Cisd and Ems

Critical incident stress debriefing is as an intervention by a trained team. Modeled upon guidelines formulated by psychologist Jeffrey T. Mitchell, Ph.D., to help emergency workers, CISD is one component of Critical incident stress management (Mitchell & Everly, p. 82.) The CISD protocol is "an intervention expressly designed to mitigate posttraumatic stress and prevent the disabling posttraumatic stress disorder" (p. 280). Mitchell, who served as a firefighter/paramedic for nearly a decade (Mitchell & Bray, p. 280), is credited as the creator of CISD in the early 1980's to meet the needs of first responders to emergencies, including paramedics and ambulance workers.

Emergency Service Worker's (ESW's) can experience excitement from saving property from destruction and the ultimate satisfaction of saving a life, but the exhilaration and thrills can come to a halt when ESW's are faced with an occupational hazard called Critical Incident Stress (CIS). (Mitchell, p.86). A critical incident does not have to be a major disaster, but is any situation faced by Emergency Service Worker's (ESW) that causes them to experience strange reactions which may have the potential to interfere in their performance of duties either at the scene or later. Every year there is a high turnover of ESW's, i.e. police, ambulance, fire brigade, ems, and volunteer organization's because of CIS.

It would be stupid to believe that ESW's can walk amongst broken bones, burning bodies, handle body parts, assist with the distraught survivor's and view terrible destruction without being affected in some way by such graphic exposures. People suffering this experience physical, emotional and cognitive effects. (Mitchell, p.86). CIS reaction's are incident specific, they may be either acute or delayed.

An acute CIS reaction begins while the ESW is engaged with on scene operations. It is an incident that is often very disturbing for ESW's and may become physically ill as a result of the intense stress level associated with the event. (Alexander, p. 77). Under particularly stressing circumstances some may be unable to function properly at the scene or at a later date. This happens, for example, in the case of a death of a fellow worker in the line of duty and cannot return to his normal duties. CIS at times can be so powerful as to cause mental and emotional breakdown in extreme case's death. (Mitchell, p.83).

The most common cognitive or mental symptom's of an acute stress reaction are impaired thinking and decision making, poor concentration and confusion, memory problem's, flashback's of previous scene's and poor attention spans. (Mitchell, p.81). The emotional reactions to an acute stress situation include anxiety and fear, grief and depression, feeling lost and abandoned, withdrawal from other's anger and resentment, feeling numb, shocked, and overwhelmed. (Mitchell, p.81). The signs and symptoms of a stress reaction may last a few days to as long as a few months and occasionally longer depending on the traumatic event. Occasionally the traumatic event is so painful that professional assistance from a counselor may be necessary.

Delayed Response Syndrome (DRS) may begin minutes, hours, days, or even week's and in some circumstances years after the incident. (Mitchell, p.81). The ESW's that are involved in critical incidents may experience a variety of symptoms which are similar to an acute reaction. The most common cognitive or mental symptoms are increased anxiety, depression and irritability. These symptoms are characteristic of a condition called Delayed Stress Response Syndrome (DSRS). It's not uncommon for ESW's to experience sleep disturbances, changes in eating habits and loss of emotional control. (Mitchell, p. 81). There are 3 main factors of DSRS: intrusive mental images such as dreams, nightmares, and flashbacks. These may be exact representations of the event or maybe completely altered by mental images developed in the workers mind, fear of repetition of the event. The fear can be fantasized or real, but it remains powerful and often causes ESW's to avoid activities associated with the event. (Mitchell, p.83). Physical

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