Critical Incident Stress Debriefing Case Study

I attended a seminar entitled Trauma Informed care which was presented by Center for Urban Community Services the Institute for Training & Consulting. The facilitator opened the training by defining Trauma informed care which is an engagement technique that recognizes the presence of trauma history and acknowledges the role of trauma in the lives of survivors’. The training provided an overview of the new diagnostic criteria from DSM-5 of Post Traumatic Disorder and other trauma related disorders (generalized anxiety, panic disorder, dissociative disorder) as well as other symptoms and behaviors that can result from trauma. The trainer also discussed vicarious trauma and its impact on staff supporting clients with trauma history.

According to the Canadian Mental Health Association, “PTSD can make people feel very nervous or ‘on edge’ all the time. Many feel startled very easily, have a hard time concentrating, or have problems sleeping well” (Association, 2016). These conditions make it hard for first responders to continue working resulting in “overwhelming exhaustion, feelings of cynicism and detachment to the job, and a sense of ineffectiveness and lack of accomplishment” (Cigognani, 2009,

Emergency rescue personnel witnessed the loss of loved ones, furthermore during recovery and rescue efforts they were limited in the amount of debriefing and clinical mental support they received. Priorities at the time focused on saving lives, while mental deterioration was taking place in many simultaneously. “A study published in the Mount Sinai Journal of Medicine found a 71.8% prevalence of PTSD among exposed first responders as opposed to 51.4% among their unexposed counterparts” (Bills et al., 2008). In a 9-year longitudinal cohort study with data gathered from 27,449 participants, including a population of police officers and firefighters among other rescue workers; the cumulative results yielded a 9.3% incidence of PTSD, 8.4% panic disorder, and 7.0% depression, with the higher rates found among those with direct exposure (Wisnivesky et al., 2011). Besides risk factors that contribute to developing PTSD, underestimating its pathophysiological effects can exacerbate the condition. According to Boscarino and Adams (2009), even though 90% of adults have experienced at least a traumatic event in their life; only a small percentage develop PTSD. This further validates the concept of the influence of underlying risk factors post

PTSD having been on the rise following various deployments necessitated by the various wars against terror, where the soldiers encounter traumatic experiences like harsh training conditions, unfavorable living standards, enemy attacks, extreme working environment, explosions, torture by enemies, loss of colleagues as well as long term separation from family back at home (Melinda S & Jeanne S., 2012). This therefore calls for a concerted effort in handling the pandemic of PTSD since it has been constantly on the increase and as a

I agree the biggest issue with dealing with mental health is people are unwilling to accept or even acknowledge that they need assistance. As you stated changing the perception of receiving mental assistance is the key to increasing the amount of first responders accepting help. Changing the stigma of the strong sucks it up and the weak can’t take it, has to be implemented by people in the position of authority. Making it mandatory with first responders and even in the military that critical incident stress debriefing (CISD) should be initiated within 24-48 hour after experiences any traumatic event may reduce any long-term impact.

Evidence Based Treatments are national priority of the public of the public. As it relates to PTSD an approach known as Critical Incident Stress debriefing find was used to treat traumatic events in someone life. (Parrish, 2011) For example, a group would come together as compared to the First Responders groups. (Parrish, 2011) Overtime research has proven that the Critical Incident Debriefing or First Responders cause more people to develop PTSD. (Parrish, 2011) Therefore, practicing just wisdom is not efficient enough when treating. (Parrish, 2011) The treatment only becomes more efficient when adding research that has been review to make sure it works. (Parrish, 2011)

The patients generally come to the clinical settings when secondary stage psychological problems surface. Therefore, early detection of symptoms and impactful intervention is the key to effective management of PTSD [27].

