16

Critical Incident Stress

Debriefing (CISD) and the
Prevention of Work-Related
Traumatic Stress among High
Risk Occupational Groups
JEFFREY T. MITCHELL and GEORGE S. EVERLY, JR.

The impact of post-traumatic stress upon society is most floridly apparent

through the process of warfare. Indeed, it is hard to imagine a more de-
structive and psychologically debilitating process than warfare. Had there
not been a Vietnam conflict, post-traumatic stress disorder (PTSD) may
never have found its way into the official psychiatric taxonomy of the third
edition (DSM-111) of the Diagnostic and Statistical Manual of Mental Disorders
(American Psychiatric Association [APA], 1980). Yet warfare is not the only
set of conditions, by far, capable of engendering post-traumatic stress.
Upon the publication of the revision of DSM-111 (DSM-111-R; APA,
1987), it was made abundantly clear that PTSD could be engendered by
trauma outside the realm of combat, including floods, earthquakes, rape,

JEFFREY T. MITCHELL • Emergency Health Services, University of Maryland, Bal-

timore County, Baltimore, Maryland 21228; and International Critical Incident Stress
Foundation, Ellicott City, Maryland 21042. GEORGES. EVERLY,JR. • Internation-
al Critical Incident Stress Foundation, Ellicott City, Maryland 21042; Union Memorial
Hospital, Baltimore, Maryland 21218; and Department of Psychology, Loyola College,
Baltimore, Maryland 21210.
Psychotraumatology, edited by George S. Everly, Jr. and Jeffrey M. Lating. Plenum Press,
New York, 1995.

267
268 JEFFREY T. MITCHELL AND GEORGE S. EVERLY, JR.

large fires, airplane crashes, car accidents, and physical violence. Though
almost anyone could be a potential primary victim of one or more of the
aforementioned trauma, some individuals are at higher risk for experienc-
ing PTSD by virtue of their career choice. Careers in the emergency services
professions are prime examples of occupations that put their constituents at
high risk for post-traumatic stress. For example, it is generally accepted that
law enforcement, fire suppression, emergency medical services, and disaster
response Oust to name a few) are examples of professions that are at higher
risk for engendering post-traumatic stress (see Mitchell & Everly, 1993).
Although we have learned much about the effective treatment of PTSD
and related syndromes (see Part III of this volume), most would agree that
prevention is dearly preferable to treatment (Butcher, 1980; Duffy, 1979;
Kentsmith, 1980; Yandrick, 1990). This chapter will focus, therefore, upon
the prevention of work-related post-traumatic stress through a structured
group process that can be employed subsequent to exposure to a traumatic
event. This process is referred to as critical-incident stress debriefing (CISD).

BACKGROUND
Critical-incident stress debriefing (CISD) and its parallel process, trau-
matic stress defusing, are group intervention techniques initially developed
by one of the authors for implementation subsequent to a potentially trau-
matizing event so as to facilitate the prevention of post-traumatic stress
among high-risk occupational groups, specifically fire suppression, law en-
forcement, emergency medicine, disaster response, emergency dispatch,
and public safety personnel (Mitchell, 1983, 1988a,b, 1991). These processes
have subsequently been adopted by the military, the clergy, and pupil per-
sonnel services as well as within high-risk business and industrial settings,
(e.g., the banking industry, mining, oil discovery and refining operations,
lifeguard services, and other recreational industries). The employee assis-
tance program (EAP) industry has begun to heavily utilize the defusing and
CISD processes as well. CISD and defusing employ both crisis intervention
and educational theory and technologies.
At the time of this writing, there exist more than 300 formal trauma-
response teams across the globe that utilize the CISD and defusing models in
the prevention of post-traumatic stress. CISD and defusing protocols have
been employed for more than 10 years in settings that range from small-
scale traumatic incidents to large-scale disasters. CISD protocols have been
employed in numerous major trauma venues, including the following:
Barneveld, Wisconsin, tornado (1984)
Mexico City earthquake (1985)
Cerritos, California, air disaster ( 1986)
El Salvador, earthquake ( 1986)
Palm Bay, Florida, mass shooting ( 1987)