Central Shenandoah
Critical Incident Stress Management Team
Guidelines and Protocols
Serving
Emergency Services Providers in:
Buena
Vista,
Central Shenandoah
Critical Incident Stress Management
The
Central Shenandoah Critical Incident Stress Management Team provides services
to community Emergency Services Workers, including police, Fire and Rescue
(EMS) personnel. The overall goal of the Team is promoting staff health, mental
health and retention. Prevention of critical incident stress reactions and
cumulative stress difficulties, along with the reduction in frequency,
intensity and duration of stress-related problems are the Team’s objectives.
Central Shenandoah
Critical
Incident Stress Management Team
Memorandum
of Understanding
I,
___________________________________________ do hereby agree to serve as a
volunteer on the Central Shenandoah EMS Council Critical Incident Stress
Management Team. As a volunteer member of this group, I agree to the following:
1.
Successfully complete Virginia CISM, ICISF CISM or
equivalent training program.
2.
To assist with the training of fire, rescue and police
departments.
3.
To participate in meetings as scheduled by the team as
possible.
4.
To complete the required reports as indicated as either
mental health or peer debriefers and submit these to the Administrative
Coordinator within two weeks of the debriefing.
5.
To maintain strict confidentiality regarding any and all
debriefings held and not divulge any information regarding incidents,
locations, personnel involved or other aspects of the debriefings except to the
Team Clinical Coordinator or within the confines of Team meetings and then
still not relating names.
6.
To coordinate emergency services stress management and Team
public education activities with the Team prior to implementation with sufficient
lead time in order to enhance communication and avoid duplication of services.
7.
To maintain professional liability insurance (mental health
team members).
8.
To assist as requested in research related to the program.
9.
To read and abides by all requirements set forth in the
Team protocols and procedures.
I fully understand that any breach in
confidentiality/professional code of ethics regarding any debriefings and/or
performance of activities deemed to be in direct conflict of interest with the
CISM program or the Team operations will result in immediate removal from the
I agree to voluntarily resign from this
team at such time when personal and/or professional commitments do not permit
compliance with all aspects of the memorandum.
Signed: _________________________________________________________
Date: ___________________
Table of Contents
Purpose
Background
Definitions
Procedures
Notification
Request for On-Site Response or
Immediate Defusing
Request for Debriefing
Categories
of Debriefings
On-Site Management and Debriefing
Formal Debriefing
Follow-up Debriefing
Individual Debriefing
Team
Member Job Descriptions
Clinical Coordinator
Administrative Coordinator
Mental Health Debriefer
Associate Mental Health Debriefer
Peer Debriefer
On Call CISM Team Member
Application
Process
Purpose: The following material are
procedures and guidelines outlining the intent and process to make available to
Emergency Response Personnel in a critical incident a means to reduce the
emotional and mental anguish associated with the abnormally stressful event.
Background: Studies have shown that rescue
personnel can have stress reactions to incidents involving horrific scenes,
numerous casualties, or high threat. Most personnel are very resilient and
bounce back after going through some temporary negative reactions. In fact, many deal with these challenging
situations in very positive ways by carrying out their mission with courage,
compassion and hope. However, in spite
of their best efforts, a small percentage may experience long-term detrimental
effects, such as declining work performance, deterioration of family
relationships, illness, and psychological problems. The purpose of an
intervention is to promote a positive resolution to a critical incident. Our
goal is to help rescue personnel to come together, support one another, and
explore how they can take better care of themselves during one of these
troubling times.
Definitions: Debriefing: A confidential psycho-educational
process designed to accelerate normal recovery from a stressful experience.
Defusing: A defusing can be held
immediately following a critical incident. This is a time when crew members
involved in an incident can meet with a
Critical Incident: Is defined by
Dr. Jeff Mitchell as, “Any situation faced by emergency service personnel that
causes them to experience unusually strong emotional reactions which have the
potential to interfere with their ability to function either at the scene or
later… All that is necessary is that the
incident, regardless of type, generates unusually strong feelings in the
emergency worker.”
Debriefing Team: The Central
Shenandoah EMS Council Critical Incident Stress Management Team is composed of
a group of individuals who represent many agencies. The team members consist of
mental health professionals, nurses, EMT’s, chaplains, administrators,
firefighters, police, etc. who have received formal training. Team members are
selected on the basis of an application and an interview.
If
a formal debriefing is needed, at least one peer debriefer and one mental
health professional will conduct the debriefing.
Procedure: Critical
Incident Assessment: Any
incident faced by emergency response personnel that causes them to experience
unusually strong emotional involvement may qualify for “Critical Incident
Stress Debriefing.” The following are examples of incidents that may be
selected for debriefing:
1. Serious injury or death of an
emergency personnel working at an incident, enroute to an incident, or any
other operations (i.e. training). *
2.
Mass casualty incidents. *
3. Suicide of a crew member. *
4. Serious injury or death of a
civilian resulting from emergency operations (i.e. ambulance accident), etc.
5. Death of a child, or violence to a
child.
6. Loss of life of a patient following
extraordinary and prolonged expenditure of physical and emotional energy during
rescue efforts by emergency personnel.
