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Crisis intervention psychotherapy (CIP) is an underutilized form of therapy that can be offered as a treatment during psychiatric disasters and emergencies, and it may be especially useful during the age of Coronavirus Disease 2019 (COVID-19). CIP is a problem-solving, solution-focused, trauma-informed treatment, utilizing an individual or systemic/family-centered approach. CIP is a brief form of psychotherapy delivered as a companion or follow-up to psychological first aid. Crisis psychotherapy is designed to resolve a crisis and restore daily functioning. CIP can be adapted as a single session for a COVID-19 mental health emergency or for a hotline or as 2 to 20 sessions of treatment with COVID-19 patients and families offered virtually on a psychiatric inpatient unit, through a consultation-liaison service, or in outpatient settings. This article reviews the history of critical incident stress management and the use of its replacement, psychological first aid. The history and core principles of crisis psychotherapy and 8 core elements of treatment are described. The use of digital and virtual technology has enabled the delivery of crisis psychotherapy during the COVID-19 pandemic. A case study of a family impacted by COVID-19 is reported as an illustration. The use of a 6-week timeline, an ecological map, and a problem-solving wheel-and-spoke treatment plan are demonstrated.

ObjectiveCritical incident stress management (CISM) teams can be adapted in urban primary care clinics to address and process traumatic events in primary care. A guide for implementing the CISM team model within this setting is delineated.MethodsReview of existing literature and guide to implementation of CISM team in primary care.ResultsRespondents reported the team validated their reactions to the critical incident and were grateful for CISM presence.ConclusionDespite indications that vicarious traumatization, burnout, and compassion fatigue are rising (Bodenheimer & Sinsky, 2014; Coles et al., 2013; Woolhouse et al., 2012), there is little information about efforts to address this. Operating and emergency rooms and intensive care units utilize CISM (Maloney 2012; Powers, 2015); however, it's overlooked in primary care (Blacklock, 2012; Naish et al., 2002).

First responders may be exposed to intensely traumatic incidents, with the potential to result in adverse psychological and physiological reactions. Peer support programs have been employed to mitigate these potential effects. Critical Incident Stress Management (CISM) has been widely employed as a means of responding to emergency services’ stress responses. This incorporates the use of “Critical Incident Stress Debriefing” (CISD), a technique in which a facilitator helps the rescuer talk about their feelings regarding the incident. Inherent in CISD, psychological debriefing has been described as a brief crisis intervention usually administered within days of a traumatic event. Controversy has arisen over the use of psychological debriefing as a safe and effective tool for peer support. Organizations may be exposed to liability when offering “a practice that is not supported by the preponderance of the available scientific evidence.” Psychological First Aid has been described as an alternative modality, broadly endorsed by expert consensus, which can be readily learned and employed by peer support teams. “Listen, Protect, Connect” is an easy-to-remember means to summarize and approach the concept of Psychological First Aid.

© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Relative to the general population, public safety personnel (PSP) appear at an increased risk of developing mental health challenges as a result of repeated exposure to potentially psychologically traumatic events (PPTEs). To help mitigate the impact of PPTEs on PSP mental health, many PSP agencies have implemented diverse peer support despite limited empirical evidence. The current study was designed to expand the empirical evidence surrounding peer support by investigating one of the most widely used and structured peer support resources: Critical Incident Stress Management (CISM). Specifically, the current study with integrated firefighters and paramedics assessed (a) the prevalence of mental disorders; (b) perceptions of high fidelity CISM peer support; and (c) the comparative associations of CISM with high fidelity (n = 91) versus unknown fidelity (n = 60) versus no CISM (n = 64) and mental health. Results indicated that (a) mental disorders are prevalent among PSP irrespective of gender, age, and years of service; (b) participants perceived CISM peer support as offering beneficial and valuable tools (e.g., skills and coping strategies); and (c) high fidelity CISM environments offer some mental health benefits to individuals who screen positive for alcohol use disorder and generalized anxiety disorder. Overall, the current study offers novel information that can inform future directions for evidence-based peer support and policy decisions designed to support the mental health of PSP. This research was funded by an Occupational Health and Safety (OHS) Futures Grant (#095244776) as awarded by the Alberta Government. Faculty yes

