Traumatic Incident Stress

Emergency workers must respond quickly to natural disasters, such as earthquakes or hurricanes, and to manmade disasters, such as technological failures or terrorist attacks. These workers are at risk of experiencing stress from what psychologists refer to as a traumatic incident. A traumatic incident is an event that overwhelms a person’s ability to cope. It is a jolt to our psychological systems. It is an event that we experience as sudden, unexpected, incomprehensible, shocking, and personally upsetting.

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The event or situation causes emotional or psychological trauma in those individuals exposed to the incident directly or indirectly and is usually a sudden, powerful incident outside the range of normal human experiences.

The incident will often have a strong emotional impact that overwhelms the usual coping skills of an individual or group and may be so emotionally impactful that it affects an individual’s ability to function normally.

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The degree of impact that an event has on an individual depends on that individual. The experience of an event is subjective and will vary among individuals. Research shows most individuals affected by a critical incident will experience at least some of the reactions listed in the Common Reactions to Traumatic Incidents section and in the Coping With Traumatic Stress brochure. Although unpleasant, these common reactions to a highly stressful event are normal. So it’s highly recommended that all workers involved in response activities help themselves and their coworkers and reduce the risk of experiencing stress associated with a traumatic incident by utilizing simple methods to recognize, monitor, and maintain health on-site and following such experiences.

Examples of a Traumatic Incidents:

Death or serious injury of a co-worker, student, or a person who is known.
Suicide.
An event that is a real or perceived threat to self.
Witnessing a gruesome or emotionally gripping event or other tragedy.
Major incidents or multiple casualties.
Crime and violent situations.
Natural disasters or environmental threats.
Death or serious injury to a child or children.
Gruesome or fatal accidents.

Symptoms of Stress

Workers may experience physical, cognitive, emotional, or behavioral symptoms of stress. Some people experience these reactions immediately at the scene, while for others symptoms may occur weeks or months later.

Physical symptoms

Workers experiencing any of the following symptoms should seek IMMEDIATE medical attention:

Chest pain
Difficulty breathing
Severe pain
Symptoms of shock (shallow breathing, rapid or weak pulse, nausea, shivering, pale and moist skin, mental confusion, and dilated pupils)

Workers may also experience the following physical symptoms. If these symptoms occur over time or become severe, workers should seek medical attention. Additional physical symptoms include:

Fatigue
Nausea/vomiting
Dizziness
Profuse sweating
Thirst
Headaches
Visual difficulties
Clenching of jaw
Nonspecific aches and pains

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Cognitive symptoms

If these symptoms occur on the scene workers may not be able to stay clearly focused to maintain their own safety or rescue injured victims. Workers may experience momentary cognitive symptoms; however, if symptoms are chronic or interfere with daily activities, workers should seek medical attention. These symptoms include:

Confusion
Disorientation
Heightened or lowered alertness
Poor concentration
Poor problem solving
Difficulty identifying familiar objects or people
Memory problems
Nightmares

Emotional symptoms

Strong emotions are ordinary reactions to a traumatic or extraordinary situation. Workers should seek mental health support from a disaster mental health professional if symptoms or distress continue for several weeks or if they interfere with daily activities. Emotional symptoms include:

Anxiety
Guilt
Denial
Grief
Fear
Irritability
Loss of emotional control
Depression
Sense of failure
Feeling overwhelmed
Blaming others or self
Severe panic (rare)

Behavioral symptoms

As a result of a traumatic incident, workers may notice the following behavioral changes in themselves or coworkers:

Intense anger
Withdrawal
Emotional outburst
Temporary loss or increase of appetite
Excessive alcohol consumption
Inability to rest, pacing
Change in sexual functioning

Recommendations to Monitor and Maintain Health On-Site

Responders need to take care of their own health to maintain the constant vigilance they need for their own safety. Responders must be able to stay focused on the job in the dynamic, changing emergency environment. Often responders do not recognize the need to take care of themselves and to monitor their own emotional and physical health. This is especially true if recovery efforts stretch into several weeks. The following guidelines contain simple methods for workers and their team leaders to help themselves and their team members. These guidelines should be read while at the site and again after workers return home.

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Control the organization and pace of the rescue and recovery efforts

Pace yourself. Rescue and recovery efforts at the site may continue for days or weeks.
Watch out for each other. Coworkers may be intently focused on a particular task and may not notice a hazard nearby or behind.
Be conscious of those around you. Responders who are exhausted stressed, or even temporarily distracted may place themselves and others at risk.
Take frequent rest breaks. Rescue and recovery operations take place in extremely dangerous work environments. Mental fatigue, particularly over long shifts, can greatly increase emergency workers’ risk of injury.

Maintain adequate nutrition and rest

Eat and sleep regularly. Maintain as normal a schedule as possible and adhere to the team schedule and rotation.
Drink plenty of fluids such as water and juices.
Try to eat a variety of foods and increase your intake of complex carbohydrates (for example, bread and muffins made with whole grains, and granola bars).
Whenever possible, take breaks away from the work area. Eat and drink in the cleanest area available.

Monitor mental/emotional health

Recognize and accept what you cannot change—the chain of command, organizational structure, waiting, equipment failures, etc.
Talk to people when YOU feel like it. You decide when you want to discuss your experience. Talking about an event may be reliving it. Choose your own comfort level.
If your employer-provided you with formal mental health support, use it!
Give yourself permission to feel rotten: You are in a difficult situation.
Recurring thoughts, dreams, or flashbacks are normal—do not try to fight them. They will decrease over time.
Communicate with your loved ones at home as frequently as possible.

Recommendations to Maintain Health Following the Incident

Over time, workers’ impressions and understanding of their experience will change. This process is different for everyone. No matter what the event or an individual’s reaction to it, workers can follow some basic steps to help themselves adjust to the experience:

Reach out—people really do care.
Reconnect with family, spiritual, and community supports.
Consider keeping a journal.
Do not make any big life decisions.
Make as many daily decisions as possible to give yourself a feeling of control over your life.
Spend time with others or alone doing the things you enjoy to refresh and recharge yourself.
Be aware that you may feel particularly fearful for your family. This is normal and will pass in time.
Remember that “getting back to normal” takes time. Gradually work back into your routine. Let others carry more weight for a while at home and at work.
Be aware that recovery is not a straight path but a matter of two steps forward and one back. You will make progress.
Appreciate a sense of humor in yourself and others. It is okay to laugh again.
Your family will experience the disaster along with you. You need to support each other. This is a time for patience, understanding, and communication.
Avoid overuse of drugs or alcohol. You do not need to complicate your situation with a substance abuse problem.
Get plenty of rest and normal exercise. Eat well-balanced, regular meals.

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