Which situation would require the emergency department manager to schedule a Critical Incident Stress Management (CISM) session?

• A. A policeman received a gunshot wound to the abdomen in the line of duty.
• B. A 4-year-old who had an accidental poisoning and was admitted to the ICU.
• C. A 22-year-old client who died after taking an overdose of sleeping pills.
• D. A school bus accident that resulted in 14 hospital admissions and 11 deaths.

Answer: (D)

Critical Incident Stress Management is used after a traumatic event that overwhelms usual coping, especially when the incident involves many victims or a disaster and affects the staff emotionally. A school bus crash with multiple hospital admissions and numerous deaths creates a mass casualty situation that can produce widespread emotional and psychological distress among emergency department staff. In such a scenario, a CISM session helps responders process their reactions, normalize their feelings, and identify colleagues who may need further support, reducing the risk of acute stress reactions or longer-term issues.

Single-injury or single-patient events, even when severe, tend to place less collective strain on the team and are less likely to require formal CISM as a standard response, though individual debriefing or peer support may still be appropriate as needed.