Psychological Guidelines for a Medical Team Debriefing after a Stressful Event

Military Medicine, Jun 2007 by Knobler, Haim Y, Nachshoni, Tali, Jaffe, Eli, Peretz, Gabriel, Yehuda, Yoram Ben

Medical and rescue workers are at risk of developing mental syndromes including post-traumatic stress disorder after disasters and it is widely accepted that they should be offered a preventive intervention. The Israel Defense Force Medical Corps has developed psychological guidelines for the medical forces: a medical team debriefing after treating the injured as a preventive intervention for an event that may be experienced as stressful. The main purpose of the debriefing is to investigate the circumstances of the event, analyze the medical team's functioning, and draw the relevant conclusions and the manner of their implementation. The purpose of the guidelines is to enhance mental coping, possibly prevent stress reactions, and help in screening individuals in need of further professional intervention for stress reactions. These guidelines are suitable for similar interventions in other professional teams.

Introduction

The participation of countries of "the west" in fighting in various areas in the world, and an increase of terror in those countries, has focused the interest in treatment of mental casualties of stressful and disastrous events. The events of September 11, 2001, the fright caused by the anthrax envelopes, the continuing chemical, biological, and atomic threat, the war in Iraq, and threats of war in other areas of the world have raised the need for managing the treatment of mental stress victims by the psychiatric services of western countries.1

Post-traumatic stress disorder (PTSD) was first included in the classification guide of the American Psychiatric Association (Diagnostic and Statistical Manual of Mental Disorders, Third Edition) in 1980.2 For the first time, common mental symptoms prevalent in trauma survivors were defined as a psychiatric disorder with both definition and treatment. Little has changed in the diagnosis in the subsequent two manuals, despite extensive research done on this subject.

In recent years, knowledge has accumulated concerning the risk of developing mental syndromes, including PTSD, in rescue and medical forces after disastrous events. Stress reactions were described in police officers, paramedics, and ambulance team members who treated survivors of a highway collapse in a California earthquake in 1989,3 in American Red Cross workers who treated Los Angeles earthquake survivors in 1994,4 in firefighters who extracted and rescued people from the government building in Oklahoma City in 1995,5 and in police officers who rescued survivors from a fire in a discotheque in Sweden.6

Rescue workers exposed to bodies and death in disastrous events are at a high risk for development of PTSD and PTSD symptomatology.7 PTSD symptoms found in morgue workers who handled bodies of the deceased in the Persian Gulf War in 1990 to 1991 were in direct relationship to the amount of exposure to bodies and body parts.8 Exposure to the horrors of the Holocaust caused mental stress symptoms in workers who founded the Holocaust museum in Washington.9 Screening of military health care workers for post-traumatic symptoms after a traumatic event revealed levels similar to the levels of PTSD after September II.10 PTSD symptoms were as prevalent among military health professionals in Turkey exposed to traumatic events as those in other settings or occupations.11

Because of the understanding that workers in health and rescue organizations involved in managing disasters are prone to developing various psychological reactions, it is an acceptable approach to offer these workers a preventive intervention: coping with stress in disaster events-"critical incident stress management."12,13 The preventive intervention should be comprehensive, reduce the underlying stress, prevent development of stress reactions, and screen for those in need of continued treatment. The intervention usually includes a group meeting in which members share their experiences of the traumatic event in a method called "psychological debriefing" (debriefing, psychological debriefing). The term "debriefing" is used to describe both single session psychological interventions for stress-related casualties led by mental health workers and sessions administered to rescue workers and military forces after their missions. This causes lack of clarity as to the purpose of the interventions and influences their results. One of the purposes of this article is to clarify this important issue.

Psychological debriefing was recommended by the taskforce guidelines of the International Society of Traumatic Stress Research in 1997 for treatment of PTSD14 and was included in the guidelines as a primary treatment of this disorder.15 According to these guidelines, psychological debriefing was recommended as a single-session crisis group intervention, administered by mental health professionals (psychologists, psychiatrists, or social workers), to decrease and prevent undesirable psychological sequelae after traumatic events, through emotional processing, by ventilation, normalization, and preparation toward possible future problems. Psychological debriefing focuses on reactions existing in the present, through avoidance of psychiatric labeling, and emphasis on the normality of the reactions. The participants are given the explanation that they are normal people who have experienced an abnormal event.