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Abstract

Firefighters face a number of occupational risks including the impact of being exposed to traumatic experiences. Critical incident stress debriefing (CISD) was previously introduced as a viable option for intervention postincident; however, concern has been raised about the efficacy of such debriefings. This study uses focus groups and key informant interviews with a national sample of firefighters to examine firefighters’ perceptions about behavioral health interventions. Although some firefighters reported positive experiences with CISD, other personnel reported finding the intervention intrusive and reported feeling more distressed after the intervention than before. Personnel reported experiencing benefits from peer support and using the crew for bonding after negative incidents as particularly useful. Findings suggest that while components (e.g., peer debriefing) of CISD may be useful, caution is warranted in employing the CISD model as designed.

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... På väg till den hjälpsökande förbereder sig räddningsaktörerna mentalt på vad de kommer att möta (80)(81)(82)(83)(84). De beskriver frustration vid utalarmeringar som kräver lång framkörningstid för att nå den hjälpsökande (85,86), när de saknar tillräckligt med förhandsinformation (9, 87) samt då de inte lyckas rädda den hjälpsökandes liv (83). ...
... Hos ambulanspersonalen är farhågan främst associerad med att möta och omhänderta det akut sjuka eller skadade barnet (83, 85-87, 91, 92), att personligen känna den hjälpsökande (9), att utsättas för hotfulla situationer (87,93,94), och att hamna i situationer då de tvingas ta etiskt svåra beslut (29,80,83,95,96). Även räddningstjänstpersonalen beskriver olustkänslor i samband med situationer där de möter barn (97) eller hjälpsökande de känner personligen, vilket frekvent förekommer bland deltidsbrandmän som arbetar i landsbygdsområden (82,98). De beskriver även en frustration då de inte upplever sig erhållit tillräckligt med sjukvårdsutbildning och över situationer då de efter medverkan vid ett akut omhändertagande inte erhåller återkoppling om hur det gått för den hjälpsökande (7). ...
... För räddningsaktörerna är det sociala stödet som den kollegiala sammanhållningen erbjuder det mest effektiva för att bearbeta traumatiska händelser (87,90,97). Oftast sker detta samtalsstöd i direkt anslutning till händelsen i form av samtal kollegor mellan (80,(82)(83)(84)87), men även andra samtalspartners kan användas vid mer formellt anordnat samtalsstöd (82,101). Dock finns risk, vid tillfällen då flera räddningsaktörer eller externa samtalsstödjare engageras, att samtalet istället leder till en ökad olustkänsla (82,101). ...
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Aim: The overall aim was to describe the first responders´ (FRs) experiences of arriving early at emergency situations in rural areas in Sweden and the characteristic features of the assignments they encounter. The four studies aimed to: describe critical incidents in which ambulance nurses experience worry in their professional life and the actions they take in order to prevent and cope with it (I), explore and describe experiences of the First Incident Person (FIP) assignment within an Fire Department (FD) (II), describe experiences of the While Waiting for the Ambulance (WWFA) assignment, as experienced by home healthcare nurses (III) and map out and describe WWFA assignments focusing on frequency, event time,CardioPulmonary Resuscitation (CPR) and survival >30 days after performed CPR (IV). Methods: The four studies in this thesis had both descriptive and explorative designs. They were analysed with qualitative and quantitative analysis methods. Results: By dispatching FRs in rural areas an early presence at the scene of an accident or emergency situation can be secured, which prevent full scenarios to happen and increase the possibility to save lives. However, FRs are worried about specific emergency situations as well as situations related to their work environment.Leaving ongoing work tasks cause ethical dilemmas and inner emotional worries why support before, during and after an FR assignment is sought for. Conclusions: Generating effective interprofessional collaboration during FR assignment requires that the FRs work conditions are adopted to the assignment requirements for immediate response. The feeling of security disappears when the FRs are excluded from the group affiliation and the need to feel support in new interprofessional collaboration structures becomes clear. Support function based on individual requests is to be designed. Continuous collaborative exercises are required where all involved FRs participate
... The traditional image of the firefighter as the strong, silent hero has fostered a reluctance to acknowledge and seek out treatment for behavioral health problems. This has contributed to a lack of focus in many fire departments on mental health issues (Jahnke et al., 2014). The earliest approach to firefighter behavioral health, if it can be called an approach, involved denying that emotional and psychological problems existed at all. ...
... Because post-incident interactions among peers often serve as natural debriefings of traumatic events, Jahnke et al. (2014) have speculated that the mandatory group debriefing prescribed by CISD interrupts that natural process. Approaches to fire service behavioral health that have been introduced since CISM/CISD have had much more of an emphasis on solid empirical findings of benefit to justify the resources devoted to their deployment. ...
... In light of research that resilience, as well as coping self-efficacy, are not considered stable personality traits but rather are dependent on the situation and environment (Lambert, Benight et al., 2012), and taking into consideration findings that social support can wane over the course of firefighter careers (Regehr et al., 2003), resilience skills should be taught early and reinforced often. Having such training provided by fellow fire service members may be the best approach, since some studies report that firefighters can be uncomfortable receiving training from those who do not have direct experience as first responders themselves because they believe outsiders cannot relate to the traumatic experiences they encounter (Jahnke et al., 2014). ...
Article
In the course of doing their jobs, firefighters unavoidably experience stressful and even traumatic situations that can lead to emotional and behavioral health problems including anxiety, burnout, depression, alcoholism, substance abuse, post-traumatic stress disorder, and suicide. Current approaches to addressing these problems tend to focus on assistance and treatment that takes place following traumatic events, or after symptoms emerge. While these important efforts must continue, the science of positive psychology can suggest a more proactive approach through the development of resilience skills, which prepare individuals to resist the negative effects of stressful events and situations, and support overall well-being. Resilience training teaches thinking and coping skills that can be employed on the job as well as at home and in other circumstances. Existing evidence-based resilience training programs used in military and educational settings are reviewed, as well as literature addressing factors specific to firefighter and emergency responder populations. A firefighter resilience training program is recommended that takes into account the fire service culture and focuses on developing increased self-efficacy through increased social support and flexible, accurate thinking habits that promote optimism. Suggested interventions and measures are presented, along with ideas for fostering an environment of resilience within the fire department.