This article demonstrates how good communication sets the foundation to provide superior comprehensive care during the stressful time surrounding end of life. Communication addressing end-of-life care in veterinary medicine has significant impact on all involved: the patient, the client, the health care team, and the practice. These conversations require training and practice to achieve mutually satisfying outcomes. Suggested guides for facilitating these conversations and several typical scenarios are presented to provide methods for future evidenced-based evaluation in effective communication. The Critical Incident Stress Management is presented as a model for mitigation of adverse consequences related to traumatic events in veterinary practice.

Objective:The most common crisis intervention used with German rescue workers is Critical Incident Stress Management (CISM). Results regarding its effectiveness are inconsistent. A negative reinforcement of avoidance, due to premature termination of strong emotions during the Critical Incident Stress Debriefing (CISD), may explain this. The effectiveness of the CISD after terror attacks in Germany has not yet been investigated.Methods:All emergency responders deployed at the terror attack on Breitscheidplatz in Berlin were invited to take part in the study; 37 of the N = 55 participants had voluntarily participated in CISD; 18 had not.Results:Participants with CISD showed lower quality of life in psychological health and higher depressive symptomatology. Of these, females had lower quality of life in social relationships, whereas males showed more posttraumatic stress symptoms. Emergency responders from non-governmental organizations had higher phobic anxiety. Emergency medical technicians showed more somatic and depressive symptoms.Conclusion:There is no conclusive explanation for why rescue workers with CISD score worse on certain measures. It is possible that CISD has a harmful influence due to negative reinforcement, or that there was a selection effect. Further research differentiating occupational group, sex, and type of event is necessary.

Statement of purpose The purpose of this qualitative study is to explore potential risk factors, treatment barriers, and coping mechanisms that may influence mental health outcomes in Minnesota firefighters. Methods/Approach This study employed a two-phased, sequential qualitative design consisting of in-depth interviews followed by focus group discussions with both fulltime and volunteer firefighters in Minnesota. Fifty-two interviews were conducted with open-ended questions designed to identify themes and main areas of concern about Minnesota firefighters’ mental health, then presented to focus groups (n=10, with 3–15 participants per group) to obtain feedback and initiate open discussion. Audio recordings were analyzed for codes and themes developed after each interview and focus group session. Results The major contributor to mental health stress perceived by Minnesota firefighters involves the personal impact of the call. Coping mechanisms varied among institutions and individuals, and included Employee Assistance Programs, Critical Incident Stress Management, departmental debriefs, peer support groups, family, and exercise. However, barriers to treatment were equally as diverse, and included departmental and individual stigma, lack of personal and institutional support, and lack of knowledge about mental health. Conclusions Our study identified potential pathways to mental health conditions in firefighters. The findings should be leveraged to improve current strategies to protect the health and well-being of firefighters. Significance Major themes identified contribute to literature gaps regarding the perceived factors influencing psychological injuries in firefighters, in addition to the perceived barriers to treatment that would mitigate or prevent these injuries. However, the burden to each of the concepts, themes, and mental health issues are currently being assessed in a statewide survey completed by Minnesota firefighters. Study findings warrant future research to consider assessing the mental health in firefighters from other states, regionally, nationally, and globally.

