1. Critical Incident Stress Debriefing (CISD)
Austin Community College
Emergency Medical Services

2. CISD
EMS personnel are routinely exposed to extraordinarily stressful situations. The psychological impact of that acute and chronic stress is increasingly recognized and critical incident stress is now being addressed by many EMS agencies through a “debriefing” process involving formal CISD Teams.

3. Common Personality Traits of Emergency Personnel
Need to be in control
obsessive (desire to do a perfect job)
compulsive (tend toward the same actions, traditional)
highly motivated by internal factors
action oriented
high need for stimulation

4. Traits Continued Have need for immediate gratification easily bored
risk takers
rescue personality
highly dedicated
strong need to be needed

5. Definition of Critical Incident Stress
Stress experienced due to an event which overwhelms the individual's normal coping mechanism, rendering the person ineffectual.

6. Stress Factors Suddenness and intensity of event age of the victim
number of victims
duration of field resuscitation
age and experience of rescuer
identification with the victim
adequacy of manpower

7. Stress Factors Continued
Equipment and training to handle the situation
Environment

8. Post Traumatic Stress Disorder (PTSD)
Chronic stress reaction following one or more horrible events.

9. Characteristics of PTSD
Fear of repetition
nightmares/flashbacks
psychic numbing, dazed
withdrawing from personal relationships
hypervigilant
physical emotional and behavioral disorders

10. Characteristics of PTSD continued
Suicidal thoughts
self medicating (alcohol abuse)
phobia’s

11. Pediatric Critical Incidence
Any sudden event that results in the death of a child
death during prolonged rescue effort
child abuse
trauma involving mutilation
emergencies with intense media coverage
identification with the victim

12. Reactions to Critical Incident Stress
Acute physical reactions
Acute cognitive reactions
Acute emotional stress

13. CISD- Debriefing
CISD is the treatment of choice following a critical incident
Goals
Mechanism

14. Coping Strategies During the Emergency
Prevent psychological trauma to incoming crews…. Inform them of what they will be walking into.
Maintain high level of pre-training and skill proficiency
be aware of others
accept your own limitations

15. Coping Strategies Continued
Learn deep breathing exercise to dispel stress
conflict resolution skills
behavioral emergencies and management of violent patients
disaster psychology
problem solving skills

16. Summary Defuse as early as possible (within 72 hours)
informal crew meeting for venting purposes
identify personnel in need of immediate support
physical exercise
eat right

17. Summary Continued It’s okay to cry…. Release emotion
spouse nights hosted by mental health professionals may help families understand stress reactions and the impact on marriages.