demonstrated by personnel operating and maintaining the system. As a result, the aviation industry has pioneered the development of CRM training. Many other organisations are now introducing non-technical skills training, most notably within the healthcare sector. Safety at the Sharp End is a general guide to the theory and practice of non-technical skills for safety. It covers the identification, training and evaluation of non-technical skills and has been written for use by individuals who are studying or training these skills on CRM and other safety or human factors courses. The material is also suitable for undergraduate and post-experience students studying human factors or industrial safety programmes. © Rhona Flin, Paul O'Connor and Margaret Crichton 2008. All rights reserved.
Previous research has demonstrated the potential for work-related stress associated with employment in the emergency service field. However, little research has considered effective interventions that may be used to mediate the effects of this work-related stress. Critical Incident Stress Debriefing (CISD) is one intervention that is currently employed with emergency service workers. However, the efficacy of this intervention is currently the source of much debate. The present discussion reviews the available literature regarding the effectiveness of CISD for use with emergency service workers and concludes that at this time, for this population, the call for the removal of current programs using CISD is unwarranted.
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Despite the successes in the treatment of chronic trauma-related distress, little attention has been devoted to developing behavioral interventions to be delivered soon after traumatic exposure in an effort to promote positive posttraumatic adjustment and to minimize the likelihood of enduring psychopathology. As a result, other forms of early intervention have filled this void and have been widely disseminated and applied, despite the lack of compelling evidence attesting to their efficacy. This article reviews the literature bearing on early interventions for trauma, including the encouraging outcomes of recently developed behavioral treatments. Empirically informed practice guidelines for intervening with recently traumatized individuals are presented. Future treatment development efforts will need to address an issue that has been largely neglected in traditional treatment models for traumatized populations-that of traumatic bereavement. Behavioral interventions may be particularly well-equipped to address this source of distress.
Article
Nearly everyone will experience emotional and psychological distress in the immediate aftermath of a disaster or other large-scale traumatic event. Although extremely upsetting and disruptive, the reaction is understood best as a human response to inordinate adversity, which in the majority of cases remits over time without formal intervention. Nevertheless, some people experience sustained difficulties. To prevent chronic post-traumatic difficulties, mental health professionals provide early interventions soon after traumatic exposure. These interventions typically take the form of single-session debriefings, which have been applied routinely following disasters. The research bearing on these traditional forms of early crisis interventions has shown that, although well-received by victims, there is no empirical support for their continued use. However, promising evidence-based, early interventions have been developed, which are highlighted. Finally, traumatic bereavement and complicated grief in survivors of disasters, an area largely neglected in the field, is discussed.
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When working with vulnerable children and their families, the specter of client death for child welfare workers and agencies is recognized as a rare but unsparingly real event. This article uses an agency-centered perspective to explore the multilayered steps agencies may implement at the supervisory through administrative levels to build agency-wide support for workers to cope and perform well during such crises.