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). Public safety personnel (PSP) and frontline healthcare professionals (FHP) are frequently exposed to potentially psychologically traumatic events (PPTEs), and report increased rates of post-traumatic stress injuries (PTSIs). Despite widespread implementation and repeated calls for research, effectiveness evidence for organizational post-exposure PTSI mitigation services remains lacking. The current systematic review synthesized and appraised recent (2008–December 2019) empirical research from 22 electronic databases following a population–intervention–comparison–outcome framework. Eligible studies investigated the effectiveness of organizational peer support and crisis-focused psychological interventions designed to mitigate PTSIs among PSP, FHP, and other PPTE-exposed workers. The review included 14 eligible studies (n = 18,849 participants) that were synthesized with qualitative narrative analyses. The absence of pre–post-evaluations and the use of inconsistent outcome measures precluded quantitative meta-analysis. Thematic services included diverse programming for critical incident stress debriefing, critical incident stress management, peer support, psychological first aid, and trauma risk management. Designs included randomized control trials, retrospective cohort studies, and cross-sectional studies. Outcome measures included PPTE impacts, absenteeism, substance use, suicide rates, psychiatric symptoms, risk assessments, stigma, and global assessments of functioning. Quality assessment indicated limited strength of evidence and failures to control for pre-existing PTSIs, which would significantly bias program effectiveness evaluations for reducing PTSIs post-PPTE. This research was funded by WorkSafeBC, grant number RS2019-SP13 (G.S.A.). The APC was funded by the granting agency. The views, results, opinions and conclusions expressed herein do not represent the views of WorkSafeBC. Faculty yes

Introduction/Background Health care providers in neonatal intensive care units (NICU) experience critical or distressing events that can overwhelm their usual coping skills and lead to significant stress. Ineffective support for health care providers dealing with critical incidents can lead to poor unit resilience, staff burnout and compromised patient care behaviours. A formalized peer program and process to address critical workplace incidents and support care providers, “Critical Incident Stress Management (CISM)” is used in many first responder professions. While there is growing interest in implementing peer CISM teams in critical care units, there is a lack of research describing the impact of CISM in NICU. Objectives This study examined the effect of implementing a multidisciplinary NICU health care provider peer CISM team on resilience, burnout, and team/safety culture in a tertiary NICU. Design/Methods Multidisciplinary team members were peer selected and formally CISM trained. Change management strategies were employed to introduce CISM to the NICU. All health care providers were invited to complete an anonymous online or paper survey before and 1 year after NICU CISM team implementation. The survey contained validated measures of resilience, burnout, and team/safety culture that were analyzed pre and post intervention. Results The response rate pre-intervention was 66% (114/172 staff) and 32% post (60/186 staff). Stress recognition significantly improved as fewer staff reported being less effective at work when feeling stressed post incident (74% vs 61%, pre and post CISM respectively, p Conclusion Implementation of a peer CISM team led to improved NICU care provider resilience, stress recognition, and team culture, all of which can mitigate the effects of increased patient load. Findings from this research and knowledge gained from the CISM implementation process should be shared with other health care environments.

Peer support has begun to gain traction as a mechanism for improving well-being in medicine. In this paper, we share our experience building, training, and piloting a peer support team based on a "critical incident stress management" model. The HOPES team (Helping Our Peers Endure Stress) is dedicated to, and composed entirely of, members of our division of pediatric hematology/oncology. Peer support will not solve all the well-being problems afflicting medicine. It is, however, a very good place to start.

Following release, former hostages face many challenges and may struggle to regain control over their lives. Research and evidence on how to effectively address the needs of hostages during their r...

