CISM standard operating procedure

Exposure to traumatic incidents on the job is an occupational hazard for emergency response and public safety personnel.
It is our belief that emergency service workers who have been exposed to critical incident stress while performing a public service should have access to critical incident debriefing interventions designed to help them identify and cope with their responses to these events. The cost of such services should not be borne by workers but should either be provided by management in the form of employee assistance programs or provided by trained debriefing teams on a no fee basis.
The King County CISD Program has been developed to provide debriefing following critical incidents to any emergency response agency requesting assistance.
The focus of this service is to minimize the harmful affects of job stress, particularly in crisis or emergency situations. As such, the highest priorities for the team are to maintain confidentiality and to respect the feelings of the individuals involved.
It is not the function of the team to replace on-going counseling, but to provide immediate crisis intervention. Through the CISD process, the team provides emergency personnel with a tool to potentially alleviate stress related symptoms. Workers who require additional psychological intervention should be referred for follow-up services to agencies or mental health professionals who are familiar with current advances in trauma theory and have experience in working with trauma victims.

Program administration

Peer Review - to be transferred
Guidelines for Team Leader Ride-Alongs

I.	Goal
	A.	The ride-along requirements for the CISM Program have been established in order to allow Team Leaders to obtain first hand exposure to the world of emergency services.
II.	Objectives
	A.	After participating in the ride-alongs, it is expected that the team leaders will have:
		1.	A better understanding of the routine daily activites associated with emergency services work.
		2.	An enhanced view of the actual rescue activities at the emergency scene.
		3.	A greater awareness of the emergency service worker's responses to critical events and their usual coping methods after the event.
		4.	Insight into their own psychological and physiological reactions to being present at an emergency scene and personally witnessing traumatic events and or serious injury.
		5.	An improved perception of witness/bystander reactions to traumatic experiences.
		6.	A greater appreciation for the emergency services worker, including personality traits, motivations, peer relationships and their committment to their profession.
III.	Requirement
	A.	Initially Team Leaders are required to make at least one ride-along with each of the following emergency services. All required ride-alongs must be complete a total of 12 hours minimum of observation time by the end of the first year on the CISM Team. Police (4 hours)
		1.	Police (4 hours)
		2.	Fire (4 hours)
		3.	Paramedic Unit (4 hours)
	B.	Observations for the following are optional, but recommended:
		1.	Private Ambulance (2 hours)
		2.	Hospital Emergency Room (2 hours)
		3.	Emergency Dispatch Center (4 hours)
	C.	After completing of the Team Leader's initial training requirements, they are required to complete four (4) hours of ride-along annually for the next 2 consecutive years to meet the continuing education requirements for the CISM Team.
IV.	Procedures
	A.	Team Leaders will be responsible for setting up each ride-along with the appropriate agency. Attached is a listing of the agencies which have agreed to allow CISM Team Members to participate in ride-alongs or observations. Team Members should call the contact persons directly and make arrangements for each ride-along.
	B.	The time for ride-alongs are negotiable with each agency and may be changed if they do not fit your schedule. However, please keep in mind that the best times are those in which the most activity occurs.
	C.	In most cases you are required to sign a legal waiver disclaiming any liability on the part of the agency while you are riding/observing.
	D.	Complete the Ride Along Report Form of your activity. Please complete this form and return to the CISM Program Coordinator within the required training period, i.e. by December 31st.

Team membership

Recruiting and Selection Process

Criteria to be selected for an interview for Team Leader:

1.	Graduate degree in a recognized mental health profession and registered, licensed, or certified to practice in the specialty area (if required).
2.	Cited practice experience as a therapist or counselor in private, group, or agency practice.
3.	Possess or be eligible for professional liability and malpractice insurance;
4.	Training and/or experience with CISD or related involvement with victims of trauma.

Criteria to be selected as a Peer Debriefer:

1.	Currently affiliated with an emergency services agency either as a paid employee or a volunteer;
2.	Knowledge, training and/or experience in stress management or CISD;
3.	Knowledge in counseling?
4.	Applicable work history or experience which demonstrates personal characteristics such as leadership ability, self-confidence, ability to communicate effectively, and ability to work as a team.

