A crisis response framework

ICACPA steps

1. Identify the problem

Recognize and acknowledge that a crisis is starting. Remember that more than one crisis can happen at once. Exactly who is involved and what is happening?

The kind of crisis will vary greatly according to what your organization does. Crises can include:

1. Interpersonal conflicts (the most common)
2. Incident requiring first aid and/or medical care
3. Psychotic episode
4. Fit (e.g. epilepsy)
5. Blood spill where blood-borne disease is a risk.

2. Take Charge

The senior staff person on location is responsible to take charge of the situation, because somebody must be able to make decisions and give orders immediately. You can't assume that you have time to get someone from off-site. Other staff need to take orders from the person in charge.

If you are in charge and hands over to another person to be in charge, make sure you communicate it clearly.

3. Assess the risk

• How serious is the risk? How likely is it?
• What kind of harm could come from the incident?
• How serious could the harm be?
• Who do you have on hand that can assist you in crises?

4. Contain the crisis

• "Nip it in the bud." Avert the crisis in its early stages, before it becomes more serious. Once the crisis becomes serious, there is no turning back and it becomes more difficult to handle. If you get it early enough, most people won't even know it's happened.
• If you can't avert it, then prevent it getting worse or slow it down.
• Isolate the problem so it doesn't spread. Keep outside sympathetic forces from interfering).
• Keep the number of people involved as small as possible. Take other people away from the situation.
• Continue to evaluate the progress of the situation. If the crisis becomes violent please refer to the violent incident/physical restraint procedure.

5. Follow Procedure

If your organization already has a procedure for this kind of incident, then you only need to follow it. Procedures should be written as simple sets of steps that are easy to remember. You should have memorized your procedures, and practiced them.

If there isn't a procedure,

• Your priority is the physical safety of people involved, including yourself.
• Consider the range of options available.
• Choose the best option.

6. Aftercare

Write an incident report. Use the incident report form. Your organization may also require you to inform your supervisor as soon as you can.

Debrief the stress. Most people will need to rest and "wind down" from a suddenly stressful situation, or talk it out with somebody. Make sure you check everyone is okay, even people not involved in the incident.

* Post Traumatic Stress Disorder (PTSD) may affect workers and residents if the incident is serious or unfamiliar. People who appear to be coping well at the time of the incident and immediately after can still suffer from PTSD later on. They might also fail to realize they have it and even deny it if others recognize it. This may not even affect only the parties involved in the incident, so check that everyone else is okay as well.

Review. Discuss the incident response in a staff meeting or with your supervisor.

1. What was the context?
2. Exactly what happened leading up to and during the crisis? (Draw up an exact timeline of events if it’s helpful.) Why did it happen?
3. What were the personal dynamics involved?
4. How effective was the response?
5. What other possible responses could have been effective?
6. What went well?
7. What didn't?
8. What do we need to learn from this?
9. What can I learn about myself?
10. What should we do differently next time? Do we need to change procedures or training?

In complex cases, the "What actually happened?" stage can involve writing a time line of events leading up to and including incident. It may include events that extend back in time, and not just focus on immediate events.

You will probably start making timeline notes fairly early in the discussions, and will have a quite good idea of what happened by the time you get to write the whole timeline. If you find gaps or contradictions, you may have to run extra discussions or look again at other evidence.

About frameworks

This framework was specifically designed for community services work. In this framework, a crisis is any incident that poses danger to people or property and may require an immediate response. Why this framework? Following a general set of steps helps to:

• Prevent workers panicking and making the incident worse.
• Prevent workers "making it up as they go along", which can be very dangerous, especially if the obvious thing to do is wrong.

You use response frameworks for other things too:

Occupational Health and Safety:

• Spot the hazard
• Assess the risk
• Fix the problem.

First Aid (DRABCD):

• Danger: Get the victim out of danger.
• Response: Try to get the victim to respond.
• Airways: Clear airways.
• Breathing: Check breathing.
• Circulation: Check pulse.
• Defibrillator: Use a defibrillator to restore pulse.

