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Critical incident stress management:
A peer-based model in B.C.

By Whitney Numan, BCSARA CISMP

In January 2007, a two-year process of developing a volunteer peer-based critical incident stress management (CISM) program for search and rescue (SAR) volunteers in British Columbia (B.C.) became fully operational. For a number of years, a few SAR volunteers who were active in other peer-based CISM programs or had training in CISM recognized that SAR volunteers were just as vulnerable to critical incident stress as other emergency responders, such as police, fire fighters and paramedics.

There are approximately 2500 trained SAR volunteers in British Columbia who respond to over 1,000 calls per year. Around 25 percent of these calls involve medical rescues. These rescues are usually compounded by difficult terrain and other conditions that place additional stress on rescuers. In the last fiscal year ending March 30, 2008, 69 subjects were found deceased and 57 subjects had not been found. This is in keeping with statistical averages for the past five years of 66 found deceased and 53 never found. In both circumstances, either body recoveries or not finding a subject add another dimension of stress on volunteers. There are currently 88 SAR teams across the province that provide this vital service on behalf of the province and the tasking agencies, which include local police authorities for missing persons, the B.C. Ambulance Service for medical rescues and the B.C. Coroner Service for body recovery.

Volunteers willing to talk to other volunteers

One may ask why we decided to instate a peer-based model. We chose to take this approach because it simply works and SAR volunteers are willing to participate in the program. As mentioned above, SAR volunteers are generally regarded as emergency responders like others and in very general terms, these volunteers could be regarded as “type A” personalities – they are strong and have a desire to help others in times of trouble or in an emergency situation. Those individuals are not likely to seek professional help on their own as they believe that it could be seen as a weakness. However, they are more willing to sit down with a group of their peers and talk about things, and this is the format that seems to work best. It is a safe place because they are with their coworkers and others who talk their talk and walk their walk – a reality that few mental health professionals (MHP) can offer.

Depending on the nature of the critical incident and the type of intervention selected, a MHP may be asked by SAR peers to participate or facilitate the intervention. CISM peers are trained based on very specific protocols to which they must adhere – just like first aid or CPR. They must follow these protocols strictly and may not deviate from them unless there is a MHP providing direction in the intervention. These interventions provide SAR volunteers with “psychological first aid” and peers are trained to recognize whether a higher level of care might be needed and to refer those individuals to that higher level of care. As a result of providing peer based interventions, experience has shown that volunteers are now receiving needed professional help. Otherwise, they may not have gone in that direction without their involvement in the intervention and following the advice of a CISM peer.

The program

Our program strictly follows and adheres to internationally accepted protocols established by the International Critical Incident Stress Foundation (http://www.icisf.org). We currently have 20 active peers around the province who have been trained based on these protocols and who get together twice a year for additional training and practice. The program also has a steering committee, which along with the Program Coordinator makes dayto- day decisions on the program. Conference calls allow the steering committee to meet once a month, and all the peers every second month. We also have a Clinical Director who is a MHP and who provides peers with someone to talk to about an incident or an intervention that may have affected them. Peers themselves can be vicariously traumatized while leading or participation in an intervention due to the graphic nature of the events.

The Provincial Emergency Program supports the program by covering all intervention costs when there is a request for our services. The British Columbia Search and Rescue Association provides funding and support for peer training, as well as the funds associated with the costs of delivering education and awareness sessions to SAR volunteers. The peers are very appreciative of this support, as are the volunteers who have benefited from our services.

The BCSARA Critical Incident Stress Management team. Photo Credit: Whitney Numan

Key services

We provide three key services for the SAR volunteers in B.C.: education and awareness, critical incident stress management interventions, and post-incident follow-up. Our goal as it relates to education and awareness is to provide all SAR volunteers with key information about critical incident stress and how to manage it, at least once every three years. Knowing what critical incident stress is and how it can be managed is like getting a flu shot; while there are no guarantees that one will not get the flu after an inoculation, it does increase your resistance to certain flu strains. In the same way, we hope to reduce the impact of these traumatic events on volunteers through knowledge, but more importantly, for them to realize that the stress responses they may be experiencing are normal reactions and that there is help available. That help takes place through a suite of interventions that are available through the program.

We stress that these interventions are an organized approach to the management of stress responses for people with normal reactions to an abnormal event. This process is designed to reduce impact and accelerate recovery. The most commonly used interventions include one-on-one support, small group defusing, and small or larger group debriefings. The final aspect is a follow-up with those involved to ensure that the stress reactions that they may have been experiencing have subsided, or are subsiding. If they are not, we encourage them to see a MHP for a higher level of care.

Confidential program

Another very important and key aspect of the program is confidentiality. Information is held in total confidence, no names of individuals or conversations are ever recorded in any form, and interventions are not allowed to become operational critiques; they are a process to provide support following a critical incident.

Any SAR volunteer in B.C. may access the program by calling the Emergency Coordination Centre and request that one of the peers contact them. As our program becomes more active with education and awareness sessions exposing SAR volunteers to CISM, and as word of mouth spreads following successful interventions, our program is responding to more calls. This past summer, our program was activated 11 times in July and August. We have experienced a drop in calls in September, which has made it possible for us to handle the volume of calls. In order to address some recent resignations due to other personal matters, we will be recruiting in the new year.

For more information on the program, please feel free to e-mail (w2num@bulkley.net) or call Whitney Numan, program coordinator at 250-847-9805.

Whitney Numan helped develop the Critical Incident Stress Management program in B.C., has been a search and rescue volunteer since 1989, and a SAR manager since 1991.

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