... Education about the impact of this workplace mistreatment should be included as part of the behavioral health trainings. It is likely that discrimination and harassment of women, a relative minority in the fire service, undermine their access to the main protective benefit of the camaraderie and bonding so common in the fire house [64]. Future work should also examine the prospective relationship between discrimination and harassment and poor health outcomes as well as potential policies and practices that can reduce these negative behaviors. ...
... In fact, when examining those with limited experiences of discrimination or harassment, rates of behavioral health concerns closely mirrored those evidenced among male firefighters. It is possible that being singled out and receiving negative differential treatment not only has a negative impact on behavioral health directly but also robs firefighters being discriminated against or harassed of the camaraderie that has been found to be so protective for firefighters [64]. In addition, while the current study did not specifically examine their impact on recruitment and retention, findings do have implications for what fire departments need to consider to effectively recruit and retain a more diverse workforce. ...
Article
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Intro: Both discrimination and harassment directly impact mental and physical health. Further, workplace discrimination degrades workplace culture and negatively impacts health behaviors, job-related outcomes, and family dynamics. Women represent a small proportion of the fire service and are often the targets of discrimination/harassment, yet little research documents the impact of such experiences. The purpose of this study was to evaluate the relationship between chronic work discrimination and/or harassment and women firefighters' (FFs) physical and mental health, substance abuse, and job efficacy, stress, and satisfaction. Methods: Snowball sampling was used to solicit participation from women career FFs. Participants completed an online survey regarding physical and mental health, health behavior, job efficacy/stress/satisfaction, and family well-being. Logistic regression examined the impact of work discrimination-harassment severity on dichotomous variables. Results: 1,773 had complete data on their experiences with work-related discrimination and harassment. Women reported experiencing verbal (37.5%) and written (12.9%) harassment, hazing (16.9%), sexual advances (37.4%), and assaults (5.1%) in the fire service. FFs in the highest tertile of work discrimination-harassment severity reported over 40% more poor health days in the last 30 days (OR=1.42; 95%CI=1.33-1.51; p<0.001). Women who experienced moderate and severe discrimination/harassment had negative mental health outcomes including higher prevalence of depressive symptoms, anxiety, and PTSD symptoms. Those who experienced high rates of discrimination and/or harassment also were more likely to report issues with alcohol consumption. Conclusion: The impact of discrimination and harassment, related negative physical and mental outcomes, low levels of job satisfaction, and negative impact of these experiences on family/home stress likely take a significant toll on women in the fire service. Findings confirm and extend previous work suggesting there is a need to improve the mental and physical health of women FFs. Future work should examine the prospective relationship between discrimination/harassment and poor health outcomes and potential policies/practices to reduce these negative behaviors.
... Medzi základné patria komplexné intervenčné programy, ktoré sa využívajú najmä v zahraničí. Najznámejší je CISD -Critical Incidents Stress Debriefeng (Jahnke et al., 2014). Ide pritom o skupinové sedenia nasledujúce po strete s náročnou situáciou, ktoré trvajú 1,5-3 hodiny po dobu 14 dní. ...
Article
Je nepochybné, že práca zdravotníckych záchranárov patrí medzi výrazne rizikové pro-fesie. Jej neoddeliteľnou súčasťou je aj schopnosť kontroly vlastných myšlienok, emócií a impulzov záchranárov, nakoľko sa od nich zakaždým očakáva bezchybný výkon. S tým nevyhnutne súvisí aj potreba starostlivosti o vlastné duševné a fyzické zdravie. V pred-kladanom príspevku sa pozornosť sústreďuje nielen na postupné priblíženie kontextu záchranárskej práce, a teda základných zdrojov stresu, popis starostlivosti o seba u záchra-nárov, ale základom je uvažovanie nad problematikou cez optiku Baumeisterovho silové-ho modelu sebakontroly. Tento poskytuje nové možnosti vysvetlenia výskytu negatívnych javov ako dôsledkov pôsobenia stresu v práci záchranárov. V závere sú diskutované mož-nosti uplatnenia popisovaných teoretických rámcov vo výskume aj v každodennej praxi. Kľúčové slová: starostlivosť o seba; zvládanie; sebakontrola; záchranári; psychológia zdravia Úvod Práca zdravotníckych záchranárov je charakteristická potrebou nadštandardných odborných výkonov v podmienkach veľkého časového tlaku. V niektorých prípadoch sú rozhodujúce minúty, či sekundy. Pre záchranára je nevyhnutnosťou maximálna koncen-trácia a minimalizácia akýchkoľvek nežiaducich myšlienok, či emócií. Aj s ohľadom na trestnoprávnu zodpovednosť pri pochybeniach je dôležité venovať pozornosť možnostiam zlepšovania ich schopnosti sebakontroly. Z toho dôvodu sa v príspevku budeme stručne venovať priblíženiu charakteru práce zdravotníckych záchranárov s ohľadom na zdroje stresu a spôsoby vyrovnávania sa s ním, a následne sústredíme pozornosť na možnosti aplikácie všeobecného Silového modelu sebakontroly do tejto oblasti. Zdroje pôsobenia stresu a jeho dôsledky v práci záchranárov Príslušníci záchranných zložiek čelia na dennej báze rôznym kritickým a traumati-zujúcim udalostiam. Súčasťou ich práce sú strety so situáciami, na ktoré bežný človek zvyčajne nenaráža, pričom niekedy sa jedná až o bizarné situácie. Podľa Výročnej správy Operačného strediska zdravotnej zásahovej služby Sloven-skej republiky (Výročná správa OSZZS SR, 2014) bolo za rok 2013 zrealizovaných
... [59][60][61][62][63][64] Other advances have been made in providing more effective EAP crisis response services to those working in fire service. 65,66 However, these works tend to neglect the role of the marital relationship of the employee as a factor in mental health and work-related trauma experiences. ...
