Neely K W, Spitzer W J
Oregon Health Sciences University, Portland 97201-3098, USA.
Prehosp Disaster Med. 1997 Apr-Jun;12(2):114-9.
Emergency services personnel are highly vulnerable to acute and cumulative critical incident stress (CIS) that can manifest as anger, guilt, depression, and impaired decision-making, and, in certain instances, job loss. Interventions designed to identify such distress and restore psychological functioning becomes imperative.
A statewide debriefing team was formed in 1988 through a collaborative effort between an academic department of emergency medicine and a social work department of a teaching hospital, and a metropolitan area fire department and ambulance service. Using an existing CIS debriefing model, 84 prescreened, mental health professionals and emergency services personnel were provided with 16 hours of training and were grouped into regional teams. Debriefing requests are received through a central number answered by a communicator in a 24-hour communications center located within the emergency department. Debriefings are conducted 48-72 hours after the event for specific types of incidents. Follow-up telephone calls are made by the debriefing team leader two to three weeks following a debriefing. The teams rely on donations to pay for travel and meals.
One hundred sixty-eight debriefings were conducted during the first four years. Rural agencies accounted for 116 (69%) requests. During this period, 1,514 individuals were debriefed: 744 (49%) firefighters, 460 (30%) EMTs, and 310 (21%) police officers, dispatchers, and other responders. Deaths of children, extraordinary events, and incidents involving victims known to the responders (35%, 14%, and 14% respectively) were the most common reasons for requesting debriefings. Feedback was received from 48 (28%) of the agencies that requested the debriefing. All of those who responded felt that the debriefing had a beneficial effect on its personnel. Specific individuals identified by agency representatives as having the greatest difficulty were observed to be returned to their pre-incident state.
CIS debriefings are judged as beneficial. A statewide response team is an effective way to provide these services at no cost to agencies.
紧急服务人员极易受到急性和累积性重大事件压力（CIS）的影响，这种压力可能表现为愤怒、内疚、抑郁以及决策能力受损，在某些情况下还会导致失业。因此，必须采取干预措施来识别此类困扰并恢复心理功能。
1988年，通过一所急诊医学学术部门与一家教学医院的社会工作部门、一个大都市地区的消防部门和救护服务机构的合作，成立了一个全州范围的汇报小组。利用现有的CIS汇报模式，84名经过预筛选的心理健康专业人员和紧急服务人员接受了16小时的培训，并被分成区域小组。汇报请求通过一个中央号码接收，由位于急诊科的24小时通信中心的一名通信员接听。针对特定类型的事件，在事件发生后48 - 72小时进行汇报。汇报小组组长在汇报后的两到三周进行跟进电话回访。这些小组依靠捐赠来支付差旅费和餐费。
在最初的四年里进行了168次汇报。农村机构提出了116次（69%）请求。在此期间，有1514人接受了汇报：744人（49%）是消防员，460人（30%）是急救医疗技术员，310人（21%）是警察、调度员和其他应急人员。儿童死亡、重大事件以及涉及应急人员认识的受害者的事件（分别占35%、14%和14%）是请求汇报的最常见原因。收到了48个（28%）请求汇报的机构的反馈。所有做出回应的机构都认为汇报对其人员有有益影响。机构代表指出有最大困难的特定人员被观察到已恢复到事件发生前的状态。
CIS汇报被认为是有益的。一个全州范围的响应小组是一种免费为各机构提供这些服务的有效方式。
