PART 9 OF 10: Research tells us that approximately 10% of the emergency workers who respond to a critical incident won't have severe reactions at all. This doesn't mean that they are cold or unfeeling, nor that they won't be affected by another incident. Remember, trauma is personal, and that one incident might not have been one that triggered negative emotions or memories for them. However, we know that approximately 80% of the emergency workers responding to that same incident will have CIS reactions, and they will follow the sequence we've discussed previously: physiological, cognitive/ emotional, and behavioral. The remaining 10% of the emergency workers responding to that incident are at risk of experiencing severe CIS reactions, and may be at risk for Post-Traumatic Stress Disorder.

"Getting over" a critical incident stress reaction requires several things: taking care of the physiological responses and making some sense, intellectually, with what happened and how we performed - i.e., "resolving" a critical incident. At the point that we have resolved the incident in our own minds, we can put the negative parts of it behind us and take from it the lessons we've learned to add to our own experience and personal history. Left to resolve a critical incident by ourselves, research suggests, takes anywhere from 3 weeks to 6 months to 1 year, depending on how powerful an experience it was for us. There is a real problem with that time frame, particularly for emergency workers. How many emergency workers would have 3 weeks between critical incidents? And how many would have 6 months to 1 year between the next critical incident? Virtually no emergency worker has that kind of time.

We know, however, that if we don't come to terms with a bothersome critical incident, it doesn't just fade away. Instead, it piles up, along with all the other unresolved critical incidents. That's how cumulative stress responses occur, and that's often what costs us our valuable emergency workers. It's been estimated that the average working life of an EMT in New York City is 4 years! The build-up of unresolved CIS in addition to the normal stress of the job causes some of our most dedicated and well-trained emergency professionals to quit! That's a high cost to pay - and one that we think we could eliminate with ongoing CIS awareness and critical incident stress debriefings following major incidents.

A critical incident stress debriefing(CISD) is a meeting of all the responders who were at an incident. It is NOT an operational debriefing, which focuses on what was done and how well it worked, but rather it is a "psychological debriefing", focusing on thoughts, feelings and reactions emerging from the critical incident. Confidentiality is essential in a debriefing, and it will be stressed throughout, that what is said in the meeting room will stay in the meeting room.

A CISD is led by trained members of a critical incident stress response team, and will include someone from a mental health profession (psychologist, social worker, clergy) and peer supporters (members of professions similar to the group being debriefed but not in their units). Participation at a CISD is voluntary, and is restricted to only those who were actually at the scene of the incident. The CISD usually takes place within 48-72 hours following the incident, because that's the time at which people tend to begin to try to resolve the critical incident and put closure on it for themselves.

During a CISD, the incident is discussed in full detail, and there is a great deal of sharing of information, thoughts and feelings with the other emergency professionals which helps to normalize what the individuals were experiencing. Critical incident stress reactions are described, and helpful information about how to relieve them is presented. And most importantly, the group discusses what they've learned from the incident, and in the process of drawing the lesson from the tragedy, the incident can be resolved and put away.

Follow-up is an important part of any debriefing, because those leading the debriefing feel a responsibility to ensure that the process was helpful to the participants. If anyone does have issues that are still bothering them, the follow-up ensures that those problems can be addressed privately later, and in the most appropriate way for the individual. The CIS debriefing takes about 3 hours - quite a difference from the 3 weeks to 1 year that each individual might spend trying to resolve that incident. The danger of cumulative stress build-up is reduced considerably. And in the group setting, there is a sharing among participants that is very powerful and very positive. The resulting level of understanding and appreciation for one another that emerges among first responder groups is strengthening, not only for the participants, but for the agencies as well!