7. Incidents that attract extremely
unusual or critical news media coverage.
8. Any incident that is charged with
profound emotion.
9. An incident in which circumstances
were so unusual or the sights and sounds so distressing as to produce a high
level of immediate or delayed emotional reaction.
* - Indicates high priority for minimizing personnel
exposure at the scene.
Notification: As soon as possible after
identification for the potential need of a debriefing, the
CISM should be notified. The
mechanism for notification is listed below. The Team
relies on the “Eyes and Ears” of
personnel in the field for notification. Eyes and Ears refer to personnel who are aware of CISM services
available and who are alert to critical
incident events.
Changed
the request for notification to include both Augusta EOC and Harrisonburg Radio
1.0 Request or Notification:
1.1
Field personnel in
1.2
Field Personnel in
1.3
Other regional Emergency Operations Centers through
which there has been a CISM request should obtain the information in section
2.0 and contact
1.4
All Emergency Operations Centers should
automatically notify the CISM Team for each of the following:
a.
Pediatric trauma resulting in death
b.
Line of duty death or severe injury of squad member,
firefighter or Police officer
c. Suicide or unexpected death of squad
member, firefighter or police officer
d.
An
accident involving an ambulance, fire apparatus or police
vehicle resulting in injury
e.
Serious injury or death of
a civilian resulting from emergency operations
f.
A mass casualty incident
g.
Prolonged events > 90 minutes
h.
Any event in which a dispatcher or officer has
concerns for the mental health of providers
i.
Any person calling and requesting CISM services
2.0 Obtaining Information:
2.1
The
a.
Name of person to call
b.
Agency name
c.
Phone number(s) w/area code(s) to call the
individual back
d.
Tell them a CISM Team Member will call them back
within 30 - 45 minutes
2.2
If the Emergency Operations Center is just notifying about an incident without an
actual request or message of a potential defusing, debriefing or on-scene
request; the information can be snap paged to the On Call CISM Team Member.
3.0 Notification Procedure:
3.1
The
*
CISM team member on call should return page/phone call within 10 minutes
IF NOT
*Re-page/
Re-alert the CISM team member on call; IF
NO response again after 10 minutes
Continue to contact the On Call CISM
Team Member on call and also alert two other CISM on call members in order down
the call list
Changed the notification procedure to start
calling 2 additional on call members if the original one can’t be reached in 10
minutes.
3.2
Once a CISM team member on call has been contacted, The
Emergency Operations Center will give
the information obtained in section 2.1 or 2.2.
4.0 Other Information:
4.1
The Administrative Coordinator will notify all
Emergency Operations Centers of any on-call changes or changes to the
notification procedure via telephone and/or memo.
4.2
In case of some strange or unusual circumstances
where the
Categories of Debriefings
The debriefing process provides an opportunity for
personnel to discuss their feelings and reactions in order to reduce stress
resulting from exposure to critical incidents. A debriefing is not a
critique of department operations at the incident, nor will performance de
discussed, except as appropriate to the debriefing.
Debriefings are usually conducted in small groups of not
more than 25 people; however, they may also occur on an individual basis. All
debriefings will be strictly confidential.
The type of debriefing conducted depends upon the
circumstances of a particular incident and the needs assessed. The following is
a listing of the debriefings most commonly utilized, singularly or in
combination:
On-Site Management
and Debriefing: Minimizing personnel exposure to
these stressful incidents produces fewer stress-related problems. The CISM Team
recommends that Command should reduce this exposure by rotating personnel and
by removing initial personnel from the scene as soon as possible.
Any personnel directly involved in incident examples 1
through 4 listed previously, should be considered high priority for immediate
removal from the scenes. Relief from duty for the balance of the shift is also
highly recommended for these personnel. Debriefings for these events should
always be offered.
On-site evaluation and counseling by a debriefing team
member should also be considered for some critical incidents when time and
circumstances permit. In such situations, debriefing team members can observe,
watch for acute reactions, provide support, encouragement, and consultation and
be available to help resting personnel deal with stress reactions. Team members
should be considered a resource available to incident command for assignment to
staging, rest area or other sectors as needed.
Team members asked to report to an incident must report to
the command located near the incident first. Team members should not allow
themselves to become directly involved in the incident but should be observing
all others involved in the incident including the command officers.
Team members reporting to the scene of an incident should
be able to produce appropriate identification, identifying themselves as
members of the CISM Team.
Team members should not report to an incident unless
requested to do so by the Clinical Coordinator, Administrative Coordinator,
Senior Peer Debriefer, or the Command Officers at the scene.
Initial Defusing: A
defusing, which is conducted shortly after the incident, is a spontaneous,
non-evaluated discussion often with no designated leader. It is primarily
informational, often including an update and status report on the incident and
related injuries.
