(CISD) is offered to organizations and their employees who have experienced traumatic events, such as the death of a co-worker, workplace violence, or a natural disaster.

The tragic results of these incidents can have consequences that reach beyond those workers directly injured or shaken up. Workers who witnessed the incident, or who know the people involved, may suffer extreme emotional upsets. Workers may become distracted and unable to concentrate on work — so much so that they pose a risk to the safety of themselves and others. Some workers may have feelings of anger, fear, or guilt. Others may feel responsible for the incident or may blame themselves for not doing more to prevent the incident or help the victims.

Because critical incidents may seriously affect the emotional well-being of workers, it’s important employers respond to these incidents appropriately and effectively.

What is a critical incident? A critical incident is a workplace event — like an accident, injury, fatality, or robbery — that causes emotional or psychological trauma in people exposed to the incident directly, or even indirectly. It is a sudden, powerful event outside the range of normal experience — and outside workers’ control. A critical incident will often overwhelm a worker’s ability to function in a normal way by causing strong emotional reactions.

What is critical incident stress? People who experience a traumatic event may be left feeling upset and shaken. Some common reactions to a highly stressful event are:

• Feeling jumpy, anxious, moody, or irritable • Having difficulty concentrating, making decisions, or thinking clearly • Having trouble going near the accident scene or to places that trigger memories of the accident or incident • Having trouble being around people • Having difficulty being alone

People may experience some or all of these reactions. These reactions are normal responses to stressful or abnormal events

However, in some cases, people may feel overwhelmed and unable to cope with day-to-day demands. They may feel numb, shocked, abandoned, and helpless. Some workers may have trouble sleeping. Some may stay away from work. Workers’ home lives and personal relationships may suffer — workers may take their feelings of guilt, powerlessness, or anger out on their families. Some may withdraw, or turn to drugs and alcohol. In other cases, workers may suffer from nightmares or have flashbacks to the event — often fearing the event will happen again.

After a critical incident, workers’ feelings about their jobs and the workplace can be seriously affected. Workers may become disillusioned with their workplace if they believe that their problems are not being taken seriously, or that they are not being given adequate support. The whole workplace suffers after a critical incident — effects may include poor morale, decreased productivity, increased accidents and sick time, higher disability claims, and greater staff turnover.

What can an employer do if a critical incident occurs at the workplace? Employers can effectively manage critical incidents with clear policies and procedures that entree on a humane, sensitive response to workers.

To reduce the intense reactions of workers to the incident, and assist them in returning to routine duties, employers could organize a critical incident intervention such as defusing and debriefing.

Participation in these sessions by workers should be voluntary. A critiquing session and an in-depth corporate review of how a critical incident was handled should also be held, following the intervention. These steps will help ensure that adequate policies and emergency procedures are in place in the future.

The needs of those affected by a critical incident, and the availability of resources, may vary. In some cases, workers may receive both a defusing and debriefing session. In other cases, neither may occur, but the employer will hold a critiquing session and corporate review of the incident. In yet other cases, all four steps — defusing and debriefing sessions, a critiquing session, and a corporate review — will take place. Employers should prepare for a critical incident now by reviewing how to respond to an emergency, before one actually occurs.

What is a defusing session? A defusing session is a short (30–45 minute), non-judgmental session where one or more workers affected by the incident meets with a trained leader (called a defuser). Defusings should be held within 6 to 8 hours of the event. Participants remain anonymous; they will not be named in any defusing reports. The defuser will explain to workers the physical, emotional, and mental reactions that they are, or may soon be, experiencing. They also provide information on how workers can take care of their emotional and physical health and the resources that are available to workers who require more assistance. This may also be an opportunity for the defuser to determine the need for a debriefing session.

It is essential that only experienced people who are specially trained conduct a defusing. The leader of a defusing may be:

• A peer support person (a worker who has been trained to offer support to co-workers in crisis) • Professional support people on a CIS (critical incident stress) team (such as through emergency services) • A qualified service provider

What is a debriefing session? You may have heard of or are using the term critical incident stress debriefing (CISD), which is an individual or group process in which one or more service providers help the affected worker(s) cope with the continuing effects of a traumatic incident. A CISD should occur within 24 to 72 hours after the event. Participation is voluntary and workers remain anonymous. The purpose of the debriefing is to alleviate the trauma of affected workers and speed up their recovery process. Debriefing focuses on the well-being of the workers; it does not attempt to find the cause of the incident or assign blame. The intent of the debriefing is to address and respond to the emotional and psychological consequences resulting specifically from the workplace incident. For example, it is not appropriate to discuss labor relations issues or emotional issues not related to the incident.

Debriefings should be led by trained, qualified professionals who can guide strong emotions such as guilt, sadness, or anger that workers may be experiencing.

Defusing and debriefing sessions are not “therapy” and are not a substitute for therapy. Individuals requiring further support should be directed to a mental health professional.

What is a critiquing session? In a critiquing session, employers, supervisors, and workers together review all aspects of the critical incident. The critiquing session aims to uncover deficiencies in the handling of the incident, and provide corrective solutions. A critiquing session should be held a few weeks after the incident and examine:

• The way the incident was handled. (Who responded? How were first responders notified?) • How the incident could have been handled better. (Did help arrive quickly?) • How the event could have been prevented. (Would better security have stopped the incident?) • The effectiveness of the critical incident intervention. (What was the overall perception of the effectiveness of the intervention?) • Related company policies. (Is there a contingency plan for emergencies?) • Related safety regulations. (Was a safety regulation ignored?) • Related safe work procedures. (Was a current safe work procedure incomplete? Is a modified procedure needed?)

What is a corporate review of a critical incident? Within 30 days of an incident, an employer should conduct a broad review of all the steps taken in response to the incident including:

• First aid. (How did first aid attendants perform?) • Emergency procedures. (Do emergency procedures address this type of situation?) • Critical incident intervention. (Are trained specialists available on short notice for interventions?) • Accident investigation. (Who investigates the accident? Was an investigation done?) • Corrective, preventive responses. (What new policies or procedures will be put in place to prevent a similar incident from happening?) • Claims management. (Are workers receiving adequate follow-up care while on a claim?)

The purpose of the corporate review is to assess:

• The suitability of the company’s procedures. (Are the procedures effective?) • How the company responded. (Is there room for improvement?) • Other corrective, preventive steps that should be put in place.

This review does not replace an accident investigation. A separate accident investigation must still be undertaken to determine the cause of the incident. A critical incident at the workplace can be disturbing and even devastating, but swift intervention may minimize the impact on workers. By effectively managing a critical incident, an employer will help workers return to their regular routine.

Employers should have a contract in place with their Employee Assistance Program to provide these services should they occur. If you do not have a plan like this in place, please contact Maribeth to discuss creating one.