Critical Incident 5/7/2018. Defining Critical Incident. Defusing. Defusing and Debriefing

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1 Critical Incident Defusing and Debriefing Defining Critical Incident Any event that overwhelms the normal coping abilities of an emergency worker such as EMS, Fire, Police, and Emergency room personnel. The incident can involve multiple casualties, death of very young people, death of family, or death of friend or co worker. Defusing A formal or informal meeting held prior to the end of the shift to discuss the circumstances surrounding the critical incident. This time can be used to evaluate individual reactions to the incident and provide the opportunity for workers to share feelings regarding the event. 1

2 Debriefing A formalized event occurring hours after the critical incident. This is lead by individuals trained in Critical Incident Stress Management. At least one leadership member should be trained in Critical Incident Stress Management and have a mental health background Formal vs Informal Defusing can occur in a formal and in a informal manner. The idea is not to necessarily have a sit at the table discussion. This discussion can take place in any place that provides some privacy and is conducive to an honest sharing of emotions related to the critical incident. Informal Defusing Examples could include co workers taking a few minutes to discuss the event and how it has impacted them. Both new and seasoned staff can benefit from taking the time to discuss normal reactions to the event. This is not a time to talk about the technical aspects of the situation. This is a time identify the emotions evoked by the incident. 2

3 Usually initiated by a member of the leadership team in response to a potentially critical incident. This should happen prior to the worker going home for the day. It should be a homogenous group involving only those who participated in the event. 3 steps 1. Normalization of feelings. Recognition and verbalization of stress/anxiety/fear/depression/anger as normal reactions. 2. Review of symptoms. Those exposed to the critical incident may not recognize the symptoms in themselves without prompting. 3

4 These symptoms can be categorized into: Physical Cognitive Emotional Behavioral Physical: Fatigue Chills Unusual Thirst Chest pain Headaches Dizziness Cognitive Uncertainty Confusion Nightmares Poor attention/decision making ability Poor concentration/memory Poor problem solving ability 4

5 Emotional Grief Fear Guilt Intense anger Apprehension and depression Irritability Chronic Anxiety Behavioral Inability to rest Withdrawal Antisocial behavior Increased alcohol consumption Change in communications Loss/increase of appetite 3. Discussion of available support resources. This can range from peer support to referral to professional therapists. Having the contact information available may assist someone in asking for help that may otherwise try and tough it out or handle it on their own. 5

6 The leader of the defusing should consider requesting a debriefing if there are multiple workers identified that could benefit from a formal debriefing. The process of formal debriefing should be organized and led by a trained group. This event should take place within hours after the incident. So why go through all of this? 1. Employee burnout 2. Suicide rates 3. Decreased job satisfaction 4. Physical health problems 5. Mental health problems 6. Problems at home 400 Physicians commit suicide each year More than double the general population 6

7 Female nurse suicide rates are the highest of any profession 23% more likely than women in general Nurses are 4 times more likely to commit suicide than those working outside of the medical profession. In 2015 there were 117 suicides among fire fighters, EMT s, and Medics Of 4000 workers surveyed 6.6% attempted suicide. This is 10 times the national average in the general population 7

8 Take care of yourselves as well as you take care of your patients. Physically Mentally Emotionally Spiritually References Trauma trauma.org Critical Incident Stress Debriefing Jeffery T. Mitchell, Ph.D. Diplomate html Critical Incident Stress Guide Critical Incident Stress Debriefing from a Traumatic Event Joseph A. Davis Ph.D. What is Defusing? training/what is defusing/ What is Critical Incident Stress Diffusion: debrief.html 8