A bus loaded with families is traveling on the interstate headed to a ski resort. The weather is marginal with low temperatures. Freezing rain begins to fall. Suddenly, cars and trucks on the highway begin to swerve and skid. Cars hit the guardrail and trucks crash into the cars. The bus skids on the black ice, hitting a car and then the guardrail. As the bus slowly comes to a stop, it’s broadsided by a truck and flipped onto its side. There are 25 vehicles involved, several fatalities and numerous injured, including children.
Your service was one of the agencies that responded. Three of your crews and a supervisor were involved in rescues and the care and treatment of the people on the bus. Two children and one adult on the bus were killed in the crash, and three children and five adults were severely injured. Your responding crews and your supervisor did great work; they participated in extrication, triage and the movement of patients, and initiated appropriate care.
The incident is over and your crews and supervisor have returned to the station. What you do for them next and over the following days, weeks, months and years may be critical to their wellbeing.
Does your agency have a plan to assist, monitor and provide support and, if necessary, treatment for employees who’ve been exposed to potentially traumatic events (PTE)? Many organizations have “employee assistance programs,” critical incident stress debriefing (CISD) teams, or critical incident stress management (CISM) programs. It’s important for you as a supervisor, manager or leader to be aware of the available resources and how to access them. It’s also important for managers and leaders to regularly assess available resources and evaluate them for effectiveness as reported in the literature, and to ensure the organization is doing its best to serve employees’ psychological needs.
There’s ongoing controversy surrounding CISD and CISM; some of the literature suggests there’s no evidence it’s of any benefit in helping people to deal with exposure to PTE, and some even suggest that psychological debriefings makes things worse.
The following statements represent the outcomes, conclusions and recommendations of available studies and meta-analyses:
- “There is no evidence that single session individual psychological debriefing is a useful treatment for the prevention of post-traumatic stress disorder (PTSD) after traumatic incidents. Compulsory debriefing of victims of trauma should cease. A more appropriate response could involve a ‘screen and treat’ model.”1
- “There’s growing consensus that early intervention for trauma, generically called psychological debriefing (PD), does not prevent subsequent psychopathology. Further, there is evidence that PD may exacerbate subsequent symptoms.”2
- “Despite the limitations of the existing literature base, several meta-analyses and randomized controlled trials found CISM to be ineffective in preventing PTSD. Several studies found possible iatrogenic worsening stress-related symptoms in persons who received CISM. Because of this, CISM should be curtailed or utilized only with extreme caution in emergency services until additional high-quality studies can verify its effectiveness and provide mechanisms to limit paradoxical outcomes. It should never be a mandatory intervention.”3
Leaders and managers should evaluate the programs in place and do their best to ensure their agencies are providing evidence-based care. Consider partnering with mental health professionals to ensure we’re helping and not doing harm. There are alternatives to explore.
A program available from the National Child Traumatic Stress Network and the National Center for PTSD is Psychological First Aid. Their website (www.nctsn.org/content/psychological-first-aid) says, “Psychological First Aid is an evidence-informed approach for assisting children, adolescents, adults, and families in the aftermath of disaster and terrorism.” You can download manuals and resources, including “a 6-hour interactive course that puts the participant in the role of a provider in a post-disaster scene.”
Another program that’s available is Stress First Aid offered by the National Fallen Firefighters Foundation. Its website (www.everyonegoeshome.com) says, “Stress First Aid is designed to reduce the risk for stress reactions in fire and rescue personnel.”
You can also access material that addresses job-related stress at the National Institute for Occupational Safety and Health website, “STRESS…At Work” at www.cdc.gov/niosh/docs/99-101/.
We all know the job we do is stressful. The scenes we see can be horrific, our daily work can be demanding and exceptionally taxing, and we’re exposed to PTE and chronic stress. As managers and leaders, we have an obligation to those we serve, to our coworkers, our organizations, and to ourselves to be prepared to seek out and provide the most appropriate resources to help people cope with the traumas and stressors that are part of the work we do.
1. Bisson J, Churchill R, Rose SC, et al. (2009). Psychological debriefing for preventing post traumatic stress disorder (PTSD). The Cochrane Collaboration. Retrieved July 1, 2013, from www.bibliotecacochrane.com/pdf/CD000560.pdf.
2. Adler A, Gray M, Litz B. Early intervention for trauma: Current status and future directions. Clinical Psychology: Science and Practice. 2002;9(2):112–134.
3. Bledsoe BE. Critical incident stress management (CISM): Benefit or risk for emergency services? Prehosp Emerg Care. 2003;7(2):272–279.