Critical Incident Training

A Critical Incident is a traumatic event or perceived event that has sufficient power to overwhelm an individuals ability to cope. When the stressor becomes extreme or severe, it often produces a heightened state of cognitive, physical, emotional and/or behavioral reactions. Critical Incident Stress Debriefings were developed as a tool to help individuals cope with their exposure to traumatic events.

The concept of a Critical Incident Stress Debriefing (CISD) embraces the tenets of crisis theory which believe that after exposure to a traumatic event: people may need additional coping skills to deal with the event and people are usually open to acquiring new skills after being exposed to critical incidents.

A CISD is therapeutic, but it is not therapy. It is not an interactive process whereby a participant gives information and the facilitator solicits another participant's feedback, as one would expect in traditional group therapy. Instead, in a CISD, the debriefer tries to systematically elicit the sharing of reactions, normalizes those reactions and teaches members coping skills. To ensure that a CISD does not inadvertently become therapy, a structured protocol is followed.

Teams of 2 people ideally perform CISD's. A primary debriefer, who does most of the talking, and the co-debriefer, who observes reactions from the group members and identifies those people who may need individual attention at the end of the debriefing. The debriefer should introduce the purpose of the debriefing.

The co-debriefer monitors the group's reaction and cofacilitates the group.

If a participant abruptly leaves the group the co-facilator should follow the participant out and de-escalate his/her feelings, encourage them to rejoin the CISD.

• Be Early
• Check in with management or union
• Greet participants personally

II. The Introduction Phase

• My name is _________ and I am an EAP counselor.
• Explain the purpose of the CISD "I have been asked to conduct this group meeting to help you deal with the robbery, suicide, shooting. No one will be required to speak, but you are encouraged to do so."
• "This meeting is private and I will not share specific information you discuss with management. I may share general themes that are discussed."
• "The FOH knows that this incident has been upsetting and has had an impact on you."
• "As a counselor I know that people may need additional coping skills following these kinds of incidents."
• I will be teaching you some skills to help you cope.
• Read the "Welcome" letter (located in the Policy & Procedure Manual in the CISD section)

• "Who was the first one to hear about the robbery, death? Or describe what you saw or heard."
• "What were you doing at the time of the incident?"
• "Who was the second person to hear about the robbery, death? Or describe what you saw or heard."
• "What were you doing at the time of the incident?"
• "Who informed you, etc?"
• Proceed in this manner until all participants have had a chance to answer this question.
• Other questions, which encourage participants to tell their story, include: "What was your reaction when you realized the crisis/incident was over?"

• What was your reaction to the incident?
• Proceed with this question until each person has a chance to answer it.
• Normalize reactions to the incident - The emphasis is on describing that it is normal & natural for participants to experience a variety of symptoms and reactions.
• Emphasize their reactions are normal reactions to an abnormal event.

• Present Coping Skills - Review w/participants what they can do to help themselves feel better.
• Distribute and discuss handouts

• Thank you for your participation today
• Summarize goals of group (teach coping skills, normalize reactions)
• Summarize general themes, if there were any
• Handout out business cards

Response: The primary function of the debriefer is to normalize all reactions to the traumatic event. Remember that participants will need to work w/each other long after you leave. Your response should comfort the participant. You might say "it is perfectly OK to let yourself cry... There are no incorrect emotional responses to a traumatic event. Everyone will deal with this situation in his or her own way and in his or her own time frame. Others here may find that tears may come today, tomorrow or not at all. I am glad that you feel comfortable enough to let the tears flow."

Situation 2. Participant abruptly leaves the room

Response: If there are two CISD team members, one debriefer can stay with the group, the co-debriefer can follow the participant that left. If the participant is found, de-escalate the feelings, provide emotional safety and attempt to re-engage the person in the group. The debriefer who stayed with the group should acknowledge concerns about the missing person and explain that the co-debriefer will go check on him or her. If there is only one facilitator, ask someone in the group to go out and check on the member who just left.

Situation 3. Participants exhibits angry or hostile behavior.

Response: Attempt to de-escalate the anger, explain that anger is one emotion people have to incidents (normalize this feeling), or refocus the participants on their reaction to the incident. Remind them that they are here to discuss their reactions to the robbery, employee death, etc.

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