1. CRITICAL INCIDENT STRESS DEBRIEFING IT COULD SAVE YOUR CAREER Nancy Craven, MD, CCFP, FAAFP 2006 AMA-CMA Conference on Physician Health

2. In presenting this workshop, I have no relevant financial relationships to disclose.

3. OBJECTIVES You will be able to: Define “critical incident” Explain the potential impact of a critical incident Describe the steps in critical incident debriefing

4. WHAT IS A CRITICAL INCIDENT? It is an event (or a cascade of events) that overwhelms normal coping mechanisms and can interfere with one’s usual ability to function. Note: Not every stressful event is a critical incident.

5. CRITICAL INCIDENT EXAMPLES An unexpected death of a patient (especially a child) Suicide of a patient or colleague Major trauma case where a doctor has inadequate back-up Workplace violence Natural disaster

6. SYMPTOMS FOLLOWING A CRITICAL INCIDENT Sleep disturbance Inability to concentrate Inability to make decisions Loss of confidence Extreme fear of making a mistake Preoccupation with the incident Social withdrawal

7. WHY ARE DOCTORS AT RISK? Image of perfection Need to be in control Secrecy about mistakes Myth of being invincible

8. COMMON UNHEALTHY COPING STRATEGIES Self-medication (alcohol, samples, self-prescribing) Isolation Blaming & anger Over-compensation at work

9. What is Critical Incident Debriefing? Defusing Fact phase Thought phase Debriefing Reaction phase Symptoms phase Teaching phase Wrap-up

10. WHO CAN FACILITATE SESSIONS? A respected member of staff Willing to take CISD training Willing to volunteer time and be available on short notice Not involved in the incident they help others to debrief

11. SESSION GROUNDRULES Anyone involved may attend Anyone not involved cannot attend The group will keep confidential what is said in the debriefing Purpose of debriefing is not to criticize or blame Each participant’s view is valid

12. USEFUL RESOURCES International Critical Incident Stress Foundation: http://www.icisf.org/ Seattle CISD website: http://www.metrokc.gov/health/ems/cism/index.htm CISD training (Vancouver): http://www.cisresponse.com/courses.htm

13. DEMONSTRATION OF A DEBRIEFING SESSION