Background: Medical cardiac arrest care in Edmonton Zone Emergency Departments does not undergo structured quality monitoring or continuous improvement. Prior to this work, quality indicators had not been selected, nor had tracking or reporting activities been undertaken. This work brings the Edmonton Zone EDs to the forefront of the continuous quality improvement recommendations made by Heart and Stroke Canada and the American Heart Association that are believed to improve both patient outcomes and overall system performance. For this project quality indicator development and implementation takes three perspectives: patients and families, frontline staff and the health care system. This work is informed by the Institute for Healthcare Improvement, the National Institute of Science and the International Liaison Committee on Resuscitation’s work on Systems of Care and Continuous Quality Improvement for Emergency Cardiovascular Care. This work is motivated by the desire to improve patient/family experience and outcome, provider experience while improving system performance. Implementation: An iterative process identified the lowest resource/highest impact areas for improvement. This process was informed through a Delphi survey conducted by the Alberta Cardiac Arrest Stakeholders group and stakeholder engagement. Four areas for improvement were identified: support of patients and families, support of staff, improvement in care metrics, and system level interventions. Support of patients and families was accomplished through the development of an advisory network, by linking families with existing supports, and through the implementation of a bereavement package. Supporting staff was accomplished through the development of a formal and informal debriefing processes. Improving clinical care was accomplished through the integration of chest compression feedback devices into clinical care. Improvements at the system level will be accomplished through the creation of a cardiac arrest registry. Evaluation Methods: Mixed methods approaches are used to evaluate this project. Post cardiac arrest quality track forms are being filled out. Chest compression feedback device data was obtained through simulated patient-care scenarios, staff experiences were obtained through a structured survey. Clinically chest compression data was collected from the feedback devices by Clinical educators, through tracking forms, and pre-and-post surveys of frontline staff measuring burnout and occupational stress are underway. Data is being collected in a local registry to generate accurate incidence and survival rates. Eventual post-implementation interviews with providers, survivors and families will be conducted. Results: A patient/family advisor network has been established. Survivor and families can be connected with the Bystander Support Network and the Heart and Stroke Foundation portal through the bereavement packages being offered at one of the QI sites. Two sites have developed staff debriefing processes: an interdisciplinary Critical Incident Stress Management (CISM) team at one site, and referral to an existing CISM team at two other sites. Chest compression feedback is being used at two sites, staff feedback has been positive. One site is tracking resuscitation metrics which are being used to guide and evaluate the interventions: continued improvement in chest compression quality has been noted. Data analytics are being used at all sites to identify additional opportunities to improve resuscitation care and efforts are underway to expand data collection to other sites and to unify pre-hospital and in-hospital cardiac arrest data. Advice and Lessons Learned: Pre-intervention data would have allowed for more meaningful comparisons in patient care. Efforts should be put into identifying what these measures could be. High levels of staff engagement at one site appear to have influenced the uptake of chest compression feedback. Effort should identify key stakeholders and gain buy in to increase uptake There are significant barriers to unifying pre-hospital and in-hospital cardiac arrest data. It is our belief that a continuous record offers some greatest opportunity to collect data on resuscitation care. Efforts should focus on building a linkage between these data sources and creating a shared data set.

This chapter provides a clear overview of a peer support program for first responders. The field of Critical Incident Stress Management (CISM) was specifically developed to prepare emergency services personnel to psychologically manage significant traumatic events and to recover from the impact of psychological trauma. CISM services are based in the theoretical foundations of crisis intervention and CISM uses the lessons learned from the 150-year history of worldwide crisis intervention services. This chapter presents a history of crisis intervention that helps the reader to understand the core principles of crisis support. It then focuses on the numerous techniques that are incorporated into the Critical Incident Stress Management field. It summarizes key peer support procedures and practices. The chapter also describes the resiliency and the “AS IF” models that aid in the application of crisis intervention services. The chapter concludes with a summary of the evidence that supports CISM services.

