CRITICAL INCIDENT STRESS DEBRIEFING IT COULD SAVE YOUR CAREER Nancy Craven, MD, CCFP, FAAFP 2006 AMA-CMA Conference on Physician Health

In presenting this workshop, I have no relevant financial relationships to disclose.

OBJECTIVES You will be able to: Define “critical incident” Explain the potential impact of a critical incident Describe the steps in critical incident debriefing

WHAT IS A CRITICAL INCIDENT? It is an event (or a cascade of events) that overwhelms normal coping mechanisms and can interfere with one’s usual ability to function. Note: Not every stressful event is a critical incident.

CRITICAL INCIDENT EXAMPLES An unexpected death of a patient (especially a child) Suicide of a patient or colleague Major trauma case where a doctor has inadequate back-up Workplace violence Natural disaster

SYMPTOMS FOLLOWING A CRITICAL INCIDENT Sleep disturbance Inability to concentrate Inability to make decisions Loss of confidence Extreme fear of making a mistake Preoccupation with the incident Social withdrawal

WHY ARE DOCTORS AT RISK? Image of perfection Need to be in control Secrecy about mistakes Myth of being invincible

COMMON UNHEALTHY COPING STRATEGIES Self-medication (alcohol, samples, self-prescribing) Isolation Blaming & anger Over-compensation at work

What is Critical Incident Debriefing? Defusing Fact phase Thought phase Debriefing Reaction phase Symptoms phase Teaching phase Wrap-up

WHO CAN FACILITATE SESSIONS? A respected member of staff Willing to take CISD training Willing to volunteer time and be available on short notice Not involved in the incident they help others to debrief

SESSION GROUNDRULES Anyone involved may attend Anyone not involved cannot attend The group will keep confidential what is said in the debriefing Purpose of debriefing is not to criticize or blame Each participant’s view is valid

USEFUL RESOURCES International Critical Incident Stress Foundation: Seattle CISD website: CISD training (Vancouver):

DEMONSTRATION OF A DEBRIEFING SESSION