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When Should I Activate CISM

For the purposes of CISM, Any event which has a stressful impact sufficient enough to overwhelm the effective coping skills of either an individual or group.  

Critical incidents are typically sudden, powerful events which are outside the range of ordinary human experiences. The International Critical Incident Stress Foundation has identified a list of “terrible ten” incidents that, in most cases, should spark a CISM Team activation. The decision to activate CISM should be based not solely on the type of incident that has occurred, but also on the level of emotion involved. The type of intervention used by our team depends on the situation, the number of people involved, and their proximity to the event.

Below is a list frequently referred to as the “TERRIBLE TEN”. 
They serve as a guide for incidents that should trigger a CISM Team response.

  1. Line of duty deaths*
  2. Suicide of a colleague*
  3. Serious work-related injury
  4. Multi-casualty / disaster / terrorism incidents
  5. Events with a high degree of threat to personnel
  6. Significant events involving children
  7. Events in which the victim is known to personnel
  8. Events with excessive media interest
  9. Events that are prolonged and end with a negative outcome
  10. Any significantly powerful, overwhelmingly distressing event

However, activations should not be limited to only these 10 incidents. The decision to activate CISM should be based not solely on the type of incident that has occurred, but also on the level of emotional effect on those involved.

*The first two incident types -1) LINE OF DUTY DEATHS  and 2) DEATH OR SUICIDE OF A CO-WORKER are to be considered a mandatory CISM activation.

The types of intervention used by our team depend on the situation, the number of people involved, and their proximity to the event.

DEFUSING

Usually occurs within a few hours of a critical incident.  The main purpose of a defusing is to stabilize and assist with the immediate needs of the affected personnel so that they can return to work if necessary or they may go home without unusual stress.  Defusing allows for initial venting of reactions to the incident and provides stress-related information to affected personnel.  A Defusing may eliminate the need for a formal Critical Incident Stress Debriefing (CISD) or enhance a subsequent CISD.

DEBRIEFING

Debriefings are usually the second level of intervention for those directly affected by the incident.  A debriefing is normally done within 72 hours of the incident and gives the individual or group the opportunity to talk about their experience, how it has affected them, brainstorm coping mechanisms, identify individuals at risk, and inform the individual or group about services available to them in their community.

FOLLOW-UP

At any stage a CISM member may recommend a higher level of care for personnel, using resources in place including our CISM clinician, the officer’s EAP and/or the LEADER program at McLean’s Hospital or any of our other listed resources under the RESOURCES section.

LEADER PROGRAM: MCLEANS HOSPITAL

The LEADER (Law Enforcement, Active Duty, and Emergency Responder) Program at McLean Hospital offers specialized mental health and addiction services, designed specifically for men and women in uniform. For more information or to make a referral to LEADER, please contact your Department’s CISM Member or call Wendy Curry, admissions coordinator, at (617) 855-3141. Be sure to mention that you are calling about a police officer, active duty National Guard, or other responder.

Signs and Symptoms

Physical reactions

  1. Exhaustion
  2. Nausea/vomiting
  3. Weakness
  4. Difficulty breathing
  5. Chest pains
  6. Rapid heart rate
  7. Headaches
  8. Dry mouth/always thirsty
  9. Elevated blood pressure
  10. Fainting/dizziness
  11. Exacerbation of allergy problems
  12. Symptoms of shock

Cognitive reactions

  1. Blaming attitude
  2. Confusion
  3. Reduced attention span
  4. Flashbacks
  5. Poor concentration/loss of confidence
  6. Negative self-talk/loss of confidence
  7. Decreased awareness
  8. Troubled thoughts
  9. Nightmares
  10. Easily distracted
  11. Short-term memory disturbance
  12. Time/place/person distortion

Emotional reactions

  1. Frustration
  2. Strong need for recognition of what they experienced
  3. Anxiety
  4. Guilt/feeling strongly for victims
  5. Sense of loss
  6. Anger
  7. Denial
  8. Fear of loss of control Irritability/agitation
  9. Depression
  10. Feeling overwhelmed
  11. Feeling isolated
  12. Loss of emotional control

Behavioural Reactions

  1. Blaming attitude
  2. Confusion
  3. Reduced attention span
  4. Flashbacks
  5. Poor concentration/loss of confidence
  6. Negative self-talk/loss of confidence
  7. Decreased awareness
  8. Troubled thoughts
  9. Nightmares
  10. Easily distracted
  11. Short-term memory disturbance
  12. Time/place/person distortion