A Primer on Critical Incident Stress

posted February 10, 2006

A Primer on Critical Incident Stress

"Stress, a ubiquitous part of life, results from the totality of all that humans experience. The decisions that people make both sharpen and dull stress. Stress is part of what makes people both alive and human."

Dr. Stephen A Pulley, Emergency Room Physician, http://www.emedicine.com

A critical incident is a relatively sudden, untimely and unanticipated event outside the range of normal human experience that evokes unusually strong emotional reactions. Extreme stress has long term effects often seen in soldiers, emergency responders, disaster victims. The more intimate a person's involvement with the traumatic event, the greater the potential impact. An accident is exceptionally troubling if the victim is a close friend or relative. When individuals exceed their abilities to manage stress, they may experience disturbing symptoms. Battle fatigue, Post-traumatic stress, and burnout both fall under the heading of critical incident stress. Many people will need some kind of professional support.

When paddlers are involved in a fatal accident, especially a failed rescue, their reactions will be similar to those who have been through a disaster or volent crime. This article is intended to help you understand what symtoms may be experienced, and how to deal with them.

Common stress reactions

1. Emotional (shock, anger, disbelief, terror, guilt, grief, irritability, helplessness, regression to earlier developmental phase)

2. Cognitive (impaired concentration, confusion, distortion, self-blame, intrusive thoughts, decreased self-esteem)

3. Biological (fatigue, insomnia, nightmares, hyper-arousal, somatic complaints, increased startle response)

4. Psychosocial (alienation, social withdrawal, increased stress within relationships, substance abuse, vocational impairment)

5. For paddlers: not wanting to paddle; staying away from certain rivers; avoiding people who were present on the day of the accident

People react differently to traumatic events and progress through the effects of critical incident stress at different rates. The symptoms experienced will vary. Accept your own feelings and reactions to the incident as well as those of others. There is no wrong or right way to feel or think.

Treatment

Critical Incident Stress Management (CISM) is a program that works to decrease the effects of CIS early on, before reactions become rooted. The goals in CISM are to restore the health of the individuals, decrease traumatic stress effects, and speed recovery. An important feature is helping an individual recognize that the danger has passed and that the need to react also has passed.

The 7 phases of a Critical Incident Stress Debriefing

This work can be done by a CISF team or other mental health professionals. Professional rafting outfitters frequently bring in outside experts after accidents and teams of whitewater boaters should give this option serious consideration.

  • Introduction phase: During the introduction, ground rules are established for the process. Confidentiality is paramount. Only individuals involved in the event should be present. People are told that they do not have to talk and to not say anything that could potentially be incriminating. Everyone introduces themselves and identifies their role in the incident.
  • Fact phase: During this phase, specific details emerge for the group. Usually, a few individuals provide core facts, while others fill in missing details. This is important because incomplete knowledge may have caused stress. The introduction of missing facts helps correct misperceptions.
  • Thought phase: Touching on emotional aspects begins during the thought phase. At this point, the group considers the following question: "When did you first realize this was a bad one?" Responses are as varied as the group.
  • Reaction phase: In this most intense phase, some people bare their souls when they answer the following question: "How did you react to the incident?" For many, emotions are intense. Not everyone feels comfortable talking, especially at this juncture. The important part of participation is being present and listening. Many participants discover that their reactions were similar to their peers'. Only a minority of participants have more severe stress reactions. However, the presence of their less affected peers is important in showing support for the more affected individuals.
  • Symptom phase: During this phase, the many varied symptoms that people have been experiencing will be discussed. Reactions, such as recurrent intrusive images, are common. In this phase, along with the reaction phase, workers realize that they are not alone in how they have been feeling
  • Teaching phase: The process of CIS, stress reactions, and techniques to decrease stress are explored.
  • Reentry phase: This final phase provides an opportunity for team members to expand upon points that they feel are important and for answering questions. The main purpose of this phase is to ensure that emotions are not still raw when the participants leave.

Post-debriefing

Afterwards: After the debriefing team members mingle with the group. This allows them to focus on those individuals who are troubled. Also, members of the group can bring up issues that they did not feel comfortable talking about with in the larger group.

Follow-up and referral

CISM is not psychotherapy. It is designed for short-term assistance. After CISM is provided, follow-up is indicated when the issues persist. Some individuals will need formal counseling.

Coping with the effects of critical incident stress (http://www.usyd.edu.au/stuserv/welfare/counselling/onsite_files/critical_incident_stress.shtml)

ยท These reactions will decrease in time; they are normal reactions to extreme stress.

  • Keep, or return to, your usual routine as much as possible. Structure your time.
  • Talk to family and friends; share your feelings and your concerns. This helps the healing process.
  • Don't have rules about your progress, just go with how you feel.
  • Avoid over-use of alcohol and drugs.
  • Get some exercise or relaxation daily.
  • Do something pleasant for yourself from time-to-time.
  • Take some time and space to work through the event.
  • Sometimes jotting down thoughts helps to process your experience cognitively as well as emotionally.
  • Delay making major decisions or life changes at this time; however making smaller day-to-day decisions increases your feeling of control over life.
  • Keep up social contacts.
  • Eat regular, balanced meals even if you don't feel hungry.
  • Memories of what you have experienced will fade with time. Don't have unrealistic expectations that they will disappear early.
  • Check on friends or colleagues who shared the experience with you. You may be having a good day and can be supportive. They can do the same for you at another time.
  • Remember, you are not going crazy.
  • Remember, help is available if you find that you are feeling too much pain.
  • Remember that there is always hope, and that the world is waiting for you to get back into it.

Contact Information:

Most localities have a designated CISM team. They can be reached through the International Critical Incident Stress Foundation, Inc. (ICISF) 3290 Pine Orchard Lane, Suite 106 Ellicott City, MD 21042 | E-mail: info@icisf.org. Their business telephone number is (410) 750-9600. The ICISF 24-hour emergency number (through the Howard County, Md, Fire and Police Communications Center) is (410) 313-2473. You can also work with a local mental health professional that you know and trust.