Article
Full-text available
EAPs may be able to better support fire fighters and their families if more is known about the marital and occupational stressors of this at-risk population. We conducted a review of literature to answer several questions. First, what is the actual rate of divorce among people working in fire service? Second, what factors relate to marital stability among fire fighters and is marital relationship predictive of job satisfaction, job safety, and overall job success in fire service? Lastly, are marital enrichment or relationship support programs in place in fire service families, and, if so, are they effective? Over 20 scholarly research works were examined that addressed marriage among fire fighters. Surprisingly, we could find empirical data on only the first question with the other questions largely missing as topics in the literature. Both U.S. census data and a large survey found rates of divorce for male fire fighters in the range of 12-14%, which was similar to national averages at the time. Other data was found on fire fighter family challenges, the spouses of fire fighters, and the marriages of volunteer fire fighters. Advances in counseling and other behavioral health services for fire fighters are also identified. Suggestions for EAP practice and future research are provided.
... Based on the current review, there is no available evidence to support the effectiveness of peer support programs for supporting psychological well-being or reducing PTSD symptoms among fire and rescue populations. Based on available research, fire and rescue personnel appear to prefer informal support from their peer network, as opposed to more formal interventions (Herbert, 2013;Jahnke, Gist, Poston, & Haddock, 2014;Jeannette & Scoboria, 2008); however, preference for formal interventions may increase alongside the severity of critical incident exposure (Jeannette & Scoboria, 2008). ...
... Among other psychopathologies, posttraumatic stress disorder (PTSD) is an increasingly recognized disorder in occupational mental health (Bisson, 2007;Herold et al., 2016;Nydegger, Nydegger, & Basile, 2011). PTSD may be highly prevalent in firefighters, given that firefighters are regularly exposed to the impact of a wide range of potentially traumatic stressors (Jahnke, Gist, Poston, & Haddock, 2014;Kehl, Knuth, Hulse, & Schmidt, 2014;Meyer et al., 2012;Vaughan, Moran, Pearce, & Hearty, 2016). They also face more intense critical incident cases than other first responders with respect to the intensity and frequency . ...
Article
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Firefighting is a an extremely stressful occupation that risks exposure to traumatic events as part of the job. Despite this, the literature on stress and trauma pays little attention to this occupation and its generalization to other, high risk occupations. This study examined resilience and work locus of control as predictors of posttraumatic stress disorder (PTSD) symptoms among Nigerian firefighters. Participants were 116 paid, professional firefighters (98 males and 18 females) who completed the Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C), Resilience Scale (RS-14), and Work Locus of Control Scale (WLCS) and provided vital demographic information. Multiple regression analysis was used to analyze the data. Results showed that resilience negatively predicted PTSD symptoms such that higher resilience was associated with fewer symptoms of PTSD. Work locus of control was a positive predictor of PTSD symptoms, indicating that externality of control beliefs in the workplace was associated with more PTSD symptoms. Relevant demographic factors especially higher years of service, being a senior firefighter, and higher educational status were associated with lower PTSD symptoms. Findings underscore the potential value of resilience training and implementing behavioral health programs to modify firefighters’ external locus of control beliefs. Interventions should consider resilience and locus of control focused interventions as protective factors for PTSD.
... Medzi základné patria komplexné intervenčné programy, ktoré sa využívajú najmä v zahraničí. Najznámejší je CISD -Critical Incidents Stress Debriefeng (Jahnke et al., 2014). Ide pritom o skupinové sedenia nasledujúce po strete s náročnou situáciou, ktoré trvajú 1,5-3 hodiny po dobu 14 dní. ...
Article
Full-text available
Je nepochybné, že práca zdravotníckych záchranárov patrí medzi výrazne rizikové profesie. Jej neoddeliteľnou súčasťou je aj schopnosť kontroly vlastných myšlienok, emócií a impulzov záchranárov, nakoľko sa od nich zakaždým očakáva bezchybný výkon. S tým nevyhnutne súvisí aj potreba starostlivosti o vlastné duševné a fyzické zdravie. V predkladanom príspevku sa pozornosť sústreďuje nielen na postupné priblíženie kontextu záchranárskej práce, a teda základných zdrojov stresu, popis starostlivosti o seba u záchra-nárov, ale základom je uvažovanie nad problematikou cez optiku Baumeisterovho silové-ho modelu sebakontroly. Tento poskytuje nové možnosti vysvetlenia výskytu negatívnych javov ako dôsledkov pôsobenia stresu v práci záchranárov. V závere sú diskutované možnosti uplatnenia popisovaných teoretických rámcov vo výskume aj v každodennej praxi.
... Another area of concern with the current CERT basic training curriculum is found in Unit 7 on disaster psychology, which includes a section about Critical Incident Stress Debriefing (CISD; Mitchell, 2017) and recommends its use for CERT teams members following a deployment. However, many researchers have found CISD to be ineffectual or even counter-productive (Alexander & Klein, 2009;Bonanno et al., 2010;Jahnke et al., 2014;Ronan et al., 2008;Ruzek et al., 2007), although a study of New Zealand social workers who had experienced traumatic events reveals that many of those surveyed regarded the CISD group debriefings as a positive experience (Pack, 2012). ...
Thesis
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Bystanders are often the first to respond to disasters and, for this reason, Community-Based Disaster Response Teams (CBDRTs) should be established in vulnerable communities. The literature review examines Disaster Risk Reduction initiatives and identifies that there is little information available regarding strategies and training curriculum that could be used to establish and maintain CBDRTs in developing nations and with vulnerable groups. The three research questions for this investigation ask how CBDRT courses could be adapted for these communities, what topics and activities would be most useful for such training, and how the teams could be established and maintained. The research objectives are to identify strategies that could be used to train CBDRT groups in these contexts, to propose an outline for a basic training course, and to describe techniques that could contribute to the sustainability of these teams. Research was conducted with CBDRTs in developing nations using a mixed methods methodology with the United States Federal Emergency Management Agency’s (FEMA) Community Emergency Response Team (CERT) programme being employed as a case study. Quantitative data was obtained from a questionnaire completed by CERT course graduates, and qualitative information was acquired from key informant interviews. After a review of the CERT programme that discusses its history, curriculum, success stories, and potential pitfalls, the data collected is presented through statistical analysis of the questionnaire replies and thematic analysis of the interview transcripts. Suggested CBDRT training strategies are creating courses for adolescents, modifying the material for non-literate learners, and providing additional practical activities. Recommendations for establishing programmes include developing teams for young people, cooperating with Community-Based Organisations to solve existing problems, and offering CBDRT training in the post-disaster environment. Techniques for maintaining the teams involve developing leadership, creating support networks, and cultivating partnerships with local authorities. The final conclusion is that the CERT model could be used as the basis for an international CBDRT training programme, although it would require adaption of the course content and presentation style.
