Critical Incident Stress Management Team

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Access the Seven Mountains/Susquehanna Valley CISM Team 24 hours a day by calling the Mifflin County Communications Center at (717) 248-9607 or the Lycoming County Communications Center at (570) 433-3166.  Provide your contact information and a team leader will re-contact you to discuss your situation. 

The Seven Mountains/Susquehanna Valley CISM team can assist emergency service personnel – First Responders, EMTs, Paramedics, Police, Firefighters, Telecommunicators, and Nursing Personnel – to resolve stress related difficulties from a critical incident.  Additional information on stress, including signs and symptoms, is included below. The debriefing is NOT a criticism of a particular performance or a critique of operations.  The process provides a forum where personnel directly involved in an incident can discuss the normal reactions & feelings that they may be experiencing from that incident.


What is a Critical Incident?     As defined by Jeffrey Mitchell, Ph.D., a critical incident is “any situation faced by emergency service personnel that causes an unusually strong emotional reaction which has the potential to interfere with their ability to function either at the scene or later… all that is necessary is that the incident, regardless of the type, generates strong feelings in the emergency worker.” The Stress Debriefing Team has only one objective – the restoration of human dignity and self-worth to people, who are experiencing normal reactions and normal symptoms of distress because they were exposed to a highly abnormal event – A CRITICAL INCIDENT.


What is a Defusing or Debriefing? George Everly, Jr. Ph.D. has described the defusing and debriefing processes “as group meetings or discussions about a traumatic event or series of traumatic events.  The defusing and debriefing processes are solidly based in crisis intervention theory and educational intervention theory.  The defusing and debriefing processes are designed to mitigate the psychological impact of a traumatic event, prevent the subsequent development of a post-traumatic syndrome, and serve as an early identification mechanism for individuals who require professional mental health follow-up subsequent to a traumatic event.  The process has both psychological and educational elements, but it should not be considered psychotherapy.  Instead, it is a setting in which personnel are given an opportunity to discuss their thoughts and emotions about a distressing event in a controlled, structured, and rational manner.  They also get the opportunity to see that they are not alone in their reactions but that many others are experiencing the same reactions.”


Who should attend?     Any emergency service persons, such as EMS, police, fire or telecommunicators, directly involved in the operation of an critical incident event and for whom the event has elicited an unusually strong reaction.


When should this take place?     Defusings are conducted within 24 hours and ideally within 8 hours after the conclusion of an event.  Debriefings normally are conducted 24-72 hours following the conclusion of an event.


Why do you need the team?     Factors and events may cause one provider to suffer the impact of stress and may have little or no effect on another.  However, research has demonstrated that very few personnel are left unaffected by stressors inherent to their professions.


STRESS is a Latin word meaning “force, pressure or strain”.  Today, there are several ways to define stress:

    • A response to a perceived threat, challenge, or change
    • A physical and pyschological response to any demand
    • A state of psychological and physical arousal


The common element of these definitions is that stress is a response to something in the environment (a stressor).  

Common Signs & Symptoms of Excessive Stress:


  • Confusion in thinking
  • Difficulty in making decisions
  • Disorientation

  • Excessive sweating
  • Dizzy spells
  • Increased heart rate
  • Elevated blood pressure
  • Rapid breathing

  • Emotional Shock
  • Anger
  • Grief
  • Depression
  • Feeling Overwhelmed Hopelessness/                                      Helplessness

  • Changes in ordinary behavior patterns
  • Changes in eating
  • Decreased personal hygiene
  • Withdrawal from others Prolonged silences


Signs of Cumulative Stress:

Warning Symptoms: Mild Symptoms:     
Vague Anxiety Sleep disturbances
More frequent loss of emotional control More frequent headaches, colds, and/or stomach problems
Depression Muscle Aches
Boredom Intensified physical and emotional fatigue
Apathy Withdrawal from contact with others
Emotional fatigue Intensifying depression
Entrenched Symptoms:                  Severe Symptoms:
Skin Rashes Asthma
General physical & emotional fatigue Coronary artery disease
Intense depression Heart attacks
Increased alcohol use Diabetes
Use of nonprescription drugs Cancer
Increased smoking Severe emotional depression
Elevated blood pressure Lowered self-esteem
Migraine headaches Lowered self-confidence
Poor appetite Inability to perform one’s job
Loss of sexual drive Inability to manage one’s personal life
Ulcers Severe withdrawal
Intense irritability Uncontrolled emotions:  anger, grief, rage
Marital discord or relationship problems Suicidal or homicidal thinking
Crying spells Muscle tremors
Intense anxiety Extreme chronic fatigue
Cardiac problems Over reactions to minor events
Rigid thinking Agitation
Withdrawal from friends, family, & coworkers Chronic feelings of tension
Restlessness Poor concentration and attention span
Sleeplessness Frequent accidents
Other physical & emotional symptoms Carelessness
Feelings of Hostility
Intense feelings of paranoia
Moderate to severe thought disorders
Other severe physical & emotional signs & symptoms