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Critical incident stress debriefing: Keeping your flight crew healthy
CLINICAL REPORT
.Incident Stress ebnef ng: Keeping Your Flight Crew Healthy
CDritical • Tracy A. Troiani, RN, BSN, CCRN, EMT-P; Richard T. Boland, EMT-P Introduction A CRITICAL INCIDENT IS AN EVENT beyond the normal range of h u m a n experience that causes an unusually strong emotional response in emergency medical personnel. 1 In the air m e d i c a l t r a n s p o r t p r o f e s s i o n , an e x a m p l e of a critical i n c i d e n t is a hard landing. This event can elicit a stress response, acute in some and s y m p t o m a t i c in almost e v e r y case. H a v i n g no e m o t i o n a l or p h y s i c a l response to these kinds of events is extremely rare. T h e purpose of this article is to help flight teams recognize s y m p t o m s of s t r e s s r e s p o n s e and discuss m e a s u r e s that can b e taken to assist personnel after traumatic events.
Stress Emotional or physical r e s p o n s e s to c r i t i c a l i n c i d e n t s a r e n o r m a l r e s p o n s e s to stress. Stress c a u s e s physical and psychological responses in people that are managed differently b y e a c h i n d i v i d u a l . 2 T h e daily e x p e r i e n c e of stressful events over time r e s u l t s in a buildup of s t r e s s c o m m o n l y r e f e r r e d to as " e x c e s s baggage." Tracy A. Troiani is a flight nurse for the Critical Care Transport Team, Saint Francis Medical Center, in Pittsburgh, Pa. Richard T. Boland is the EMS coordinator for the University of Pittsburgh Medical Center.
D u r i n g n u r s i n g and p a r a m e d i c training, the word "stress" is u s e d casually. During flight training, stress is part of the job; in fact, most flight t e a m s thrive on it. However, continuous e x p o s u r e to daily stressors can result in an overwhelming a c c u m u l a t i o n of s t r e s s . U n f o r tunately, there are no formal answers provided by training institutions for managing these daily stressors. In today's society an i n c r e a s i n g n u m b e r of natural and man-made disa s t e r s i n d u c e s t r e s s in t h e individual. 3 These disasters result in m a n y i n j u r i e s and fatalities. T h i s human suffering has the potential to r e a c h far b e y o n d the s c e n e of the e v e n t s and i n c r e a s e t h e s t r e s s responses of an individual or even of an entire flight service. 3 T h e s e events can influence normal, everyday life, affecting the home, job, and personal relationships. E v e n if the e v e n t is small, reactions can still arise at any time. T h e death or serious injury of a co-worker, caring for critically ill or injured patients, as well as feelings of depression or conflict with superiors are j u s t a few c a u s e s of s t r e s s f u l responses during any given day. Understanding daily stressors can be one of the most difficult aspects of a professional career. T h e prolonged c a r e p r o v i d e d to a y o u n g c a r d i a c a r r e s t patient during t r a n s p o r t can affect a person physically as well as mentally. Serious injuries, loss of life,
The Journal of Air Medical Transport • October 1992
mutilation and disfigurement, especially to y o u n g children, will have direct stress responses on any EMS professional. Some flights are intense, requiring flight crews to use their resources to t h e i r fullest. O t h e r s m i g h t be perceived as routine. Such h i g h s and lows can result in fatigue, apathy, and burnout. 4 T h e s e mood swings experienced every day by flight teams can lead to cumulative stress responses.
