Navigating the aftermath: the vital role of Post-Critical Incident Stress Debriefing in the workplace

Post Critical Incident Stress Debriefing (PCISD) training in the workplace is an essential aspect of employee well-being, especially in high-stress or trauma-exposed professions.

This blog post aims to shed light on the importance and benefits of PCISD training, whilst also addressing common incorrect beliefs.

What is a Critical Incident

Critical incidents can be defined as events or situations ‘that have sufficient emotional power to overcome the usual coping abilities of people, even those working in environments where some degree of exposure is expected’, (Mitchell & Bray, 1990).

Such incidents fall outside normal working routines, pose a significant threat to the participants and or others, or they include factors likely to increase their stressful nature.

These may be single events, a protracted period of difficulty (as with the Covid 19 pandemic), or a series of less intense occurrences in quick succession.

Critical incidents are characterised by demands for which staff may not have been prepared, go beyond their role specifications, or are outside their normal routine.

A critical incident may create a significant risk of harm to the mental health or well-being of an employee.

Factors affecting employee outcomes following the incident are:

  • the nature of the incident,
  • the way it is managed by direct supervisors and more senior managers,
  • the involvement of the community or media (supportive or intrusive),
  • lack of personal support networks, and
  • pre-existing or subsequent personal vulnerabilities

Exposure to a traumatic incident can overwhelm an individual’s psychological defenses, leading to various acute stress reactions (ASR’s). These reactions differ from person to person and are generally temporary. Common ASR’s include persistent thoughts about the incident, emotional outbursts like crying, irritability, sleep disturbances including nightmares, increased caution and hypervigilance, feelings of guilt or shame, memory loss, and emotional numbness.

These responses to a traumatic event are considered normal to the extent that many individuals might experience them. However, the range and intensity of these reactions can vary depending on the person and the nature and severity of the trauma experienced.

Typically, these reactions should reduce over time, with the severity and intensity beginning to diminish within 48 hours following the incident.

What is PCISD?

  1. PCISD is a structured 7 step process used for staff not for primary victims (the recommended support intervention for primary victims is PFA – Psychological First Aid – World Health Organisation)
  2. PCISD is hosted by a trained facilitator
  3. PCISD is a supportive, crisis/trauma focused discussion of a critical or traumatic event and subsequent acute stress reaction with a small homogenous group
  4. It is psycho-educational in nature
  5. Sometimes called CISD (critical incident stress debrief)
  6. PCISD is one of the many tools in the organisational management of workplace stress (it is rehabilitative in nature rather than preventive or curative).
  7. There are many types of debriefing and they often get confused. PCISD is NOT a hot debrief or a defusing session or a reflective practice debrief. PCISD is a structured evidence-based intervention aimed at reducing post-traumatic stress for those involved in the traumatic event – please see common incorrect beliefs of PCISD and trauma below.

The aims of PCISD/CISD are:

  1. To process what happened and mitigate acute stress reactions
  2. To normalise common acute stress reactions following a traumatic incident
  3. To provide useful information regarding coping strategies
  4. To demonstrate the support and understanding of management
  5. To identify those that might need extra help
  6. To encourage restoration of group cohesion and re-entry to work

Benefits of PCISD Training for Workplace Incidents

  • Assists participants with the timeline of what happened during the critical incident and why certain members of the group behaved in a certain way. It helps to complete the puzzle by putting the pieces all together. This helps with psychological and emotional ‘processing’ of the event.
  • Promotes knowledge about Acute Stress Reactions in all five domains (physical, cognitive, emotional, behavioural and spiritual) and when these reactions might require further support: It educates employees involved in the incident on recognising acute stress symptoms and encourages seeking help if symptoms do not diminish over time.
  • Reduces long-term absenteeism: By addressing acute stress reactions early, PCISD can prevent long-term psychological consequences because the participants will be taught to recognise when extra support is required, thus reducing absenteeism, burnout and staff turnover.
  • Enhances group cohesion: Shared experiences in debriefing sessions can strengthen group bonds, fostering a supportive work culture.
  • Improves resilience: Employees who undergo PCISD are often better equipped to handle future stressors, enhancing overall resilience.