Background Clinicians working in the ED setting are exposed to traumatic and stress-inducing incidents, which may increase the incidence of psychological sequelae, including burnout and acute stress disorders. The purpose of this project was to develop and implement a novel debriefing program as an early intervention for acutely stress-inducing events in the emergency department. Methods The 2-stage Acute Incident Response program was developed and implemented in the emergency department of the John Hunter Hospital to guide an interprofessional response to acutely stress-inducing incidents. This psychological support framework draws on existing concepts of critical incident stress management along with elements of contemporary “hot debriefing” models to create a concise, clinician-led response program incorporating elements of both work group peer support and clinical team performance improvement. The Acute Incident Response program is novel in its concurrent focus on both salient clinical factors and emotional responses of affected clinicians. Results The developed Acute Incident Response program framework predominantly focuses on the wide dissemination of a peer-driven debriefing model. When additional support is deemed necessary by trained clinical champions after the Hot Acute Incident Response process, escalation to a central response coordinator ensures targeted secondary support follow-up for all affected team members. This program has been introduced at 1 site and warrants further targeted investigation to determine its efficacy and utility in a broad range of clinical contexts. Conclusion The Acute Incident Response program is an accessible and meaningful model to guide a functional, clinician-led response to acute incidents in the ED setting. The model could feasibly be applied in a wide variety of clinical contexts.

Introduction The Staff Counselling Service (SCS) promotes positive mental health and motivation by providing counselling, consultation, critical incident stress management (CISM) psycho-educational services, and Mindfulness Based Interventions (MBI’s) to all staff in an acute hospital setting. An evaluation of the core counselling service commenced in 2016, to gather data on presenting issues and to ascertain the effectiveness of the service. Methods Contextual statistical data such as client occupation, presenting issue, work related presentations (per Health Services Executive Management standards) are recorded and treatment outcomes are tracked via a web based Feedback Informed Treatment (FIT) system. Clients complete an Outcome Ratings Scale (ORS)1 at the beginning of each session to indicate their perception of how they are functioning and complete a Session Ratings Scale (SRS)2 at the end of each session scoring their experience of the session. 1 2000, Scott D. Miller and Barry L. Duncan 2 2000, Scott D. Miller and Barry L. Duncan Results In 2016, 21% of presenting cases were ‘Work Related’, the remaining 79% were ‘Personal’ or ‘Both’ (work and personal). A breakdown of Work Related issues show 33% due to Relationship issues; 21% Support issues; 19% ‘CISM’; 16% ‘Demands’ with the remaining 11% relating to Role, Investigations and Work Injury. The average intake scores indicate that presentations were in line with scores typical for Out Patient Mental Health Settings. Client progress for those still in counselling were 2 times better than no treatment. For those who had completed counselling, progress was 5 times more than no treatment and above average compared to International clients with identical intake scores. Discussion Data suggests that this is an effective counselling service. From a clinical perspective FIT facilitates ongoing collaboration and case review with clients. Low ORS scores can prompt timely onward referral to Occupational Health Physicians, allowing for clear dialogue, referencing measures which are easily understood. Work related presentations appear to support the ongoing provision of SCS interventions as a means of creating greater emotional intelligence and improving relationships.

Problem Active shooter incidents are becoming more common, and although they are still rare compared with other shooting sites, incidents have increased in health care facilities. Agencies such as the Federal Bureau of Investigation, The Joint Commission, and the Emergency Nurses Association have emphasized that an action plan and training are essential for hospital preparedness. Methods Planning an active shooter simulation for the emergency department was a complex project and involved collaboration between the hospital’s Emergency Management team, simulation staff, security, and ED leadership, which included the educators and clinical nurse specialist. Decisions were made related to appropriate location, equipment, and needs for the functional exercises. Scenarios also were developed with roles for the ED population and actors. Results A total of 204 staff members participated in the simulations between August and December of 2016. A survey was distributed to staff who attended the simulation. Ninety-two percent of staff felt more prepared to respond to an active shooter event and reported a 70% improvement in knowledge and preparation. Attendees reported their first response would be to flee the scene (66%), protect patients (15%), hide (7%), fight (6%), and call 911 (4%). Implications for Practice The active shooter education included a didactic portion, a pre- and postsurvey, and the simulation event. The presentation focused on statistics of active shooters, possible threats, and the concepts of RUN, HIDE, and FIGHT. A Critical Incident Stress Management team member was present to ensure the emotional and psychological health of the participants. The debriefing was a crucial part of the simulation experience so staff could talk about their experience and express their concerns.