Critical Incident T h e response to a critical incident can occur immediately at the event, can be delayed, or can be cumulative. 1,2,5 Commonly, people think of a major disaster as a critical incident, but any event may affect an individual emotionally. How a person feels emotionally before a situation occurs can d e t e r m i n e h o w t h e individual will respond during or after the incident. The most common examples of critical incidents are as follows: • T h e serious injury or death of co-workers in the line of duty. • The serious injury or death of a civilian resulting from equipment failure, s u c h as a h e l i c o p t e r c r a s h or hard landing with a patient on board. • The sudden death of an infant or child, especially if it involves a criminal act by an adult. • A n y l o s s of life f o l l o w i n g extraordinary and prolonged expend i t u r e s of p h y s i c a l and e m o t i o n a l
21
energy by the rescuers. This occurs with prolonged extrication time, hazardous working conditions, and extreme weather environments. • Any incident that could cause death or serious injury to the workers. In air medical transport, such incidents are hard landings, whiteouts, and near misses with trees and wires. • Any u n u s u a l c i r c u m s t a n c e s . These include incidents where sights and sounds produce a high level of i m m e d i a t e or d e l a y e d e m o t i o n a l responses that overload the normal c o p i n g m e c h a n i s m s . In a d d i t i o n , repetitive flights with little or no break for rest, especially when they tax resources to the limit, can quickly result in stress reactions. 1,2,5,6 Stress Response
W h e n a s t r e s s f u l event occurs, 90% of the individuals involved will experience stress, while 10% will say there is no effect. 5 Approximately 7% of those 10% will be in denial, where-
as 3% will actually escape any negative effect. Of the 90% of individuals who experience a stressful event, 80% will usually develop symptoms within 24 hours. 5 Half of this 80% can have some form of delayed stress reaction that continues for 3 to 4 weeks, while the other half might experience stress lasting 6 months to a year after a specific incident. 5 Ten percent of those experiencing s t r e s s can u n d e r g o p r o f o u n d effects and need professional assistance for some time after the event. Incident-specific r e s p o n s e s are c o m p o s e d of signs and s y m p t o m s that most of us can relate to. These responses can be physical, cognitive, or e m o t i o n a l . P h y s i c a l r e s p o n s e s i n c l u d e n a u s e a , vomiting, m u s c l e tremors, profuse sweating, chills, and dizziness. 1,2,~ Cognitive responses in the acute phase include memory loss, difficulty in problem soMng and making decisions, loss of attention span, inability to concentrate, or even the inability to perform routine tasks.
E m o t i o n a l r e s p o n s e s can v a r y widely according to the individual's character. Anxiety, fear, and grief are the most common responses, along with depression, hopelessness, irritability, anger, and sympathy for the victims. 1,2,a T h e s e a c u t e s t r e s s responses can affect one's personal life and professional relationships. A delayed stress response is typically manifested by intnlsive images, s u c h as f l a s h b a c k s and nightmares. 1,3,5 In addition, individuals m a y fear the r e p e t i t i o n of similar events or situations, which can lead to frequent absenteeism. If the event was significant e n o u g h , t h e t e a m member may never fly again. These symptoms can occur a few weeks to a year after the event. The cumulative stress results in a state of fatigue or frustration that can lead to burnout. 2,5 Most often these individuals are apathetic, work less, and are physically and mentally exhausted. People respond to stress in many different ways. In order to cope effec-
A.R.C.H. - AREA RESCUE CONSORTIUM OF HOSPITALS
St. Louis University • Barnes Hospital • St. John's Mercy Medical Center St. Louis, MO - Since 1979 Two (2) MBB BK-117BI's and One (1) MBB BO-105CBS
HAMMONS LIFE LINE St. John's Regional Health Center Springfield, MO - Since 1984 One (1) MBB BO-105CBS
LIFE STAR
22
LIFE BEAT
Southeast Missouri Hospital Cape Girardeau, MO - Since 1987 One (1) Bell 206L-1
Stormont-Vail Regional Medical Center St. Francis Hospital and Medical Center Topeka, K S - 1988 One (1) Bell 206L-1
MED-LINK St. Elizabeth Hospital Beaumont, TX - Since 1989 One (1) MBB BO-105CBS
LIFE FLIGHT Welborn Baptist Hospital Evansville, IN - Since 1992 One (1) Bell 206L-1
St. John's Regional Medical Center Joplin, MO - Since 1992 One (1) MBB BO-105CBS
MED FLIGHT
The Journal of Air Medical Transport • October 1992
