1 www.swgmdi.org                                                                                                  Published June 2012

SWGMDI’S NOK Services and Communication Committee

   

Principles for Critical Stress Management in MDI Settings: 

Critical Event Debriefing and Recommendations for Development 

Critical stress management (CSM) is an essential component for medicolegal death investigation 

offices. Stakeholders and the functions of CSM extend from first responders and workers in 

medicolegal death investigation (MDI) as well as family and community members affected by 

the incident. A well-conceived critical stress management program will yield benefits not only 

regarding a specific critical incident but also result in improved investigation skills overall and 

may yield long reaching preventative measures within a community. 

There are two general considerations in critical stress management for medicolegal death 

investigation offices. 

 Normal Office Duties: CSM should recognize and support employee and responders’ 

emotional and mental responses to the routine stressful situations encountered in MDI. 

The quality of investigations has the potential to improve at all levels when 

communication with families is enhanced through the formal use of CSM programs. A 

further benefit of these programs is an improved pro-active response to families and 

communities when a high risk situation, such as teen suicide occurs, or when a family 

member appears to have an abnormal grief response. Prompt recognition of situations 

such as these, and others, may allow earlier mental health intervention opportunities. 

 Mass Fatality Incidences: The second set of programs for CSM is aimed at stress 

management for MDI professionals, additional staff and all volunteers utilized when 

mass fatality incidences or other events occur that overwhelm normal office resources 

and/or flow. Those unaccustomed to dealing with MDIs should be included in CSM 

programs and training should ideally occur prior to any involvement to prepare and 

screen persons for the expectations of mass fatality incidences. 

A critical stress management program seamlessly functions through the continuum of actual and 

potential office encounters, improving emotional health and response of responders, MDI, 

families and the larger community. These programs are not designed as comprehensive mental 

health care, but rather a way to help “bounce back” from encounters and to recognize and refer 

individuals when mental health needs suggest additional professional referral. 
2 www.swgmdi.org                                                                                                  Published June 2012

SWGMDI’S NOK Services and Communication Committee

   

Current principles and available resources for CSM programs in MDI settings today 

include, but are not limited to: 

 Empirical evidence does not currently point to a single best model. 

a. There is a potential for harm from applying a “one-size-fits-all” approach to 

intervention. 

b. Maintain flexibility in utilizing what works most effectively in the specific time, 

place and context. 

 Programs support the process of resilience to adapt in the face of adversity, trauma, 

tragedy, threats, or even significant sources of personal stress in order to “bounce back”. 

 “Debriefings” are conducted following critical events that overwhelm an office’s 

resources or events that have strong emotional circumstances outside routine office 

operations. 

a. Debriefings are part of a comprehensive stress management continuum that 

enables individuals and groups to receive an assessment of needs, practical 

support and follow up that will facilitate the early identification and prompt 

treatment of any psychological conditions, up to and including PTSD (Regel, 

Stephen, Post-Trauma Support in the workplace: the current status and practice 

of critical incident stress management (CISM) and psychological debriefing (PD),

Occupational Medicine 2007 57) 

b. Debriefings are a process not an event 

c. Debriefings can be defined as: Psychological First Aid (PFA) which refer to a set 

of skills used to limit the distress and negative behaviors that can increase fear 

and anxiety (National Academy of Sciences, 2003). PFA is as natural, necessary 

and accessible as medical first aid. PFA assists people with emotional distress by 

providing support and good listening skills. As with Medical First Aid skills, an 

individual does not need to be a highly trained professional to provide immediate 

care to those in need. Psychological First Aid is usually used during a response to 

a crisis. 