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Two principles of medicine are reflected upon when considering psychological interventions for people who were exposed to or experienced trauma. The first maxim is the medical model's sequence of assessment, diagnosis, and treatment. The second dictum for helpers is first, do no harm (a.k.a., primum non nocere). Keeping these admonitions in mind, helping professionals, organizational management, and human relations specialists are advised to proceed cautiously when prescribing remedial treatment for potential mental distress. Some vulnerable people seem to favorably respond to psychological debriefing and other more resilient individuals may be adversely affected. Various results have locked apostles and disparagers into a contentious relationship that goes against the spirit of good science. This article intends to bring some balance to a very popular and sometimes universally applied intervention for exposure to critical incidents. The objective is to bring sanity to an uncontrolled conflict over Critical Incident Stress Debriefing (CISD). In an attempt to provide balance to the CISD brouhaha claims and counterclaims are discussed. Advocates personal involvement with the movement, hardiness and vulnerability are considered. Prologue I do not have an ax to grind in the Critical Incident Stress Debriefing (CISD) issue that will be discussed below. The reason for this opening disclaimer will become apparent when the parochial and aggressive tone used by participants debating the unresolved controversy becomes apparent in the following article. After surveying the biased literature and propaganda on psychological debriefing, the motivation to write this article came from moral and ethical considerations, My original interest was in researching coping mechanisms for dealing with the stressor of unemployment; which then expanded to include income loss, divorce, cancer, injury, death, disasters, military deployment and combat. Reviewing the scholarly research was a straightforward process. Acting upon the politics will require customer knowledge, motivation, courage, and judgment. To do this, commanders, executives, and human relations professionals need unvarnished information from unbiased reports. Managers will need to differentiate self-serving puff pieces from impartial evidence. A source of truth might be found in legitimate refereed scholarly journals and other reliable publications. Fortunately, extensive inquiry is no longer difficult. Academic literature on business and social science issues is now relatively easy to broadly explore because of technology advancers, in recent years. Multiple computer databases can be simultaneously searched in seconds. Many are directly connected to full-text sources of cited articles. Several more papers can be quickly unearthed through electronic journals. These on-line resources at college libraries provide quick and easy ways to assemble pertinent copies of credible scholarly papers. Of course, photocopies and interlibrary loan can fill in the gaps. Google searches of the Internet provide ready access to public outlets. This is useful information for commanding and executive officers that want to and should, after digesting the articles, periodically and independently assess the pros and cons of movements after reading the articles. Fortunately, in recent years the readability of much scholarly literature in the social sciences has improved and can be readily understood by the uninitiated.
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In Nederland behoort het bieden van een eenmalige debriefing na een ingrijpende gebeurtenis tot de standaardzorg. Na iedere gebeurtenis met een waarschijnlijke stevige mentale impact, worden door de overheden complete legertjes hulpverleners gemobiliseerd om de betrokkenen op te vangen en hun verhaal te laten doen. Vaak wordt geclaimd dat deze zorg bedoeld is om ernstige psychische problemen op de lange termijn te voorkomen. Maar kan die claim worden waargemaakt? In dit artikel een zoektocht naar een antwoord op die vraag en natuurlijk het antwoord zelf.
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In the face of manmade and natural disasters, first responders are called upon to respond to emergencies, protect the public, and mitigate further disaster consequences. While this is a professional expectation, extreme crisis events can present an inimitable set of challenges for responders, particularly when they are personally impacted by the disaster in which they are expected to respond. The media reports of "abandonment of duty" among police officers in New Orleans during the Hurricane Katrina disaster highlight the need to better understand factors that both challenge and encourage resilience among first responders. This study examines the coping practices that fostered resilience among the officers of the New Orleans Police Department (NOPD) who served as first responders to the Katrina disaster. To gain insight into the experiences and activities of officers during the most stressful parts of the crisis, face-to-face interviews were conducted with officers (N = 57) of varying ranks and divisions. The data demonstrates the dynamic nature of coping in disasters, as well as the range of strategies practiced by first responders in crisis situations.