tively with stress induced by their jobs, people often talk to fellow workers, friends, and family about their emotions and experiences. However, the most productive means of keeping the flight crews h e a l t h y is t h r o u g h Critical I n c i d e n t Stress Debriefing (CISD). 1,5 CISD is a formal approach intended to assist an individual or a group of individuals in understanding their responses to stress. Specific goals include an accurate accounting of events, dispelling rumors, and identifying feelings and thoughts related to the incident. D e b r i e f i n g s are to enhance an employee's well-being, as well as to maintain their effectiveness at work by facilitating a supportive and reassuring environment. CISD relies on a specific process d e s i g n e d for the n o r m a l person, allowing for the recovery of a normal emotional state after experiencing an abnormal event. 5,6 Determining and identifying how one feels can prevent f u t u r e problems, especially with other flight team members and their own family. To illustrate, a flight
medic spoke of his situation involving two young children involved in fatal automobile accidents. Both children were unrestrained. One day he returned home to find his two children eating dinner. They were eating spaghetti and, as children do, were playing with their food and both were a mess. When he saw this he became hysterical, screaming at his wife, accusing her of being an unfit mother. After six months of counselling, he began to put the two situations together. Had he been debriefed, he may not have had to suffer through those six months. ClSD Protocols Every flight service should incorp o r a t e CISD p r o t o c o l s for t h e i r team m e m b e r s who have experienced an extraordinary event. When an individual or an entire flight team experiences distressing symptoms, they should have access to a CISD teamfi Individual or group debriefings should occur 24 to 72 hours after the event. 7 Experience has shown that debriefings too soon or too late
after the event are ineffective. A specific a g e n c y with d e d i c a t e d CISD team members trained to handle these events should perform the debriefings. CISD teams consist of a team leader, usually a mental health provider with an interest in emergency services, as well as other individuals trained in the debriefing format. The other team members are called peer debriefers and are trained in the debriefing process. Each CISD debriefing team is constructed with the individual or group i n t e r e s t s in mind, a t t e m p t i n g to match the skill level with the group. The team could be c o m p o s e d of e m e r g e n c y medical t e c h n i c i a n s , paramedics, registered nurses, flight nurses and paramedics, or any combination of these individuals. CISD debriefing should not be confused with a critique, where an individual or a group's performance is analyzed by t h e i r peers or superiors, and should not be c o n f u s e d with the debriefing done after any normal flight.
!!!! FLIGHT NURSES !!!! Are you looking for a CHALLENGE? Do you want a career you can commit to? Looking for a company to grow with? Wrap it all up with a great place to live, good benefits, salary, and excellent orientation program Eagle Rescue of Arizona, a division of Rocky Mountain Helicopters, Inc. Has one opening for full-time and part-time experienced flight nurse. Qualifications for this program include:
1) AZ state nursing license, current or applied for 2) Previous experience as a flight nurse with an EMS helicopter service, preferably more than 1 year. 3) ACLS and PALS course completion 4) CEN and/or CCRN preferred 5) Previous experience in emergency and critical care nursing Call or send resumes to:
Wendy Slater, RN Chief Flight Nurse, Eagle Rescue of Arizona 7350 E. Evans Rd., Suite Cl12 Scottsdale, Arizona 85260 Phone: (602) 596-1594 ° Fax: (602) 596-1986
The Journal of Air Medical Transport • October 1992
23
®
B
Samaritan
AirEvac
8UTrERWORTH
If an individual or group requires i m m e d i a t e a t t e n t i o n following a major disaster, a defusing should o c c u r . 1,3,5 Defusings are short interviews with healthcare providers, conducted by CISD-trained debriefers. They provide an opportunity to discuss the event and share information about stress and how people react to it. Most often, flight team defusing occurs during restocking and cleaning the aircraft after a flight. When flight team members talk about the call, good or bad, the expression of feelings and thoughts towards that incident can be shared. Problems arise when flight personnel do not get along or have consecutive flights and are unable to communicate their feelings. This is especially true if one team m e m b e r feels another acted inappropriately.
