Impact of Crisis Intervention on the Mental Health Status of Emergency Responders Following the Berlin Terrorist Attack in 2016

Abstract

Objective:The most common crisis intervention used with German rescue workers is Critical Incident Stress Management (CISM). Results regarding its effectiveness are inconsistent. A negative reinforcement of avoidance, due to premature termination of strong emotions during the Critical Incident Stress Debriefing (CISD), may explain this. The effectiveness of the CISD after terror attacks in Germany has not yet been investigated.Methods:All emergency responders deployed at the terror attack on Breitscheidplatz in Berlin were invited to take part in the study; 37 of the N = 55 participants had voluntarily participated in CISD; 18 had not.Results:Participants with CISD showed lower quality of life in psychological health and higher depressive symptomatology. Of these, females had lower quality of life in social relationships, whereas males showed more posttraumatic stress symptoms. Emergency responders from non-governmental organizations had higher phobic anxiety. Emergency medical technicians showed more somatic and depressive symptoms.Conclusion:There is no conclusive explanation for why rescue workers with CISD score worse on certain measures. It is possible that CISD has a harmful influence due to negative reinforcement, or that there was a selection effect. Further research differentiating occupational group, sex, and type of event is necessary.

Longitudinal Mental Health Effects of the 2016 Terrorist Attack in Berlin on Various Occupational Groups of Emergency Service Personnel

“…For example, negative effects were found among participants in these measures after the terrorist attack in Berlin. 27 To our knowledge, this is the first study that addresses differences in the levels of psychological stress experienced by different groups of emergency service personnel who responded to a terrorist attack in Germany. Our study, however, has certain limitations.…”

High-fidelity simulation in healthcare education: Considerations for design, delivery and debriefing.

“…A facilitator's desire to help a distressed individual, may inadvertently push them to initiating a well-intentioned discussion -with the belief that "a problem shared is a problem halved". However, psychological debrie ng may not prevent ASD, PTSD, anxiety, or depressive symptoms -and in fact 'Good Samaritan' acts yield the potential to cause harm [69, 70,71,72,73].…”

Systematic Debriefing for Critical Events Facilitates Team Dynamics, Education, and Process Improvement

“…The debriefing goals address caregivers' stress while improving future clinical performance, education, team morale, and emotional processing 17. For team communication to be considered a debriefing, it should include the following elements: (1) the participants are actively engaged in assessing performance and identifying positive (plus) or opportunities for improvement (deltas); (2) the emphasis is on development and not judgment; (3) performance of participants is discussed in terms of the specific event; and (4) a debriefing incorporates 2 or more information sources 18. Most debriefing programs follow a 7-step process as described in 2 seminal papers 10,11…”

“…17 For team communication to be considered a debriefing, it should include the following elements: (1) the participants are actively engaged in assessing performance and identifying positive (plus) or opportunities for improvement (deltas); (2) the emphasis is on development and not judgment; (3) performance of participants is discussed in terms of the specific event; and (4) a debriefing incorporates 2 or more information sources. 18 Most debriefing programs follow a 7-step process as described in 2 seminal papers. 10,11 Debriefing has been used in simulation education and the clinical setting to improve psychological response, clinician skill, process improvement, and performance.…”