... The research suggests that talking and relying on others for support is indeed very beneficial. Jahnke, Gist, Poston and Haddock (2014) reported from their firefighter health research that "a substantial majority indicated that their existing social networks and workplace interactions, particularly those involving their own crews, were preferred and effective in mitigating the impacts of difficult events" (p. 122). ...
Thesis
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Volunteer firefighters make up approximately 85% of the fire service in Canada (Haynes, 2016) and almost the entire fire service on Prince Edward Island. As a result of this voluntary service, many firefighters are exposed to traumatic events and critical incidents, which may lead to poor mental health outcomes. Training and education in the area of critical incidents was shown to be lacking in a sample of 100 volunteer firefighters on PEI, with 67% indicating they have never been educated on mental health issues in the fire service (Brazil, 2017). Through a social constructionist theoretical lens, this study describes how volunteer firefighters informally learn and socially construct critical incidents and how to manage them. The findings suggest that there is a traditional culture into which firefighters are socialized and that the cultural values and norms that are implicitly learned lend to the informal learning pertaining to critical incidents. What is most notable about this study is that the traditional hyper-masculine fire service culture was found to be evolving, including the social constructs that contribute to its institutionalization. As such, firefighters are undergoing an informal re-education pertaining to critical incidents and mental health, which bodes well for the introduction of psychoeducation services within departments.
... to professionals, and general information on stress management (Jahnke, Gist, Poston, & Haddock, 2014). To date, neither the CISD package as a whole nor the individual components have been exposed to thorough study with the exemption of its foundational element, CISD. ...
... Beyond line-of-duty injuries and fatalities, it is difficult to determine the long-term effects of workplace exposures on occupational health related injuries, illnesses and fatalities, including those associated with suicide . Behavioral health issues among fire service members are now garnering increased attention since current firefighters are experiencing high levels of stress, depression, anxiety, burnout and post-traumatic stress disorder as a result of job demands and work tasks that expose them to violence, trauma and life or death situations (Jahnke et al. 2014). The emergence of these behavioral health outcomes has further increased the risk of injury and fatalities, including suicidal ideation and suicides (Antonellis and Thompson 2012;Stanley et al. 2015;Henderson et al. 2016). ...
... Another area of concern with the current CERT basic training curriculum is found in Unit 7 on disaster psychology, which includes a section about Critical Incident Stress Debriefing (CISD; Mitchell, 2017) and recommends its use for CERT teams members following a deployment. However, many researchers have found CISD to be ineffectual or even counter-productive (Alexander & Klein, 2009;Bonanno et al., 2010;Jahnke et al., 2014;Ronan et al., 2008;Ruzek et al., 2007), although a study of New Zealand social workers who had experienced traumatic events reveals that many of those surveyed regarded the CISD group debriefings as a positive experience (Pack, 2012). ...
Preprint
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Bystanders are often the first to respond to disasters and, for this reason, Community-Based Disaster Response Teams (CBDRTs) should be established in vulnerable communities. The literature review examines Disaster Risk Reduction initiatives and identifies that there is little information available regarding strategies and training curriculum that could be used to establish and maintain CBDRTs in developing nations and with vulnerable groups. The three research questions for this investigation ask how CBDRT courses could be adapted for these communities, what topics and activities would be most useful for such training, and how the teams could be established and maintained. The research objectives are to identify strategies that could be used to train CBDRT groups in these contexts, to propose an outline for a basic training course, and to describe techniques that could contribute to the sustainability of these teams. Research was conducted with CBDRTs in developing nations using a mixed methods methodology with the United States Federal Emergency Management Agency's (FEMA) Community Emergency Response Team (CERT) programme being employed as a case study. Quantitative data was obtained from a questionnaire completed by CERT course graduates, and qualitative information was acquired from key informant interviews. After a review of the CERT programme that discusses its history, curriculum, success stories, and potential pitfalls, the data collected is presented through statistical analysis of the questionnaire replies and thematic analysis of the interview transcripts. Suggested CBDRT training strategies are creating courses for adolescents, modifying the material for non-literate learners, and providing additional practical activities. Recommendations for establishing programmes include developing teams for young people, cooperating with Community-Based Organisations to solve existing problems, and offering CBDRT training in the post-disaster environment. Techniques for maintaining the teams involve developing leadership, creating support networks, and cultivating partnerships with local authorities. The final conclusion is that the CERT model could be used as the basis for an international CBDRT training programme, although it would require adaption of the course content and presentation style. i
... Further, United Nations peacekeeping soldiers preferred CISD interventions even though they reported only moderate stress symptom reduction (Adler et al., 2008). Recent findings (Jahnke, Gist, Poston, & Haddock, 2014) affirm that both combat and fire service personnel prefer the bonding and connections of the CISD group format. ...
Article
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Critical incident stress debriefing (CISD) is a psychoeducational group intervention offered after exposure to potentially traumatizing events. This exploratory inquiry examined how mental health and peer facilitators utilized elements of group work practices during CISD interventions. Narratives from 16 mental health and 14 peer facilitators reported how elements of group planning, performing, and processing appear. Important group-process aspects included attention to establishing ground rules and defining boundaries for confidentiality, managing member disclosure, and pacing the process to prevent harm from over-processing the traumatic event. Implications for practice suggest that following best practice guidelines in group work is protective of the CISD process and the participants.
Article
The present study described participatory action research regarding behavioural health of firefighters. At the request of the participant fire department, the Veterans’ Affairs Wellness kit was used to provide wellness information to members. During the intervention, qualitative data from the researcher perspective was collected and subsequently coded to reveal themes about lessons learned during provision of the materials. Following the intervention at the department level, individual interviews were completed with a subsample of members and their spouses. The combined outcomes from these two research phases suggest that wellness interventions for firefighters should be informal, fire-fighter specific, focused on programs endorsed by firefighter related organizations, and supported by management and frontline supervisors. From our data, we suggest that the Veterans’ Affairs Wellness kit should be studied further as a potentially meaningful fire service intervention. Further, we propose that this and other interventions should take into account job aspects identified as important by both members and their spouses.