Summary
I
AMR COMBS
WORLDWIDE FLIGHT OPERATIONS
The future is now! see us at booth
611. 24
Most flight team members have experienced some type of a stress reaction in their flight career, but few have been debriefed appropriately. Debriefings are necessary to keep flight personnel mentally healthy. Fatal c r a s h e s have always drawn attention, and some teams have been debriefed afterward. Proper debriefing and formal mental health evaluation may be the answer. Conclusion T o d a y ' s flight teams c u r r e n t l y treat a diverse patient population in a b r o a d r a n g e of e n v i r o n m e n t s . Everyone, from the referring hospital to patients' families, relies on the flight personnel to get the patient to the receiving hospital alive. T h e tasks involved for flight services are stressful and b e c o m i n g more so. More complex machinery and new technical approaches to medicine have only begun to increase the ability of flight teams across the country to quickly and efficiently transport a broad range of patients. At present, a p p r o x i m a t e l y 200 CISD p r o g r a m s exist across the country in 38 states. 8 Some CISD teams have taken steps to incorporate individuals from local flight teams into their programs. In most
cases, however, it is necessary for a flight service to seek out a CISD program in their area. Starting a CISD program is not easy. Any program wanting to start a CISD program will have to have administrative support. T r a i n i n g is e s s e n t i a l and can be expensive, so financial support must also be available. Support from local mental health providers is essential. CISD training is available through the American Critical Incident Stress Foundation, but scheduling a training program for any group could take as long as one year. The easiest approach would be to contact an already established CISD team near the flight program. CISD teams are always looking for good peer support, and a flight nurse or paramedic would be a welcome addition to most teams. For more information about CISD, or to find the closest CISD program, please call the American Critical Incident Stress Foundation (301/7500856), or call the Referral Communication Center, Pittsburgh, Pa., (1-800/544-2500). • Reference 1. Mitchell JT: When disaster strikes: The critical incident stress debriefing process. Journal of Emergency Medical Services 1983; 12 (1):23-34. 2. Mitchell JT, Resenk HLP: Emergency Response To Crisis. Englewood Cliffs, N.J., Robert J. Brady Co., 1981, pp 183-195. 3. Mitchell JT: Assessing and managing the psychologic impact of terrorism, civil disorder, disaster, and mass causalities. In: Emergency Care Quarterly, Disaster Management. Jacobs LM, Bennett BR, (eds), 1986, 2(1):51-58. 4. F r e u d e n b e r g e r HJ, Richelson G: Burnout, the high cost of high achievement. Garden City, N.Y., Anchor Press, Doubleday & Co. Inc., 1980. 5. Manson E: Critical incident stress debriefing team training handout. Pittsburgh, Pa., July 1990, pp 12-28. 6. Hartsough DM, Garauenta MD: Disaster work and mental health: prevention and control of stress among workers. Washington, D.C., Center for Mental Health Studies of Emergencies, U.S. Department of Health and Human Resources, 1985, pp 37-43. 7. Mitchell JT, Bray G: Emergency services stress: Guidelines for preserving the health and careers of emergency services personnel. Englewood, N.J., Prentice-Hall, Inc., 1990, pp 143-147. 8. American Critical Incident Stress Foundation, Ellicott City, Md., 1991, p 3.
The Journal of Air Medical Transport • October 1992
.Incident Stress ebnef ng: Keeping Your Flight Crew Healthy
CDritical • Tracy A. Troiani, RN, BSN, CCRN, EMT-P; Richard T. Boland, EMT-P Introduction A CRITICAL INCIDENT IS AN EVENT beyond the normal range of h u m a n experience that causes an unusually strong emotional response in emergency medical personnel. 1 In the air m e d i c a l t r a n s p o r t p r o f e s s i o n , an e x a m p l e of a critical i n c i d e n t is a hard landing. This event can elicit a stress response, acute in some and s y m p t o m a t i c in almost e v e r y case. H a v i n g no e m o t i o n a l or p h y s i c a l response to these kinds of events is extremely rare. T h e purpose of this article is to help flight teams recognize s y m p t o m s of s t r e s s r e s p o n s e and discuss m e a s u r e s that can b e taken to assist personnel after traumatic events.
Stress Emotional or physical r e s p o n s e s to c r i t i c a l i n c i d e n t s a r e n o r m a l r e s p o n s e s to stress. Stress c a u s e s physical and psychological responses in people that are managed differently b y e a c h i n d i v i d u a l . 2 T h e daily e x p e r i e n c e of stressful events over time r e s u l t s in a buildup of s t r e s s c o m m o n l y r e f e r r e d to as " e x c e s s baggage." Tracy A. Troiani is a flight nurse for the Critical Care Transport Team, Saint Francis Medical Center, in Pittsburgh, Pa. Richard T. Boland is the EMS coordinator for the University of Pittsburgh Medical Center.