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A large number of emergency personnel were involved in the response to the May 2004 storms that devastated a 52 mile swath of Southeast Nebraska. Emergency workers who responded the night of the storm were exposed to bad weather, darkness, and uncertainty about their own safety. Later, they were asked to work alongside survivors and neighbors who had lost everything amidst widespread destruction of farms, homes, and businesses. Some, but not all of the emergency personnel were offered formal psychological support services like critical incident debriefing to assist with the emotional processing of the event. The research literature is mixed regarding the type of psychological support that is best for emergency response personnel after they respond to a disaster. This has resulted in some confusion on the part of practitioners about the most effective way to offer support services to emergency workers. The Lincoln Metropolitan Medical Response System was interested in understanding how local service structures could be better utilized to support responders after large scale events like the May 2004 storms. Rather than rely on the literature alone, an exploratory study was completed to discover what emergency workers relied upon to support psychological or emotional health after the storms and how they preferred to experience that support. Thirteen in-depth interviews and four focus groups were held with emergency personnel who responded to the May 2004 storms. An on-line survey was also administered but the response rate was quite low (eight responses). The interviews and focus groups were conducted a little over a year after the storm. The information was analyzed using qualitative research methods with the aid of the software program Atlas.ti. Formal debriefing service was highly thought of by many responders. They reported feeling better as a result of being in a debriefing. Some responders appreciated unobtrusive service of mental health and faith professionals who offered water and assistance at the disaster site. Most emergency responders said they relied on peers for informal support. Participants reported positive effects of going through this response experience. They said it brought them closer together as a team, made them appreciate what they had, and strengthened their knowledge and confidence related to responding to such events. The research resulted in several practical recommendations based on the preferences and experiences of responders. First, respondents indicated that they might have taken advantage of more formal support services if they had been offered rather than relying on department heads to request them. Responders were very concerned about maintaining the confidential nature of their work and tried not to talk to their families about the event or their personal experiences. This left peers as the primary audience for any discussion of the event. A second practical recommendation is to equip responders to provide appropriate psychological support to each other since this is the preferred way to get emotional support for many of the responders. Although it requires no formal training to be a friend, it may be beneficial to equip responders with psychological first aid skills so they are more comfortable facilitating referrals to professionals when a peer needs more formal support. A third recommendation is to increase communication about the importance of self care. Most responders participating in the study reported that they did not heed the advice of experts regarding self care. This was particularly true of physical care (exercise, diet, avoiding alcohol). The overall conclusion of this study was that Nebraska responders are well trained and confident of their collective ability to respond to disaster. They rely on each other for support more than they rely on formal support systems. This could be because of the limited access they have to these systems and because it is more natural to turn to peers for such support. As a result of this research, Nebraska’s Critical Incident Stress Management Program is studying ways it can increase accessibility to services after disaster. It may be beneficial to consider equipping peers to appropriately support each other and to care more prudently for themselves after disaster response. Using mental health and faith professionals in unobtrusive support roles during the disaster response increases their acceptance by responders. Educating these professionals about the advantage of adopting a consultant model as part of their service to emergency responders may increase their effectiveness with this population.
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Objective To study the critical incident stress reactions of aircraft mishap and the application of an intervention program in order to reduce the negative psychological impact and promote recovery. Methods The design is case–control study based on general practitioners’ medical records. A crisis intervention program was developed to cope with stress of aircraft mishap and applied after an accident. The crisis impact was measured by interview; data review and intervention effectiveness were analyzed. Results The most popular symptoms within 72 h include worried, anxious, sleep problems, disturbed appetite. Heart rate, white blood cells count, and urine protein concentration of a survival pilot through ejection increased immediately following the accident though he claimed very mild discomfort. CISM intervention included 2 defusings for 50 people, 2 CISDs for 12 people, and 2 individual counselings for 2 people. Conclusion Stress reaction occurs after aircraft mishap, and intervention program should be activated as early as possible.
Article
Incidents of mass violence, such as the September 11, 2001, terrorist attacks on the World Trade Center and the Pentagon, have the capacity to produce profound emotional distress in thousands of people. Such distress is a normal human emotional response in the wake of such devastation, and in the vast majority of cases this distress remits in the weeks following the traumatic event. Despite the fact that only a small percentage of individuals fail to adjust positively following trauma, the magnitude and scope of incidents of mass violence dictate that a large number of individuals may develop enduring psychopathology as a result of such events. This article reviews the empirical literature bearing on early interventions for trauma victims that have been developed to date. Promising cognitive-behavioral interventions that appear to overcome significant limitations of traditional early intervention approaches are delineated and discussed. Although early interventions for trauma remain underdeveloped and understudied, practice guidelines gleaned from preliminary but promising treatment approaches are offered. Attention to PTSD risk factors is paramount in order to facilitate the identification of individuals most likely to benefit from early posttraumatic treatment. These risk factors are presented and discussed in order to facilitate assessment and treatment planning.
