Dealing with critical incidents and trauma (Key points)

• Seek safety and support.
• Be in contact with your family and friends.
• Check symptoms (acute stress reactions).
• Contact the staff welfare section.

Overview

A critical incident is a sudden, unexpected and overwhelming event, that is out of the range of expected experiences. You may feel intense fear, helplessness, horror and completely out of control. After such an abnormal event, most people experience reactions that are disturbing and difficult to accept.

Inform yourself about typical responses (acute stress reactions) you can expect in the aftermath of a critical incident, how to develop a ‘healthy' response, and when to seek support.

Managers and colleagues should be aware that initial support is critical. How you support and respond to colleagues who have experienced a critical incident may influence the duration and depth of their symptoms.

Main guidance

Underlying policies, principles and/or standards

Critical incidents include:

• Accidents (such as traffic accidents).
• Hostage-taking or kidnapping.
• Incidents involving improvised explosive devices (IEDs).
• Natural or man-made catastrophes.
• Physical assaults.
• Rapes and sexual abuse or assaults.
• Armed or terrorist attacks.
• Torture.
• Riots or mob violence.
• Incidents involving mines or explosive remnants of war (ERW).
• War.

Critical incidents trigger an office-wide response.

Management. Ensure that services to persons of concern continue. Encourage staff well-being and team morale. Oversee the overall response.

Security. Save lives. Contain and manage the incident. Prevent others from being affected by it.

Health. Ensure a medical response when staff are physically injured.

Well-being. Help staff and others who are affected to understand and process the psychological impact of the incident.

Administration/human resources. Oversee arrangements for evacuation. Process Appendix D compensation claims and other administrative procedures.

Good practice recommendations

It is important to recognize symptoms
Even after a critical event is over, you may experience strong physical and emotional reactions, or emotional aftershocks. These reactions are called acute stress reactions. They may be immediate or appear hours or days later.

 

Phase of Reaction	Common Types of Reactions	Tips
Normal reactions in the first few hours after an event   Mainly physical and perceptual. Related to ‘fight or flight' nervous responses.	Mild reactions. Persons fixate on what happened, are not aware of their surroundings, gag, have a lump in their throat or a heavy feeling in the stomach,feel like crying. Intense reactions. Time warps (moves too fast or too slowly); individuals experience hearing distortions or visual disturbances (see in great detail or have tunnel vision); they have tremors or ‘the shakes'.	Allow yourself to be overwhelmed by your reactions. Remind yourself that your reactions are normal. Do not stay alone. Ask colleagues, friends or family to be with you.
Normal reactions in the first few days after the event   Initially numb, you start to feel the impact of the incident as you begin to process it. Reactions related to higher levels of stress.	Mild reactions. Heart palpitations, stomach aches, heartburn, changes in bowel function (diarrhoea or constipation), muscle aches, difficulty sleeping (very common), decreased sex drive. Intense reactions. Individuals feel numb, disbelief, function on ‘auto-pilot'. They are inattentive, experience memory gaps, lose perspective. They are tense,irritable, feel isolated, feel no one cares or understands, are preoccupied by the event, are highly sensitive.	Get plenty of sleep and rest. If you are able, exercise vigorously. Your body had been on high alert during the incident and needs to get rid of stress hormones. Do not make major decisions. Give yourself time to adjust.
Normal reactions 3-7 days after the event   Fewer physical reactions; psychological and emotional reactions continue.	Mild reactions. Reactions seem abnormal outside the context of the event.Individuals start to experience harmful impacts on their family and work relationships. Intense reactions. Individuals may have difficulty sleeping. They may have insomnia, or wake up suddenly; they may experience sexual difficulties.They may use alcohol or drugs to cope. Individuals may have flashbacks, nightmares, feel a heightened sense of danger. They may have an increased startle response, and feel anger, blame,or guilt. They may isolate themselves, withdraw from social contact, feel alienated from people, avoid things associated with the incident. They may feel fear or anxiety about the future, feel numb, depressed, out of control, fear the event will recur. Family problems and misunderstandings may increase.	Spend time with trusted family members, friends and colleagues. Tell your story, but only when you want and to whom you want.Wait until the timing feels right for you. Try not to be critical of your behaviour during the incident. You were trying to survive. Resume a routine. Minimize use of alcohol, nicotine, caffeine and other drugs. Practise stress management and relaxation techniques. Take your time. Recovery is a gradual process.