D u r i n g n u r s i n g and p a r a m e d i c training, the word "stress" is u s e d casually. During flight training, stress is part of the job; in fact, most flight t e a m s thrive on it. However, continuous e x p o s u r e to daily stressors can result in an overwhelming a c c u m u l a t i o n of s t r e s s . U n f o r tunately, there are no formal answers provided by training institutions for managing these daily stressors. In today's society an i n c r e a s i n g n u m b e r of natural and man-made disa s t e r s i n d u c e s t r e s s in t h e individual. 3 These disasters result in m a n y i n j u r i e s and fatalities. T h i s human suffering has the potential to r e a c h far b e y o n d the s c e n e of the e v e n t s and i n c r e a s e t h e s t r e s s responses of an individual or even of an entire flight service. 3 T h e s e events can influence normal, everyday life, affecting the home, job, and personal relationships. E v e n if the e v e n t is small, reactions can still arise at any time. T h e death or serious injury of a co-worker, caring for critically ill or injured patients, as well as feelings of depression or conflict with superiors are j u s t a few c a u s e s of s t r e s s f u l responses during any given day. Understanding daily stressors can be one of the most difficult aspects of a professional career. T h e prolonged c a r e p r o v i d e d to a y o u n g c a r d i a c a r r e s t patient during t r a n s p o r t can affect a person physically as well as mentally. Serious injuries, loss of life,
The Journal of Air Medical Transport • October 1992
mutilation and disfigurement, especially to y o u n g children, will have direct stress responses on any EMS professional. Some flights are intense, requiring flight crews to use their resources to t h e i r fullest. O t h e r s m i g h t be perceived as routine. Such h i g h s and lows can result in fatigue, apathy, and burnout. 4 T h e s e mood swings experienced every day by flight teams can lead to cumulative stress responses.
Critical Incident T h e response to a critical incident can occur immediately at the event, can be delayed, or can be cumulative. 1,2,5 Commonly, people think of a major disaster as a critical incident, but any event may affect an individual emotionally. How a person feels emotionally before a situation occurs can d e t e r m i n e h o w t h e individual will respond during or after the incident. The most common examples of critical incidents are as follows: • T h e serious injury or death of co-workers in the line of duty. • The serious injury or death of a civilian resulting from equipment failure, s u c h as a h e l i c o p t e r c r a s h or hard landing with a patient on board. • The sudden death of an infant or child, especially if it involves a criminal act by an adult. • A n y l o s s of life f o l l o w i n g extraordinary and prolonged expend i t u r e s of p h y s i c a l and e m o t i o n a l
21
energy by the rescuers. This occurs with prolonged extrication time, hazardous working conditions, and extreme weather environments. • Any incident that could cause death or serious injury to the workers. In air medical transport, such incidents are hard landings, whiteouts, and near misses with trees and wires. • Any u n u s u a l c i r c u m s t a n c e s . These include incidents where sights and sounds produce a high level of i m m e d i a t e or d e l a y e d e m o t i o n a l responses that overload the normal c o p i n g m e c h a n i s m s . In a d d i t i o n , repetitive flights with little or no break for rest, especially when they tax resources to the limit, can quickly result in stress reactions. 1,2,5,6 Stress Response
W h e n a s t r e s s f u l event occurs, 90% of the individuals involved will experience stress, while 10% will say there is no effect. 5 Approximately 7% of those 10% will be in denial, where-
as 3% will actually escape any negative effect. Of the 90% of individuals who experience a stressful event, 80% will usually develop symptoms within 24 hours. 5 Half of this 80% can have some form of delayed stress reaction that continues for 3 to 4 weeks, while the other half might experience stress lasting 6 months to a year after a specific incident. 5 Ten percent of those experiencing s t r e s s can u n d e r g o p r o f o u n d effects and need professional assistance for some time after the event. Incident-specific r e s p o n s e s are c o m p o s e d of signs and s y m p t o m s that most of us can relate to. These responses can be physical, cognitive, or e m o t i o n a l . P h y s i c a l r e s p o n s e s i n c l u d e n a u s e a , vomiting, m u s c l e tremors, profuse sweating, chills, and dizziness. 1,2,~ Cognitive responses in the acute phase include memory loss, difficulty in problem soMng and making decisions, loss of attention span, inability to concentrate, or even the inability to perform routine tasks.