Chapter
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This chapter presents a literature review to explore the importance of emotions within the work conducted by Fire Service personnel. Drawing from Emotional Intelligence theory, the intense demands placed upon Fire Service personnel are discussed alongside the benefits and risks associated with the emotions experienced and the strategies used to manage them. Key findings within the literature are synthesised and demonstrate the fundamental role of emotion for effective coping and decision-making, securing meaningful work and ensuring team cohesion. Whilst some consensuses emerge from the field, there is much left to do to encourage acknowledgement of the role of emotions at all levels of the Fire Service and thus recommendations for conducting Job Analyses are provided.
Chapter
As of 2013, the most recent year for which data are available, the United States was protected by approximately 30,000 fire departments. Nearly 2500 of these departments were all career, protecting primarily communities of 25,000 people or more. Almost 20,000 were all volunteer, typically protecting communities of fewer than 25,000 people.
Article
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Rescue workers who are exposed to mutilated bodies, mass destruction, multiple casualties, and life threatening situations may become the hidden victims of disaster. In response to concerns about the mental health implications of exposure to work-related trauma in emergency service personnel, the crisis debriefing model has arisen as an early intervention strategy designed to mitigate stress reactions. Recently however, controversy has arisen about the efficacy of the crisis debriefing group model. Initial reports supporting the efficacy of crisis debriefing groups have relied on anecdotal evidence, client satisfaction surveys, and clinical impressions of group leaders. Subsequent research has suggested that the model fails to reduce and may in fact exacerbate symptoms of post-traumatic stress disorder (PTSD). This article reviews the crisis debriefing model as it has been applied to workers in various emergency fields and discusses the conflicting data surrounding efficacy. It concludes that there is some empirical support for the social support and psychoeducational components of the model. However, the component of the model that reviews graphic details of the event may increase intrusion symptoms through a process of vicarious traumatization.
Article
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Emergency service personnel are at high risk of developing post-traumatic stress disorder (PTSD). However, there is little in-depth information on the psychological responses of firefighters to the daily incidents that they attend. This preliminary study aimed to investigate the PTSD symptoms of firefighters in relation to traumatic events experienced by them, and the availability of social support. Thirty-one UK fire service workers completed an adapted version of the Post-traumatic Diagnostic Scale (PDS; Foa, 1995) to investigate the existence of post-traumatic stress disorder (PTSD). They were also individually interviewed to explore the symptoms they had experienced, what events these were related to, types of social support and coping strategies. Two participants reached the DSM-IV criteria for PTSD. Rumination and sleep disturbance were the most commonly reported PTSD symptoms. Participants reported high levels of social support from within the service and outside. The results suggest that fire service personnel are at risk of developing some symptoms of PTSD; however most had not experienced severe enough symptoms for PTSD to be diagnosed. The study suggests that high levels of social support may play a role in buffering firefighters from the development of PTSD.
Article
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Interest in critical incident stress debriefings for firefighters has grown over the last decade. Some researchers report that debriefings protect firefighters from stress-related disorders, including posttraumatic stress disorder (PTSD). Proponents of the interventions claim extraordinary need and success. Controlled and correlational studies have largely failed to demonstrate therapeutic effects, and some report iatrogenic effects. This study examined the relationships between debriefings and several mental health variables in a large sample of firefighters. Debriefing had a weak inverse correlation with negative affectivity and a weak positive correlation with positive world assumptions. No relationship was found between debriefing and PTSD.
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.
Article
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Firefighters are exposed to a range of potentially traumatic stressors, yet studies examining the impact of this exposure are equivocal. Although some studies suggest increased risk for mental health problems, others suggest unusual resilience. Type of assessment methodology may contribute to the lack of consistent findings. We assessed 142 trauma-exposed, professional firefighters utilizing a standardized clinical interview and self-report measures and found low rates of posttraumatic stress disorder (PTSD) diagnoses (4.2%), and depressive, anxiety, and alcohol-abuse symptoms. Frequency of trauma exposure did not predict psychological symptoms. Perceived social support, occupational stress, coping, as well as the interaction between perceived social support and self-blame were significant predictors of symptoms. Firefighters reporting low-perceived social support and high self-blame demonstrated the highest levels of clinically significant symptoms. These findings may inform education, treatment, and resilience training for emergency personnel.
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This study provides a comprehensive, population-based examination of tobacco use among both career and volunteer firefighters. Data are from a population-based cohort study of randomly selected career (N = 11) and volunteer (N = 13) departments comprised of 677 male firefighters. Unadjusted rates of smoking were 13.6% and 17.4% for career and volunteer firefighters, respectively. Smoking rates were less than a comparable occupational group (military personnel) and adult males in the states represented. Smokers were more likely to have been diagnosed with an anxiety disorder (OR = 5.8; P = 0.010), have an elevated CAGE alcohol problem score (OR = 2.9; P = 0.040), and more likely to report driving after drinking too much (OR = 4.5; P = 0.020) compared to never-smokers. Large percentages of career (18.4%) and volunteer (16.8%) firefighters used smokeless tobacco. CONCLUSIONS SMOKIN: g among firefighters is associated with other significant health and safety risks. High rates of smokeless tobacco use suggest that the fire service is an important target for intervention. Thus, despite strong statements against smoking by the fire service, the need to maintain high levels of health and fitness and relatively low smoking rates, a significant proportion of firefighters continue to use tobacco products. Am. J. Ind. Med. 54:697-706, 2011. © 2011 Wiley-Liss, Inc.
