IRMA Members are unique, as the nature of municipal work exposes the majority of employees to potential critical incidents. This includes not only Police and Fire, but also Public Works departments. Recently, IRMA has seen an increase in reported mental stress and post-traumatic stress disorder (PTSD) claims. Development of a critical incident stress management (CISM) program is important to limit potential risk to the pool and more importantly to keep your employees healthy following a critical incident.

A critical incident is any event that has a stressful impact sufficient enough to overwhelm the usually effective coping skills of an individual. These incidents are abrupt, powerful events that fall outside the range of ordinary human experiences. Critical incidents can include unexpected employee death, suicide or serious injury, a multi-casualty incident, officer involved shootings, workplace violence, natural disasters, and acts of terrorism or hostage situations.
 
Intervention may be necessary following a critical incident, injury or accident to support your affected employee(s) post-incident regardless of whether the incident could result in a claim. The main goals of CISM are to proactively facilitate and accelerate the recovery to a very unusual event, and identify employees within the group who may be in need of additional counseling services through their EAP or another resource.
 
By incorporating psychological first aid to those who experience or observe a substantial loss and utilizing the appropriate services in a timely manner, your employee(s) will receive the necessary tools for emotional and mental support resulting in a return to his/her daily routine more quickly, with less likelihood of experiencing PTSD.
 
It is best to be prepared if a critical incident occurs within you organization. Prior to an event, be sure to have the following completed:

• Educate your staff, upper management, and department heads on critical incidents, signs and symptoms of worker stress and coping strategies.
• Develop procedures and establish effective management structure and leadership for post-incident management.
• Identify who coordinates CISM following an event and establish a clear chain of command and reporting relationships.
• Coordinate briefings with shifts. Shifts should overlap so that outgoing workers can brief incoming workers.
• Develop a plan for stress management and contact EAP or a designated trauma response team for assistance and expertise.

Simple steps can be taken to minimize the effects of stress on your employees. Following a traumatic event:

• Make sure employees are safe.
• Notify the appropriate authorities and personnel within your entity such as Human Resources, Executive Management, IRMA, OSHA, media relations coordinators and/or a designated trauma response team.
• Acknowledge to employees that a critical incident occurred. Provide factual and consistent information to all groups to avoid the spread of rumors. Address rumors and employee concerns.
• Consult counsel before responding to the media or communicating to employees. Designate a spokesperson to speak to press or other media. Instruct employees what to do if approached by the media. Take precautions to insulate directly affected employees and their family from the media.
• Traumatized employees need structure, peer support, facts and instructions on what to expect next. Before employees leave, find out what they plan to do with their time once they leave work and encourage time be spent with friends or family.
• Identify employees most affected by the event and offer them a quiet place to be but don’t force them to be isolated if they’d prefer to stay with their co-workers.
• Set an example. Your caring support and professionalism will set a standard that will last long after this experience.
• Stay in touch. If the employee hasn’t returned to work designate a co-worker and supervisor to remain in contact with him/her.

Some common mistakes to avoid:

• Ignoring the situation
• Delaying response
• Stifling communication
• Misunderstanding the purpose of a response team

Management should continue to monitor employees up to one (1) year following an event as it can have lasting effects or delayed onset. Although it may be difficult to judge if employees have been or are still being affected, some signs may include:

• Declining productivity
• Increased absenteeism
• Increased concerns about personal safety
• Irritability, anger or tearfulness
• Complaints about loss of appetite, headaches, shivering or rapid heart rates
• Sense that employee(s) are highly uncomfortable or overwhelmed
• Increased attrition

Additional Resources

Northern Illinois Critical Stress Management Team (NICISM)
Toll-Free Number: 800-225-CISD (2473)
Website: www.ni-cism.org
 
Substance Abuse and Mental Health Services Administration
Toll-Free Number: 877-SAMHSA-7 (877-726-4727)
TDD: 800-487-4889
Website: www.samhsa.gov
 
National Institute for Occupational Safety and Health (NIOSH), CDC
Toll-Free Number: 800-232-4636
Website: www.cdc.gov/niosh
 
Illinois Department of Human Services
Toll-Free Number: 800-843-6154
Website: www.dhs.state.il.us
 
Office for Victims of Crime, U.S. Department of Justice
Toll-Free Number: 800-363-0441
Website: www.ovc.gov
 
National Center for PTSD, U.S. Department of Veterans Affairs
Toll-Free Number: 800-296-6300
Website: www.ptsd.va.gov
 
National Suicide Prevention Lifeline
Toll-Free Number: 800-273-8255
Website: https://suicidepreventionlifeline.org

The types of potential losses that are intended to be addressed by the Pre-Litigation Management program are high exposure incidents or occurrences that have a good probability of escalating into a claim or lawsuit (i.e., shootings, pursuits, severe injuries involving a use of force report and resulting in an ambulance transport, and member involved fatalities). Also included are potential losses that may involve initial allegations of civil rights actions, which may escalate into formal claims or lawsuits, such as discrimination or retaliation claims, employment practices liability such as sexual harassment and wrongful termination or police professional liability. The losses may also involve alleged violations of federal and/or state statutes, i.e. ADA, FMLA or the like.