E m o t i o n a l r e s p o n s e s can v a r y widely according to the individual's character. Anxiety, fear, and grief are the most common responses, along with depression, hopelessness, irritability, anger, and sympathy for the victims. 1,2,a T h e s e a c u t e s t r e s s responses can affect one's personal life and professional relationships. A delayed stress response is typically manifested by intnlsive images, s u c h as f l a s h b a c k s and nightmares. 1,3,5 In addition, individuals m a y fear the r e p e t i t i o n of similar events or situations, which can lead to frequent absenteeism. If the event was significant e n o u g h , t h e t e a m member may never fly again. These symptoms can occur a few weeks to a year after the event. The cumulative stress results in a state of fatigue or frustration that can lead to burnout. 2,5 Most often these individuals are apathetic, work less, and are physically and mentally exhausted. People respond to stress in many different ways. In order to cope effec-
A.R.C.H. - AREA RESCUE CONSORTIUM OF HOSPITALS
St. Louis University • Barnes Hospital • St. John's Mercy Medical Center St. Louis, MO - Since 1979 Two (2) MBB BK-117BI's and One (1) MBB BO-105CBS
HAMMONS LIFE LINE St. John's Regional Health Center Springfield, MO - Since 1984 One (1) MBB BO-105CBS
LIFE STAR
22
LIFE BEAT
Southeast Missouri Hospital Cape Girardeau, MO - Since 1987 One (1) Bell 206L-1
Stormont-Vail Regional Medical Center St. Francis Hospital and Medical Center Topeka, K S - 1988 One (1) Bell 206L-1
MED-LINK St. Elizabeth Hospital Beaumont, TX - Since 1989 One (1) MBB BO-105CBS
LIFE FLIGHT Welborn Baptist Hospital Evansville, IN - Since 1992 One (1) Bell 206L-1
St. John's Regional Medical Center Joplin, MO - Since 1992 One (1) MBB BO-105CBS
MED FLIGHT
The Journal of Air Medical Transport • October 1992
tively with stress induced by their jobs, people often talk to fellow workers, friends, and family about their emotions and experiences. However, the most productive means of keeping the flight crews h e a l t h y is t h r o u g h Critical I n c i d e n t Stress Debriefing (CISD). 1,5 CISD is a formal approach intended to assist an individual or a group of individuals in understanding their responses to stress. Specific goals include an accurate accounting of events, dispelling rumors, and identifying feelings and thoughts related to the incident. D e b r i e f i n g s are to enhance an employee's well-being, as well as to maintain their effectiveness at work by facilitating a supportive and reassuring environment. CISD relies on a specific process d e s i g n e d for the n o r m a l person, allowing for the recovery of a normal emotional state after experiencing an abnormal event. 5,6 Determining and identifying how one feels can prevent f u t u r e problems, especially with other flight team members and their own family. To illustrate, a flight
medic spoke of his situation involving two young children involved in fatal automobile accidents. Both children were unrestrained. One day he returned home to find his two children eating dinner. They were eating spaghetti and, as children do, were playing with their food and both were a mess. When he saw this he became hysterical, screaming at his wife, accusing her of being an unfit mother. After six months of counselling, he began to put the two situations together. Had he been debriefed, he may not have had to suffer through those six months. ClSD Protocols Every flight service should incorp o r a t e CISD p r o t o c o l s for t h e i r team m e m b e r s who have experienced an extraordinary event. When an individual or an entire flight team experiences distressing symptoms, they should have access to a CISD teamfi Individual or group debriefings should occur 24 to 72 hours after the event. 7 Experience has shown that debriefings too soon or too late
after the event are ineffective. A specific a g e n c y with d e d i c a t e d CISD team members trained to handle these events should perform the debriefings. CISD teams consist of a team leader, usually a mental health provider with an interest in emergency services, as well as other individuals trained in the debriefing format. The other team members are called peer debriefers and are trained in the debriefing process. Each CISD debriefing team is constructed with the individual or group i n t e r e s t s in mind, a t t e m p t i n g to match the skill level with the group. The team could be c o m p o s e d of e m e r g e n c y medical t e c h n i c i a n s , paramedics, registered nurses, flight nurses and paramedics, or any combination of these individuals. CISD debriefing should not be confused with a critique, where an individual or a group's performance is analyzed by t h e i r peers or superiors, and should not be c o n f u s e d with the debriefing done after any normal flight.
