The debrief

…further attempts at resuscitation were futile.

Debriefing is a dialogue between two or more people pertaining to the actions and thought processes involved in a particular patient care situation. Educational research strongly supports debriefing as an effective mechanism for promoting adult learning and enhancing skills and team performance.

After clinical cardiopulmonary resuscitation events, debriefing programs have demonstrated improved rate of return of spontaneous circulation, neurologic outcomes, hands-off compression times, and time delay to first compression.  Accordingly, the 2015 ILCOR guidelines officially  recommend the use of debriefing after resuscitations to improve clinical performance.

Kessler et al’s 2014 paper “Debriefing in the Emergency Department after Clinical Events” Offers an evidence based practical guide to debriefing on the front line.

None of this however it to be confused with defusing or psychological first aid in response to a critical incident or trauma.  The evidence for this is more controversial.   Critical Incident Stress Management CISM, is a short group intervention designed for secondary victims of trauma (first responders) with the aim to return to normal duties quickly and with less risk of PTSD.  Its origins are rooted in response to traumatic wartime events aimed at normalising acute stress reactions.

Today the Crisis Intervention and Management Australasia offers management of critical incident stress and trauma for personnel in emergency services, police, corrections, health, welfare and related services.  This paradigm adapted from the American based International Critical Incident Stress Foundation (ICISF) is utilised by a wide range of major organisations including the United Nations, World Vision International, the US National Fire authority and major international airlines. Its framework encompasses a short ‘defusing’ at the time of the incident followed by a formal 7 strep process 72hours later and subsequent follow up within a week.

There is little evidence to support this type of intervention and which, if any psychological harms are avoided 2014 Systematic review.  There is some evidence to suggest that such interventions may increase the risk of PTSD.  A 2002 Cochrane review recommended against the practice.

My own experience of Critical Incident Mental Health Support as a Military Medical officer suggests sharing experiences, thoughts and reactions to a traumatic event in small groups may worsen symptoms and recovery in some individuals through the process of vicarious trauma and shared memory.  70% of individuals will draw on their own supports and resilience, recovering given time and a supportive environment, without any input from mental health services.  Still for the other 30%, its important to know where to find them.