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Emergency medical technicians and paramedics are the backbone of the emergency medical services (EMS) system. Because of the physical nature of their work, unpredictable calls, and irregular hours, emergency medical technicians and paramedics are at high risk for occupational injuries. In this chapter we discuss occupational issues affecting EMS providers, including hearing loss, mental health and stress, violence against EMS providers, ambulance crashes, aeromedical transport crashes, accidental discharge of epinephrine auto-injectors, and exposure to infectious diseases.
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In reference to the necessity of providing early interventions following mass disasters such as 9/11, the authors suggest that the focus on the need for immediate intervention for those psychologically affected by traumatic events might be misplaced. In the debate regarding provision of interventions in the aftermath of a trauma, opinions range from mandatory provision of such services (e.g., Hokanson and Wirth, International Journal of Emergency Mental Health 2(4): 249–257, 2000) to the recommendation of wait, reevaluate, and delay treatment until necessary (e.g., Brewin et al., Journal of Traumatic Stress 21(1): 3–8, 2008). In this chapter, we will review the rationale for preventing posttraumatic stress disorder (PTSD), and review the studies examining early interventions for PTSD. In addition, the results of a large effectiveness and efficacy study of early PTSD treatment will be discussed. Lastly, the implications of these studies will be evaluated in terms of service planning and provision.
Article
The present study explores emotional intelligence and proactive coping as possible protective factors for both a group of paid-professional firefighters (n = 94) and a group of similar comparison participants (n = 91). Each respondent completed the Impact of Events Scale-Revised, Symptom Checklist 90-Revised, Emotional Intelligence Scale, and Proactive Coping Scale. Using an exploratory/liberal Type 1 error rate (α ≤ .10), our results suggested that for firefighters emotional intelligence negatively predicted self-reported traumatic stress (β = −.198), while proactive coping negatively predicted several other mental health symptoms (obsessive-compulsive β = −.192, depression β = −.220, anxiety β = −.295). For the comparison participants, the pattern of results was substantially different from the firefighters in that emotional intelligence negatively predicted several mental health symptoms (interpersonal sensitivity β = − .465, depression β = − .239, anxiety β = −.269, hostility β = −.349) and proactive coping only predicted a lack of psychoticism (β = −.216).
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The South African communities has shown to have a challenge in accessing health services especially in rural areas; hence the national strategic objective 1.7 aimed at strengthening community systems to expand access to services using the community-based care programmes (NSP 2012-2016). The programmes enhance access to health services whilst promoting health and educating the community to improve health knowledge and work towards attaining a healthy living (NSP 2012-2016). However, the health promoters from the rural Hammanskraal region in the North West Province of South Africa often found themselves rendering the health promotion services in their communities with limited resources. This study aimed at exploring and describing the challenges faced by health promoters in implementing health promotion programmes for families with adolescents orphaned by HIV and AIDS. The study followed a qualitative design. Data was collected using focus group interviews. Participants were purposely selected by the social worker and the health promotion coordinator working at Hammanskraal. The process of data analysis was adapted from the eight steps of Tesch method of data analysis where categories, sub-categories and themes were isolated. The following categories emerged as the needs of health promoters on health promotion programmes for families with adolescents orphaned by HIV and AIDS, (1) financial needs, (2) resources, (3) basic life needs, (4) educational needs and (5) health promoter's needs. It is therefore recommended that equal distribution of resources: including medicine, equipment and finances, should be maintained in order to ensure non-interrupted services.
Article
Although psychological debriefing (PD) represents the most common form of early intervention for recently traumatized people, there is little evidence supporting its continued use with individuals who experience severe trauma. This review identifies the core issues in early intervention that need to be addressed in resolving the debate over PD. It critiques the available evidence for PD and the early provision of cognitive-behavioral therapy (CBT). Based on available evidence, we propose that psychological first aid is an appropriate initial intervention, but that it does not serve a therapeutic or preventive function. When feasible, initial screening is required so that preventive interventions can be used for those individuals who may have difficulty recovering on their own. Evidence-based CBT approaches are indicated for people who are at risk of developing posttraumatic psychopathology. Guidelines for managing acutely traumatized people are suggested and standards are proposed to direct future research that may advance our understanding of the role of early intervention in facilitating adaptation to trauma.
