Trauma Interventions in Emergency Personnel


In crises situations, organizations have two populations to attend to and manage: their civilians and the emergency personnel or first responders. While a lot of emphases has been channelled towards addressing the emotional needs of the civilians affected, emergency personnel have been left to their means. However, CISM was conceived to cater to the emotional needs of emergency personnel in terms of traumatic stress and help them in dealing with various work-related trauma. While CISM has been used to treat emergency personnel, it has attracted dissent from various stakeholders who claim it is ineffective in addressing the problem. Subsequently, various alternatives to the CISM model have been devised with the hope that they will better help in assisting emergency personnel in their dealing with traumatic and highly stressful components of their occupation.



It is estimated that stress-related disorders will be the second leading cause of disability by the year 2020.Thus, stress-related disorders have become the primary strategic goal for the world health organization’s Global Burden of Disease of the NIOSH work organization and Stress-related Disorders Program (Fagel, 2011). In the United States, work-related stress is estimated to cost $171 billion annually, which is the same as cancer and cardiovascular disease, and greater than Alzheimer’s’ or HIV or AIDS. There is an estimated $300 billion annual cost due to lost hours from absenteeism, decreased work productivity and cost of health expenditures. One source of work-related stress streams from personnel who are involved in emergency situations.Research demonstrates that individuals without the benefit of prior disaster training or experience are at a greater risk for posttraumatic stress disorder. In a study of PTSD post world trade Centre, the rate was 21.1 percent for construction, engineering, sanitation and unaffiliated workers compared to a rate of 12.4 percent for rescue personnel. Thus, it is crucial to consider the mental health needs of not only primary survivors, but also of the secondary survivors and response personnel. This paper presents an in-depth examination of CISM as an intervention approach for emergency personnel, evaluating whether itis the best solution for long-and short-term mental health related issues. In addition, the paper will present some of the alternate interventions that can be employed to assist emergency personnel.

CISM as Interventions For Emergency Personnel

CISM is one of the earliest interventions used by personnel involved in the provision of emergency services. First adopted at the beginning of 1980 it has been used as the intervention of choice. CISM is a comprehensive and multicomponent work-based approach that is designed to assist emergency personneldeal effectively with the traumatic and highly stressful components of their work. The core elements are the comprehensiveness of the approach (preventative and remedial) and its focus on traumatic stress as opposed to general work stress or organizational stress. It comprisesof elements such as education on trauma and its management, one-on-one counselling, group meetings, follow-up and partner support.

Whether CISM is the best solution for long-and short-term mental health related issues

The use of CISM has attracted varied dissent in its use. However, it remains a favourite approach for many agencies and has been supported by findings from various studies. This is because in many settings ithas proved to be effective in helping individuals cope with trauma. The strengths of CISM lie in its goals.It aims to reduce the incidence, duration, as well as severity of, or impairment of emergency personnel from trauma that has been occasioned by crisis environments. Further, CISM has been credited with successfully facilitating an individuals’ psychological closure of a traumatic situation by means of group interventions expedited by mental health professionals and counsellors(Regel & Joseph, 2010).CISM also includes leadership training and support, and pre and post-incident teaching and education aspect which are critical to making any intervention successful. The inclusion of informal non-compulsory group discussions and social support post-incident with referrals to mental health professionals for individuals requiring advanced intervention makes CISM a proper intervention for long-term mental health related problems.

Whilecriticism directed at CISM are few, they pre-empt the use of CISM as a successful intervention. Criticism has been founded on the effectivenessof the CISM inassisting emergency personnel deal with trauma and its abilityto be applied to different persons with similar positive results.Studies in the area of post-incident and disaster mental health have brought into question the efficiency of CISM.It has beenstated that CISM can be ineffectual and sometimes harmful to individuals. Studies have revealed that majority of the personnel are not in need of structured group interventions such as CISM.Personnel who are in need of clinical attention have been advised to avoid this model as it would be traumatic too soon after an event.Studies have stated that affected individuals can individually settle their stresses giventime and with minimal outside assistance. That is CISM has been blamed for interfering with the natural recovery process that is inherentin any individual. Further criticism of CISM stems from the generalized approach of the intervention. Studies claim that CISM is contraindicated. This isbecause emergency personnel who have been intensely traumatized and are experiencing PTSD are required to revisit the location of the incident whereasin such situation person-to-person intervention maybe more appropriate.

