CRITICAL INCIDENTS & THEIR AFTERMATH

Dr. Mary Doty, Director

What constitutes a critical incident?
A critical incident can be considered to be an event, or series of events, falling outside the realm of "normal" human experience in some way. Examples include, but are not limited to, natural or man- made disasters (e.g.: flood, tornado, fire, explosion, chemical spill, terrorism); accidents(e.g.: vehicular, sporting); interpersonal victimizations (e.g.: robbery, break-in, rape, assault, hostage situation), and other unexpected death/near-death (from trauma, acute illness, suicide, homicide, etc.).

Are there other factors that contribute to the "critical" nature of the incident?
Yes. Some significant factors include: individual's proximity to the event; exposure to death or destruction; degree of life threat or loss; suddenness of the event; length of impact (duration); anticipation level; degree of displacement; potential for recurrence; degree of moral conflict; perceived role in the incident ("did I somehow cause or contribute to this?"); and amount of community disruption.

Are there personal factors that contribute to how a person is effected by the incident?
Of course. We all have our strengths and challenges. In addition to those individuals who are experiencing a direct personal impact from the event, there are those who may be particularly susceptible to physical and psychological reactions to a critical incident, including people who:

  • are vulnerable from previous traumatic life events
  • are at risk because of recent ill-health
  • experience severe stress and loss
  • have a diminished level of or accessibility to social and emotional support
  • lack effective coping skills and adequate defense mechanisms

Additionally, these events often create, in those directly involved as well as in bystanders or others who hear about the event, a sense of increased vulnerability. There may be a loss of widely-held beliefs such as: "I am safe in the world," "Iım in charge of what happens to me," &Other people are basically good and can be trusted," "Life is predictable and makes sense", "Bad things only happen to other people," and so on. When these life assumptions are challenged, we can be more affected by critical incidents.

What are common reactions to a critical incident?
Reactions to a critical event vary widely, depending on numerous factors, many of which are mentioned above. Listed below are some common reactions to critical incidents. Keep in mind, however, that what seems threatening to one person may not be perceived as such by another person. Therefore, one normal reaction to a critical incident may be no reaction at all.

Physical Emotional Cognitive Behavioral
nausea anxiety memory problems withdrawal
GI upset fear poor attention restlessness
fatigue sadness nightmares emotional outbursts
racing heart guild intrusive images increase alcohol use
chest paid denial hyper-alertness increased avoidance
strained breathing numbing disorientation changes in speech
shock symptoms panic poor problem-solving change in appetite
muscle cramps apprehension poor decissions increased startle reflex
headaches disturbed thoughts rumination blaming others
chills anger disturbed sleep change in attitude

What are some ideas to help people get through a critical incident?
Critical incidents can be quite stressful. They may even be traumatic in nature. Given that, there are several things that can be helpful in navigating the tricky waters of these events.

1. Recognize when you are feeling overly stressed. Learn to recognize your own personal cues that you are too stressed (e.g. "overwhelmed"). When over-stressed, simplify your life. Remember, significant chronic stress can lead to illness, accidents, and diminished coping.

2. Talk about what troubles you. Find a friend, clergy member, mentor, counselor, or therapist with whom you can allow yourself to be open. Expressing your thoughts, feelings, and reactions to stressful events to an understanding, caring person can be very helpful. Be sure the person you talk to can keep confidences and accept you for who you are. Avoid those who give too much advice.

3. Keep to as much of your routine as realistically possible. We humans tend to derive comfort from our routines. At times when life already feels disrupted, it is often beneficial to keep from disrupting life any further.>/p>

4. Practice a systematic, drug-free method of relaxation. Breathing exercises, meditation, yoga, and relaxation training (autogenic or progressive muscle) can be easily learned from professionals who have been trained to teach such methods, or from credible books and tapes. It will require motivation and commitment on your part, because like anything that is learned, you will need to practice regularly. Trying to learn relaxation in the midst of a crisis is very difficult and will work better as a preventive measure for use in future situations.

5. Get regular physical exercise. Exercise helps eliminate cortisol, a toxic stress by-product, from the body. You should always check with your physician before beginning any exercise program. Remember that you will be more likely to stay with an activity you find enjoyable than one you find uncomfortable or boring.

6. Maintain healthy nutrition. Stress sometimes makes us want to load up on high-fat/high carbohydrate foods (ice cream, chips, etc.). While itıs okay to have some of those things, it is important, especially when stressed, to eat balanced, regular meals. You may want to consider moderate use of vitamins, especially during times of stress. (The "B" vitamins are considered important for handling stress, for example.) Also, keep from overuse of caffeine; avoid nicotine.

7. Get enough sleep. Research shows that lack of sleep creates problems even in the best of life circumstances. So, when stress is high, it is especially important to get adequate sleep. While this amount varies between individuals, most people need at least six hours of sleep per night for proper cognitive and physical functioning. Experts suggest that bedtime hours, particularly awakening hours, be constant when possible, regardless of whatıs going on that day.

8. Practice planning. Disorganization can breed stress. Having too many irons in the fire at the same time can lead to confusion, forgetfulness, and the feeling of having things "hanging over your head." When possible, tackle projects one at a time, seeing each of them through to completion before beginning the next one. Schedule things, including breaks. Prioritize. Delegate. Get enough "quite time."

9. Recognize and accept limits. Most of us set unrealistic and perfectionistic goals for ourselves. Because we cannot be perfect, however, we may end up with feelings of failure or inadequacy, regardless of how well we perform. Set reasonable goals, that take into account unplanned situational stressors. Learn to say "no," graciously but firmly.

10. Take time to get away. We may find that, during critical times, we need time away from mundane pressures and responsibilities, to reflect on our experiences and concerns. Be sure to make some space in your routine for contemplation, meditation, reflection, etc. Such times "away" can help us to connect with internal sources of strength and understanding.

OFFERING SUPPORT

When offering support to individuals affected by critical incidents, there are a few guidelines to keep in mind. First, be a good listener. Allow the person to vent and process their thoughts and feelings. Second, communicate that it is normal to have reactions to critical events. Third, give supportive feedback. Suspend any thoughts you have that are critical, judgmental, or questioning. Communicate your concern for them. Avoid telling them what they "should" or "need to" do. Instead, encourage them to access their support system, and to seek out professional support if need be. Fourth, be sure that you take time to take care of yourself. It can be draining to give aid and comfort to others. Be sure you, too, are getting your physical and psychological needs adequately met.

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