Whether CISM is the Best Solution for Long-And Short-Term Mental Health Related Issues for Emergency Personnel
In crisis situations, community management has two populations to attend to and manage: their civilian citizens and their own employees. While a lot of emphasis has been channelled towards addressing the emotional needs of the civilians affected, emergency personnel have been left to their own means. However, CISM was conceived to cater for the emotional needs of emergency personnel in terms of traumatic stress and help them in dealing with the various work related stress. While this intervention model has for long been used to treat emergency personnel, it has attracted dissent from various stakeholders who claim it is ineffective in addressing the problem. Subsequently, various alternatives to the CISM model have been devised with the hope that they will better help in helping emergency personnel in their dealing with traumatic and highly stressful components of their occupation.
The field of emergency management is continuously expanding with 9,900 emergency managers and a projected increase of 6% between 2014 and 2024. These individuals hold a unique role during an incident with the requirement to make decisions under various levels of stress. The stress effecting emergency managers is similar in nature to the types experienced by first responders, yet this aspect is not well researched. Although the working conditions may be similar to first responders, emergency managers must deal with added pressures of coordinating complex and dynamic response efforts involving a wide range of professional actors. Moreover, emergency managers are forced to make quick decisions with limited or incomplete information. This further complicates the decision-making process, increases stress and concern about unintentional negative outcomes. The potential effects of stress causing health issues are quite real. Fortunately, there are actions to counteract and mitigate negative effects. There are many CISM techniques utilized by professionals, including inner dialogue, coping, debriefing, defusing, and pre-crisis education.
Common responses to stress in emergency workers are increased absenteeism and sick leave, decreased job satisfaction, the formulation of antagonistic work factions, and mistakes in job performance (Mitchell & Dyregrov, 1993). “Crying spells, intensifying depression, sleeplessness, sudden mood swings, angry outbursts, frustration with small tasks, a sense of helplessness, feelings of hopelessness, and other signs of emotional distress may develop after emergency service responders engage rescue operations” (p. 147). These issues are old problems, but since the terrorist attack against the United States on September 11, 2001 (9/11), more EMS workers in New York are taking leaves of absence, quitting their jobs, being reprimanded for unprofessional behaviors, and committing suicide (Dionne, 2002). Despite the high rate of psychological problems EMS workers face, many EMS agencies appear to be lacking trained mental health personnel for staff. If mental health care is available, it is often unknown to the EMS workers. The tragedy on 9/11 has created awareness of the importance of mental health issues for EMS providers and to the amounts of stress the EMS provider faces while on duty. The purpose of this study is to explore a sample of EMS providers as to the presence of Post Traumatic Stress Disorder (PTSD) symptoms, gender and training of the EMS provider, the location in which the provider works (rural area in this study), and the effectiveness of CISM/CISD on reducing these symptoms.
In short, instead of trying to prove that something does or does not work, efforts should be made to more clearly understand what interventions should be implemented for which populations and at what times and by whom. Dependent variables should be appropriate to the intervention and not mixed up with treatment dependent variables. Research should focus on what factors make an intervention more likely to succeed. We should also learn what factors are likely to detract from an intervention’s success. Once these factors are clarified, every effort should be made to train CISM team members to do the very best things that enhance the potential for successful interventions and reduce the chance of failure.
Dphil, P., Dphil, A. (2001). Critical incident stress debriefing following traumatic life experiences. Journal of Psychiatric & Mental Health Nursing, 8, 307-314.
Dionne, L. (2002). After the fall. Journal of Emergency Medical Services, 12, 37-54.
Mitchell, J., Schiller, G., Eyler, V., & Everly, G. (1999). Community crisis intervention: The Coldenham tragedy revisited. International Journal of Emergency Mental Health, 1, 227-236.