The strengths of Psychological First Aid (PFA) include: 

i. It is a basic information-gathering technique for rapid assessment 

ii. It relies on proven strategies that can be applied in a variety of disasters 

and crisis situations 

iii. It is appropriate across ages and cultures 

iv. It includes the use of printed material to provide important information for 

dealing with post-disaster reaction 

MDI professionals are aware and have basic training in Psychological First Aide 

by recognizing family or community high risk situations, such as teen suicides, 

domestic/family violence, etc. Training includes basic training for improved 

sensitivity and non-verbal cueing for family interviews and responses. 

d. Debriefings” are not to be limited to any one model, but have the flexibility to 

accommodate to the unique characteristics of the participants, or the unique 

circumstances surrounding the crisis event. This is particularly critical in rural 
3 www.swgmdi.org                                                                                                  Published June 2012

SWGMDI’S NOK Services and Communication Committee

   

districts where responders are usually local volunteers rather than full time 

employees. Gathering the responders and “team” following the event may be 

challenging. 

e. Quality assessment survey is conducted 6 months to a year following the 

debriefing to ask participant to evaluate the process. 

f. “Debriefings” are conducted by either: 

i. Experienced, credentialed professionals who meet a set of predetermined 

standards: 

1. Successfully pass a structured screening process 

2. Complete annual training 

3. Masters degree in the behavioral sciences 

4. State licensure 

5. At least 5 year’s experience conducting debriefings 

6. Experience working in a medical setting, Etc 

ii. Peer counselors 

1. Successfully pass a structured screening process 

2. Complete annual training program 

3. Have access to supervision/consultation with credentialed and 

experienced professional counselor, at least via telephone 

 Common warning signs of mental stress in employees at risk are known (see Appendix 

A) 

Conclusion 

Critical needs of the MDI community do exist and are currently not available to fully meet 

the needs in both rural and metropolitan areas. Appendix B outlines SWGMDI’s 

recommendations to fulfill the needs of those who serve in this capacity in order to maintain 

their mental health during periods of critical stress. 
4 www.swgmdi.org                                                                                                  Published June 2012

SWGMDI’S NOK Services and Communication Committee

   

Appendix A

Common Warning Signs of Employees at Risk (Not all inclusive) 

*Note: These can occur outside of a critical incident and “non-critical” recognition of mental 

stress is optimal for both employees and offices. 

 Irritability (over long periods of time) 

 Ongoing fatigue 

 Insomnia 

 Under/over eating 

 Alcohol/other drug abuse 

 Relationship difficulties over an extended period of time 

 Gambling... 

 Affairs 

 Withdrawal from friends/family 

 Poor concentration leading to poor performance 

 Arriving at work late/leaving early 

 Disengaged from everyday activities 

 Preoccupation with illness 

 Depression 

 Suicidal discussion – “not worth living”
5 www.swgmdi.org                                                                                                  Published June 2012

SWGMDI’S NOK Services and Communication Committee

   

Appendix B

Committee Recommendations to meet needs of MDI community 

 Develop guidelines for WHEN to conduct debriefings as well ongoing availability as 

resource; 

o Discussion Point: Mandatory vs. Voluntary Participation (Varying opinions) – 

i. Supporters of voluntary feel that participants recognize their need for 

assistance will be more willing to get involved in a debriefing. 

ii. Supporters of mandatory believe that those most in need will not attend 

voluntarily; that even passive/resistant attendees at a debriefing will get 

benefit from hearing the concerns of others; and that mandatory 

attendance will at least “demystify” the debriefing process.

iii. No current agreement on which is most effective.

 Develop a screening tool for evaluating the suitability of crisis debriefing professionals 

and peer counselors 

o Emphasize screenings in advance 

o Emphasize education of debriefing professionals in advance to prepare 

themselves for dealing with mass casualties and understanding the particular 

stresses of those working in MDI professions daily. 

 Develop two training programs: 

o Training for professionals regarding the flexibility necessary to recognize the 

need to and conduct effective debriefings; 

o Training for Peer Counselors in Psychological First Aid 

 Develop a resource file/database that identifies professionals who meet the recommended 

standards for debriefing practice, and include how to access professionals who meet 

above criteria.