The effectiveness of critical incident stress debriefing with primary and secondary trauma victims.

Critical incident stress debriefing (CISD) (Mitchell, 1983) has been under intense scrutiny recently in the psychology literature. Several authors have concluded that CISD has no effect or even negative effects on victims of trauma (Bisson, McFarlane, & Rose, 2000; van Emmerik, Kamphuis, Hulsbosch, & Emmelkamp, 2002). This review calls these conclusions into question by critically contrasting: (1) studies that utilize CISD with emergency services personnel ("secondary" victims of trauma, for whom the CISD and the larger Critical Incident Stress Management models were first created) and (2) studies that utilize CISD with primary victims of trauma. This review suggests that CISD is an effective method of reducing risk for PTSD-related symptoms in emergency services personnel. However, when debriefings are conducted with primary victims of traumatic events (e.g., accident victims, burn victims still in the hospital), the results are much less promising. The authors conclude that protocols are needed for interventions with primary victims to help mitigate the impact of trauma on this population. Appropriate interventions might include risk assessment and appropriate referral services, or in some instances, focused psycho-educational group debriefings. Further research is clearly warranted to examine the effectiveness of alternative interventions for the primary victim population.