Article
Accumulating evidence suggests that stress-dose corticosteroids impair fear memory in animals and humans. Corticosteroid treatment after critical illness is seen as a potential psychotropic medication by which to prevent posttraumatic stress disorder. However, individual difference in the responsiveness to stress (i.e., stress reactivity) is a factor that modulates the efficacy of corticosteroids. To understand the contribution of fear reactivity to the effect of post-stress corticosterone, male Sprague-Dawley rats were subjected to classical tone-cued fear conditioning and separated into high and low reactivity (HR and LR, respectively) responder groups based on their levels of freezing during conditioning. The HR rats showed significantly higher fear responses than the LR rats during conditioning as assessed by freezing behavior. At two intervals, 30 min and 48 hr later, the HR rats still displayed more pronounced conditioned responses to cued stimuli compared with the LR rats. Moreover, in contrast to the LR rats, the enhanced fear response in the HR rats was difficult to attenuate by post-training high-dose corticosterone. These results suggest that fear reactivity results in stronger fear memory, and that it is difficult to disrupt this strong fear memory in the HR phenotype using monotherapy. However, the strong fear memory in the HR rats was impaired by concurrent intramedial prefrontal cortex infusion of a high dose of the dopamine D1 receptor antagonist SCH 23390 and systemic administration of corticosterone. SCH 23390 and corticosterone alone did not decrease freezing levels in the HR rats. The fear impairment induced by SCH 23390 combined with corticosterone was not attributable to the effect of these drugs on locomotor activity. This effect was not found with administration of the D2 antagonist eticlopride combined with corticosterone. Our findings demonstrate that the conditioned fear memory in individuals with high stress reactivity is difficult to disrupt using monotherapy, but that combined pharmacotherapy may be useful for treating intervention-resistant fear. © 2012 The Institute of Psychology, Chinese Academy of Sciences and Blackwell Publishing Asia Pty Ltd.
Article
Although psychological debriefing (PD) represents the most common form of early intervention for recently traumatized people, there is little evidence supporting its continued use with individuals who experience severe trauma. This review identifies the core issues in early intervention that need to be addressed in resolving the debate over PD. It critiques the available evidence for PD and the early provision of cognitive-behavioral therapy (CBT). Based on available evidence, we propose that psychological first aid is an appropriate initial intervention, but that it does not serve a therapeutic or preventive function. When feasible, initial screening is required so that preventive interventions can be used for those individuals who may have difficulty recovering on their own. Evidence-based CBT approaches are indicated for people who are at risk of developing posttraumatic psychopathology. Guidelines for managing acutely traumatized people are suggested and standards are proposed to direct future research that may advance our understanding of the role of early intervention in facilitating adaptation to trauma.
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Full-text available
The Royal Air Force Wroughton Post-Traumatic Stress Disorder (PTSD) Rehabilitation Programme is described. It comprised a 12-day structured in-patient 'course' of group psychotherapy and day-case group follow-up sessions over a one-year period. Psychological debriefing was the main therapeutic technique employed. This is a 'before and after' open outcome study. A comprehensive assessment protocol confirmed the presence and severity of PTSD and measured co-morbid psychopathological status, occupational and social function longitudinally. A highly significant global response to treatment is demonstrated in the 34 subjects included in the study, with 85.3% not fulfilling the DSM-III-R criteria for PTSD at one year after treatment. Further controlled studies assessing the value of psychological debriefing techniques in the treatment of established PTSD are required.
