THE CRITICAL

INCIDENT STRESS
DEBRIEFING (CISD)
Important considerations and preparation
Introduction
• The Critical Incident Stress Debriefing (CISD) is the
most complex of all the Critical Incident Stress
Management (CISM) interventions.
• This is so whether the process is employed by CISM
teams in their work with emergency personnel, or
Community Response Teams(CRT) which work
with the citizens of various communities, schools
and other organizations after traumatic events.
• The CISD was originally designed to reduce stress
in emergency personnel after extremely traumatic
experiences.
• In other words, the average victims of the
traumatic experience does not have to keep up a
good “front” before his or her colleagues as a police
officer or fire fighter or other rescuer might have to
do.
• CISD is a useful tool for stress mitigation when
applied properly. The overuse of the procedure on
relatively minor events is not a proper application
of the process.
• Nor is it a proper application for organizations to
use too broadly for events that are not truly critical
incidents to nature, such as mediating
management-employee conflict or investigating
employee’s behavior. Other procedures would be
more applicable to these situations.
Debriefing Defined
• A CISD is a group process . It can best defines a group meeting or
discussion, employing both crisis intervention and educational
processes, targeted toward mitigating or resolving the
psychological distress associated with a critical incident (a
traumatic event).

• The CISD team consist of one mental health professional and one,
two or three peer support personnel when a CISD is applied to
emergency services personnel or disaster workers.
• The structure of the team often is modified when a debriefing is
applied to community groups, schools, industries or other
populations.

• In any event, traumatic stress interventions should be only be

applied to trained individuals who are familiar with both
traumatic stress and its effects on people and the broad range of
crisis intervention services available to contend with the traumatic
experience.
• The CISD has seven phases.
• The structure allows participants in the groups to discuss a
traumatic incident in a controlled manner which does not leave
them feeling out of control of themselves.
• The CISD uses some techniques common to counseling, but it is
not counseling nor psychotherapy nor a substitute for
psychotherapy.
• Stress survival techniques to manage traumatic stress are also
taught.
GOALS AND OBJECTIVES OF DEBRIEFING
• There are three main goals of a Critical Incident Stress Debriefing.
The process has been designated to:
1. Mitigate the impact of the critical incident on those who are
victims of the event, be they:
a. Primary victims, (those directly traumatized by the event)
b. Secondary victims, (emergency services personnel who witnessed or
managed the traumatic event)
c. Tertiary victims, (family, friends, and those to whom traumatic event
may be indirectly communicated)
GOALS AND OBJECTIVES OF DEBRIEFING
2. Accelerate normal recovery processes in normal people who are
experiencing normal stress reactions to abnormal traumatic events.
3. Facilitate the identification of individuals within the group who might
be in need of additional CISM services or a referral for therapy.

The core focus of CISD is the relief of stress in normal, emotionally

healthy people who have experienced traumatic events. The debriefing
has not been developed to resolve degenerative stress, psychopathologies
or personal problems which existed before the disaster or traumatic
event which is the subject of debriefing.
CRITICAL INCIDENTS
A critical incidents is defined as any event with sufficient impact to
produce significant emotional reactions in people now or later.

It is an event which is, in general, considered to be extremely

unusual in the range of ordinary human experiences. The incident
may be the foundation for POST TRAUMATIC STRESS DISORDER if
not resolved effectively and quickly.
CRITICAL INCIDENTS
• The CISD has been developed to help people cope with the most
stressful of events. It was never designed with the routine in mind.
• CISD should be applied only to those events which are
extraordinary. Overuse of the process dilute its potency and cause
it to be far less helpful on more serious events.

