T​HE CONCEPT OF CISM (C​RITICAL INCIDENT S​TRESS MANAGEMENT)


CISM is a multi-component program designed with the purpose of providing assistance and psychological support to those involved in a critical incident.

Besides its primary goal of support and follow-up during the crisis (the crisis represents a disruption in the psychological balance) it also includes an educational program, which comprises an efficient and prevention-oriented health promotion education plan, thus allowing individuals to learn how to deal with a stress leading situation in the moment it occurs and in the following moments.

CISM begins before the incident: with information, education and training, making the possible changes in the enterprise’s culture concerning Human Factors

Critical Incident -
 A critical incident is defined as any event that has enough impact to oppress the individual’s or group’s usual and effective coping (of stress management) and with the power to interfere in their capacity to perform their tasks in that moment or later on. 

Examples of possible critical incidents in the Air Traffic Services are: loss of separation, temporary loss of the traffic situation perception/awareness, near collision, abnormal and emergency situations and accidents. These are stress leading situations inherent to the profession and therefore it is necessary that one learns how to deal with them by adopting strategies that might diminish their impact.   

Stress after a critical incident - The physiological, cognitive, emotional and behaviour reactions experienced by an individual or a group as a response to a critical incident. These can last a few days or a more extended period of time. They are normal reactions to an abnormal event.   

CISM intervention -
 It is a formal, structured and professionally acknowledged process with the purpose of helping those who have been involved in a critical incident. It is an educational, voluntary and confidential process.

Some of the signs and symptoms of stress after a critical incident

Physical
Weakness, dizziness, nausea, fatigue, chest pain, headaches, high blood pressure, vomiting, grinding of teeth, shivers, muscle tremors, tachycardia, eyesight problems, profuse sweating, breathing problems, etc.

Cognitive
Nightmares, confusion, uncertainty, hyper vigilance, distrust, intrusive images, blaming someone, lack of the capacity to solve problems, lack of abstraction capacity, lack of attention / decision, lack of concentration / memory, time, place or personal disorientation, problems with identifying objects / people, etc..

Emotional
Fear, guilt, panic, denial, anxiety, agitation, irritability, depression, intensive anger, worriment, emotional control losses, inappropriate emotional response, etc.

Behaviour 
Anti-social attitudes, inability to rest, hyperactivity, asynchronous movements, speech and appetite changes, hypersensitivity, alcohol use increase, tobacco use increase, changes in the normal communication methods, etc.
 

What to do after a critical incident
If you have experienced a trauma event or critical incident (any situation you have lived causing you a strong emotional reaction, which has the potential to interfere with your capacity to perform your job that moment or later on) you might feel strong reactions, both emotional and physical, immediately or after. Sometimes the reactions to stress occur right after the event. Other times, they appear hours or days later. And in some cases, it takes weeks and even months.

The signs and symptoms of stress can last days, weeks, months or even longer, depending on the seriousness of the event.

As soon as possible, and the sooner the better, contact your CISM team (one of the Peers or the National Coordinator). They are prepared to help you at anytime and anywhere you chose. Sometimes a healthcare professional’s intervention is needed; the Peers know when to do the referral.

Such a reaction usually disappears faster with the understanding and support of relatives and/or co-workers. Sometimes it is such a traumatic situation that the intervention of a professional is needed and this is not a symptom of madness or weakness. It only means that the event was too strong for a person to be able to overcome it by herself. 

Ways to respond to / cope with your stress responses


IN THE FIRST  24 – 48 HOURS

• Periods of physical exercised combined with relaxing periods might relief some of your physical reactions;
• Organize your time – keep yourself busy;
• Remember that you are having normal reactions to an abnormal situation;
• Talking about the event is the best remedy;
• Avoid the alcohol and pills/tablet’s abuse, you don’t need to worsen the situation even further;
• Seek support – the others care about you;
• Don’t isolate;
• Help your co-workers/colleagues as much as possible by sharing feelings, sensations;
• Don’t restrain from feeling depressed and share that feeling with others;
• Write down what is happening to you during the periods you can’t sleep;
• Do things that please you;
• Remember that those around you are under tension as well;
• Don’t make radical changes in your lifestyle;
• Make as many decisions as possible so that you can feel you have control over yourself, e.g.: if someone asks you what you want to eat, answer even if you don’t know for sure;
• Rest;
• Repetitive thoughts, dreams or retrospectives are normal – don’t try to fight them – they will fade away with time and will become less painful;
• Eat regular and balanced meals (even if you don’t feel like doing this).

Useful Information for relatives and friends 


• Pay attention while listening;
• Find the time to spend with the traumatised person;
• Offer to help and listen;
• Show them trust;
• Help them in the daily tasks such as: cleaning, cooking, looking after the family, taking care of the children;
• Leave them alone for a while;
• Don’t think that any angry-like attitude is against you;
• Don’t tell them that “it could have been worse” – traumatised people don’t take comfort in such reasoning. On the other hand, say that you are sorry for the event and show that you understand and want to help them.