What is Critical Incident Stress Management (CISM)?
Written by Louise Cullinan (FO) and Gideon Ewers
In CIRP, we define a critical incident as a stressful event that may evoke stress reactions by those either directly or indirectly involved. It may be an incident or accident, an occurrence such as an unruly passenger on the flight deck, or investigating an aircraft accident. A critical incident may overwhelm the normal coping mechanism and leave the individual feeling out of control or helpless. Like any stressful event aviation accidents prompt strong reactions for those involved, that almost goes without saying. Again unsurprisingly, pilots, cabin crews, accident investigators and their families have an elevated risk of developing critical incident stress reactions and this is best described as a psychological or physiological reaction to a critical incident; it often appears as a characteristic set of symptoms (some typical reactions are detailed in figure 1). Sometimes these normal reactions to an event can develop into the more serious post traumatic stress disorder (PTSD).
While there are obvious examples of the kind of critical incident that may induce stress reactions like being involved in an accident where serious injuries or deaths have occurred or an incident where there has been significant aircraft damage, we must also consider the effect of less obvious “survivor syndrome” scenarios where, for example, there was a real threat of death or injury (for example a bomb threat or near mid air collision) or even the perception of such a threat. It might bean incident where, because of its nature, there is major coverage by the media. An obvious example of these two factors coming into play was the ditching of US1549 in New York’s Hudson River. Clearly, this high stress situation did not conclude with the successful evacuation of the aircraft. In the weeks and months following the event the crew (and their families) had to deal with their hero status and the glare of media attention as well as the more typical stress that such an incident would bring. In addition to being directly involved with an incident or accident, taking part in an investigation into an accident brings its own risks. Naturally, pilot investigation representatives are placed in situations of elevated stress as they seek to discover the reasons behind an accident in often gruelling and distressing circumstances, perhaps heightened by a greater empathy the situation that the crew involved found themselves in. Other factors that may elevate critical incident stress risk include an engine failure or fire, an unruly passenger, a windshear event on approach or an unexpected deviation into an unusual attitude.
The stealthy stressors
Besides these more obvious stress inducing scenarios, a number of less obvious events common to the lives of pilots have been demonstrated as factors that can elevate stress including a simulator check failure, a crew member injured on the way to, from or during a layover as well as less obvious factors like a disturbance such as a fire in the layover hotel. Sadly, we live in times where there are additional risks to crews, a prime and tragic example being when terrorists attacked the Oberoi Trident and the Taj Palace hotels in Mumbai in 2008. As you may know, these hotels are used by a number of airlines as layover hotels. While this was a horrific event, it also revealedthe capabilities of the global CIRP network with teams from KLM and Lufthansa’s CIRP programmes working with those from the Mayday Foundation and ALPA, International.
What is a stress reaction?
In the context of critical incident stress management, stress reactions are psychological and physiological changes that occur in a person who has been exposed to a stressful event. Often we may not recognise our stress reactions and may even believe that because of our training and experience we are immune to them. Almost all people exposed to a critical incident will suffer some form of critical incident stress. Each person’s stress reactions will be different (see Fig 1). However, CIRP has found that crewmembers experiencing stress reactions from an accident or incident most often complain about sleep problems, anger at the company, or the loss of “flying as fun.” The ALPA Aeromedical Office has also found that of the pilots with post-traumatic stress disorder or long-term severe stress, approximately 70 percent of those who received proper assistance continued their aviation careers. Of those pilots not receiving any critical incident stress support, 60 to 70 percent left their aviation careers within two years of the critical incident or accident. Stress reactions may appear within days or they may take months or years to surface. If stress reactions do not diminish in frequency and intensity within a few weeks of the event it may be a sign that PTSD is developing. PTSD is a psychiatric diagnosis described as the development of characteristic symptoms following a psychologically distressing event that exposes a person to an intensity and/or duration of emotions outside the range of usual human experience.
Major characteristics may include:
1. The traumatic event is persistently re-experienced, often as flashbacks or
intrusive memories,
2. There is persistent avoidance of things associated with the trauma and
numbing of general responsiveness, such as the inability to enjoy aspects
of life previously important, e.g. sex, hobbies, children, etc., and
3. There are persistent symptoms of increased arousal such as hyper-vigilance
(always being on the alert for something to happen), sleep problems, irritability
and outbursts of anger, difficulty concentrating, and exaggerated startle response.
PTSD has long-term debilitating effects but it can be treated. The diagnosis is not
made if the disturbance lasts less than one month. A less severe form of PTSD is
Acute Stress Disorder.These stress disorders seriously threaten your health,
career, and family. Early intervention has proven effective in preventing or
mitigating the development of long-term stress disorders.
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Formally the National Chair for CIRP (Critical Incident Response) with the Air Line Pilots Association (ALPA) 2007-2019, Louise continues to consult with IFALPA and assists airlines around the world in developing their own CISM programs. Currently a First Officer with Frontier Airlines flying the A320/321, Louise was a captain with Mesa Airlines flying the ERJ 175 along with the CRJ 200/700/900 and Be1900. With over 30 years of grief experience, she continues to volunteer her time in her hometown of Steamboat Springs, Colorado.