title: Critical incident stress management (CISM): benefit or risk for emergency services?
abstract: BACKGROUND
  Critical incident stress management (CISM) has become a common practice in modern emergency services. Described in 1983 as critical incident stress debriefing (CISD), CISM was originally marketed to help emergency personnel deal with ostensibly stressful situations they would encounter as a part of their work.
  
  
  OBJECTIVE
  To review the status of the medical and psychological literature regarding the efficacy and safety of CISM.
  
  
  METHODS
  Several pertinent databases were accessed and searched for scientific articles pertaining to CISM. These were subsequently analyzed for methodology and pertinence to the study topic.
  
  
  RESULTS
  Numerous scientific articles were found concerning CISM. Several high-quality studies were identified, but many other studies lacked adequate methodology sufficient for use in an evidence-based medicine approach. Others were from trade magazines, non-refereed journals, and obscure mental health journals. Several meta-analyses and randomized controlled trials (RCTs) were found. Overall, these studies show that, at best, CISM has no effect on preventing psychiatric sequelae following a traumatic event, particularly post-traumatic stress disorder (PTSD). Furthermore, several studies report possible paradoxical worsening of stress-related symptoms in patients and personnel receiving CISM.
  
  
  CONCLUSIONS
  Despite the limitations of the existing literature base, several meta-analyses and RCTs found CISM to be ineffective in preventing PTSD. Several studies found possible iatrogenic worsening of stress-related symptoms in persons who received CISM. Because of this, CISM should be curtailed or utilized only with extreme caution in emergency services until additional high-quality studies can verify its effectiveness and provide mechanisms to limit paradoxical outcomes. It should never be a mandatory intervention.
authors.affiliation: Department of Emergency Medicine, University of North Texas Health Sciences Center, Fort Worth, Texas, USA. bbledsoe@earthlink.net
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Bledsoe
mesh_terms: D003419:Crisis Intervention / Q000379:methods*; D004634:Emergency Medical Technicians / Q000523:psychology*; D019317:Evidence-Based Medicine; D006801:Humans; D015201:Meta-Analysis as Topic; D009786:Occupational Health Services; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D013313:Stress Disorders, Post-Traumatic / Q000517:prevention & control / Q000628:therapy; D013315:Stress, Psychological / Q000517:prevention & control / Q000628:therapy*