The impact of Critical Incident Stress Debriefing on coping in emergency health care providers : a rapid review

Abstract

Emergency health care providers (EHCPs) are medical specialists who are trained to provide victims of sudden or acute illness or injury with emergency care and transportation to a hospital. An inherent aspect of this occupation is being exposed to traumatic scenes and incidents on a very regular basis. Without constructive coping, the possibility for the development of problems such as burnout, anxiety, depression or even PTSD increases drastically. Critical Incident Stress Management (CISM) was developed by Mitchell, originally with the primary target group being first responders to critical incidents (Mitchell, Sakraida & Kameg, 2003).Critical Incident Stress Debriefing (CISD) forms the fifth step or element of the CISM process and aims to reconstruct the traumatic event, to allow for ventilation, normalising specific reactions to the event and also to limit the development of maladaptive cognitive, behavioural and coping responses. CISD is often presented in isolation as a once off intervention following a critical incident. This entails a group meeting within 72 hours after the incident for an average of 1-3 hours. However, CISD was never intended to be applied in isolation, rather as a step in CISM. As there is a lack of data available on the impact of CISD as a stand-alone intervention, this study attempts to answer the following question: What scientific evidence exists regarding the impact of CISD used in isolation on coping in EHCPs? The researcher expects to indicate through this research whether it is recommended to use CISD in isolation, as well as how CISD can specifically be applied in a South African context where EHCPs are often exposed to critical incidents without adequate training or infrastructure. The aim was to explore the impact CISD as stand-alone intervention has on the coping of EHCPs. Impact was evaluated according to three guidelines, namely the nature, relevance and effectiveness of CISD. A rapid review was conducted, entailing a shorter timeframe and utilising less resources than a traditional systematic review. Six articles were identified which complied with the inclusion criteria. The Joanna Briggs Institute (JBI) approach was used to maintain a clear distinction between quantitative and qualitative data, with individual synthesis done before the final synthesis of both types of research. Thematic analysis was employed to convert both quantitative and qualitative data to themes related to the nature, relevance and effectiveness of CISD as stand-alone intervention. In essence, it was found that, although CISD as stand-alone intervention for EHCPs has both positive and negative outcomes, it is clear that CISD leaves a void between what is offered and what is subjectively needed by EHCPs. It is therefore difficult to clearly indicate to what extent CISD as stand-alone intervention is effective or not. It has been argued that CISD can be relevant and effective on its own, but not in its current reactive format which does not allow for effectively addressing the needs EHCPs have. The most important limitation of this study is that only six articles, none within the South African context, adhere to all the search terms and inclusion criteria in the current study. Generalising the findings of this study is therefore not possible and more research is needed before any practical recommendations can be made.