Healthcare

Critical Incident Stress Management & Peer Support

by Tania Glenn

In the aftermath of 9/11, aviation and other transportation incidents have become the focus of much national and international attention. Commercial aviation incidents like U.S. Airways Flight 1549 making an emergency landing on the Hudson River in January 2009, Asiana Airlines Flight 214 making a crash landing onto the San Francisco runway in July 2013, and Malaysia Airlines Flight 370 disappearing in midair in March 2014 raise legitimate concerns over aviation safety, standardization, and security. However, regardless of the type of incident, the personal resilience levels of those affected may vary greatly.

Lasting Effects of Critical Incidents Frequent land, sea, and air travelers feel the effects of these incidents as new regulations, rules, and standards arise and change almost daily. Some transportation incidents touch lives in unexpected ways, leaving a lasting effect (both negative and positive) that shapes both professional and personal lives. Ultimately, these catastrophic incidents severely influence the psyche of flight crew members, commercial passengers, and their respective associations such as co-workers, family members, and close friends. They each may experience stress and trauma after such life-changing events.

Large-scale events that involve loss of life often are known as “critical incidents” – sudden and extreme events that can overwhelm the usual coping mechanisms of rescuers, bystanders, and travel personnel. At any given point, an incident could affect even the most experienced and seasoned rescuers. It is human nature to have a coping capacity or threshold, beyond which a person no longer tolerates stress in a productive manner. In addition, the definition of a critical incident may change or evolve over time as people grow and acquire new life experiences.

The most debilitating type of critical incident is one that involves death. The repercussions that such incidents have for personnel and responders are powerful and very painful.

Proactively Managing Stress During the mid-1980s, Jeffrey Mitchell, Ph.D., ex-firefighter and now psychologist, created the concept of critical incident stress management (CISM). Mitchell researched the stress responses of police officers, firefighters, paramedics, and emergency room nurses and found that, across the board, people in these professions experience the same types of reactions both during and after traumatic events. Some of these reactions include, but are not limited to: nausea, vomiting, diarrhea, pupil dilation, headaches, indigestion, tremors, muscle aches, increased smoking, insomnia, nightmares, social isolation, anger, depression, increased startle response, restlessness, and increased use of alcohol.

Mitchell also found that, for the most part, people in these professions were trying to cope with these symptoms in unhealthy and unproductive ways. Attempts to “forget” or repress recurring thoughts and memories have resulted in frightening rates of alcoholism, divorce, and suicide among emergency personnel.

The concept of CISM became the focus of Mitchell’s career. In 1983, he created the Mitchell Model for debriefings, which rescuers and transportation professionals worldwide have used successfully. The strength behind the model lies in the fact that it is a nonthreatening, peer-driven process that enables police officers to talk to police officers, paramedics to talk to paramedics, and so on. In aviation, flight personnel can talk to others who understand their culture, terminology, lifestyle, and stressors.

This is not psychotherapy, just a chance to sit down with people who care enough to be there to talk about the incident, to receive stress management reminders, and to “cuss and discuss” if they so choose. Repeatedly, studies have shown this model to be quite successful in mitigating the stress response of those serving in the line of duty. Additionally, this process has facilitated connections to professional counselors when follow up is necessary for personnel.

When proactively dealing with critical incidents, the aviation, first responder, law enforcement, and military communities often develop and employ CISM teams and peer support teams in response to manmade and natural disasters. Hence, in preparing for an emergency, it is useful for both the private and public sectors to develop and employ similar capabilities in advance of an unexpected disaster response. Ultimately, during a critical incident, whether manmade or natural disaster, people will experience stress and trauma. The goal of any organization always should be to create a safety net for all personnel, and to ensure that no one falls through that safety net. Mission first, people always.

Tania Glenn, PsyD, is the president of Tania Glenn and Associates (TGA) PA, a clinical practice in Austin, Texas, and the TGA Readiness Action Division (RAD). As a licensed clinical social worker and certified trauma specialist with 22 years experience treating anxiety and depression, she deployed to Oklahoma City in 1995, New York City in 2001, and New Orleans in 2005 in support of law enforcement officers, firefighters, and national guardsman who responded to the Oklahoma bombing, 9/11, and Hurricane Katrina. Her broad experience includes serving as: the clinical director for several critical incident response teams; the traumatic stress management coordinator for Austin/Travis County Emergency Medical Services and Round Rock Police Department; an active faculty member and trainer for the International Critical Incident Stress Foundation; an advisory board member for the Brattleboro Hospital Uniformed Services Worker’s Retreat, Brattleboro, Vermont; and a regular contributor to Air Beat: The Official Journal of the Airborne Law Enforcement Association.