What Is Critical Incident Stress Management?

Critical incident stress management (CISM) is a type of structured crisis intervention used to support people who have experienced traumatic events. Interventions include education, prevention, and mitigation techniques implemented to reduce stress and prevent longer-lasting mental health issues, such as PTSD.

These interventions most commonly occur at a workplace, school, institution, or within a community after a natural disaster or tragedy. CISM is not a type of psychotherapy, and is usually carried out by people trained in crisis management.

What Are Critical Incidents?

To better understand what CISM is, it can be helpful to be aware of the types of incidents that may trigger the use of an intervention like CISM. Critical incidents are events that may quickly overwhelm a person or a group of people. The events are usually unexpected and may be traumatic.

Some examples of critical incidents include:

• Being witness to any type of mass casualty event
• Severe injury or loss of someone you worked with
• Losing a co-worker to suicide
• Being in a situation where your life was in peril
• Losing a patient you were trying to help
• Losing someone you were trying to rescue
• Being part of an event that was covered widely in media, often with sensationalism

Often, CISM teams are called when there is a natural disaster, a homicide, a suicide, a mass shooting, or a major car accident. Crisis teams often work with people on the front lines of disaster or traumatic events, such as firefighters, law enforcement, or emergency medical services. But they also may work with schools, communities, or other industries affected by a critical incident event.

What Is Critical Incident Stress?

People who experience a critical incident usually have an intense emotional reaction, and one of the primary purposes of CISM is to help people work through the feelings they may be experiencing in the early aftermath of the event. Most types of critical incident stress occur for an average of 2-4 weeks.

Critical incident stress can include physical, mental, and emotional components. Some of the signs and symptoms of critical incident stress include:

• Exhaustion
• Inability to concentrate
• Sadness and grief
• Guilt
• Trouble sleeping and nightmares
• Feeling uncertain
• Feeling fearful
• Headache and dizziness
• Trouble making decisions
• Feeling heightened anger
• Feeling confused
• Feeling on edge
• Feeling depressed or numb
• Wanting to socialize less
• Changes in appetite
• Increased use of alcohol or drugs

It’s important to understand that not everyone reacts the same way to a traumatic event. Some people don’t react right away, and different people may have completely different reactions to the same event. That’s normal and to be expected.

What Does Critical Incident Stress Management Involve?

Critical stress management involves various different programs, interventions, and protocols designed to help people recover from traumatic events at work, school, and elsewhere. These may include education, support groups, disaster relief, and preparedness, and community outreach events.

Some of the protocols used in critical stress management may include the following.

Crisis Management Briefings

Crisis management briefings are informational events that take place within a community or organization. They provide details regarding the traumatic incident, such as what is being done to address stress, and what resources are available to help people.

Any falsehoods or rumors about the event may be addressed at this time, and questions may be fielded. Crisis management briefings may take place at workplaces, schools, religious organizations, and within neighborhoods and communities.

Critical Incident Stress Debriefing

Critical incident stress debriefing (CISD) is a tool used to help people process the traumatic event. CISD consists of seven sequential steps focused on managing stress and trauma. CISD usually occurs within the first 72 hours after the event, and the crisis team identify people who might need further support, such as psychotherapy.

Rest Information Transition Services (RITS)

RITS refers to support services that may be set up near where the traumatic incident took place. Support centers are likely to offer food, shelter, counseling, necessary supplies, and resting/sleeping accommodations for people who need it.

Individual Support

Many people need one-on-one support after a traumatic event. This may include peer support, support from religious clergy, or basic counseling services from crisis experts. Referrals may be made for people who need extra mental health support, such as psychotherapy or psychiatric help.

Impact of Critical Incident Stress Management

The effectiveness of critical incident stress management is something that’s been debated on an ongoing basis. Although some experts believe it can be helpful, it has a fair number of critics, especially those who feel CISM doesn’t do enough to help people deal with potential psychological conditions that can occur after trauma, such as post-traumatic stress disorder (PSTD).

A 2021-review of the data published in the International Review of Psychiatry found that crisis intervention that occurs in the acute phase of a disaster or catastrophic event can be helpful and effective. The most effective type of crisis interventions are ones that offer assistance that’s “simple, brief, immediate, practical, and innovative,” according to the study authors. Additionally, any mental health services must include varied, integrated, and robust care and support.

Efficacy of CISM

Some studies have found issues with CISM. For example, a 2019 study published in the International Journal of Nursing Student Scholarship found that although medical staff usually view CISM as helpful, there isn’t enough evidence to show that it works successfully. This may be because of insufficient adherence to CISM protocols and lack of training.

An older review from 2003 published in Prehospital Emergency Care found that CISM is not effective enough at preventing the future development of PTSD among CISM participants. In fact, there may be evidence that CISM exacerbates stress in people who participate in it, according to the study.

A Word From Verywell

Critical incident stress management can be helpful in the initial management of crises and traumatic events. But some people need more support or ongoing support. If you are experiencing continual stress, anxiety, agitation, or depression in the weeks and months following a difficult event, please reach out to your healthcare provider or a licensed therapist for support.