• If mildly distressing events occur, other types of interventions

should be applied by the CISM team or the Community Response
Team.
Table 10.1
CRITICAL INCIDENTS FOR EMERGENCY SERVICE PERSONNEL
• Line of death • Serious line of duty injury
• Suicide of an emergency worker • Police shooting
• Multi-casualty incident/ disaster • Excessive media interest
• Significant event involving children • Prolonged incident with loss
• Knowing the victim of the event • Any significant event
ASSESSING THE NEED FOR CISD
• Since CISM and CRT teams want to do debriefings only when they
are necessary, they should be careful to properly assess the need
for doing a debriefing when a traumatic incident occurs.
• The following questions and comments should be helpful in
determining if a debriefing is necessary or if some other form of
intervention would be more appropriate. The team coordinator
should use these questions as a guideline for assessment of the
situation which needs either a CISM or CRT response.
Here are the questions which can help a team
coordinator assess the need for a CISD:
1. What is the nature of the critical incident?
2. How long ago did it occur? Is the event ongoing?
3. Is the event of sufficient magnitude as to cause significant
emotional distress among those involved?
4. Does the event fit within the definition of a critical incident?
5. How many individuals are involved in the incident?
6. If more than three, think CISD? If less, perhaps a defusing or
individual consult would suffice.
7. Are there several distinct groups of people involved or is there only
one? For example, are targets of CISD operations personnel, victims,
witnesses or community members? If so, more than one CISD will be
required.
8. What is the status of involved individuals? Where are they and how
are they reacting? Some incidents may need a more immediate
defusing rather than waiting for debriefing.
9. What signs and symptoms of distress are being displayed by the
participants or the witnesses of the incident?
10. How long have the reactions or signs and symptoms of distress been
going on? Significant symptoms which have continued longer than a
few days are good sign that a debriefing may be necessary. If
symptoms of distress are going on longer than one week after the
incident, a debriefing is definitely necessary.
11. Are symptoms growing worse as time passes? Worsening
symptoms in a group may indicate a need for debriefing.
12. Is the distressed group unusually fearful or anxious?
13. Is the distressed group suffering sleep disturbance?
14. Are members of the group avoiding certain activities?
15. Has the behavior of the group changed significantly?
16. Is the group preoccupied with the death or fear of death?
17. Are members of the group suffering from mental confusion?
18. Is there anyone who seems so distressed that they may be
contemplating suicide?
19. Are any of the following key indicators of a need for debriefing
present:
- Behavioral change - regression
- Continued symptoms - intensifying symptoms
- New symptoms arising - group symptoms
20. Is the formal debriefing process necessary or a group members
requesting information on stress and stress management?
21. Is the group willing to come to the debriefing or are they being
ordered to come?
22. Are there other concurrent stressor going on?
23. Has the place and time of the debriefing been chosen?
24. Ate there any other issues which should be discussed>
 Preparing for a CISD
• When the decision to hold debriefing is made, a series of
important preparations must be made to enhance the potential
that the debriefing will run smoothly and be beneficial to the
participants. The coordinator stays busy making phone calls to
confirm each aspect of the preparations to be made.
Date and Time
• The ideal debriefing in response to acute, well defined critical
incidents takes place between 24 and 72 hours after the incident.
It is only in a are case that everything will work out so well that it
can actually be held within the 24 to 72 hour time frame, but that
is the ideal target time.
• The average time frame in which a CISD is actually provided is
about five days after the event because scheduling or other
considerations get in the way.
• The CISD will not realize its full potential unless the recipients are
psychologically receptive, or ready, for intervention.

• No one should “throw” a debriefing together without a full team of

trained CISM personnel.

• Instead a defusing will be helpful initially (as long as it is done

within about 8-12 hours) and a debriefing can be provided later if
it is still required.
PLACE

• Debriefing can take place in practically any private, quiet location.

They have been provided with the group gathered under a tree.
This is certainly not the most ideal setting, but it emphasizes the
point that a debriefing is not limited to one site or another.
• Debriefings have been held in living rooms, libraries, meeting
halls, hotel conference rooms, union halls and many other
facilities.
It is usually not possible to obtain a perfect facility, but if an ideal debriefing
room did not exist, it could be described as follows:
• Private
• Quiet
• Moveable furniture
• Well-lighted but with adjustable lights
• Suitable for the size of the ground
• A single door
• Air conditioned or heated
• Well-ventilated
• No windows which allow a view in from outside
• Available for the full length of the debriefing
• With one or more small private rooms for individual consultations
Debriefing Room Arrangement
• Having an ideal room will not be helpful to the CISD if the room is not
arranged properly. If the group is small (4-12 people) the debriefing can
be carried out in the living room of a home or a small conference room.

