Helping caregivers find their way back to normal

When a critical incident takes its toll on staff, the volunteers on the Critical Incident Stress Management team helps them figure what normal looks like after an emotional trauma.

As professionals, part of what we do is compartmentalize, not letting how we feel about a situation get in the way of what needs to get done. But that approach has its limitations too, especially when we are faced with a traumatic event. In these moments, the volunteers on the Critical Incident Stress Management (CISM) team at the UNC Medical Center get to work.

CISM volunteers work with teams and sometimes individuals in the immediate aftermath of a traumatic event to help those involved debrief, ventilate some of the emotions they may be having, and prepare them for what might be considered normal after undergoing an abnormal event.

This kind of intervention can be especially valuable to help reestablish unit cohesion for a group that has just shared an unsettling experience. Maureen Heck, RN, one of the CISM team’s earliest members and current director of the program, recalls one experience in particular in which a unit requested a CISM debriefing following the death of a young patient who had been the victim of abuse.

“It was a large group, and we gave them a place to express some of things that they were experiencing internally—the kinds of things that we often feel like we have to keep hidden because we are professionals. The CISM created space for them to have a bit more empathy and understanding for one another, let them be a little kinder and more gentle with each other. And that makes the whole workspace a more healing environment.”

“We gave them a place to express some of things that they were experiencing internally—the kinds of things that we often feel like we have to keep hidden because we are professionals.”

Susan Criscenzo, a senior consultant in Learning and Organizational Development who has also been on the team since its earliest days, says that creating this sense of community is one of the most important objectives of a CISM debriefing.

“The overall goal is that you are going to create a little community and that the people in it are going to continue to support each other after we’ve left. The people that come to the CISM are going to feel more comfortable when they leave because they will have each other; they’ve been through this together and talked it out.”

But even more than providing a sense of community, the CISM team lets them know what to expect as they recover emotionally from a challenging experience.

“This is a chance for people to talk about an abnormal event that happened to them and to get some support from each other, and to be supported, and to get the sense that these symptoms you are having are normal and they will go away,” says Criscenzo.

First started in the late 90s, after a pair of catastrophic fires brought an especially large influx of burn patients—including a firefighter—the team was originally composed of around 20 volunteers trained in techniques officially sanctioned by the international Critical Incident Stress Foundation.

While membership has waxed and waned over the years, a core group of volunteers has ensured that the UNC Medical Center is always prepared to help its employees after a traumatic event—whether it is a co-worker suicide or the death of a beloved long-time patient.

Maureen Heck emphasizes that a CISM isn’t therapy or counseling but has an important role to play in mitigating the damage that can be done by an acute trauma.

“The CISM gives people a safe and confidential place to work through some of the feelings they might have about an event. It’s like taking a covered pot that’s coming to boil, lifting the lid a little to let out some steam and then closing it again.”

Data also suggest that interventions like a CISM can help prevent an acute trauma from developing into a chronic problem.

The CISM team has someone on-call 24 hours a day. Anyone on staff can call to request a debriefing from the CISM team. The individual on-call will then assess the request and decide whether CISM is appropriate or if it should be referred to another group, such as pastoral care.

“People that have a chance to talk through how they feel after a traumatic event tend to bounce back faster than those that don’t have that chance,” says Criscenzo. “We try to help people figure out what normal is in an abnormal situation and that makes it possible for people to avoid developing chronic problems by dealing with the acute ones.”

“People that have a chance to talk through how they feel after a traumatic event tend to bounce back faster than those that don’t have that chance.”

If a CISM is indicated, a time for a debriefing is scheduled and a pair of CISM volunteers (sometimes more for larger groups) meets with anyone who chooses to come to the session.
Criscenzo explains the process:

“All anyone is required to say is who they are and how they were involved in the event. Then we walk people through their reactions, trying to stay as factual as possible: what was their first reaction, what was the worst thing, how are they feeling about the incident now? Once we get through thought and feelings, that’s where we do education on what’s normal, the importance of self-care, these kinds of things.”

Heck adds that leading CISM debriefing requires a unique combination of skills. “You need someone who is very empathetic, but who can also think quickly on their feet and keep the debriefing on track.”

Luckily, this skill set is well-represented around the hospital and the CISM team has worked hard to maintain a diverse group.

“We’ve tried to maintain connections with people all around the hospital,” says Heck. “That way, we not only have a lot of different perspectives, but we also have people who can be our eyes and ears so if something happens they can suggest a debriefing.”

To be most effective, a CISM debriefing should be scheduled within 72 hours of the critical incident—before symptoms have a chance to take root.

“The whole purpose of the debriefing is preventative,” says Criscenzo. “We’re not waiting for symptoms. If someone isn’t sure that they are going to be able to come into work tomorrow, or they can’t stop thinking about it, or everyone on the unit is talking about it and we can’t get back other things, that’s when someone should call our hotline.

“These are the kinds of things that can cause someone to leave the profession if they aren’t dealt with, so it’s important that people remember that we are here and available to help whenever it’s needed.”

Ensuring that they are staffed well enough to be able to meet whatever need may exist for their services. The CISM team is holding a two-day training on Aug. 24–25 and will be teaching 40 new volunteers how to run a debriefing.

“When we started, we were just one hospital,” says Heck. “Now we are a system with hospitals all over the state. What we’d really like is to get some volunteers trained at some of our affiliate hospitals so they can start their own teams. We’d like to be able to offer this everywhere so right now our philosophy is to train the trainers.”

If you are interested in the Aug. 24–25 training, contact Maureen Heck at to learn more. If you or your team would like a CISM debriefing, please contact the hotline at 216-3636.