Definitions

In this context, a crisis is a potential or actual emergency. Crises are also called "critical incidents."

• A crisis usually has a sudden, unexpected onset.
• A crisis creates an immediate risk of harm of some kind. There are many kinds of harm, such as physical, emotional/psychological, sexual, or financial.

A framework is a set of approaches that covers all situations. Approaches generally fit into two categories:

1. procedures (i.e. sets of steps of what to do) for specific kinds of incidents, and
2. a general strategy to guide people how to handle most foreseeable cases where there is no specific procedure.

Myth and reality

Alert people to the myths and realities. Some things are counter-intuitive; the myths look right, but they aren't. For example:

Be prepared

Your normal procedures and OHS processes should prevent most crises. Workers and participants should report problems before they become serious. Remember "Prevention is better than cure."

If you do a good risk assessment, you will identify most possible crises and be able to follow procedures in response to them.

This means that:

• You will know the signs to look for. This can help you identify the crisis earlier and avert it.
• You will have thought out approaches on what to do so you can give a better response.
• You decrease or eliminate your legal liability, because you have done what you can against anything that is "reasonably foreseeable."
• Delegate!! This is the most important part in any crisis. You need to know who you have on hand at any time that can assist you in crises.

You will find these resources helpful:

• A mobile phone to get help.
• Phone numbers of key people to get help.
• First aid training and supplies.
• Your organization's procedures.

Risk assessment

If you do a good risk assessment, you will identify most kinds of incidents you need to be prepared for and so decide on the crisis procedures you need.

1. What sorts of things could go wrong? Make a list. The main sources of information might be:
• Ask staff what kinds of incidents they have had to cope with.
• Ask staff what kinds of incidents they think could easily happen.
• Ask your OHS officer if your organization has a risk assessment.
• Look through any written incident reports.
• Ask people in other organizations similar to yours.
• Do an Internet search.
2. How much harm could each one cause? Rate it from 1 to 5.
3. How probable is it that each one could actually happen? Rate it from 1 to 5.
4. Calculate the risk. For each one, multiply harm and probability; that is, multiply scores from lines 2 and 3 above. This tells you how much risk.
5. You can then use those scores to decide what to do:
• A score of 1 indicates that the item is no risk; it either would cause no harm or won't happen. You can ignore it.
• A score of 25 indicates that the item is extreme risk; it will cause serious harm and will definitely happen sooner or later. (In fact, it probably already has happened.) It is a top priority.
• A score of 5 – 20 indicates the level of risk. It will cause some harm and will probably happen sometime.
• Risks rated 9 or above are mid to high risks. Make sure you have something in place for each one.

For example:

 

Note

In working with at-risk youth, many crises involve some kind of altercation, and you should already have training in conflict resolution. You should include any of these in your risk management strategy if they apply to you.

• Characteristics of aggressive and abusive behaviour
• Methods of promoting less aggressive/abusive behaviour
• Methods of crisis intervention including mediation and negotiation

About procedures

It's easier to make a good decision if you already know what to do and why one option is better than another.

Policies and procedures are ready-made decisions for foreseeable kinds of incidents. Having good policies and procedures in place beforehand helps people in difficult situations to make good decisions consistently, quickly, easily, and with less stress.

So what's the difference between policy and procedure?

• A policy is usually a general statement of a principle.
• A procedure is normally a set of steps on how to do something.

Staff can even use procedures to practice their responses until they can do them automatically and very quickly.

The basics

Several of the most important principles of crisis management are:

1. Nip it in the bud. Avert the crisis in its early stages before it becomes more serious. Once the crisis becomes serious, there is no turning back and solutions become more difficult to find. If you get it early enough, most people won't even know it's happened.
2. If you can't avert it, then prevent it getting worse or slow it down.
3. Isolate the problem so it doesn't spread.
4. Keep the number of people involved as small as possible.

