CRITICAL INCIDENT STRESS MANAGEMENT


TCTI specializes in Critical Incident Stress Management, particularly as it applies to trauma. We are equipped with cell phones and at least two team members are available for call-out services 52 weeks a year, 7 days a week, and 24 hours a day. The time of response is within 2 hours from the request for help. Our out of state response time is 24 hours. TCTI's Critical Incident Stress Management Services are currently utilized by various agencies for specific types of critical incidents. A critical incident is any event or experience, usually unexpected which has the power to overwhelm the defenses of an individual. TCTI can instruct supervisors how to understand the origins of stress in the workplace, how it is manifested and can learn what steps could be taken to manage the effects of critical incident stress.

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Examples of possible critical incidents are:

  • Serious injury, death, or suicide of a fellow co-worker
  • Shootings (including both shooting or being shot at, whether anyone was hit or not)
  • Any other serious threat to the life of you or your co-worker
  • Any incident in which circumstances are unusual
  • Any incident in which sights and sounds are distressing
  • Any catastrophic event/major disasters
  • Rescuing a victim, where pain and suffering is obvious
  • Mass casualty event
  • Knowing the victim
  • Death, injury, or abuse of a child
  • Contact with communicative diseases, e.g. AIDS/Hepatitis B
  • Major traffic accident
  • Death of a close family member
  • Sudden Infant Death Syndrome
  • Toxic chemical fire/explosion
  • Extreme attempts where lives are lost
  • Hostage or barricaded situation
  • Physical or Sexual Assault
  • Victim of a violent crime
  • Robbery
  • Incidents that attract extremely unusual or possible derogatory news media coverage

What is a Critical Incident Stress Defusing/Debriefing?

A defusing/debriefing is a confidential, non-evaluative discussion of the incident with a Mental Health Professional who understands the dynamic thoughts and reactions involved with traumatic events. Participants learn to understand their reactions and to strengthen their coping mechanisms.

Goals of Critical Incident Stress Management

  • Lessen the emotional impact on personnel exposed to the critical incident.
  • Accelerate recovery from the event, before harmful stress reactions damage work performance, health, work and family relations...to stop reactions before they start and to confine them before they spread to other employees.
  • Provide an atmosphere of concern and caring within the organization and avoid creating disgruntled employees.
  • Reduces sick leave, tardiness and Worker's Compensation claims.

Signs of Critical Incident Stress

Each person reacts to stress in their own way. What is traumatic for one person may not be for another.but traumatic stress can happen to anyone. Stress from a critical incident cannot be prevented, it is the result of exposure to trauma...but it can be managed through TCTI's Critical Incident Stress Management program.

PROCESS

Being involved in a traumatic situation, regardless whether or not it was an assault, car accident, death, or attempted suicide, produces feelings equal in intensity and similar reactions to those which an actual death of a loved one can cause.

These reactions are:

INITIAL DENIAL - that the traumatic incident took place, "this couldn't have happened to me", and produces at first a retreat into a fantasy life where it never happened. Many feel that the event happened in slow motion. After the traumatic incident, it took them quite a few moments to realize what happened.

HOSTILITY AND ANGER - which can be non-directed (just mad that it happened), or directed toward the person who caused you to be involved in the traumatic incident. This hostility is short-lived, but returns several times during the adaptation process.

FEELINGS OF GUILT/BARGAINING - internalized or projected, over things you did or didn't do (wishing the assault didn't occur), or things you might have done differently during the traumatic incident. Fear of loss of job is also common.

WITHDRAWAL/DEPRESSION - from those happenings too painful to cope with. The depression lasts the longest and may go on for weeks or months in degrees. The length of time depends on your basic personality, the type of traumatic incident, how the company deals with the incident, the availability and use of employee support services, and the handling of the incident by the media.

GRADUAL TESTING AND RE-TESTING REALITY - to contemplate the possibility of being able to cope with future situations that are similar. This leads to final ACCEPTANCE, acknowledging that this incident happened and that you have survived. The pattern ends with an eventual letting go from the influence of the past experience so that a new part of your life can begin.

NOT ALL OF THESE REACTIONS ARE EXPERIENCED BY EVERYONE, AND NOT NECESSARILY IN THIS ORDER, ALTHOUGH THIS IS THE MOST COMMON FORM OF REACTION TO A TRAUMA. Some feelings may return, usually anger and resentment, but not to a debilitating degree after the final acceptance.


REACTIONS

The feelings involved after a traumatic incident consist of seven basic reactions. These are:

EMOTIONAL NUMBING - many distance themselves from the incident and make an effort not to feel any thing. They almost deny having an emotional component, and therefore give the appearance that they are in a state of shock. They usually say, however, that they are in control and are having no problems dealing with the situation.

ISOLATION - They experience the feeling of being alone and that no one else knows what they are going through. They may experience irritability and agitation, and may again deny that anything is wrong.

INTRUSIVE THOUGHTS/FLASHBACKS - They will relive the event in their mind: over and over again. If it continues, they begin to wonder or question whether they have complete control of their thoughts. This can change their final outlook, for better or worse.

SLEEP DISTURBANCES - Disturbances which can result from a traumatic incident include inability to sleep, nightmares, and waking in a cold sweat. In the nightmares, the theme is fear or guilt. Guilt is common in 95% of traumatic incidents to varying degrees. This guilt can be translated into anger or depression.

ANXIETY & FEAR - The fear most commonly felt is that of returning to the exact job duties as before, i.e. returning to routine duty.

LOSS OF INTEREST/BURNOUT - Loss of interest in work is difficulty in returning to it. Mundane activities suddenly become boring.

RE-CONSIDERATION - Re-evaluation of each person's value system, goals and status is often the final step which determines the person's abilities to cope and how they will continue their future activities. Some consider giving up their current careers. They may also re-evaluate their personal relationship situations. Some make a stronger commitment and others exit the relationship.


HOW TO PSYCHOLOGICALLY SURVIVE

AVAILABLE EMPLOYEE SUPPORT SERVICES - Have available TCTI's services immediately, before the person involved goes home. On-call Mental Health Professionals are ideal. This allows them to verbalize their feelings and concerns while they are still fresh, and in an atmosphere that is "safe".

PROVIDE A PEER SUPPORT PROGRAM - Allow Peer Supporters who have been trained to respond to the incident if available. This para-professional can help aid and assist in the recovery process.

CRITICAL INCIDENT DEFUSINGS/DEBRIEFINGS - Many times they can relate to a group of their peers with whom they can share their experiences. The Mental Health Professional will arrange this group defusing/debriefing, which allows the ventilation process to occur.

BE AWARE OF PERFORMANCE - When on the job or doing light duty after a traumatic incident, it is important to be aware of his/her performance and his/her feelings about the change. They should examine their feelings, identify those parts of their job which can cause anxiety and then work on alleviating that anxiety.

RE-REFERRAL IF PROBLEMS CONTINUE - If the initial intervention does not completely ease the tension and help the person return to productive duty, re-referral to TCTI, or to another source may be necessary.