CISM Defusing

A defusing is a small group process which is instituted after any traumatic event powerful enough to overwhelm the coping mechanisms of the people exposed to it (Mitchel, 1996). Defusing is defined as rendering something harmless before it can do damage. Defusing and Debriefings are similar in process but the difference lies in the timing of the response and the type of response to the incident. Not characteristics of the incident itself.

A defusing is done closer to the time at the end of the incident, ideally within 3 hours after the event. The benefit is to have the group talk about their experience before time, rethinking and interpretation or the stages of trauma begin affecting the true nature of the experience. It is a process with less structure and organization than a debriefing and does not require a full team of debriefers. Groups are smaller and generally done with like personnel, that is, a group of nurses, group of policemen etc., where a debriefing can consist of a larger group and a mixture of personnel.

*Consider a large plane crash. A Search and Rescue team is deployed to the site to search for survivors. After the first five hours nothing has been discovered but body parts thrown all about even outside of the perimeter of the crash. After coming upon the second decapitated head, a worker stops, kneels down and vomits. Not sure he can continue with the search, he receives some on-scene supportive services from a peer. The peer listens to his experience, supports and validates his reactions, assures him that this is a normal reaction to an abnormal scene and that he will be ok to resume. He provides some water, thanks the team member and returns to his work. After 8 hours, it is determined that there are no survivors. A second team of responders is deployed to relieve the first. Soon, with in the next 3 hours, the group meets with CISM team member and has a defusing.

Being able to defuse the team this early on has advantages. This team has witnessed horrific carnage, the team returns in a state of shock. Members are vulnerable to further damage at this time, but are also more available to receive help. The bodies natural healing process is to reestablish its defenses. To do this it needs to shut down its connections with the outside world. In doing so it cannot differentiate between friend and foe and stays guarded until they are stabilized. Being able to reach people before this shut down occurs is one of the goals of defusings. If they shut down before there's an intervention, it is here, where misinterpretations, and self-blame can enter into the processing of the experience of the incident. The defusing process than becomes ineffective and sets the stage for a debriefing.

Sometimes the defusing process is very helpful, but the incident is so powerful that a debriefing is deemed necessary as well. Having already gone through the defusing, the process of the debriefing can be more beneficial to the team members.

The defusing is held away from the scene. In this case, a meeting room at a hotel down the road. The defusing is planned to last 20 minutes to an hour. The conference room is set up with chairs circled around the table.

Defusings consist of three main segments.

Introduction- 5-7 minutes

Introduction of defusing team
Purpose of gathering
Describes defusing process
Motivates participants
Summarizes defusing process
Encourages mutual support
Encourages participation
Instills need for confidentiality
Accepts any questions before beginning
alleviates group anxiety about the defusing process
Insures that this is not investigative
Offers additional support, if needed, after the defusing

"Thank you for coming together after such difficult work. I'd like to introduce myself and my team for those who do not know me. My name is Joe Smith and I am a member of the Search and Rescue team and peer counselor for the CISM team. My colleague, Mary Richards is a licensed clinical social worker and CISM team member as well. Mary volunteers her time to be available for consultation when such tragedies occur. Her background is in trauma recovery and crisis intervention. We are meeting together like this as a way of "coming down" from the highly stressful work you have just performed. Work like like this and the experience you have just went through can set off powerful stress reactions that are normal and minimized by participating in this defusing. While speaking is purely voluntary, we encourage you to speak openly about your experiences. As you speak and listen remember you have all been through this together and can offer a great deal of support to each other as well. Having said this let me also inform you about some of the guidelines. Confidentiality- we must be in agreement that what is said in this room stays in this room. We encourage you to continue talking about your experiences after this meeting, but not to share to others what was said in this defusing. Speaking for myself and Mary, I can assure you that the strictest of confidence will be maintained. Are we in agreement with this? Good. Now is there anybody here who shouldn't be? Or are we missing anybody? As I mentioned before, you do not have to speak, that is your right. Just shake your head no. As a group we will respect your decision and move on. If you need to leave the room, do so quietly and return quickly. While there is an ongoing investigation about the nature of the plane crash, this process is not part of that. It is simply to help us manage our responses and allow us to continue to do the work we do. If, however, you feel that you should not disclose something for whatever reason, that is fine. Also, please suspend your rank or position for the purposes of his meeting and speak as a person who has just been involved in a tragedy. This group is not the time to critique anybody's work or operational aspects of the job just our human reactions to the stressful experiences you have gone through. If anybody wants to talk further afterwards myself or Mary are available."

Exploration- 10-30 minutes

Exploration is a process that encourages participants to share their experience in conversational format. Participation is voluntary, but all are gently encouraged to participate. Due to the process of defusings being brief, questions look to incorporate responses that offer a combination of fact, thought, reaction and symptom phases. Questions can be simple or complex based on the nature of the group. It is likely that once the conversation starts going, participation increases as the atmosphere becomes more relaxed. Asking for more detail, signs of distress, acknowledging the commonality of experience are all ways to keep the process moving. Keep in mind that the process is short in nature and can move to the last phase when participation declines or topics change to peripheral subjects.

"When someone feels ready, please share with the group what you were doing, and what your experiences were..."

"What were your first thoughts when you began seeing body parts?"

Information- 5-15 minutes

Having used effective communication skills and engaging members to share during the exploration phase, the last stage, Information phase, is important in rapping up the content while educating the members to move forward with effective stress management techniques. The defusing team will need to:

Accept and summarize the information provided in the group.
Answer any questions.
Normalize the experiences and reactions.
Teach practical stress survival techniques.
Organize a debriefing it it appears one is necessary.
Comments are framed in summation form to lead the group to close.
Make themselves available to the group after the defusing.

"Let me just first thank the group for your participation and your dedication to this much needed work. Your experiences are powerful and sometimes it is not often easy to discuss them. As a group, however, your common experience also provides you with an effective source of support in each other. The reactions reported by all of you are normal reactions. It is important to remember that it is the incident of the plane crash and massive death and carnage that is an abnormal event, not your reactions to it. The signs and symptoms you've reported are the result of the normal stress response our bodies automatically engage in to protect us from what we perceive as dangerous or threatening to us. They are often temporary and will pass as time moves on. Talking amongst yourselves and others, maintaining your routine in life, exercise, good diet, and proper sleep, all help to alleviate these symptoms from lingering on. If you drink alcohol, now is an important time to exercise moderation as too much use of alcohol to help cope with the stress will actually suppress you experience and keep it around longer. This than can interfere by resurfacing in future stress related events you work on. Both Mary and I will be available after this group if any one has further questions, comments, or want s to talk further about their experience. If you are interested in additional local resources we can assist you with those as well. Are there any further question or comments be for we end the defusing? Please remember the importance of confidentiality and thank you for you time."

*This example is designed to provide you with guidance of the defusing technique. It is not meant as a script, but as a teaching tool incorporating important points when doing the defusing.

Remember, as a CISM interventionist, you will be meeting with individuals who are cognitively and emotionally vulnerable. Poorly timed, and inappropriate use of this and other CISM techniques can cause permanent, possible life threatening harm to people. Using the appropriate technique, in a timely manner, by trained professionals is necessary to achieve successful interventions.

As the call for Onsite Services can be immediate, the call for "abbreviated" debriefing may be required. In practice it would be a similar to a group PFA approach. Typically, however, by the time the EAP is called onsite, it is not necessary to provide this version or individual PFA has already been administered.