SOP 211.02 CRITICAL INCIDENT STRESS DEBRIEFING (CISD)

The Critical Incident Stress Debriefing is a team concept that utilizes a multi-dimensional approach through both a proactive and reactive format. The program is proactive by educating members of the Ennis Fire Department about stress response syndromes and stress management techniques, thereby preventing the development of psychological stress disorders. The program is also reactive by activating CISD Teams during a critical incident in order to provide emotional support and professional referrals for those impacted by the magnitude of events.

Case studies of major incidents, where numerous injuries or fatalities occurred, have revealed that a significant number of rescue personnel experienced some form of stress related symptoms following the incident. . Many of these symptoms were transitory and most personnel had no long-term detrimental effects resulting from exposure to such incidents. Some of these effects have been delayed. surfacing later after a period of no apparent symptoms. Without professional intervention, personnel experiencing these long-term effects show declining work performance, deterioration of family relationships, and increased health problems. The objective of this procedure is to provide professional intervention immediately after major incidents in order to minimize stress related injury to Ennis Fire Department personnel.

DEFINITIONS

1. Critical Incident Stress Debriefing (CISD): An organized approach to supporting Emergency Service Personnel, who are involved in emergency operations under conditions of extreme stress in order to assist in mitigating long term emotional trauma syndromes.

2. Critical Incident: Any situation faced by emergency service personnel that causes them to experience unusually strong emotional reactions which have the potential to interfere with their ability to function either at the scene or later.

3. CISD Coordinator: Ennis Fire Department Chaplin or the Chaplin's designated representative.

4. Facilitator: A mental health professional, who is trained in disaster psychology, crisis intervention, stress level assessment, and the use of the formal critical incident stress debriefing model. The facilitator is responsible for training of the peer leaders.

5. Co-Facilitator: A mental health professional working with or under the direction of the facilitator.

6. Peer Leader: Representative from the City of Ennis Fire Department of any rank, who is trained and approved by the facilitator to assist with the CISD process.

7. The Debriefing Team: The debriefing team will consist of stress related counseling professionals as well as Ennis Fire Department personnel. The Fire Department member's role in the debriefing process will be to and support the professional counselors as necessary. Any follow-up care will be administered by the counseling group.

8. Debriefing: Critical incident debriefing is not a critique of Ennis Fire Department operations at the incident and performance issues will not be discussed during the debriefing. The debriefing process provides formats in which personnel can discuss their feelings and reactions, thus reducing the stress that results from exposure to critical incidents. All debriefings will be strictly confidential.

CRITICAL INCIDENT STRESS DEBRIEFINGS

There are many methods to deal with a stress response syndrome resulting from exposure to a critical incident. Among them are strenuous physical exercise and special relaxation programs within 24 hours after the critical incident. However one of the most effective methods, especially in emergency personnel, is Critical Incident Stress Debriefing (CISD).

The task of the CISD team is to provide an organized approach to the management of stress responses for firefighters having been exposed to, or showing signs of, traumatic stress experienced in the line of duty. A critical incident can be any situation that causes firefighters to experience strong emotional reactions that have the potential to interfere with their ability to function at the scene or later. Company Officers and Chief Officers are responsible for identifying/recognizing significant incidents that may qualify for debriefing.

When an incident is identified as a "Critical Incident", a request for debriefing consideration should be made as soon as possible.

THE FOLLOWING REQUIRE AUTOMATIC NOTIFICATION:

Major disaster/mass casualties.

Serious injury, death, or suicide of a firefighter

Request of a Chief Officer or the City Manager

THE FOLLOWING ARE EXAMPLES OF INCIDENTS THAT MAY RESULT IN A CISD TEAM NOTIFICATION:

Death of a child, or other incident involving profound emotional responses.

Any case that attracts unusually heavy attention from the news media.

Loss of life following an unusual, or prolonged, extremely prolonged expenditure of emotional and physical energy by the emergency services personnel.

Any unusual incident that produces a high level of immediate or delayed emotional response.

Accumulating trauma syndromes from long periods of incidents.

The Critical Incident Stress Debriefing process consist of three basic elements or phases:

The first phase of the CISD process consist of ventilation of feelings by the emergency worker, and an assessment by the facilitator of the intensity of stress response.

The second phase of the process consists of a more detailed discussion of the signs and symptoms of stress response, and provides for education, support and reassurance.

