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Critical incident stress management (CISM): benefit or risk for emergency services?
Prehosp Emerg Care. 2003 Apr-Jun; 7(2):272-9.PE

Abstract

BACKGROUND

Critical incident stress management (CISM) has become a common practice in modern emergency services. Described in 1983 as critical incident stress debriefing (CISD), CISM was originally marketed to help emergency personnel deal with ostensibly stressful situations they would encounter as a part of their work.

OBJECTIVE

To review the status of the medical and psychological literature regarding the efficacy and safety of CISM.

METHODS

Several pertinent databases were accessed and searched for scientific articles pertaining to CISM. These were subsequently analyzed for methodology and pertinence to the study topic.

RESULTS

Numerous scientific articles were found concerning CISM. Several high-quality studies were identified, but many other studies lacked adequate methodology sufficient for use in an evidence-based medicine approach. Others were from trade magazines, non-refereed journals, and obscure mental health journals. Several meta-analyses and randomized controlled trials (RCTs) were found. Overall, these studies show that, at best, CISM has no effect on preventing psychiatric sequelae following a traumatic event, particularly post-traumatic stress disorder (PTSD). Furthermore, several studies report possible paradoxical worsening of stress-related symptoms in patients and personnel receiving CISM.

CONCLUSIONS

Despite the limitations of the existing literature base, several meta-analyses and RCTs found CISM to be ineffective in preventing PTSD. Several studies found possible iatrogenic worsening of stress-related symptoms in persons who received CISM. Because of this, CISM should be curtailed or utilized only with extreme caution in emergency services until additional high-quality studies can verify its effectiveness and provide mechanisms to limit paradoxical outcomes. It should never be a mandatory intervention.

Authors+Show Affiliations

Department of Emergency Medicine, University of North Texas Health Sciences Center, Fort Worth, Texas, USA. bbledsoe@earthlink.net

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

12710792

Citation

Bledsoe, Bryan E.. "Critical Incident Stress Management (CISM): Benefit or Risk for Emergency Services?" Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors, vol. 7, no. 2, 2003, pp. 272-9.
Bledsoe BE. Critical incident stress management (CISM): benefit or risk for emergency services? Prehosp Emerg Care. 2003;7(2):272-9.
Bledsoe, B. E. (2003). Critical incident stress management (CISM): benefit or risk for emergency services? Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 7(2), 272-9.
Bledsoe BE. Critical Incident Stress Management (CISM): Benefit or Risk for Emergency Services. Prehosp Emerg Care. 2003 Apr-Jun;7(2):272-9. PubMed PMID: 12710792.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Critical incident stress management (CISM): benefit or risk for emergency services? A1 - Bledsoe,Bryan E, PY - 2003/4/25/pubmed PY - 2003/6/27/medline PY - 2003/4/25/entrez SP - 272 EP - 9 JF - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors JO - Prehosp Emerg Care VL - 7 IS - 2 N2 - BACKGROUND: Critical incident stress management (CISM) has become a common practice in modern emergency services. Described in 1983 as critical incident stress debriefing (CISD), CISM was originally marketed to help emergency personnel deal with ostensibly stressful situations they would encounter as a part of their work. OBJECTIVE: To review the status of the medical and psychological literature regarding the efficacy and safety of CISM. METHODS: Several pertinent databases were accessed and searched for scientific articles pertaining to CISM. These were subsequently analyzed for methodology and pertinence to the study topic. RESULTS: Numerous scientific articles were found concerning CISM. Several high-quality studies were identified, but many other studies lacked adequate methodology sufficient for use in an evidence-based medicine approach. Others were from trade magazines, non-refereed journals, and obscure mental health journals. Several meta-analyses and randomized controlled trials (RCTs) were found. Overall, these studies show that, at best, CISM has no effect on preventing psychiatric sequelae following a traumatic event, particularly post-traumatic stress disorder (PTSD). Furthermore, several studies report possible paradoxical worsening of stress-related symptoms in patients and personnel receiving CISM. CONCLUSIONS: Despite the limitations of the existing literature base, several meta-analyses and RCTs found CISM to be ineffective in preventing PTSD. Several studies found possible iatrogenic worsening of stress-related symptoms in persons who received CISM. Because of this, CISM should be curtailed or utilized only with extreme caution in emergency services until additional high-quality studies can verify its effectiveness and provide mechanisms to limit paradoxical outcomes. It should never be a mandatory intervention. SN - 1090-3127 UR - https://www.unboundmedicine.com/medline/citation/12710792/Critical_incident_stress_management__CISM_:_benefit_or_risk_for_emergency_services L2 - https://linkinghub.elsevier.com/retrieve/pii/S1090312703500739 DB - PRIME DP - Unbound Medicine ER -