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Safe Harbour: March 2015

Its 2:30 a.m. and you wake up in a cold sweat. You have an impending feeling that everything around you is falling apart: reality, as you know it, seems to be fragmented; random thoughts run through your head; you are unable to concentrate on any one thought; you are trying to get a grip on why you are feeling this way . . . you keep asking yourself in your head, “Why is this happening?” Your heart is racing; you have feelings of hyper-vigilance. There may be smells, or images such as movies that play over in your head. This is shaking you straight through to your very core. And this is not the first time this has happened to you.

You think to yourself “Wait a minute, this is not who I am. Why is this happening? I am strong and this does not happen to me.”

If this sounds familiar, you may have experienced the psychological and physiological reactions to a critical incident.

The most important thing you need to understand is that you are not broken or damaged goods. In fact, you are having a normal reaction to an abnormal event.

First thing’s first: my perspective on critical-incident stress is based on my training as a peer de-briefer and experience with people in both the fire service and the armed forces. It’s important that first responders understand the emotional response to a critical incident and learn emotional resiliency strategies from individual and organizational perspectives.

One of the things that separates firefighters from civilians is training – copious amounts of training; endless training – and for good reason. Further, there are several outcomes that training provides; one of those outcomes is expected behaviour in a given circumstance. However, no amount of training prepares emergency responders for the bad things they will encounter many, many times over the course of their careers. Simulations and full-scale exercises pale in comparison to what responders experience come game day.

So, what is a critical incident? In essence, a critical incident is any event that significantly overpowers a person’s coping methods, such as a sudden death or a line-of-duty death. A critical incident is also any situation faced by emergency responders that causes a disruption or distressing change in their physical or psychological functioning. There are unusually strong emotions attached to critical incidents that have the potential to interfere with a person’s ability to function either at the scene or away from it.

Critical incidents produce characteristic sets of psychological and physiological reactions or symptoms in all people, including emergency-service personnel. Typical symptoms of critical-incident stress include restlessness, irritability, excessive fatigue, sleep disturbances, anxiety, suspiciousness, startle reactions, depression, moodiness, muscle tremors, difficulty concentrating, nightmares, vomiting, and diarrhea.

The physical and emotional symptoms that develop as part of a stress response are normal, but have the potential to become dangerous to the responder if they become prolonged. Researchers have also concluded that future incidents (even those that are more “normal”) can be enough to trigger a stress response. Prolonged stress saps energy and leaves the person vulnerable to illness. Under certain conditions, responders may have the potential for life-long after-effects. Symptoms are especially destructive when a person denies their presence or misinterprets the stress responses as something going wrong with him or her.

The severity of reactions depends on factors related to the incident, such as suddenness, intensity, duration, available social support, severity and nature of the event, and factors related to the person. These include past experience, personal loss, perception of threat, personal coping abilities, degree of personal danger, the present circumstance of the person’s life, behaviour of others, role and level of responsibility.

Critical incidents cannot be predicted, nor can critical-incident stress be prevented. However, you can increase your resistance by being healthy. In Part 2 of this series in May, we will discuss strategies to become more resilient and what the organization – the municipality or your department – can do. Until then, take care of yourself. As for me, I am off to a yoga class.

March 2, 2015 
By Keith Stecko