Notice of these types of issues may come from several sources: Complaints made or filed by employees, citizens or contractors; filing of a claim prior to litigation by an attorney; observations by elected officials, supervisors, department heads, employees, risk managers, loss control or claim representatives or employees; or inspections by employees, IRMA or governmental agencies.
 
Once a risk has been recognized by either formal or informal notice, or even if there is a suspicion of a risk, that is the time for intervention – before the issue escalates to more formal resolution procedures, such as litigation. The resolution of an issue may be something as simple as providing instructional material, a model policy or a focused training dealing with the risk or loss identified; or it may involve something more complicated, such as the retention of a consultant to investigate, make recommendations or mediate the issue or the retention of defense counsel to assist the member with pre-litigation issues.

Process

The following is the process that may be used in potential claims or litigation that may benefit from early intervention or pre-litigation management.

1. When a member receives notice or identifies an issue or potential claim, the member should contact the Executive Director, the Director of Legal Services or the Director of Risk Management with a description of the issue or potential claim. Additionally, if IRMA receives notice or identifies an issue or potential claim, IRMA will contact the Member’s delegate to advise the member of the issue or potential claim.
2. The appropriate staff person at IRMA will conduct an initial interview with Member contact to determine the relevant facts and issues involved. IRMA staff will make a determination if the issue or complaint can be addressed through a simple resolution process or if a more complex solution is required.
3. If it is determined that a simple resolution is appropriate, IRMA may provide the member with a risk assessment and plan to address the risk, or the appropriate instructional materials and the training necessary to address the issue, or refer the member to a suitable resource to obtain the instructional materials or training.
4. If IRMA determines that the issue is of a more complicated or serious nature, IRMA may conduct an initial preliminary investigation to determine the basis and likelihood that it may result in a liability to the Member. Upon that determination, IRMA and the Member will work together to determine how to proceed to best resolve the issue within the ability (legally and/or financially) of the Member.
5. Upon a determination by IRMA and the Member of an appropriate action, IRMA can, if necessary, provide the Member with suggested resources or consultants, including defense counsel, to assist the Member in addressing the issue. In certain situations involving a financial commitment to resolve the issue, the Executive Director, in his or her sole discretion, may agree, subject to the availability of the amounts budgeted for this program, to fund the entire cost or share the cost of any such action with the Member, if there is an identifiable benefit or value to all Members or the pool. If a matter in pre-litigation early intervention subsequently results in a lawsuit or claim, the early intervention program account will be reimbursed from the claim.
6. If the issue or risk is one which IRMA requires a resolution pursuant to the terms and provision of the Contract and Bylaws of IRMA, the Member shall address the issue or risk according to the recommendation of IRMA.
7. Within an agreed upon reasonable period of time, IRMA and/or the Member shall conduct a follow-up evaluation to determine if the issue is resolved or if further action is required by IRMA or the Member.

In the event of a critical incident or accident, IRMA requests immediate notification. If an incident occurs after business hours, please contact the IRMA Emergency Number (708) 236-6373. Upon notification of such an event, IRMA will determine whether to send the Rapid Response Team on-site.

Accidents that qualify for deployment of the Rapid Response Team may involve a catastrophic injury of an employee(s) or resident(s), shootings or hostage situations, police pursuits, severe injuries involving a use of force report and resulting in an ambulance transport, member involved fatalities, exposure of hazardous materials to employee(s) or resident(s), and/or large scale losses to member property including natural disasters or terrorism. IRMA encourages notification of any type of incident determined to be critical.

The team is comprised of experts in claims administration, investigations, and risk management best practices with extensive experience in managing catastrophic-level injuries, conducting post-accident investigations, handling complex litigation, and are proficient in OSHA compliance, regulations and reporting. Additional resources such as attorneys and nurse case managers are also available.
 
Following a critical incident, our Rapid Response Team can be on-site assisting with the investigation, preserving important evidence, interviewing witnesses and assisting with regulatory conversations.
 
Thereafter, an internal review will be conducted by the Rapid Response Team to provide recommendations for potential future remedial measures in order to bolster risk prevention through an introspective assessment.
 
We hope by providing this service, it reduces the stress and impact of a catastrophic event in your organization.

This program is an additional step to directly connect claims with risk management and training solutions. It is a collaborative effort between IRMA staff and the Membership that involves identifying preventable losses, verbal consultations and training recommendations, recognition of outstanding excellence in safety as well as monthly articles in IRMA’s E-News.

The goal of this program is to assist in the reduction of preventable losses, address claim patterns and trends, track IRMA outreach and trainings, and promote IRMA programs.

Once a claim or series of claims are determined to be preventable, consultation efforts will begin with the Member. Initial contact will be made telephonically with the Supervisor or Department Head to discuss claim details, identify best practices within the Department, and obtain a Member action plan. After additional information is gathered, IRMA staff may recommend additional training measures, revamp policies and/or procedures, or evaluation of equipment. The Risk Management Recommendation form will be used on a case-by-case basis and sent to Department Head, Claims Coordinator, Safety Coordinator, Alternate and Delegate.