Keeping stress under control: occupational health consultant Bev Cornish offers an overview of the recent work done in the management of critical incident stress.(Operational Assurance)(Report)


Management is a major occupational issue for the Fire and Rescue Service. It is necessary to have policies and procedures in place to manage, record, measure and evaluate critical incident stress--and the evaluation and measurement is crucial. Measurement provides essential statistical evidence of effective policy and procedure function. We cannot manage what we have not measured--that is to say, we need to know the size of an issue in order to resource its management.

With the theme of measurement and management in mind, this article discusses a snapshot of the current research literature and what it reveals about the known effectiveness and value of Critical Incident Stress Management (CISM).

For clarity (as there is confusion surrounding some terms relating to CISM), and to set the scene, the article covers a brief history, with definitions as well as the terminology of CISM. Additionally, information from the literature about the NICE guidelines is considered along with interesting legal considerations that the literature has brought forward.

Copious literature has been reviewed from a number of sources--too many to mention in this article. Therefore a snapshot of representative literature has been used to put this article together, with three pieces of research literature reflecting what views were found in the wider literature.

The key points summarised from the literature indicate why it is essential for fire and rescue services to review, measure and evaluate regularly all aspects of Critical Incident Stress Management. They also give an idea of where we are now.

What is Critical Incident Stress Management?

Critical Incident Stress Management is a comprehensive range of multi-component, crisis interventions. The beginnings of CISM can be seen in the emergency service professions dating back to the late 1970s, and it is developing into an international 'standard of care' in organisations, education institutes, and communities unrelated to the emergency services. Dyregrov (1997) identified that training, skills and the leadership style of the group leader can have a significant positive effect on a team. If the team is prepared in a holistic way, the impact of the trauma on it may be reduced. Management of a critical event from its beginning to its end is a major element in Critical Incident Stress Management process, as the development work of Everly and Mitchell (1999) of CISM and CIS Debriefing has illustrated. The literature reveals that as crisis intervention is a generic term, CISM specifically represents a sub-specialty within behavioural health. CISM is not psychotherapy, or a substitute for it; it is a form of psychological 'first aid'. Only those with specific and adequate training can apply CISM. Further Information and Resources The International Critical Incident Stress Foundation, Inc (ICISF), on their web page, sums up the work of the foundation: 'The International Critical Incident Stress Foundation, Inc is a non-profit, open membership foundation dedicated to the prevention and mitigation of disabling stress through the provision of--education, training and support services for all emergency services professions; continuing education and training in the emergency mental health services for the mental health community; and consultation in the establishment of crisis and disaster response programmes for varied organisations and communities worldwide'. …

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