CISM

Empirical evidence, from as far back as World War I, indicates that early psychological intervention following traumatic or crisis situations can reduce the need for more formal care and the risk of long-term psychological effects.

Crisis Intervention is sometimes referred to as "emotional first-aid" and may be thought of as urgent psychological/behavioural care, designed to first stabilise and then reduce symptoms of distress/dysfunction, so as to achieve a state of adaptive functioning or facilitate access to continued care when necessary.

What is a Critical Incident? A Critical Incident is any situation that causes a person to experience unusually strong stress reactions that the person perceives as disturbing or disabling (in other words - that which affects one's ability to cope). The reaction depends not only on the event (which may have no adverse affect at all), but on the physical and mental condition of the person affected - so what affects one person might not affect another and what affects that person on a particular day, may not have the same affect at another time. Professional image and the personal system of values may also be severely challenged.

Critical Incident Stress reactions can be thought of as falling into four broad groups of symptoms: Psychological (e.g. guilt, anxiety); Cognitive (e.g. difficulties in concentrating or making decisions); Physical (e.g. sleeping problems, faster pulse) and Behavioural (e.g. irritability, increased alcohol consumption).

Critical Incident Stress Management (CISM) is an integrated method of providing immediate and direct intervention, to help the person affected to cope with and manage their CIS. The objectives are to:

reduce CIS reactions as quickly as possible
normalise the unusual experience and reaction
reactivate the cognitive functions and processes affected by the incident
regain the ability to work effectively as soon as possible

A CISM Peer is a member of operational staff whose role is to provide immediate short-term help in the aftermath of an incident or accident to affected colleagues. They should provide, where necessary, support and information to family members and facilitate access to further care where required. Peers have a special credibility within their own professions and are familiar with local terminology and procedures. CISM peers are not mental health professionals, but are specially trained in techniques for immediate support to colleagues, reducing the risks of long-term effects on mental health.

CISM support is multi-component and peers are trained in various techniques which they can select and apply according to their level of training and the situation. The most common methods used in ATC follow the Mitchell models:

One-on-One - a structured, short discussion with a trained peer or mental health professional; usually on site immediately following a critical incident.

Crisis Management Briefing (CMB) - used to provide facts about the event (thus controlling rumours) and giving practical, stress diminishing information about possible stress reactions, their effects and about available support; for large groups who have already experienced or are about to experience a distressing event (increases social cohesion within the group).

Defusing - for small homogeneous groups (less than 12, who have together encountered the same event), it should only be applied between 8-12 hours after the event and provided by a trained team (peers and/or mental health professionals), lasting no longer than one hour.

Debriefing/PEGS (Powerful Event Group Support) - a 7 phase structured technique provided by a trained team (peers and Mental Health Professional), between 24-72 hours after the conclusion of the critical incident, for homogeneous groups of no more than 25 people, lasting 1-3 hours, designed to moderate stress, ventilate and or normalise reactions and facilitate recovery processes to whatever is normal and to identify members within the group who might benefit from additional support or referral to other resources.

CISM processes help people to recover effectively towards some kind of normality in the immediate aftermath of events and to prevent long-term adverse psychological effects. DFS - the German Air Traffic service provider - recently carried out a study through Copenhagen University, finding a 364% return on investment following the establishment of a peer based programme.