The final or closure phase of CISD is where information is provided and, if necessary, a plan of further action or referral may be necessary.

The Critical Incident Stress Debriefing Plan.

Critical Incident Stress Debriefing shall begin with ON-SCENE MANAGEMENT. Minimizing personnel exposure to stressful incidents results in fewer stress related problems. Commanders should reduce this exposure by rotating personnel and by removing initial respondents from the scene as soon as possible.

When appropriate, personnel should be sensitized to an incident. This means they need to be told what they will encounter. Rotation into an area should start with an area of lesser impact, then to the main area. Rotation away from the main area should be to an assignment of lesser impact, then to the rest area.

On-site evaluation and counseling by a CISD team member should be considered for some critical incidents when time and circumstances permit. In such situations debriefing members can observe, watch for acute reactions, provide support, encouragement, consolation, and be available to heap resting personnel deal with stress reactions. Team members should be considered a resource available to command.

An Initial Diffusing may take place shortly (several hours) after the incident and will be facilitated by Ennis Fire Department CISD members and a counselor. This is an informal process encouraging an open, free expression of feelings without a critique of the incident or of the individual's responses. This shall provide educational information regarding normal responses to abnormal events.

Formal Critical Incident Stress Debriefing. This debriefing shall be led by a trained traumatic Stress counselor and will be held after the conclusion of the incident.

The Counselor will be an individual with a good background in group interactions and dynamics, with a working knowledge of stress response syndromes, and of the Ennis Fire Department operational procedures.

The debriefing shall follow this general format:

Introductory Phase. The peer leader introduces their self and describe the rules the debriefing, and emphasize the need confidentiality. The peer leader will introduce the counselor.

Fact Phase. The counselor will ask the participants to describe facts about themselves and their activities during the incident, as well as facts about the incident itself.

Feeling Phase. When enough information has been provided to make the incident vividly clear, the Counselor will encourage a sharing of feelings by all participants. The counselor should emphasize that all feelings, positive or negative, important or unimportant should be expressed and listened to.

Symptom Phase. Participants are encouraged to describe their own experience with the Stress Response Syndrome.

Teaching Phase. The counselor provides the participants with an education about Stress Response Syndromes, with emphasis on how normal and natural such responses are for emergency service workers.

The Re-entry Phase. This phase seeks to wrap the briefings up, answer outstanding questions, and establish a plan of further actions. Summary comments are offered by the counselor and the peer leader, advising personnel on how to seek further help if they need it.

A follow-up debriefing performed several weeks or months after the critical incident, may be held if necessary. The main purpose of this debriefing is to resolve any issue or problems that were not initially resolved. The follow-up CISD may be performed with the entire group or a portion of the group.

ACTIVATION/NOTIFICATION

Company Officers and Chief Officers are responsible for identifying/recognizing significant incidents that may qualify for debriefing. When an incident is identified as a "Critical Incident", a request for debriefing consideration should be made as soon as possible.

Activation of the CISD process may be made in one of the following ways:

1. Any Chief Officer or the City Manager may initiate the debriefing process. For serious events, this shall be done at the scene by having communications notify the CISD Coordinator.

2. Company Officers, whose crew may have experienced a traumatic event, shall request the debriefing process by contacting any Chief Officer.

3. Any member who feels a need for confidential debriefing shall contact the CISD Coordinator for proper assistance and referral.

When activated, the incident will be evaluated for the amount of debriefing required. The specific debriefing services utilized will depend greatly upon how early the team is activated, and the nature of the incident. Notification, shall be made through communications who will notify the CISD Coordinator.

On scene, the team will report to the Command Post where the CISD Coordinator is located and proper identification will be provided.

RULES DURING DEBRIEFING

All statements, facts, opinions, and discussions made during the diffusing or debriefing shall be "Strictly Confidential".

Attendance to a debriefing shall be MANDATORY for all personnel who were directly exposed to the traumatic aspects of the incident.

No one should be criticized for how they feel. Instead, they should be allowed free expression of feeling with acceptance, support, and understanding from each other.

No recordings or notes are allowed.

Personnel shall not leave debriefing once in progress.

Critical incident debriefing is NOT a critique of Ennis Fire Department operations at the incident.

No media coverage; Media shall be handled by the City of Ennis Public Information Officer.

Location of CISD debriefing shall be held away from the scene, such as a school, community center or other location where personnel are out of service.