Critical incident stress: do you recognize the symptoms?

The Report: January / February 2003 vol.24 num.1


residential / outreach support worker is working alone with a group of young offenders one night when he is surrounded and severely beaten by three residents. He returns to work a week later having recovered from the physical effects of the assault, but finds in the following days and weeks that he cant stop thinking about the incident. He feels more and more anxious, especially at work. He becomes increasingly fatigued over the following weeks, and eventually goes off work because of severe depression.

An x-ray technologist in a small town is called in one weekend to perform x-rays on the victims of a serious traffic accident involving several cars. All of the victims are well known to her, including three children from her seven-year-old daughters class. The technologist has to perform a spinal x-ray on her daughters best friend, who lives next door. The x-ray shows its unlikely the little girl will ever walk again, and she is rushed by air ambulance to Vancouver. During the following weeks the x-ray technologist has recurring nightmares about this incident. When she looks at her daughter, she has vivid images of her lying injured on the x-ray table, or in a wheelchair. Although previously an easy-going individual, the technologist begins to experience angry outbursts and feels increasingly detached from her fellow workers and family.

Both of these workers have experienced a critical incident while at work. A critical incident is a sudden, powerful event that is outside the range of normal experience, and is beyond the workers control. It includes such things as a serious accident, fatality or violent incident.

A critical incident can overwhelm a persons ability to function in a normal way by causing strong emotional and psychological reactions. Workers exposed to such an incident ... either directly or indirectly ... may experience such emotional and psychological trauma.

Common reactions to such a critical incident include:

  • feeling moody or irritable
  • feeling jumpy, anxious or depressed
  • having difficulty concentrating or making decisions
  • having trouble going near the accident scene or places that trigger memories of the incident
  • having trouble interacting with others
  • experiencing recurrent thoughts, dreams or flash-backs of the episode.

Even professionals with counselling or mental health services training shouldnt assume they can deal with a critical incident when they experience one, according to Sharon Geoghegan, an occupational health and safety steward. -You need the opportunity to debrief, and look at ways to protect yourself, and sometimes you need another person to help put that situation into perspective," she said.

-If youve witnessed a traumatic situation or youve been the victim of something thats happened, you become caught up. Your abilities ... and all the tools that youve learned as a counsellor ... go out the window."

Geoghegan, who works as a youth counsellor at the John Howard Society in Campbell River, said this stress reaction is caused by the crisis. -You go into self-preservation mode," she said. -You start to block out things, you arent able to see things as clearly, your objectivity disappears. As counsellors, were trained to talk to people who have experienced violence and examine their situation. But if Ive been there, and Ive witnessed the violence or been the victim of the violence myself, my emotions get involved."

Jackie Spain, chair of HSAs Occupational Health and Safety Committee, is convinced that many cases of critical incident stress go unreported ... and undiagnosed. -I think health and social service workers all over the province may be suffering from critical incident stress and not know it," she said. -Its not just people who work in emergency rooms. We need to get workers and employers to understand what critical incident stress is, and how to recognize the symptoms. Then we need to understand what steps to take, and how others can help you."

Workers who experience such incidents may develop a medically-recognized stress disorder such as acute stress disorder (which lasts anywhere from two days to four weeks) or post-traumatic stress disorder (which has similar symptoms to acute stress disorder but is persistent, lasting for at least four weeks, and sometimes for much longer).

Workers feelings about their jobs and the workplace can be seriously affected, and the whole workplace may suffer after a critical incident. Effects may include poor morale, decreased productivity, increased accidents and sick time, higher disability claims, and greater staff turnover.

Worksites with a significant risk of critical incident exposure should develop a critical incident response program as part of their occupational health and safety program. Critical incident response programs should include provision for defusing and debriefing, as well as for ongoing counselling, if necessary.

Geoghegan reports that the occupational health and safety committee at her workplace is currently developing a critical incident defusing/debriefing team. -I think its really important," she said. -We looked at what the needs of our members are, in all the different work areas we work in. We already have an employee assistance plan, so most of us have access to that when we need it." However, Geoghegan said some members face access problems due to the nature of their work schedules. -One of the areas identified by our residential staff was that when youre leaving your shift at 11:30 p.m. or midnight, theres nobody to talk to for defusing," she said.

A defusing session is a brief, confidential, non-judgmental group meeting of workers affected by the incident, which should be held within six to eight hours of the incident. It is essential to have an experienced person with appropriate training conduct the defusing session. This defuser explains the physical, emotional and mental reactions that workers may be experiencing, and how to take care of their emotional and physical health.

Article 38.04 of the paramedical professional collective agreement and Article 22.4 (d) of the health services and support / community subsector collective agreement both require employers to provide critical incident stress defusing as follows:

-Critical Incident Stress defusing shall be made available and known to employees who have suffered a serious work-related traumatic incident of an unusual nature. Leave to attend such session will be without loss of pay."

Spain, who has earned her certification in critical incident defusing and debriefing from the Justice Institute, observed that many staff are too often inadvertently left out of the defusing/debriefing process.

-Ive heard this myself when theres been a traumatic case: ‘Well, you were only in the ER for a couple of minutes. But were in there, and then for some of us in the lab, you are entrusted with a piece of that person, whether its a blood or tissue sample," she said. -I know this has happened to me; when a person dies, I still have a piece of them in my hands. So this is how some of our members get left out of the defusing and debriefing process, but we are just as involved and we are under just as much pressure."

A debriefing session is ideally held within 24 to 72 hours after an incident. It is a confidential, non-judgmental discussion of the continuing effects of a traumatic incident on workers. The purpose of a debriefing session is to alleviate the trauma of affected workers, and to assist in the recovery process. Debriefing focuses on the emotional well-being of workers. It does not attempt to find the cause of the accident or assign blame. Again, it is imperative that debriefing sessions be led by trained professionals.

-Id encourage members at other facilities to raise these issues with their occupational health and safety committees," Geoghegan said. -This has been a year in the works for us, and we have an advantage in that most of us in our workplace already work as trained counsellors in other respects."

Workers exposed to a critical incident may also require ongoing counselling. Employee assistance and extended health care benefit plans may help cover some of the costs of this counselling. In some cases, workers compensation benefits may be payable for the psychological injury caused by a workplace critical incident.

Finally, each critical incident, like any other work place accident, must be investigated. The investigation must determine the causes of the critical incident, and develop recommendations to prevent a reoccurrence of such a critical incident and to improve response procedures if such an incident does occur.

The WCB also coordinates critical incident interventions for work-related traumatic events. For information about this service, or to arrange an intervention, contact the critical incident response coordinator at 604 276-5188 or toll free at 1-800-661-2112 local 5188. For urgent or after-hours calls, phone the emergency pager toll-free at 1-888-922-3700. Calls will be answered immediately between the hours of 9:00 a.m. and 11:00 p.m., seven days a week.