As an intervention to assistingpersonnel with trauma, CISM is hailed as having various benefits that make it an intervention of choice for long-and short-term mental health issues. However, the unpredictable nature of the success of CISM makes its use a trial-and-error intervention. This is because it can result inadverse effects on a traumatized individual, thus, making it a solution only to individuals on whom it can be successfully applied.

Other mental health professionals can assist emergency personnel

The efficacy of the CISM to handling emergency personnel mental health has been a subject of debate among stakeholders such medical professionals, emergency service workers, and allied professionals. While CISM has been the intervention of choice for majority of the emergency service personnel since the early 1980, beginning the 1990 there has been an increase in dissent concerning its effectiveness.As a result, various intervention programmes and mental health professionalshave been identified as alternative to CISM. These include programmessuch as Crisis Counselling Program (CCP), Psychological First Aid (PFA), and Resiliency Development. Mental health professional include Professional therapist, Psychiatrists, occupational therapists in mental health, mental health nurses, social workers in mental health, in addition to general practitioners(Levers, 2012).

Psychological First Aid (PFA) is an intervention that is used by disaster relief workers and first responders. The National Center for Posttraumatic Stress Disorder (NCTSN) and The Substance Abuse and Mental Health Services Administration (SAMHSA) recommend PFA for emergency personnel. The approach isrecognizedas being an emerging crisis intervention program of choice. It was effective especially as the intervention used by law personnel deployed during 9/11. It promotes a supportive atmosphere and encourages individual resiliency. It has been endorsed as an alternative to CISM.

Crisis Counselling Program (CCP) is another alternative to CISM. It was devisedby the Federal Emergency Management Authority Agency and is founded on the belief that crisis counseling takes on a natural resiliency. The approach was meant to provide assistance to regions and personnel affected during disasters resulting from terrorism. The approach is implemented on a grand scale and necessitates the involvement of a mental health corps.

Resiliency Development primarily targets the resiliency of first responders in an emergency. It has been recommendedas an alternative to CISM. This is because it purges reliving graphic details of an emergency situationby first responders. It is founded on the internal strength of an individual to build on the individuals’ natural resilience.

The mental health professionals who can assist emergency personnel include the use of licensed and competent mental health professionals who havepast experience working with, and treating people suffering from trauma-related stress. Professional therapists have also proved to be more effective that CISM in some cases. Their sessions mostly involve the emergency personnel talking, with the therapist who simply listening and allowing the individual to speak.Psychiatrists have also been suggested as effective mental health professionals who can help emergency personnel deal with stress. Psychiatrists employ the use of psychological treatments such as interpersonal therapy, medication or behavior therapy and in situations where stress levels are severe requiring hospital admission, a psychiatrist will oversee the individual’s treatment. Alternative mental health professionals include occupational therapists in mental health, mental health nurses, social workers in mental health, in addition to general practitioners.


The last thing any organization wants is to expose their employees to services that harm the individual as opposed to helping them recover from an exposure to a stressful situation. While CISM as an intervention approach has been effective in addressing the challenge of traumatic stress, research has shown that it is not completely effective and in some cases has proved to be harmful to individuals. Thus in the face of new, modern and more effective intervention to address the problem of traumatic stress, it is critical that these modern interventions are employed and in some situations where CISM is appropriate, it be used



Fagel, M. J. (2011). Principles of Emergency Management and Emergency Operations Centers (EOC). Boca Raton, Florida: CRC Press, Taylor & Francis Group.

Levers, L. L. (2012). Trauma Counseling: Theories and Interventions (illustrated ed.). New York, NY: Springer Publishing Company.

Regel, S., & Joseph, S. (2010). Post-traumatic Stress. Oxford, New York: Oxford University Press.

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