Formal Debriefing:
This debriefing is usually conducted within 48 – 72 hours after a
critical incident. It is confidential, non-evaluation discussion about
involvement in the incident, thoughts and feelings, and stress reactions. All
personnel involved in the incident (i.e. police, fire, rescue, dispatchers,
etc) are invited and encouraged to attend. Debriefings are conducted anywhere
that provides ample space, privacy, and freedom from distractions. Selection of
the site will be determined by the On Call CISM Team Member or other designated
team member
The person requesting the debriefing should be contacted
and told:
a. Encourage all involved personnel to
attend
b. Attendance is not mandatory
c. A debriefing requires honest and
open communication
d. A debriefing is confidential
e. Please arrive on time
f.
Expect
to stay through the entire debriefing
Follow-up
Debriefing:
This informal debriefing, which occurs weeks or months after the incident, is
concerned with delayed or prolonged stress reactions.
Individual
Consultation:
Peer debriefers will contact the Clinical Coordinator when having received a
request for an individual debriefing. The Clinical Coordinator will then make
recommendations and referrals as needed.
Team Member Job Descriptions
Clinical Coordinator:
1. The Clinical Coordinator must be
mental health professional who has received Virginia CISM, ICISF CISM, or
equivalent CISM training.
2. The Clinical Coordinator or
designee will be responsible for finding all mental health debriefers and
coordinating with the Senior Peer Debriefer as needed.
3. The Clinical Coordinator is
responsible for reviewing all applications for Team Membership and make
recommendations for approval or disapproval of the applicant.
4. The Clinical Coordinator must
comply with the Central Shenandoah EMS Council CISM Team’s Memorandum of
Understanding.
Administrative
Coordinator:
1. The Administrative Coordinator may
be a non-mental health professional but should have received Virginia CISM,
ICISF CISM, or equivalent CISM training.
2. The Administrative Coordinator
shall be responsible for maintaining all Team records, updated mailing and
telephone listings, updated guidelines and protocols, minutes, etc.
3. The Administrative Coordinator is
responsible for notifying Team members about upcoming meetings.
4. The Administrative Coordinator will
prepare meeting agendas and conduct Team meetings.
5. The Administrative Coordinator must
comply with the Central Shenandoah EMS Council CISM Team’s Memorandum of
Understanding.
Mental Health
Debriefers:
1. Mental Health Debriefers shall
consist of individuals who have a minimum of a Master’s Degree in a mental
health field.
2. Mental health Debriefers shall have
received Virginia CISM, ICISF CISM, or equivalent CISM training before
participating as a Team member.
3. The Mental Health Debriefers after
observing, then assisting with a debriefing may then lead a formal debriefing
when requested to do so by the On Call CISM Team Member.
4. Mental Health Debriefers must
comply with the Central Shenandoah EMS Council
Associate Mental
Health Debriefers:
1. Associate Mental Health Debriefers
shall consist of individuals who do not have a Master’s Degree in a mental health
field.
2. Associate Mental Health Debriefers
should have a minimum of three years of mental health service, delivery
experience, and should currently provide Clinical Services to clients in a
mental health setting. –Or- be currently pursuing a master’s degree
in a mental health field.
3. All Associate Mental Health
Debriefers shall have received Virginia CISM, ICISF CISM or equivalent training
before participating as a Team member.
4. The Associate Mental Health
Debriefers, after observing, then assisting with a debriefing, may then co-lead
a debriefing, under the supervision of a Mental Health Debriefer.
5. All functions/assignments of the
Associate Mental Health Debriefer are determined by the Clinical Coordinator.
6. Associate Mental Health Debriefers
must comply with the Central Shenandoah EMS Council CISM Team’s Memorandum of
Understanding.
Peer Debriefers:
1. Peer Debriefers shall consist of
individuals who do not have a minimum of a Master’s Degree in mental health
(i.e. rescue squad member, firefighter, police officer, minister, RN, etc.).
2. All Peer Debriefers should have
received Virginia CISM, ICISF CISM, or equivalent training before participating
as a Team member.
3. The Peer Debriefer is responsible
for working with the Mental Health professionals during a formal debriefing or
an on-scene Team function.
4. The Peer is the “eyes and ears” for
the agency’s personnel after response to critical incidents. The Peer Debriefer
should contact their designated
5. All functions of the Peer Debriefer
during a defusing, formal debriefing or an on-scene debriefing are coordinated
and directed by the Mental Health Debriefer.
6. At no time will a Peer Debriefer
lead a formal debriefing.
7. Peer Debriefers must comply with
the Central Shenandoah EMS Council CISM Team’s Memorandum of Understanding.
On Call CISM Team Member:
1. The On Call CISM Team Member must be an active Mental Health
Debriefer, Associate Mental Health Debriefer, or Peer Debriefer.
2. The On Call CISM Team Member must maintain an up to date call
list for the CSEMSC CISM Team
3. The On Call CISM Team Member must participate with the CSEMSC
CISM Team on call rotations
4. Once contacted by the
a. Organizing an appropriate CISM team
for a defusing or debriefing
b. Notifying the requesting
agency/contact person about the date, time and place of a defusing or debriefing.
c. The On Call CISM Team Member must
also make sure all involved agencies involved in the critical incident are
notified that a formal debriefing is going to be held.
Any
deviations or waivers of these job descriptions must receive approval of the
Clinical Coordinator.
Application Process