!!!! FLIGHT NURSES !!!! Are you looking for a CHALLENGE? Do you want a career you can commit to? Looking for a company to grow with? Wrap it all up with a great place to live, good benefits, salary, and excellent orientation program Eagle Rescue of Arizona, a division of Rocky Mountain Helicopters, Inc. Has one opening for full-time and part-time experienced flight nurse. Qualifications for this program include:
1) AZ state nursing license, current or applied for 2) Previous experience as a flight nurse with an EMS helicopter service, preferably more than 1 year. 3) ACLS and PALS course completion 4) CEN and/or CCRN preferred 5) Previous experience in emergency and critical care nursing Call or send resumes to:
Wendy Slater, RN Chief Flight Nurse, Eagle Rescue of Arizona 7350 E. Evans Rd., Suite Cl12 Scottsdale, Arizona 85260 Phone: (602) 596-1594 ° Fax: (602) 596-1986
The Journal of Air Medical Transport • October 1992
23
®
B
Samaritan
AirEvac
8UTrERWORTH
If an individual or group requires i m m e d i a t e a t t e n t i o n following a major disaster, a defusing should o c c u r . 1,3,5 Defusings are short interviews with healthcare providers, conducted by CISD-trained debriefers. They provide an opportunity to discuss the event and share information about stress and how people react to it. Most often, flight team defusing occurs during restocking and cleaning the aircraft after a flight. When flight team members talk about the call, good or bad, the expression of feelings and thoughts towards that incident can be shared. Problems arise when flight personnel do not get along or have consecutive flights and are unable to communicate their feelings. This is especially true if one team m e m b e r feels another acted inappropriately.
Summary
I
AMR COMBS
WORLDWIDE FLIGHT OPERATIONS
The future is now! see us at booth
611. 24
Most flight team members have experienced some type of a stress reaction in their flight career, but few have been debriefed appropriately. Debriefings are necessary to keep flight personnel mentally healthy. Fatal c r a s h e s have always drawn attention, and some teams have been debriefed afterward. Proper debriefing and formal mental health evaluation may be the answer. Conclusion T o d a y ' s flight teams c u r r e n t l y treat a diverse patient population in a b r o a d r a n g e of e n v i r o n m e n t s . Everyone, from the referring hospital to patients' families, relies on the flight personnel to get the patient to the receiving hospital alive. T h e tasks involved for flight services are stressful and b e c o m i n g more so. More complex machinery and new technical approaches to medicine have only begun to increase the ability of flight teams across the country to quickly and efficiently transport a broad range of patients. At present, a p p r o x i m a t e l y 200 CISD p r o g r a m s exist across the country in 38 states. 8 Some CISD teams have taken steps to incorporate individuals from local flight teams into their programs. In most
cases, however, it is necessary for a flight service to seek out a CISD program in their area. Starting a CISD program is not easy. Any program wanting to start a CISD program will have to have administrative support. T r a i n i n g is e s s e n t i a l and can be expensive, so financial support must also be available. Support from local mental health providers is essential. CISD training is available through the American Critical Incident Stress Foundation, but scheduling a training program for any group could take as long as one year. The easiest approach would be to contact an already established CISD team near the flight program. CISD teams are always looking for good peer support, and a flight nurse or paramedic would be a welcome addition to most teams. For more information about CISD, or to find the closest CISD program, please call the American Critical Incident Stress Foundation (301/7500856), or call the Referral Communication Center, Pittsburgh, Pa., (1-800/544-2500). • Reference 1. Mitchell JT: When disaster strikes: The critical incident stress debriefing process. Journal of Emergency Medical Services 1983; 12 (1):23-34. 2. Mitchell JT, Resenk HLP: Emergency Response To Crisis. Englewood Cliffs, N.J., Robert J. Brady Co., 1981, pp 183-195. 3. Mitchell JT: Assessing and managing the psychologic impact of terrorism, civil disorder, disaster, and mass causalities. In: Emergency Care Quarterly, Disaster Management. Jacobs LM, Bennett BR, (eds), 1986, 2(1):51-58. 4. F r e u d e n b e r g e r HJ, Richelson G: Burnout, the high cost of high achievement. Garden City, N.Y., Anchor Press, Doubleday & Co. Inc., 1980. 5. Manson E: Critical incident stress debriefing team training handout. Pittsburgh, Pa., July 1990, pp 12-28. 6. Hartsough DM, Garauenta MD: Disaster work and mental health: prevention and control of stress among workers. Washington, D.C., Center for Mental Health Studies of Emergencies, U.S. Department of Health and Human Resources, 1985, pp 37-43. 7. Mitchell JT, Bray G: Emergency services stress: Guidelines for preserving the health and careers of emergency services personnel. Englewood, N.J., Prentice-Hall, Inc., 1990, pp 143-147. 8. American Critical Incident Stress Foundation, Ellicott City, Md., 1991, p 3.
The Journal of Air Medical Transport • October 1992