Walsh describes the context of and relationship to each of the case studies in greater detail. She situates each case study in its historical, sociocultural context and describes the mission, philosophical influences, programs, and infrastructure of each trauma response ministry. The Louis D. Brown Peace Institute was founded by a survivor family when their 15-year-old son was murdered in Boston in the 1990s. The Peace Institute follows both a public health model of violence prevention and an anti-oppression model of empowerment. The Unitarian Universalist Trauma Response Ministry was founded in the aftermath of 9/11 and draws from Critical Incident Stress Management trainings among others. The second case study focuses on their work with a politically and religiously targeted 2008 church shooting in Knoxville, TN.

In complex systems, such as hospitals or air traffic control operations, critical incidents (CIs) are unavoidable. These incidents can not only become critical for victims but also for professionals working at the "sharp end" who may have to deal with critical incident stress (CIS) reactions that may be severe and impede emotional, physical, cognitive and social functioning. These CIS reactions may occur not only under exceptional conditions but also during every-day work and become an important safety issue. In contrast to air traffic management (ATM) operations in Europe, which have readily adopted critical incident stress management (CISM), most hospitals have not yet implemented comprehensive peer support programs. This survey was conducted in 2010 at the only European general hospital setting which implemented CISM program since 2004. The aim of the article is to describe possible contribution of CISM in hospital settings framed from the perspective of organizational safety and individual health for healthcare professionals. Findings affirm that daily work related incidents also can become critical for healthcare professionals. Program efficiency appears to be influenced by the professional culture, as well as organizational structure and policies. Overall, findings demonstrate that the adaptation of the CISM program in general hospitals takes time but, once established, it may serve as a mechanism for changing professional culture, thereby permitting the framing of even small incidents or near misses as an opportunity to provide valuable feedback to the system.

Firefighters face a number of occupational risks including the impact of being exposed to traumatic experiences. Critical incident stress debriefing (CISD) was previously introduced as a viable option for intervention postincident; however, concern has been raised about the efficacy of such debriefings. This study uses focus groups and key informant interviews with a national sample of firefighters to examine firefighters’ perceptions about behavioral health interventions. Although some firefighters reported positive experiences with CISD, other personnel reported finding the intervention intrusive and reported feeling more distressed after the intervention than before. Personnel reported experiencing benefits from peer support and using the crew for bonding after negative incidents as particularly useful. Findings suggest that while components (e.g., peer debriefing) of CISD may be useful, caution is warranted in employing the CISD model as designed.

Employees are increasingly becoming victims of critical incidents. From a systems theory point of view, it is necessary to acknowledge the impact of critical incidents not only on the personal life of the employee, but on the workplace itself. Employees respond differently to critical incidents, which makes it even more complicated when this reaches the point of requiring therapeutic intervention. The most common response to critical incidents may be the risk of developing post-traumatic stress disorder (PTSD) and/or depression. This reality requires management – through the Employee Assistance Programme (EAP) – to be able to effectively deal with such critical incidents.

Traumatic workplace events (critical incidents) occur with unfortunate regularity and with significant repercussions for affected organizations. Critical incident stress management (CISM) units, often a specialty component of employee assistance programs, provide consultation and support for workplace incidents. While CISM seeks to support both individual and organizational outcomes, trauma research oriented toward individual traumatic stress dominates the literature, mirroring practitioner training that tends to emphasize clinical over organizational practice. This research contributes to less-prevalent studies that explore organizational-level outcomes. Despite the facts that social workers play a central role in critical incident response and CISM units collect massive amounts of practice data, there are no published social work studies capitalizing on the potential of existing critical incident data. Employing the methodology of clinical data mining, this practice-based, exploratory research examines ...

BACKGROUND: Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. METHODS: A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. RESULTS: In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. CONCLUSIONS: The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety. Language: de