• Avoid placing the chairs so close that the participants grow

uncomfortable with the close proximity to one another. Enough chairs
should be in the circle to accommodate the CISD teams as well as the
participants.

• The CISD team is spaced more or less equally among the group
members.
• The door to the debriefing room should be closed, but not locked.

• A sign may be placed on the door which notifies anyone who

would come to the door that a debriefing is in progress and
personnel from the emergency organizations or the other groups
who were involved in the event are welcome to enter.

• If unwanted people show up, that peer does not permit them to
enter the room.
Figure 10.2
Figure 10.3
Figure 10.4
• They should be instructed by means of a sign to knock in order to
get into the room

• The team leader should be positioned in such a manner that the

door is not behind him or her. The management of the door is the
responsibility of the one of the peers (ssee “ doorkeeper” or role
below.)
FOOD
• Whenever possible, refreshments should be served after the
debriefing. It helps to keep those who attended the debriefing
together a little longer.
• The best types of food are those which are not likely to enhance
stress such as fresh fruits, fruit juices and the like.

• Having some refreshments available is better than not having at

all.

• All food arrangement must be made in advance of the debriefing.

Incident Review
• CISM team members who are going to provide the CISD arrive at
the site of the debriefing about an hour before the debriefing
starts.

• The more a team knows about the incident before starting the
debriefing, the better they will be able to do their job.
TEAM MEMBER DEBRIEFING ROLES
• The CISM team must perform numerous functions during and
after the CISD. No person can perform all the functions single-
handedly and expect to do an excellent job with all of them. The
tasks of the debriefing must be divided up among the team
members. Peer support and mental health professionals need to
blend their talents and abilities for the benefit of the entire group.
TEAM LEADER
• The team leader is the person who is assigned to be primarily
leader in the group.

• A CISD should have pone primary leader to avoid confusing the

participants.

• The team leader’s role is to use his or her communication skills to

tactfully invite and encourage the group participants discuss the
traumatic event.

• The team leader starts the questions for each segment of the CISD.
TEAM LEADER
• Whether he or she is in the term leader role, needs to keep a careful eye on
the overall psychological well-being of the group and especially on any one in
the group who may ne experiencing more distress than the others.

• The team leader should be very involved in the teaching aspects of the
debriefing and attempt to help people clarify their own perspectives of the
incident.

• The team leader frequently has to weave the various aspects of the group
experience into a coordinated patterns so that people can recognize their
own part of the experience as a part of a bigger picture.

• Good team leaders develop their skills over time and with a variety if
experiences.
CO-LEADER
• If the debriefing is with the emergency services professions, the co-
leader is one of the peers.

• The co-leader’s main role is to share and support the leadership of the
group with the team leader.

• The co-leader will bring up-any items in the introductory remarks

which the team leader did not mention and will add several important
comments of his or her own.

• The co-leader watches the group members for signs of distress and
questions, clarifies and makes statements whenever appropriate.
CO-LEADER
• The co-leader plays a significant role in the teaching phase of the
debriefing.

• The co-leader usually has a considerable role in providing for

follow-up contacts.

• The co-leader assigns specific follow up tasks to appropriate CISD

team members.
DOORKEEPER
• The doorkeeper has a key role in debriefing. The doorkeeper will
prevent any unauthorized or inappropriate individuals for the entering
the room where the debriefing is taking place.

• The doorkeeper has another vital role. If someone leaves the debriefing,
it is the doorkeeper's job to go out after that person and encourage that
person to return.

• The doorkeeper simply has to remind the person to come back into the
debriefing as soon as possible.

• It is very important to encourage the person to return to the debriefing

as soon as possible.