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Exposure to traumatic stressors is potentially an integral part of the job for emergency medical services (EMS) personnel, placing them at risk for psychological distress and mental health problems. The prevalence of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms was examined in a sample of EMS personnel in a multiethnic locality in Hawaii. Commonly encountered traumatic incidents at work were also assessed. The PTSD Check List-Civilian version was sent to 220 EMS personnel. The survey included questions on demographics, traumatic incidents at work, general stressors, coping methods and post-traumatic stress symptoms. 105 surveys were returned (48% response rate); 4% of respondents met clinical diagnostic criteria for PTSD, 1% met subclinical criteria for PTSD, 83% reported experiencing some symptoms but no PTSD and 12% had no symptoms. However, few had received treatment for these symptoms. Serious injury or death of a co-worker along with incidents involving children were considered very stressful. General work conditions also contributed to the overall stress levels. Most common coping strategies reported were positive reinterpretation (63%), seeking family and social support (59%) and awareness and venting of emotions (46%), with significant differences by ethnicity. EMS personnel are at high risk of experiencing post-traumatic stress symptoms. Early identification and treatment of potential stressors, psychiatric and medical problems is warranted and necessitates ongoing assessment and employee assistance programmes at the minimum.
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Psychological debriefing (PD) is a brief, short-term intervention aimed at mitigating long-term distress and preventing the emergence of posttraumatic stress. In recent years, it has become a ubiquitous intervention, one which has evolved as almost prescriptive following harrowing events and grew through a practical need to offer assistance to those who are exposed to severe trauma. Despite disturbing data from the recent refereed literature of psychology, it is still referred to as the “standard of care” for disaster and crisis response and its use in many quarters continues. This article critically reviews the evidence for and against its use and outlines the weaknesses in the research. The emphasis of this review is on the appropriateness of debriefing in organizations. This article also proposes a set of hypothesized constructs that may, in part, be responsible for the paradoxical effects found in some outcome studies on debriefing. Guidelines are also proposed to help organizations and professionals react appropriately using evidence-based interventions. Yes Yes
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Following a catastrophic natural disaster, the authors evaluated whether brief psychological intervention (debriefing 6 months later) reduced disaster-related psychological distress as measured by the Impact of Event Scale. Two groups of subjects who had been exposed to Hurricane Iniki in Hawaii were assessed before and after participating in a multihour debriefing group. The intervention aimed to provide ventilation of feelings, normalization of responses, and education about normal psychological reactions to the disaster in a context of group support. To provide a partial control for the passage of time, the pretreatment assessment of the second group was concurrent with the posttreatment assessment of the first group. A repeated measures analysis of variance indicated that Impact of Event Scale scores were reduced in both groups after the treatment. There is preliminary empirical support for the effectiveness of postdisaster psychological intervention and for the feasibility of treatment research in postdisaster environments.
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Psychological debriefing (PD) is widely used following major traumatic events in an attempt to reduce psychological sequelae. One hundred and thirty-three adult burn trauma victims entered the study. After initial questionnaire completion, participants were randomly allocated to an individual/couple PD group or a control group who received no intervention; 110 (83%) were interviewed by an assessor blind to PD status three and 13 months later. Sixteen (26%) of the PD group had PTSD at 13-month follow-up, compared with four (9%) of the control group. The PD group had higher initial questionnaire scores and more severe dimensions of burn trauma than the control group, both of which were associated with a poorer outcome. This study seriously questions the wisdom of advocating one-off interventions post-trauma, and should stimulate research into more effective initiatives.
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Psychiatric disorders were studied in a volunteer group of 181 firefighters who served as rescue/recovery workers after the Oklahoma City bombing. Approximately 34 months after the disaster, the authors retrospectively assessed psychopathology both before and after the bombing with the Diagnostic Interview Schedule. Findings for male rescue workers were compared with those of male primary victims who had been in the direct path of the blast and who had been assessed with the same instrument. The prevalence of posttraumatic stress disorder related to the bombing was significantly lower in male rescue workers (13%) than in male primary victims (23%). High rates of alcohol disorders (postdisaster: 24%; lifetime: 47%) were seen among all rescue workers, with virtually no new cases occurring after the bombing. The resilience seen in firefighters may be related to their career selection, their preparedness and experience, the fewer injuries they suffered, and postdisaster mental health interventions. However, alcohol disorders were endemic before the disaster, indicating a need for ongoing programs targeting this problem.
Article
Certain individuals, such as police officers, are exposed to traumatic events as part of their occupational roles. In an effort to prevent psychological illnesses, notably the post-traumatic stress disorder, from arising out of work-related traumatic incidents, psychological interventions have been developed such as Critical Incident Stress Debriefing (Mitchell, 1983; Mitchell & Everly, 1996). The present study tests the hypothesis that debriefing reduces the psychological morbidity caused by work-related incidents. Because debriefing techniques were not designed for application on a 'one-off' basis (Robinson & Mitchell, 1993), the procedure studied here consisted of three successive debriefing sessions (at 24 hours, 1 month and 3 months post-trauma), which included traumatic stress education. In a sample of 243 traumatized police officers, a subgroup of debriefed officers (N = 86) was compared with non-debriefed internal (N = 82) and external (N = 75) control groups. No differences in psychological morbidity were found between the groups at pre-test, at 24 hours or at 6 months post-trauma. One week post-trauma, debriefed subjects exhibited significantly more post-traumatic stress disorder symptomatology than non-debriefed subjects. High levels of satisfaction with debriefing were not reflected in positive outcomes. The findings are translated into recommendations for the future use of debriefing in police practice.
Article
When a person experiences a traumatic event, s/he may have a strong emotional reaction. This reaction may disrupt the person's ability to function at the scene of the incident or later, and may range from a normal stress response to the symptoms indicative of Post Traumatic Stress Disorder (PTSD). Psychological debriefing is an immediate intervention used following a trau-matic experience that purportedly helps individuals manage their normal stress reactions to the incident. Critical Incident Stress Debriefing (CISD) was designed for workers in high-risk occu-pations, such as police officers, disaster workers, and firefighters. Critical Incident Stress Management (CISM) is a multi-compo-nent intervention system that incorporates CISD. The use of this intervention has been expanded to individuals, groups, and com- munities. While this intervention has been used extensively fol-lowing traumatic events, its efficacy is under much debate. Currently, there is a controversy regarding the issue of whether it helps with initial distress and if it does, in fact, prevent post-trau-matic symptoms. This review is limited to studies assessing emergency response workers, as critical incident stress debriefing and management was originally designed for this population.