Critical incident stress results from the crisis of a critical event such as a death of a loved one, a traumatic incident, or an officer-involved shooting. A crisis for an individual is defined as “the perception or experiencing of an event or situation as an intolerable difficulty that exceeds the person’s current resources and coping mechanisms” (James & Gilliland, 2013, p. 8). For a law enforcement officer, “Mitchell (1991) said that a critical incident is one in which the officer’s expectations of perfect performance suddenly are

It is estimated that nearly 100,000 people die each year from medical errors in hospitals, with an estimated cost of between $17 and $29 billion per year. Finding a solution to this crisis has become a priority for every healthcare organization, with the realization that most errors are not caused by reckless staff, but by poor systems and processes (Institute of Medicine, 2000). Consequently, healthcare has begun to look to outside organizations in order to find solutions, by examining industries that are considered highly reliable, despite operating in hazardous situations. The lessons learned by these Highly Reliable Organizations (HROs) can be used to promote safe and reliable performance, which in turn should improve patient and staff

This treatment approach is based on cognitive and learning theories, tackling-misleading beliefs related to the traumatic events of acknowledgments related to the abuse and provides a supportive environment of which individuals are encouraged to talk about their traumatic experience. A numerous amount of research has been carried out to investigate into how effective CBT really can be for PTSD. (Resick et al, 2002) carried out an investigation comparing CBT with strong cognitive restructuring focus and CBT with a strong exposure focus and to a waiting-list control of rape survivors. Prior to this experiment approximately 80% of patients who completed either form of CBT no longer met the criteria for PTSD. Once this investigation was complete a follow up treatment took place of which it was noted 2% of the waiting list group had lost the PTSD diagnoses. Only a year after this investigation Bryant, Moulds, Guthrie, Dang & Nixon, (2003) restructured the experiment comparing exposure alone, exposure plus cognitive restructuring, and supportive counselling in civilians with PTSD resulting from various traumatic events. At this particular follow up 65-80% of participants who either completed either form of CBT were now clear of PTSD diagnosis, compared to less than 40% of those who completed supportive counselling.

Working in the field of Emergency Response I have seen and felt first hand the effects of posttraumatic stress disorder. It is not possible to respond to emergency after emergency and not be subject to some of PTSD’s effects. When I saw this topic in the list I felt compelled to use this opportunity to learn more. My hope is by increasing my knowledge, of a disorder so prevalent in my career field; I can recognize the symptoms in others and myself before there effect becomes devastating.

When humans undergo traumatic events that threaten their safety and wellbeing, they may become vulnerable to nightmares, fear, excessive anxiety, depression, and trembling. Post Traumatic Stress Disorder (PTSD) is a psychological illness that results from the occurrence of a “terribly frightening, life-threatening, or otherwise unsafe experience” (Posttraumatic Stress Disorder (PTSD), 2012). This condition often leads to unbearable stress and anxiety. PTSD is significantly prevalent as indicated by data from the National Co-morbidity Survey which shows that at a particular time in their lives, 7.8% of 5, 877 adults in America suffered from PTSD (Andrew & Bisson, 2009). In the general population, the lifetime prevalence is estimated at 8%,

Mitchell has been shown to be credible because of the seven steps he believes to be workable. In 1983, he introduced Critical Incident Stress Debriefing (CISD). The model he developed was designed to prevent and manage the horror resulting from traumatic stress, and reduce the casualties among emergency service personnel. Mitchell model poses the below seven unique phases, which are integrated with stress education and information throughout the process.

Disaster conditions also challenge their physical and mental endurance [9]. Healthcare professionals may have increased risks of post-traumatic distress due to their work. For example, Shrestha R reported that health professionals working in the Nepal earthquake of 2015 were at significantly higher risk of developing post-traumatic stress disorder (PTSD). The overall prevalence rates of PTSD were 21.9% and 17.1% using cut off scores and diagnostic criteria, respectively [10]. A study by Oglodek E. showed that 40% of medical rescuers experiencing PTSD reported that the dissociation was caused by the death of a patient being rescued [11]. Additionally, Yu YM et al. revealed that during the Wenchuan earthquake in 2008, more than 50% of medical staff demonstrated several of the following signs of stress: grief, fear, depression, anxiety, fatigue, headache, and dizziness [12]. Therefore, health quality of healthcare professionals after disasters is a significant issue [9, 13].

Narrative greatly contributes to this process. Posttraumatic stress disorder (PTSD), an anticipated condition among disaster survivors and one which FEMA and the Red Cross both incorporate in their disaster response plans, torments patients with hyperarousal, persistent and intrusive memories, and constrictive symptoms of withdrawal from social interaction and emotional numbness. While some, including Allen Young, note that a diagnosis of PTSD differs