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Critical Incident Stress Management Methodologies Provide Healing

by Mike Oshry BCC

APC™ Forum, February 2016, Vol. 18 No. 1

Such a tremendous emotional and psychological shock to all who had known him. How could this have happened? When did this happen? Where did this happen?

It was during this time, employee staff and management at Providence Hospitals in Spokane, WA appreciated and benefited from the healing qualities of Critical Incident Stress Management (CISM) and its array of services designed to support individuals and groups who have experienced a crisis.

In fall 2015 and then again the following spring, first a beloved cardiothoracic/ transplant surgeon, David, and then an Internist, Christopher, both respected by all who knew them, died suddenly after heroic measures on the part of all clinical staff present. While much could be said about the lives, medical contributions and life-saving ministries of these two amazing physicians, their sudden deaths had a profound effect upon our community.
In the aftermath of this crisis, shock, dismay, denial, anger, grief and eventual acceptance called for a quick response, as various CISM interventions and tactics were deployed.

It was during the first few hours our team provided Crisis Management Briefings (CMBs). These CMBs were “informational” in nature and served to:

1. Provide information.
2. Help to control or reduce rumors.
3. Reduce chaos and provide better understanding.
4. Provide suggestions for coping and self-care.
5. Engender community cohesion.
6. Give an opportunity to assess further needs of those in attendance.

When providing the CMB, our trained CISM representatives assumed a confident leadership demeanor to involve key clinical staff for visits to various departments to convey information and give voice to the facts of “what exactly happened.” In the aftermath of the sudden death of each of our physicians, the CMB served staff well. After all, shortly after any form of crisis, “just knowing” can provide a healing quality and help mitigate distress, while often encouraging movement toward adaptive functioning and departmental cohesion. In addition, the facilitation of a CMB becomes an opportunity for the CISM team to watch for individuals who may need follow-up one-on-one assistance, and in some cases, a referral to continued care.

In the hours, days and weeks that followed, the CISM team was invited to facilitate several other forms of critical incident interventions: Defusings, Critical Incident Stress Debriefings (CISD), and One-on-One Assistance with Individuals. These interventions were far more “interactive” than the CMB, which was informational. They attended to the emotional and psychological needs (think “psychological first aid”) of smaller, homogenous groups. In other words, the Defusings and Debriefings were intended for groups that hold a “shared history” and benefit from “existing relationships.”

The Defusings we provided shortly after David and Christopher’s deaths occurred within the first 12 hours of the incident (or, as I was taught, before folks had a chance to sleep) and followed a three-step methodology:

1. Share the “Facts”
2. “Explore” and briefly describe the traumatic event
3. Provide “Information” around the importance of self-care, along with reassurance that we were normal people responding normally to an abnormal event

After 24 hours, we began to facilitate what is more familiar to people, the Critical Incident Stress Debriefings (CISD). This intervention assisted relatively small homogeneous groups through a process designed to begin with the “cognitive,” with movement toward the “affect,” and back gradually to the “cognitive.”

In conversational tones, the CISD sequence was:

1. “Introduce” CISM team members and perform general housekeeping
2. Review the “Facts”
3. Discuss first impressions and “Thoughts”
4. Explore “Reactions” and aspects of the event that may have produced the greatest personnel impact
5. Discuss the “Signals of Distress”
6. Offer “Information” about self-care, resiliency and stress management
7. Provide a summary and what is termed, “Re-entry”

Finally, in the days and weeks that followed, there were numerous requests (sometimes simply in passing) for one-on-one conversations on behalf of the multitude of staff who knew, loved and worked with David and Christopher.

When providing “Assistance to Individuals,” our CISM team members followed a process known as the SAFER model, which was designed to:

1. Seek to meet basic needs (Abraham Maslow) and mitigate key stressors
2. Acknowledge the incident or crisis and reactions
3. Facilitate empathic listening and understanding, and encourage a movement toward normalization
4. Encourage effective coping and self-care
5. Facilitate recovery and/or referral to continued care

Our CISM goals and objectives time and again were a means to:

• Provide employees with an understanding that we were normal people responding normally to abnormal events.
• Equip employees with healthy coping skills while watching to identify risk behaviors
• Identify employees who may need additional support
• Increase cohesion within a group following the critical event
• Minimize the risk of developing more stress-related symptoms
• Help employees return to their previous level of functioning
• Create an opportunity to gather, to hold conversation, to share powerful thoughts and feelings, and to discover amongst ourselves commonalities in the way we may grieve, along with movement toward learning how to cope and, ultimately, recover.

After each death, a Memorial Service and celebration of life was held in the Providence Sacred Heart Medical Center Auditorium. During each service, over 500 people were in attendance. These two physicians, their memory and the impact they had on the lives of so many will continue to live on.

Michael Oshry MDiv BCC is a staff chaplain at Providence Sacred Heart Medical Center in Spokane, WA. A trained CISM Instructor and facilitator, Oshry leads, supports and helps to maintain the CISM initiative and its “core group” at Providence Health. He may be contacted at

This article is adapted, with permission, from LifeNet Vol 26, No. 4, the member publication of the International Critical Incident Stress Foundation Inc.

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