Article
This study surveyed 747 firefighters on their perceptions of work stress. The current emphasis in the fire brigades is on the management of traumatic or critical incident stress, but other work stressors may also be important. The firefighters rated their jobs as more stressful than other occupations, and psychological work stress as highest among a set of potential sources and types of stress. Although many factors were mentioned, the most frequently indicated stressors were associated with exposure to traumatic incidents such as major accidents or the suffering of others. Those who had previous experience with stress were more likely to rate current and future risk of stress as higher. Knowledge of existing organizational approaches to stress management was limited. The firefighters rated individual and informal sessions for dealing with stress as potentially more useful than the formal debriefing sessions now common in many emergency organizatins. Those who had previous experience with stress, however, were more likely to favour a formal organizational approach.
Article
Background: 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. Objective: To review the status of the medical and psychological literature regarding the efficacy and safety of CISM. Methods: 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. Results: 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. Conclusions: 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.
Article
This study investigates appraisal and coping behaviours, and symptom and expectation outcomes following a critical incident and Critical Incident Stress Debriefing (CISD). Two groups of 30 Australian police officers from the New South Wales Police Service who had been involved in shooting incidents were examined. One group received CISD and the other did not. The group that received CISD showed a significant reduction in anger levels and greater use of some specific adaptive coping strategies. However, one cannot be certain as to the extent of CISD's contribution to this improvement, since a variety of other factors in the officers' lives, as evidenced by other measures taken throughout the study, may help to explain the variation. Results are discussed in light of the contextual features in officers' lives that impact upon the outcome responses to such incidents.
Article
Purpose: Firefighters are expected to respond to any domestic emergency at a moment's notice, and therefore their health and readiness are key to the public safety net. Although emerging research is focusing on understanding firefighters' increased risk for disease and injury, the perspectives of fire service personnel is lacking. Design: This study uses the cross-sectional qualitative data collection techniques of key informant interviews and focus groups. Setting: Data collection occurred with a national sample of firefighters from 28 (municipal and federal) career fire departments. Participants: Participants were 332 career firefighters (57.2%), company officers (23.4%), fire chiefs (15.4%), and other fire service personnel (3.9%). Method: Focus groups and informant interviews were conducted with firefighters, fire chiefs, health promotion personnel, and medical directors to assess attitudes, opinions, and perceptions about firefighter health. Results: Major themes that developed among fire service personnel included concerns about cancer, risk of cardiovascular disease, the importance of and barriers to physical fitness, the food culture of the firehouse, psychological stress resulting from repeated exposure to trauma, sleep disruptions, injuries, and risk for infectious disease. Health concerns identified by firefighters are juxtaposed with current efforts and trends within the national fire service. Conclusions: The health concerns of firefighters parallel both available epidemiological research and the health priorities of national fire service organizations. Unfortunately, these concerns often are in contrast with efforts by local governments to limit their financial liability for illnesses presumed to be caused by occupational exposures and long-held traditions in the fire service. This study highlights the need for epidemiological surveillance of firefighters and innovative health and organizational policy in the fire service. Future directions for the fire service, the public health community, and researchers are discussed.
Article
Examined the effects of 29 emergency medical workers' (aged 21–35 yrs) distress and recovery for the weeks before and after they worked a mass shooting incident, using a longitudinal repeated-measures design. Ss completed a semi-structured interview, incident questionnaire, and social support questionnnaire. Psychological distress was measured by the SCL-90, given at 1 wk and 1 mo post-event. Results indicate that psychological and psychosomatic symptom changes were related to their social supports, including participation in critical incident stress debriefing (CISD). Feeling that others understood their experience was related to lower acute obsessive compulsive, general, and psychosomatic symptom levels, and also to better recovery from obsessive compulsive, depressive, and hostility symptoms. CISD attendance was related to better recovery from depressive and anxiety symptoms. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
ABSTRACT 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
Little attention has been given to factors contributing to firefighters' psychosomatic well-being. The purpose of this descriptive study was to examine such contributing factors in a sample of professional firefighters. Measures assessing sleep, depression, substance use, social bonding, and quality of life were examined in 112 firefighters. Overall, many firefighters reported sleep deprivation (59%), binge drinking behavior (58%), poor mental well-being (21%), current nicotine use (20%), hazardous drinking behavior (14%), depression (11%), poor physical well-being (8%), caffeine overuse (5%), or poor social bonding (4%). Small-to-medium correlations were identified between sleep deprivation, depression, physical/mental well-being, and drinking behaviors. High-risk behaviors that impact psychosomatic well-being are prevalent in professional firefighters, which require environmental and individual-based health promotion interventions. The inter-correlation relationships between such behaviors, therefore, need to be explored in further details.
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
Few studies have investigated stressors to which fire fighters are subjected and the potential psychological consequences. One hundred and forty-five fire fighters were studied to enumerate potential occupational stressors, assess psychological distress and problems with alcohol use, and determine whether a relationship exists between these measures and self-reported stressors. Hearing that children are in a burning building was the highest ranked stressor. According to three self-report instruments, between 33 and 41% of the fire fighters were experiencing significant psychological distress, and 29% had possible or probable problems with alcohol use. These figures are significantly higher than would be expected in a typical community or working population. In a logistic regression analysis, no relationship was found between measures of psychological distress and alcohol use and the 10 most highly ranked work stressors.
Article
Certain individuals, such as police officers, are exposed to traumatic events as part of their occupational roles. In an effort to prevent psychological illnesses, notably the post-traumatic stress disorder, from arising out of work-related traumatic incidents, psychological interventions have been developed such as Critical Incident Stress Debriefing (Mitchell, 1983; Mitchell & Everly, 1996). The present study tests the hypothesis that debriefing reduces the psychological morbidity caused by work-related incidents. Because debriefing techniques were not designed for application on a 'one-off' basis (Robinson & Mitchell, 1993), the procedure studied here consisted of three successive debriefing sessions (at 24 hours, 1 month and 3 months post-trauma), which included traumatic stress education. In a sample of 243 traumatized police officers, a subgroup of debriefed officers (N = 86) was compared with non-debriefed internal (N = 82) and external (N = 75) control groups. No differences in psychological morbidity were found between the groups at pre-test, at 24 hours or at 6 months post-trauma. One week post-trauma, debriefed subjects exhibited significantly more post-traumatic stress disorder symptomatology than non-debriefed subjects. High levels of satisfaction with debriefing were not reflected in positive outcomes. The findings are translated into recommendations for the future use of debriefing in police practice.