Article
Post-traumatic psychiatric reactions to physical trauma are readily acknowledged and accepted. However, there is a relatively new phenomenon of developing similar reactions after providing emergency care to such patients. The purpose of this study was to examine the effectiveness of a crisis intervention technique known as group psychological debriefing, which is designed to mitigate the impact of post-traumatic morbidity in individuals exposed to vicarious traumatization. Using adequately controlled, peer-reviewed journal articles and clinical proceedings as the database, 698 subjects from 10 investigations were submitted to a meta-analysis. The results support the effectiveness of group psychological debriefings in alleviating the effects of vicarious psychological distress in emergency care providers. Copyright © 1999 John Wiley & Sons, Ltd.
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Stress debriefing has been used extensively following traumatic events; however, there is little evidence of its effectiveness. This paper reports the effects of stress debriefing on the rate of recovery of 195 helpers (e.g., emergency service personnel and disaster workers) following an earthquake in Newcastle, Australia (62 debriefed helpers and 133 who were not debriefed). Post-trauma stress reactions (Impact of Event Scale) and general psychological morbidity (General Health Questionnaire: GHQ-12) were assessed on four occasions over the first 2 years postearthquake. There was no evidence of an improved rate of recovery among those helpers who were debriefed, even when level of exposure and helping-related stress were taken into account. More rigorous investigation of the effectiveness of stress debriefing and its role in posttrauma recovery is urgently required.
Article
A three-group quasi-experimental design contrasted the responses of rescue workers to the 1989 Loma Prieta earthquake Interstate 880 freeway collapse (n=198) with responses to critical incident exposure of Bay Area Controls (n=140) and San Diego Controls (n=101). The three groups were strikingly similar with respect to demographics and years of emergency service. The I-880 group reported higher exposure, greater immediate threat appraisal, and more sick days. The three groups did not differ on current symptoms. For the sample as a whole EMT/Paramedics reported higher peritraumatic dissociation compared with Police. EMT/Paramedics and California road workers reported higher symptoms compared with Police and Fire personnel. Nine percent of the sample were characterized as having symptom levels typical of psychiatric outpatients. Compared with lower distress responders, those with greater distress reported greater exposure, greater peritraumatic emotional distress, greater peritraumatic dissociation, greater perceived threat, and less preparation for the critical incident.
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This article looks at the stresses inherent in crisis intervention work in general, and on the effects on psychologists in particular. The authors review debriefing strategies currently used and argue that the needs of psychologists differ from those of other crisis interveners such as police or ambulance workers. They present a debriefing strategy that takes into account the psychologist''s need for psychological understanding and integration.
Article
The psychological responses of two groups of fire fighters were examined following the performance of rescue work. Four types of responses were reported: identification with the victims, feelings of helplessness and guilt, fear of the unknown, and physiological reactions. Stress was found to be mediated by availability of social support, type of leadership, level of training, and use of rituals. Implications of these findings for preventive intervention measures are discussed.
Fifty-eight non-professional fire fighters, 91% of all firefighters from different industries who participated in a hotel fire rescue operation, were investigated by means of a structured self-report questionnaire about their stress experience during and after the rescue action. Together with 57 professional fire fighters, they participated in rescuing hotel guests confined for as much as three hours in a 12 storeyed hotel building on fire. Fourteen persons (11%) died, 114 guests survived. Forty-seven percent of the non-professional fire fighters reported that the disaster experience was the worst they had ever experienced. Even so, 80% thought that they had coped with the job well to fairly well and for as many as 66% the rescue action represented something positive to them in retrospect. Ten percent claimed that stress reactions disturbed them in executing effective rescue work. Fifty-eight percent maintained that more preparation and training could have improved their effort. Fire fighters with previous practical experience seemed to "digest" the disaster experience more easily than inexperienced fire fighters as measured by the Impact of Event Scale. High level of competence and opportunity for debriefing as well as disaster characteristics are discussed as factors explaining the favourable coping with extreme stress.