Examples of PCISD in action

  • Emergency Services: After a particularly grueling rescue operation, a fire department hosts a PCISD session, allowing firefighters to discuss their experiences and emotions.
  • Healthcare Settings: Nurses and doctors and health care workers dealing with traumatic cases (like a mass casualty event or having to select who gets a ventilator and who doesn’t) participate in a debrief to emotionally and psychologically process the incident collectively.
    • This is not a hot debrief which a term sometimes used for a short ‘debrief’ following a critical incident.
    • It is also not a reflective practice debrief which focuses on operational processes, what happened prior to the incident, what happened during and after the incident and what could be done better in the future – these debriefs focus on quality of service and is more investigative in nature
    • PCISD is entirely therapeutic as it focuses on the thoughts, feelings, behaviours and coping strategies of those involved, and what supports they may require
  • Work Environments:  Following a serious workplace accident (e.g. witnessing a colleague lose a limb perhaps even being involved in the first aid thereafter) or an incident (colleague or client taking their life), exposed employees are offered a post critical incident debriefing session to process their thoughts and feelings, to learn about common acute stress reactions and to identify where and when to access further help.
  • Housing sector: People requiring assistance with housing and finance often have mental health difficulties, alcohol and drug problems and relationship problems which could lead to staff having to deal with challenging behaviours and mental health crises
  • Residential care: People requiring residential care may have learning disabilities, mental health problems, severe physical problems or may be elderly. All these issues may present with various crises that staff might have to deal with that are potentially traumatic. (E.g. a resident with learning disabilities who seriously bites themselves, a resident with mental health difficulties who often self-harms or who attempts suicide or may even complete suicide, etc.)
  • Prison and probation services: Staff are frequently assaulted (verbally and physically), self-harm & suicide are common issues that staff must deal with within these services.

Common Incorrect beliefs about PCISD

Incorrect belief: People believe that the incident is the trauma.

Reality: The trauma is the nervous systems reaction to the traumatic incident

Incorrect belief: Talking about a traumatic incident worsens it

Reality: Structured debriefing in a safe environment often helps mitigate the impacts of traumatic incidents.

Incorrect belief: Needing PCISD is a sign of weakness

Reality: Participating in PCISD reflects strength and a proactive approach to mental health and wellbeing.

Incorrect belief: All people involved in a traumatic incident will develop PTSD

Reality: Very few people develop PTSD, most people will however experience acute stress reactions (ASR’s) and some will experience acute stress disorder (ASD).

Incorrect belief: PCISD is the same as a hot debrief or a reflective practice debrief

Reality: A hot debrief (also known as proximal debriefing or clinical debriefing) is a learning conversation that occurs after a clinical event and involves employees that took part in patient care. The aim of the hot debrief is to promote learning, identify opportunities for improvement in processes, procedures and systems.

PCISD is a structured evidence-based intervention aimed at reducing post-traumatic stress for those involved in the trauma.

The British Association for Counselling and Psychotherapy (BACP) recommends organisation’s provide access to PICSD services for their employees following a critical workplace incident.

Implementing PCISD training in high-risk workplaces is a crucial proactive step and a commitment to the wellbeing of employees. Remember, addressing mental health is as crucial as physical safety in the workplace and a requirement of the Health and Safety at Work Act.

ATICC LTD provides a 3-day training course for PCISD (Post Critical Incident Stress Debriefing)

Learning Outcomes

  1. Define key terms and concepts in Post Critical Incident Stress Debriefing
  2. Identify the key skills required by a debriefing facilitator
  3. Define active listening and its key components
  4. Participate in active listening activities
  5. Describe and participate in empathetic listening and responding
  6. Utilise body language to demonstrate empathy and a positive listening attitude
  7. Identify and utilise effective questioning
  8. Identify and utilise co regulation skills
  9. Describe Mitchell’s 7 phase critical Incident stress debrief
  10. Be able to identify & transition between one phase and the next in the Post Critical Incident Stress Debriefing process
  11. Differentiate between a homogenous group and a heterogenous group
  12. Compare other models with the Mitchell model
  13. Identify common acute stress reactions following a critical incident
  14. List 3 common group challenges and strategies for their management
  15. Facilitate a simulated post critical incident debriefing session using Mitchells 7 phase model
  16. Utilise Driscoll’s model to reflect on your facilitation of the simulated critical incident
  17. Implement peer to peer feedback
  18. Receive feedback on your facilitation of the simulated critical incident

ATICC LTD provides a 1 day training course for PFA (Psychological First Aid)

Learning Outcomes

  1. Differentiate between Mental health first aid and psychological first aid and debriefing
  2. Demonstrate knowledge of the principles and techniques of PFA
  3. Identify common reactions from each of the physical, emotional, behavioural, cognitive, spiritual and sensory reactions to a traumatic event in both adults and children
  4. When provided with scenarios and profiles, select and provide appropriate PFA responses to individuals presenting with common reactions, positive coping strategies, maladaptive coping strategies and severe reactions to traumatic events
  5. Demonstrate knowledge of responder stressors and principles of self-care as they apply to another’s personal crisis or a disaster – before during and after the event
  6. Apply knowledge and understanding of principles of self-care by developing a printable personal resiliency plan for use following providing PFA

Please contact us on info@aticc.co.uk for more information