Reference: International Critical Incident Stress Foundation Inc.

Following the incident, your first reaction may be to want to return as quickly as possible to your home. However, remaining with your team for a few days, if the conditions allow, may give you an opportunity to start working on your traumatic reactions with people who have gone through the same. These few days might help you to feel calmer and more ready to join your family back home. Should you prefer to depart immediately, do establish the contact with the Staff Welfare Officer for the follow up while you are at home.

Self-help

Your reactions may be powerful and unusual, especially in the week after the incident. In the hours immediately following the incident, you will not be able to do anything but will experience acute reactions that are part of your body's survival mechanisms. You should seek comfort and support.

Try as much as possible not to isolate yourself. Spend time with people you trust. You do not have to share your experience if you do not wish. You will share them when it is the right time for you.

You should take as much rest as possible and be gentle with yourself. Give yourself the time to recover. Do not try to force the recovery process.

Get back to your normal routine, because this will help you to structure your day, to contextualize the incident, and minimize anxiety.

It is strongly recommended that you practice stress reduction and relaxation techniques (deep breathing exercises, progressive relaxation, meditation), do physical activities, play music or read.

The importance of support

For individuals who have survived traumatic incidents, the care and support of managers and colleagues can make a very great difference.

How long will symptoms last? When should I seek help?

Symptoms will be evident immediately after a critical event. They will diminish within days or weeks. Most people do not require 'psychological treatment. They work through their reactions by following their usual routines, supported by family and friends.

If symptoms persist for more than a month, it may indicate a stress reaction that could lead to a post-traumatic stress disorder (PTSD). In such cases, it is important to consult a staff welfare officer or a mental health professional.

You should seek help if:

• You feel that you cannot handle your intense feelings or physical sensations.
• The effects which followed the incident are getting worse not better.
• You continue to experience distressing thoughts, or physical or emotional symptoms.
• You continue to have nightmares or your sleep continues to be affected.
• You are using increased amounts of alcohol or drugs.
• Your responses are hurting your relationships with other people.

Considerations for practical implementation

Taking care of yourself after a critical incident

• Expect the incident to bother you.
• Expect to feel guilty: be gentle with yourself.
• Remind yourself that your reactions are normal.
• Learn as much as possible about acute stress reaction.
• Get plenty of sleep and rest.
• Spend time with trusted family members, friends and colleagues. Talk with them about the event. Talk about your immediate reactions as the incident was unfolding, particularly your thoughts and feelings.
• As much as possible, try to follow your routines and eat a balanced diet.
• Practice stress management and relaxation techniques, do physical activities, play music, read.
• Attend group debriefings and informational update meetings unless these deeply disturb you.
• Minimize use of alcohol, nicotine, caffeine, other drugs, and sugar.
• Contact staff welfare or visit a mental health professional.

Taking care of others (for managers and colleagues)

• Comfort and console the distressed person.
• Protect him or her from further threats or distress. Protect him or her from the media, onlookers, insensitive colleagues, and emergency workers.
• Meet his or her immediate physical needs and provide practical help.
• Facilitate social support. Provide access to a phone, contact supportive friends and family.
• Listen actively and supportively if he or she wishes to talk about the experience. If he or she does not wish to talk, respect his or her decision.
• Offer access to information, including information about the event. (What happened? Who was affected? How seriously? Where they are now?)
• Try to ground the person. Help him or her to identify specific goals, break tasks down into manageable sub-tasks, encourage a return to routine. At the same time, advise him or her not to undertake a heavy workload, take on demanding tasks, or work long hours, because this will impede the natural healing process.
• Assist him or her to find sources of help and support. Offer access to professional counselling.