Caught off guard and "numb" from the impact of a critical incident, people are often ill-equipped to handle the chaos of such a catastrophic event such as the Manchester Arena bombing. This is equally true for those tasked with protecting the public. Consequently, survivors of such an event often struggle to regain control of their lives to regain a sense of normalcy. Additionally, many who have been traumatised by a critical life-changing event may eventually need professional attention and care for weeks, months and possibly years to come. The final extent of any traumatic event may never be known or realistically estimated in terms of loss, bereavement, mourning and grief. In the aftermath of any critical incident, psychological reactions are quite common and are quite predictable.
When I joined the Police in the early 1980's there was little or no consideration given to supporting your emotional and physical well being after a traumatic incident. Often our coping strategies were sharing experiences in the pub over a pint.
I came straight into my police service facing civil discord and rioting in London, Liverpool, Birmingham which led into many months policing the Miners Dispute.
Later as a firearms officer I became involved in life changing tragedy such as the Hungerford shootings. As the 80's progressed into the 90's following many such high profile events, the need to provide assistance to emergency services personnel involved in trauma became understood and positive movement towards intervention became available.
The development of Psychological Debriefing (PD) or “Critical Incident Stress Debriefing” (CISD), was developed and formulated for use with emergency services personnel. Essentially based on a crisis intervention model, developed by Mitchell ( “When Disaster Strikes - The Critical Incident Stress Debriefing Process” (1983) jems 36-39) the technique was further articulated and refined by Dyregrov (Dyregrov “Caring for Helpers in Disaster Situations: Psychological Debriefing” (1989) Disaster Management Vol.2, No.1, 25-30) who coined the term “Psychological Debriefing” (PD). These two terms are often used interchangeably to describe the same process.
PD represents a structured form of group crisis intervention and represents a discussion and review of the traumatic event or critical incident. The most common current model of PD is facilitated through a series of seven phases. The only differences between Mitchell and Dyregrov are that they use different terminology for some of the phases.
Defining a Critical Incident
A "critical incident" can be defined as a sudden death in the line of carrying out his or her day-to-day duties, serious injury from a shooting, a physical or psychological threat to the safety or well being of an individual, business or community regardless of the type of incident. Moreover, a critical incident can involve any situation or event faced by emergency, public safety personnel (responders) or employees that causes a distressing, dramatic or profound change or disruption in their physical (physiological) or psychological functioning.
There can and often will be unusually strong emotions attached to the event which have the potential to interfere with that person’s ability to function either at the crisis workplace scene or away from it at home (Mitchell JT. January, 1983 - When disaster strikes: The critical incident stress debriefing process. Journal of Emergency Medical Services). The closer a person is to the critical incident (at the scene, a responder, friend/family of those involved, call centre) the stronger or weaker the reaction they will have to the event.
Stages of CISD/Psychological Debriefing
Initial contact to talk and debrief typically takes 1 1/2 to 3 hours to facilitate and is usually held 2-14 days post incident. The aim of PD is also to provide education about normal and pathological reactions to traumatic events, indicate resources for further help and support if necessary and facilitate the process of psychological “closure” upon the traumatic incident. Both Mitchell and Dyregrov have always maintained it was never intended as a “stand alone” intervention or as a substitute for psychotherapy.
Research on the effectiveness of applied critical incident debriefing techniques in the workplace has demonstrated that individuals who are provided CISD within a 24-72 hour period after the initial critical incident experience less short-term and long-term crisis reactions or psychological trauma (Mitchell, 1988; Young, 1994). Subsequently, emergency service workers, rescue workers, police and fire personnel as well as the trauma survivors themselves who do not receive CISD, are at greater risk of developing many of the clinical symptoms outlined in this article (Davis, 1992; Mitchell, 1988).
So why is this important?
When applying debriefing techniques, an appropriate and effective standardised protocol must be followed when assisting emergency responders and crisis survivors of any critical incident.
As an individual who has suffered from incident trauma and having received support and care, I am now in a position to pay forward my experiences and techniques to support you and your people.
I see a big gap now in the support and care provided to event and security personal. I would like to put that right!
So, if you have been involved in a critical incident or find yourself there in the future we can support you.
Our CISD support follows the Seven Phase Model.
It should be acknowledged that you will always be affected by your experiences. Our aim will be to lead you to a new "normal" where you can move forward in a positive and grounded way.
If you would like to know more, please get in touch. Thank you for reading.
Author Post Script
There are other mothodolgires which have not been covered in this article and in use within Police organisations in the UK. Some are utilising Trauma Risk Management (TRiM) whilst others have chosen, mainly on evidence from outside of the UK, Critical Incident Stress Debriefing (CISD). Both have their merits although their approach is different. TRiM employs a "watching brief" (NICE Guidance on Post Traumatic Stress Disorders - https://www.nice.org.uk/guidance/cg26/resources/posttraumatic-stress-disorder-ptsd-the-treatment-of-ptsd-in-adults-and-children-pdf-193439629 ). Whilst CISD employs the seven steps intervention directly post incident (Mitchell, 1988; Young, 1994).
For people with Post Traumatic Stress, it is very common for their memories to be triggered by sights, sounds, smells or even feelings that they experience. These triggers can bring back memories of the trauma and can cause intense emotional and physical reactions. I have personal experience of this and know how powerful the event can be.
I sincerely hope that by highlighting this important issue, we can work together to ensure that the right steps are taken, by properly trained and skilled practitioners, at the right time to support our colleagues, friends and families.
Steve Laws Cert Ed, BA (Hons)
Director Safe and Trained