Critical Incident Stress in the Workplace.
ASHLEY HEWER, MA, RCC - VITALITY COLLECTIVE CLINICAL COUNSELLOR (SURREY, BC)
Critical incidents are defined as events that are sudden, powerful, out of our control and often unexpected.
They can be a threat to the personal safety (physical, or emotional) of yourself or someone else, a fatality, or a result of human error. First responders and health care employees are commonly exposed to critical incidents on a regular basis and as a result, these traumatic events seem more normal and expected for them, potentially preventing them from getting support in a timely manner. For example, as a firefighter you expect your job to include going into burning buildings, or attending accident scenes, as a nurse in critical care you know that not all patients will survive. Just because these events are part of your day-to-day job, does not mean you need to be able to mentally handle every incident that occurs.
Critical incident stress is a normal stress reaction to traumatic events. These reactions can be different for different people and can develop over time. Although these reactions are normal, they can cause disruption to daily functioning in multiple ways.
Common reactions include but are not limited to:
Physical- feeling uncoordinated, muscle aches, upset stomach, fatigue, vision problems and headaches.
Cognitive- flashbacks to events, disruption in logical thinking, poor concentration, and memory problems.
Behavioural – changes in interactions with others, changes in eating habits, suspiciousness, increased substance use, excessive humour and blaming others.
Psychological- uncertainty of feelings, identifying with the victim, anxiety, depression, anger, and feeling numb.
Over careers, different things may trigger different responses if we identify with a victim, or they remind us of a family member or friend. For example, if a family member recently had a heart attack, a response to cardiac distress may trigger different feelings than it did prior to your family member's health concerns.
After an incident
After a critical incident occurs, staff groups often spend time sharing what happened and the facts of the situation in a policy and procedure way. but talking about emotional reactions is just as important in processing the event. Although trauma in the workplace is expected for first responders and health care employees, it is not a normal situation.
Mental health support 24-72 hours after an incident occurs can help to reduce reactions, lessen the impact, and reduce the rate of post-traumatic stress disorder. This support can come in the form of a group debriefing or individual support with a trained mental health professional. This support can help you to understand and normalize your reactions, process the event, and assist you in moving forward.
Self-care after an incident is an important piece of recovery, practicing this regularly can help you to identify if an incident has impacted you differently than other times. After an incident, your regular self-care routine may not be as effective as it is normally. Self-care after an incident can include eating a balanced diet, exercising, getting appropriate sleep, avoiding excessive use of substances, and maintaining your regular routine. Additionally, self-care after an incident includes talking with trusted others, connecting with colleagues to share how you’re feeling on a regular basis, practicing mindfulness and relaxation techniques, and avoiding isolation.
Supporting Co-workers
Create a space of non-judgement where people can feel free to express their emotions regarding an event without fear. Often people don’t speak up about how they are feeling because they don’t want to be perceived by others or themselves as inadequate, weak, unable to cope, or overly emotional. Creating a team dynamic where staff can check in on a regular basis (start of shift and end of shift) can be beneficial in building trusting relationships, and effectively working as a team. For example, did everyone have a good sleep, is someone experiencing pain, is someone experiencing extra stress in their lives (family illness, new child, separation/divorce etc), or did something happen on shift someone wants to talk about.
Supporting a loved one
If your loved one is in a profession where incidents happen frequently it can be hard to know how to support them. They may not share what happened in their day in detail or at all, to protect you from secondary trauma. You may notice changes in them that they themselves deny, or that they may not be aware of. Continue to check with them and remind them that you are there to support them. Try not to take their mood personally, they may not ask for help or know what they need from you. Simple ways to be supportive can be taking some little tasks off their plate, laundry, cooking, groceries etc. Encourage connection to their co-workers or encourage them to talk to a mental health professional.
Moving Forward
Processing events and incidents as they occur can allow people to continue to enjoy their life outside of work as well as reduce burnout and compassion fatigue.
If you are not sure what resources your work has for critical incident support reach out to a manager, union representative, or occupational health and safety department.
If you need more individual support or want more information on critical incidents and critical incident stress management for your team, please reach out. Both individual support can be via phone, video or in-person, and group support can be in person or video.
References
George S Everly, Raymond B Flannery, Jeffrey T Mitchell (2002). Critical incident stress management (Cism): A review of the literature. Aggression and Violent Behavior, Volume 5, Issue 1, Pages 23-40,
https://bcfirstrespondersmentalhealth.com/resource/critical-incident-stress-management/