Team membership duties and responsibilities

Recruitment/Qualifications - Volunteer Team Members

1.	Who are candidates for team membership? Team Leader: Licensed mental health professional with strong background in counseling and interviewing skills, e.g., psychiatrist, psychologist, social worker, psychiatric nurse, physicians with family practice training, counselors, etc. Peer Debriefers: Emergency service workers (police officer, firefighter, paramedic, EMT, etc.), with current or recent employment in the field.
2.	What are the qualities looked for in team members?
	a.	It is important that all team members be sensitive persons who will keep confidential the information shared in debriefing sessions. Team members must be well adjusted, empathetic, respected by peers, credible and non-judgmental.
3.	What are the minimum educational requirements?
	a.	Team Leader: Graduate degree in a recognized mental health profession; registered, licensed or certified to practice in specialty area. Trauma and/or critical incident debriefing experience strongly recommended.
	b.	Peer Debriefers: Employment or volunteer status as an emergency service worker. Post-high school (e.g. community college or university level courses in sociology, psychology, or similar behavioral sciences with appropriate knowledge of group processes, communication skills, interpersonal relationships, etc.) desirable, but not required. On-the-job training and workshops/seminars in dealing with critical incident stress, also desirable but not required.
4.	Are there other desired special traits or personal characteristics?
	a.	Yes, mainly dependable, flexible, patient, out-going, creative approachable, etc. Able to respond on-call for incident debriefings, defusings, demobilizations or to emergency scenes (rarely).
5.	What special skills are needed?
	a.	Ability to listen and communicate effectively with others. Training in communication skills or leading groups is desirable, but not required.
6.	What kind of commitment is involved?
	a.	The volunteer team member must be willing to complete a required initial 2 day training session (16 hours), attend team meetings/continuing education sessions (6 annually, 3 hours each) and complete required reports. Must be able to respond to team assignments to conduct a debriefing on short notice during periods of volunteer duty. Mental health professionals will be required to participate in "cross training" with rescue workers (police, fire or EMS), including 12 hours of "riding along" annually.
7.	What can be expected as expenses?
	a.	Training will be provided at no charge. Carpools to debriefings and training sessions are encouraged. Agencies/organizations requesting debriefings will be asked to cover team expenses to, at and from the site of the debriefings; however, details for reimbursement of out-of-pocket expenses (travel, meals, personal supplies, etc. ) have not yet been worked out.
	b.	Mental health professionals must be responsible for their own professional liability/malpractice insurance.
8.	Are there guidelines or protocols for debriefings?
	a.	Yes, the King County CISM model is based on a CISD process developed by Jeffrey Mitchell, PhD., University of Maryland at Baltimore, in 1983.
	b.	An information packet about the King County Critical Incident Stress Management Program is available on request. (See information below.)
	c.	The King County CISM team participates in the Washington CISM Network statewide mobilization plan and CISM team members may be mobilized for response outside King County and Washington State, as needed.
9.	Where can applications be obtained?
	a.	Application forms for Team Leader or Peer Debriefer or CISM Informational Packets can be obtained from:

Revocation/Suspension of Membership

Mobilization

King County

Valley Communication Center (253-372-1400)

Washington State CISM Network (See Washington State CISM-Net Map)

Statewide Disaster Response Plan
Purpose - Mutual Aid CISD Teams
Four Statewide Regional Zones
24 Hour Zone Contacts
International – International Critical Incident Stress Foundation, Inc.
24 Hour Response: (410-313-2473)

Program evaluation

User Comments:

"Being able to talk about what happened, having people listen, and not being judged in the talking. Learning more about the incident."
"It allowed me to vent my frustrations with the way the call went."
"It allowed those of us who knew the victim and responded to the scene to come together and share our feelings in a controlled atmosphere."
"The debriefing allowed me to put things into proper perspective. I personally feel this program should never stop."
"It's a great release at the most important time. Helps you realize you are not alone with your feelings."