What is a “Critical Incident?” 1
A critical incident is an abnormal or traumatic event which has the potential to overwhelm an employee’s usual coping mechanism, resulting in psychological distress and the impairment of normal functioning in the workplace. Examples include: suicide; homicide; robbery; assault; threats of violence; worksite accidents; industrial and natural disasters; as well as organisational changes such as staff restructuring or reductions.
In response to a critical incident, crisis intervention is a specialised acute emergency mental health intervention which provides help for individuals or groups during a period of extreme distress and requires specialised training. As such, Employee Assistance Programmes (EAPs) play an important role in providing support to employees following a traumatic event or critical incident in the workplace. Such a critical incident may affect a few individuals or an entire organisation.
The importance of trauma debriefing
A trauma debriefing allows individuals impacted by a critical incident to process their thoughts and feelings alongside other individuals who have experienced the same incident. It is important to remind individuals that their responses are a normal reaction to an abnormal event. The critical incident debriefing also provides insight into the signs of cognitive, behavioural and emotional symptoms commonly experienced after a traumatic event. The EAP counsellor will also discuss self-care techniques and how to determine if professional help is necessary.2
Some people have unresolved personal losses or traumas that can resurface at the time of a critical incident. This can make their reactions to the new event even more intense. If necessary an EAP counsellor can provide one-to-one counselling to such individuals, if needed. Allowing employees the opportunity to share their feelings and reactions in a confidential environment that is supported by their employer, can prevent individuals from experiencing post traumatic stress disorder. Furthermore it allows employees to feel validated, supported and loyal towards their employer.2
Group crisis intervention3
Three goals guide the techniques used in a crisis intervention:
- Mitigate impact of event.
- Facilitate normal recovery processes.
- Restore adaptive function.
The seven objectives of a crises intervention, according to the Mitchell model (developed by PhD Jeffrey T. Mitchell, in 1974), are:
- Introduction: establishment of a good relationship with those individuals associated with the event, as well as maintaining a very high level of confidentiality. Ideally, all individuals taking part should be temporarily off duty and not liable to be interrupted during the procedure. Individuals will be asked to introduce themselves and identify their role in the incident. They will be encouraged to discuss various aspects of the incident that distressed them.
- Fact: individuals provide core facts and fill in missing details. The introduction of missing facts helps correct any misperceptions.
- Thought: individuals explore the emotional aspects prompted by the event. Responses are as varied as the group and this helps individuals to personalise their experiences.
- Reaction: in this most intense phase the group is asked, ‘How did you react to the incident?’. Not everyone will feel comfortable talking about this, so it is emphasised that the important part of participation is being present and listening. Some of the participants will discover that their reactions are similar to those of their peers. For those who have suffered more severe stress reactions, the presence and support of their less affected peers is often as important. The most affected individuals can describe the worst part of the event for them and why it has caused them such stress.
- Symptom: the range of symptoms that individuals have been experiencing is discussed. These include those experienced during and immediately after the incident, 3–5 days later and those remaining at the time of the debriefing. During this and the reaction phase, workers come to realise that they are not alone in how they have been feeling. The sudden realisation that their feelings are normal is the first step for many emergency workers towards feeling better.
- Teaching: this is similar to post-incident education. The process of critical incident stress, stress reactions and techniques to decrease stress are explained.
- Re-entry: the final phase, which allows team members to expand relevant points they feel are important and to answer questions. The main purpose is to ensure that emotions are not raw when the participants leave. The team gives a summary and the debriefing meeting is concluded.
There are seven core principles to the manner in which crisis interventions are run. They are: 4
Simplicity—People respond to simple, not complex things, during a crisis.
Brevity—Most crisis intervention contacts are short in duration, some lasting only a few minutes. It is typical to have three to five contacts to complete crisis intervention work with an individual.
Innovation—Crisis Intervention providers must be creative to manage unique and emotionally painful situations.
Pragmatism—Suggestions must be practical if they are to work in resolving a crisis.
Proximity—Most effective crisis intervention contacts occur closer to the operational zone or in someone’s comfort zone.
Immediacy—A crisis reaction demands rapid intervention. Delays cause more pain and complications.
Expectancy—When possible, the crisis intervener works to set up expectations of a reasonable positive outcome.