The distinctive steps in a crisis are:

1. Recognize and acknowledge that there is a crisis.
2. Contain the crisis (keep outside sympathetic forces from interfering).
3. Isolate the crisis from interference from within the organization.
4. Assess the crisis (who? what? where? why? when? how?)
5. Give an appropriate response.
6. Evaluate the progress.
7. Close the crisis: treat Post Traumatic Stress Disorder (PTSD), evaluate the handling of the crisis.

Timeframes are not the same for all kinds of crisis. In some kinds of crisis, you must act immediately (e.g. First Aid). In other kinds of crisis, you need to gather information and avoid making decisions too quickly (e.g. civil unrest).

In community services, many crises involve some kind of interpersonal conflict.

1. If possible, move the conflict away from public areas. For example, you might ask an angry client into a separate office where you can discuss the matter more privately.
2. Calm the person down so that you can at least communicate. Contain their emotional responses and escalating behavior. Stressed and dysfunctional people are often unable to communicate clearly; they tend to communicate in short, incoherent bursts.
3. Ask questions and listen reflectively. Get them to explain the problem and make sure the person feels listened to. (Sometimes that is really all they want.)
4. Identify and address the source of the issue.
5. In some cases, you just can't give in. You have to follow the rules. In other cases, you can negotiate and make realistic compromises, or create solutions that they hadn't have thought of.
6. If more than one person in involved, mediate between them.
7. You may need to ask for help from other people or services.

Training

Crisis training should always cover the basic concepts of this framework. After that, there is space for variation:

• The easiest kind of training to give is through the regular staff meeting. Staff evaluate how real cases were handled, review procedures, and consider arguments for and against different approaches.
• Lots of crisis training involves analyzing scenarios. They may be hypothetical or based on real cases. They may involve discussion of a written story or practiced as if they were real. If crisis responses generally can't be proceduralized, it is best to use a wide range of different scenarios.
• Conflict resolution training often involves role-plays.
• In some other kinds of crisis preparation, the kinds of incidents are fairly clear (if not predictable), responses must be very fast, and errors are unacceptable. In this case, it is best to provide long, intense periods of practice so that personnel naturally give the correct response very quickly even when they are highly stressed or very tired. Military training is a good example.
• In some kinds of crisis preparation, it is best to manage risks very comprehensively, put good communications systems in place, and give personnel a handbook of instructions about what to do.

CPAP version

Ross Woods, 23 Nov. 08,Rev. 2010

Follow the CPAP steps: Control, Problem, Assess, Procedure

This crisis response framework was specifically designed for community services work. It is not as good as ICACPA, but it is easier to learn and remember.

1. Take Control.

• The senior worker on location is responsible to take charge of the situation. (Somebody must be able to make decisions and give orders immediately.) You can't assume that you have time to get someone from off-site.
• Other workers need to take orders from the person in charge.
• If the person in charge hands over to another person to be in charge, make sure you communicate it clearly.

2. Identify the Problem.

• Exactly who is involved and what is happening?
• What kind of harm could come from the incident?
• How serious could the harm be?

3. Assess the risk.

• How serious is the risk? How likely is it?

4. Follow Procedure.

If your organization already has a procedure for this kind of incident, then you only need to follow it. It should be written as simple sets of steps that are easy to remember. You should have memorized your procedures, and (usually) practiced them.

If there isn't a procedure,

• Your priority is the physical safety of people involved, including yourself.
• Consider the range of options available.
• Choose the best option.

After the crisis

1. Write an incident report. There should be a simple procedure, usually with a form. Your organization might also require you to inform your supervisor as soon as you can.
2. Debrief the stress. Most people will need to rest and "wind down" from a suddenly stressful situation, or talk it out with somebody.
   Post Traumatic Stress Disorder (PTSD) may affect workers and residents if the incident is serious or unfamiliar. People who appear to be coping well at the time of the incident and immediately after can still suffer from PTSD later on. They might also fail to realize they have it and even deny it if others recognize it.
3. Review Discuss the incident response in a staff meeting or with your supervisor. What went well? What didn't? What would you do differently next time? Do you need to change procedures?