Article
Increasingly, theorists and researchers in the area of trauma are pointing to the importance of individual differences in resilience and vulnerability as key determinants of the intensity and duration of trauma-related symptoms. Determining the relative influence of individual predictors is important for the further development of theoretical models for understanding trauma responses and for the subsequent development of intervention strategies that are sensitive to individual differences. This study explores the influence of individual factors and social support on traumatic reactions in firefighters exposed to tragic events in the line of duty. A total of 164 Australian firefighters completed questionnaires targeting locus of control, self-efficacy, patterns of interpersonal relating, social support and level of emotional distress. Results indicate that individuals with feelings of insecurity, lack of personal control, and alienation from others were more likely to experience higher levels of depression and posttraumatic stress symptoms subsequent to exposure to traumatic events on the job.
Despite a long and rich history as a specialty within applied mental health, crisis intervention has, within recent years, been the target of criticism. Singled out for specific criticism has been the intervention referred to as "debriefing." Some authors have not only challenged its effectiveness but have raised the specter that it may cause significant harm. While superficially such arguments appear to have merit, closer scrutiny reveals an antiquated interpretation of even the most fundamental of terms and concepts inextricably intertwined with research based upon applications contrary to the most recent principles, prescriptions, and protocols regarding clinical use. A review of research based upon more extant formulations reveals many crisis intervention practices, including the Critical Incident Stress Debriefing model of "debriefing" and the Critical Incident Stress Management (CISM) model of crisis intervention to be highly clinically effective, indeed. This paper will review the terms and concepts which serve as the foundation of the field of crisis intervention, while subsequently reviewing key research investigations addressing its efficacy. It may be that outcome research directed toward assessing the effectiveness of crisis intervention can prosper from following trails blazed by psychotherapy researchers. The parallels seem striking. It may be that outcome research in crisis intervention (and "debriefing") needs to now focus upon "who" does crisis intervention, to "whom," and in "what specific situations," so as to maximize outcome associated with this clinically effective tool [International Journal of Emergency Mental Health, 2000, 2(4), 211-225].
Article
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association, the post-traumatic stress disorder (PTSD) is diagnosed when a person: (a) is exposed to a traumatic event that is well outside the range of usual human experience accompanied by intense fear or horror; (b) reexperiences the event in his/her thoughts, dreams and daily life; (c) avoids the stimuli associated with the trauma and numbs his/her emotions; (d) demonstrates symptoms of increased arousal; and (e) manifests these disturbances for a longer period than one month. Since the 1980s, it has been pointed out that PTSD may occur not only among survivors of severe traumatic events but also among those who have rescued the victims of those events. Members of fire brigades constitute a large occupational group exposed to traumatic experiences. The aim of our study was to find an answer to the question of what are the relationships between the level of PTSD symptoms and the sense of coherence (and its three dimensions). In all, 464 firemen were interviewed. PTSD-Interview developed by Watson et al. was used to assess the level of PTSD symptoms and the presence]absence of PTSD. The higher level of PTSD symptoms was associated with the lower level of the sense of coherence. A small group (3.9%) of subjects who experienced traumatic events met DSM-IV diagnostic criteria for PTSD. The sense of coherence of these people was significantly lower than that of others.
Article
This review concerns the efficacy of single session psychological "debriefing" in reducing psychological distress and preventing the development of post traumatic stress disorder (PTSD) after traumatic events. Psychological debriefing is either equivalent to, or worse than, control or educational interventions in preventing or reducing the severity of PTSD, depression, anxiety and general psychological morbidity. There is some suggestion that it may increase the risk of PTSD and depression. The routine use of single session debriefing given to non selected trauma victims is not supported. No evidence has been found that this procedure is effective.
Article
Studies have not previously considered postdisaster adjustment in the context of psychiatric disorders. After the Oklahoma City bombing, a volunteer sample of 181 firefighters who served as rescue and recovery workers was assessed with a structured diagnostic interview. The firefighters had relatively low rates of posttraumatic stress disorder (PTSD) and described little functional impairment, positive social adjustment, and high job satisfaction. PTSD was associated with reduced job satisfaction and functional impairment, providing diagnostic validity. Turning to social supports, seeking mental health treatment, and taking medication were not widely prevalent coping responses. Postdisaster alcohol use disorders and drinking to cope were significantly associated with indicators of poorer functioning. Surveillance for problem drinking after disaster exposure may identify useful directions for intervention.
Article
Despite conflicting research findings and uncertain efficacy, single session debriefing is standard clinical practice after traumatic events. We aimed to assess the efficacy of this intervention in prevention of chronic symptoms of post-traumatic stress disorder and other disorders after trauma. In a meta-analysis, we selected appropriate studies from databases (Medline Advanced, PsychINFO, and PubMed), the Journal of Traumatic Stress, and reference lists of articles and book chapters. Inclusion criteria were that single session debriefing had been done within 1 month after trauma, symptoms were assessed with widely accepted clinical outcome measures, and data from psychological assessments that had been done before (pretest data) and after (post-test data) interventions and were essential for calculation of effect sizes had been reported. We included seven studies in final analyses, in which there were five critical incident stress debriefing (CISD) interventions, three non-CISD interventions, and six no-intervention controls. Non-CISD interventions and no intervention improved symptoms of post-traumatic stress disorder, but CISD did not improve symptoms (weighted mean effect sizes 0.65 [95% CI 0.14-1.16], 0.47 [0.28-0.66], and 0.13 [-0.29 to 0.55], respectively). CISD did not improve natural recovery from other trauma-related disorders (0.12 [-0.22 to 0.47]). CISD and non-CISD interventions do not improve natural recovery from psychological trauma.
Article
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.
1555-5240 print=1555-5259 online DOI: 10.1080/15555240 Critical incident stress debriefing (CISD): Efficacy in question
  • Copyright
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