Article
Workers who are mobilized to help with disaster relief are exposed to a multitude of stressors. Debriefing may prevent or minimize the negative consequences of stress reactions in relief personnel. The multiple stressor debriefing (MSD) intervention promotes the discussion of troubling aspects of the disaster work in a group format. This article discusses two models of debriefing and describes how the MSD model was used with American Red Cross personnel during the East Bay Hills firestorm in California. Specific recommendations are made for debriefing in large-scale, long-term disaster relief efforts.
Article
The aim of this study was to identify characteristics of emergency services personnel related to acute dissociative responses at the time of critical incident exposure, a phenomenon designated "peritraumatic dissociation." The authors studied 157 rescue workers who responded to the Nimitz Freeway collapse during the 1989 Loma Prieta earthquake in the San Francisco Bay Area as well as 201 rescue workers who were not involved in that disaster. Demographics, level of critical incident exposure, perceived threat at the time of exposure, personality attributes (assessed by the Hogan Personality Inventory), coping strategies (assessed by the Ways of Coping Questionnaire), and locus of control were related to subjects' scores on the Peritraumatic Dissociative Experiences Questionnaire. According to univariate tests, the subjects with clinically meaningful levels of peritraumatic dissociation were younger; reported greater exposure to critical incident stress; felt greater perceived threat; had lower scores on the adjustment, identify, ambition, and prudence scales of the Hogan Personality Inventory; had higher scores on measures of coping by means of escape-avoidance, self-control, and active problem solving; and had greater externality in locus of control. Linear modeling with multiple logistic regression analyses indicated that greater feelings of perceived threat, coping by means of escape-avoidance, and coping by means of self-control were associated with a greater likelihood of being in the peritraumatic dissociation group, above and beyond age and exposure to stress. Rescue workers who are shy, inhibited, uncertain about their identity, or reluctant to take leadership roles, who have global cognitive styles, who believe their fate is determined by factors beyond their control, and who cope with critical incident trauma by emotional suppression and wishful thinking are at higher risk for acute dissociative responses to trauma and subsequent posttraumatic stress disorder.
Article
Volunteer firefighters in NSW were surveyed for experiences of posttraumatic stress. Firefighters were asked to describe their experiences of stress and indices were obtained of psychological disturbance. Findings indicated that most firefighters felt that their safety had been threatened. One-quarter of firefighters indicated that they experienced significant levels of posttraumatic stress, although many respondents attributed their stress to personal events. Posttraumatic stress was associated with multiple and recent critical incidents. Findings are discussed in terms of etiological factors of posttraumatic stress and the need for appropriate intervention.
Article
Armed conflict is associated with significant long-term psychiatric morbidity. Interventions to reduce the incidence of psychiatric disorder following psychological trauma may be classified into three categories. Primary prevention includes the selection, preparation and training of individuals likely to be exposed to potentially traumatizing events. Secondary prevention comprises a variety of brief psychological techniques immediately or shortly after traumatizing life events, the best known of which is Psychological Debriefing. Tertiary interventions comprise the treatment of established PTSD and others. Psychiatric morbidity was studied in 106 British soldiers returning from UN peace-keeping duties in the former Republic of Yugoslavia. All 106 soldiers received an Operational Stress Training Package prior to their deployment and a randomly selected group also received a post-operational PD. Very low rates of PTSD and other psychopathology were found overall and the Operational Stress Training Package may have contributed to this. Elevated CAGE scores suggestive of significant alcohol misuse were observed in both groups and chemical avoidance behaviours arising from this may have masked psychopathology. CAGE scores diminished significantly in the debriefed group by the end of the follow-up period suggesting that PD may have been of benefit despite the apparent absence of PTSD. This study also demonstrates that a high incidence of psychiatric morbidity is not an inevitable consequence of military conflict.
Psychological debriefings represent a genre of group crisis interventions. Critical Incident Stress Debriefing (CISD) represents the oldest standardized variation of this genre. Recent reviews have called into question the effectiveness of CISD. In this study 5 previously published investigations were meta-analyzed revealing a large effect size (Cohen's d = .86) supporting the notion that the CISD model of psychological debriefing is an effective crisis intervention.
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