Critical Incident Stress Debriefing: What is a CISD?
In an era of workplace shootings and increasingly intense natural disasters, it's more likely than ever that your workforce will experience a traumatic event on the job. How can you plan for these events? How do you minimize their impact on everyone's health and safety? And what can you do in the aftermath to help your employees cope?
Emergency action plans, critical incident stress management, and critical incident stress debriefings are all key answers to these questions.
What is Critical Incident Stress (CIS)?
When workers experience an emergency or disaster, they may experience an acute stress reaction that will negatively impact their health and safety. Symptoms include fatigue, confusion, guilt, inability to rest, anxiety, depression, change in appetite, antisocial behavior, chills, chest pain, and impaired cognitive function.
CIS is similar to Post-Traumatic Stress Disorder (PTSD), except that the timelines differ. If you experience the symptoms above within the first four weeks of a critical incident, it's called critical incident stress. If you're still experiencing them after a month, it's PTSD.
Some workers are more at risk for critical incident stress than others. First responders, for example, are regularly exposed to tragedy, death, serious injury, and threatening circumstances. That makes critical incident stress a common occupational hazard.
However, critical incident stress can happen within any occupation as a result of a workplace accident, near-miss, fire, natural disaster, or workplace violence.
How Can You Prevent Critical Incident Stress?
You probably can't prevent all occurrences of critical incident stress, but you can definitely minimize, manage, and address it.
Every workplace can and should create an emergency preparedness plan for potential incidents. Knowing what to expect and how to react to a foreseeable emergency will help minimize the amount of uncertainty and stress they experience.
During and after an emergency, you can reduce the likelihood and severity of workers' stress reactions by providing the opportunity and resources for workers to rest, recharge, and "come down." In the days following a critical incident, you should hold a specialized type of debriefing to help employees process their experience and learn what to expect.
Workplaces at high risk for critical incident stress should have a system for education, prevention, and mitigation in place as a matter of routine.
What is a CISD?
CISD stands for Critical Incident Stress Debriefing.
Critical incident debriefings are facilitator-led processes conducted soon after a traumatic event for a group of people who are experiencing or at risk for a stress reaction. The best practice is for a CISD to occur within 72 hours. The debriefing typically takes three hours.
A critical incident stress debriefing consists of seven steps:
- The Assessment Phase. During planning, team leaders and facilitators tailor the program for the situation, the people, and the specific needs of the group. As the CISD begins, they explain what the group can expect from the process.
- The Fact Phase. Participants share a brief account of the event from their point of view, focused on facts and not emotions.
- The Thought Phase. The group vents their thoughts and feelings about the incident. Validation is an important aspect of this step.
- The Reaction Phase. People discuss the impact of the event. Facilitators prompt participants to share the worst or most painful aspect of the event for them.
- The Symptom Phase. Participants share the physical, emotional, behavioral, and cognitive symptoms they've been experiencing.
- The Teaching Phase. Facilitators help the group understand their reactions and provide stress management and self-care tools.
- The Re-entry Phase. The group leaders summarize the takeaways from the session and encourage people to ask questions or share what they've learned. Facilitators provide information about next steps and additional resources. Team leaders often hold individual meetings afterward as the first step in follow-up care.
CISDs serve as both an early intervention and an educational opportunity. The meeting itself helps people understand their experience, feel less alone, and regain a sense of control. It also gives leaders a chance to identify people who may need extra support and to connect people with resources like individual counseling.
What is Critical Incident Stress Management?
Workers who are regularly exposed to traumatic events need Critical Incident Stress Management.
In other words, they need an entire system in place to deal with the inevitability of critical incident stress. This system should include education, prevention, monitoring, and mitigation efforts.
In most workplaces, education about critical incident stress isn't necessary unless a traumatic incident has taken place. But proactive education is needed when critical incidents are simply a part of your job description. At-risk employees need to understand the symptoms they may experience, ways to reduce the likelihood of occurrence, and the risks of not getting treatment.
Supervisors and workers should be taught how to identify individuals who are exhibiting stress reactions so that the problem can be addressed as soon as possible.
Preventative measures for critical incident stress should be built into the routine for these workplaces. Managers and supervisors should make an effort to provide workers with a rest period after moments of high stress have passed. Food and drink, a quiet environment, and physical rest are all key elements.
Finally, these workers need access to specially trained crisis intervention specialists – as individuals on an as-needed basis and as a group after a particularly traumatic experience.
Do Any OSHA Standards Apply to Critical Incident Stress?
OSHA doesn't have any specific standard that relates to critical incident stress.
However, they do recommend that first responders and employers with similar hazards take steps to reduce the associated risks, and technically, critical incident stress is covered by the General Duty Clause.
Additionally, OSHA requires employers to plan and prepare for emergencies with either a written or oral emergency action plan (EAP), depending on the employer's size.
What Kind of Workplace Emergency Preparedness Does OSHA Require?
OSHA requires emergency evacuation plans for everyone, including fire prevention and fire evacuation procedures in the workplace. Depending on the types of disasters your workplace may experience, you might also need to create plans for when and how to shelter in place.
If some workers must remain in place to handle critical operations shutdown and emergency response, you need a plan for their safety and egress, including PPE.
Depending on your workplace, other OSHA standards may require you to plan for specific types of emergencies. For example, the HAZWOPER standard requires an emergency response plan (ERP) for situations like an unexpected release.
Why Engage in Emergency Preparedness Plan for the Workplace?
Aside from OSHA's requirement, creating an emergency action plan forces you to clearly and logically consider procedures, resources, and contingencies.
By thinking through a situation ahead of time, you have the opportunity to reduce injuries and secondary accidents, not to mention downtime and property damage. You'll have time to gather supplies, assign responsibilities, and practice procedures and emergency evacuation routes.
That's why it's smart to go above and beyond what OSHA requires. Depending on your workplace, you may want to plan for specific natural disasters, equipment malfunctions, and other dangerous events that could occur.
Train Workers on OSHA's Emergency Action Plan Standards
OSHA requires employers to train their workers on emergency evacuation standards, required action plans, fire detection systems, and fire extinguishing mechanisms.
One of the easiest ways to provide this training is to go with an online course from an OSHA-authorized training provider like us. Our one-hour emergency action plan course is compliant with all training requirements.