Emergency and disaster workers are highly motivated and highly trained individuals. They perform strenuous, stressful, and often dangerous work. They seek to ease the suffering of victims. At the same time, they put themselves at high emotional risk for stress reactions that may be harmful to themselves, their work life, and their family life. It is important to remember and recognize the inherent strengths and qualities of the people who do this work. They embody the traits of the survivor personality:

• A sense of commitment to and involvement in life; strong commitments; clear values; and things they believe in.

• Paradoxical traits of gentleness and strength, trust and caution, self-confidence and self-criticism, dependence and independence, toughness and sensitivity.

• A feeling of control over their circumstances, and the willingness to admit what can't be controlled.

• The ability to see change as a challenge, not just a threat; the commitment to meet challenges in a way that will make them stronger persons.

Emergency and disaster workers are survivors. They can see both the positive and negative sides of any situation. They like to challenge themselves. They intend to survive, and to do so in good form.

A debriefing is an organized approach to the management of stress responses following a traumatic or critical incident. It is a specific, focused intervention to assist workers in dealing with the intense emotions that are common at such a time. It also assists workers by teaching them about normal stress responses, specific skills for coping with stress, and how to provide support for each other.

A debriefing involves a one-to-one or group meeting between the worker(s) and a trained facilitator. Group meetings are recommended, as they provide the added dimension of peer support.

A debriefing is not a critique. A critique is a meeting in which the incident is discussed, evaluated, and analyzed with regard to procedures, performance, and what could have been improved upon. A critique is a valid and important meeting. It can help workers to sort out facts, get questions answered, and plan for what to do in the future. A debriefing has a different focus: that of dealing with the emotional aspects of the experience.

It will not work to combine a critique and a debriefing in the same meeting. The goals and focus of the two meetings are entirely different. If an attempt is made to combine them, personnel may be much more comfortable analyzing logistics of the operation than dealing with the feelings involved, and the critique is all that occurs.

The basic ground rules for conducting a debriefing are outlined below.

Who Should Attend?

Everyone who participated in the incident should attend, unless the group is too big. In that case, it can be split into smaller groups. Multidisciplinary groups with police, firefighters, paramedics and EMTs, emergency room nurses, etc, are good. They bring together the whole team. Command officers and line staff should participate in the same debriefing. The media should be excluded if they wish only to observe. If they were part of the traumatic incident, they should participate in the debriefing as a participant and observe confidentiality like all other participants.

Mandatory vs Optional Debriefings

Opinions vary as to whether debriefings should be made mandatory. Many departments are moving in the direction of making debriefings routine and mandatory after any critical incident. This policy gives personnel the message that:

1. the organization is concerned for workers' well-being, and

2. the debriefing is a natural and routine procedure, with no stigma attached.

When debriefings are not mandatory, personnel who might benefit may not attend for fear of being labeled "weak".

Who Conducts the Debriefing?

The debriefing should be conducted by an experienced mental health facilitator. A professional facilitator is recommended because the emotions expressed in a debriefing may overwhelm an untrained facilitator. The facilitator should be skilled in group dynamics and communications, use a crisis intervention approach, have a good knowledge of stress response syndromes and interventions, and be well-versed in operational procedures of emergency service organizations.

When a Debriefing Should Be Held

The best time to hold a debriefing is about 24 to 48 hours after the incident. Prior to that time, workers may still be emotionally "numb", either from the shock of the incident or because their feelings are still being suppressed. Workers are also in the process of intellectually restructuring the incident, often trying to figure out if they operated "by the books". At the 24-48 hour period, emotions are often surfacing in an intense form. This is a good time to deal with them. Effectiveness diminishes with the passage of time between the event and the debriefing. Every effort should be made to conduct the debriefing within 6 weeks of the event. However, successful debriefings have been conducted a year or more following a traumatic incident.

How Long Should a Debriefing Take?

Usually 2 to 4 hours should be allowed for a debriefing. In some situations, it may take longer. It is usually wise to block out a morning or afternoon to devote to the debriefing.