Incident stress

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Incident stress is a condition caused by acute stress which overwhelms a staff person trained to deal with critical incidents such as within the line of duty for first responders, EMTs, and other similar personnel. If not recognized and treated at onset, incident stress can lead to more serious effects of posttraumatic stress disorder.

Contents

Signs and symptoms

Signs and symptoms can manifest different reactions for each and every individual. These signs and symptoms can be emotional, physical, behavioral, or cognitive. [1] Seeking medical attention is recommended if signs and symptoms occur over time and/or become more severe.

EmotionalPhysicalBehavioralCognitive
  • Fatigue
  • Nausea/vomiting
  • Chills
  • Dizziness
  • Profuse sweating
  • Thirst
  • Headaches
  • Visual difficulties
  • Clenching of jaw
  • Nonspecific aches and pains
  • Chest pain
  • Difficulty breathing
  • Symptoms of shock (shallow breathing, weak or rapid pulse, nausea, shivering, pale and moist skin, mental confusion, dilated pupils)
  • Intense anger
  • Withdrawal
  • Emotional outburst
  • Temporary loss or increase of appetite
  • Excessive alcohol consumption
  • Inability to rest, pacing
  • Change in sexual functioning
  • Confusion
  • Uncertainty
  • Disorientation
  • Heightened or lowered alertness
  • Poor Concentration
  • Poor problem solving
  • Difficulty identifying familiar objects or people
  • Memory problems
  • Nightmares

[2]

Symptomatology

Symptomatology associated with excessive acute or sustained stress may include cognitive impairments such as diminished memory, decision-making capacity, and attention span; emotional reactions such as anger, irritability, guilt, fear, paranoia, and depression; and physical problems ranging from fatigue, dizziness, migraine headaches, and high blood pressure to diabetes and cancer. Self-destructive and antisocial behavior may also be triggered. [3] Symptoms can vary depending on several factors, such as trauma severity, the amount of social support, and additional life stresses. [4]

Causes

A critical incident that occurs to an individual is the starting point for incident stress if the individual is unable to cope. Critical incidents are defined as sudden, unexpected events that have an emotional impact sufficient to overwhelm the usually effective coping skills of an individual and cause significant psychological damage. [4]

Healthy attachment among adults is key to managing critical incident stress. Adults have four attachment styles: 1) fearful avoidant, 2) anxious-preoccupied, 3) dismissive avoidant, and 4) secure. Fearful avoidant adults have mixed feelings about close relationships, because they want emotional connections but are very reluctant to allow them. Anxious-preoccupied adults tend to deal with their stress by distancing themselves from the reality of the situation to avoid the emotional burden. They also tend to see themselves negatively and doubt their worth in relationships frequently. Dismissive avoidant adults view themselves as self-sufficient, and in no need of emotional connectedness. Secure adults have positive views about themselves, and feel comfortable with independence and intimacy. Secure adults typically cope better with critical incident stress, as opposed to non-secure adults, because they develop less stress by nature. Secure adults are also less likely to develop post traumatic stress disorder (PTSD). [5]

Emergency workers must respond quickly to incidents. Incident stress can occur immediately while a worker is still on the scene, or manifest at a later time. Medical emergency.jpg
Emergency workers must respond quickly to incidents. Incident stress can occur immediately while a worker is still on the scene, or manifest at a later time.

People exhibiting signs of incident stress require professional help to avoid the more serious condition of posttraumatic stress disorder. [6] The DSM IV-TR describes posttraumatic stress disorder (PTSD) as having three distinct symptom clusters: 1) re-experiencing the event, 2) avoidance of stimuli associated with the event and numbing of general responsiveness, and 3) increased arousal. The first symptom cluster, re-experiencing the event, is a mixture of physical and psychological reactions someone goes through after the critical event has occurred. This includes nightmares, reoccurring thoughts/flashbacks, or panic attacks. The second symptom cluster, avoidance of stimuli associated with the event and numbing of general responsiveness, occurs when someone avoids anything that could possibly trigger memories of the critical event. This includes thoughts and feelings associated with the event, and even physical stimuli such as people and places having to do with the event. The third symptom cluster, increased arousal, produces anxiety-driven responses, such as trouble sleeping, excessive anger and irritability, hypervigilance, poor concentration, and exaggerated startle response. When these symptoms persist for more than 2 weeks, a diagnosis of acute stress disorder may be appropriate. [5] Factors, such as family psychiatric history, or childhood abuse may mediate the relationship between critical incidents and PTSD. [4]

Management

Critical incident-stress debriefings (CISDs) have proven to be a successful coping method over the past 15 years for individuals in high-stress, emergency response professions. [7] Nearly 300 CISD teams exist in the United States, offering intervention to fire, paramedic, police, and other emergency personnel. These debriefings are designed to offer emotional reassurance, time for ventilation of feelings, education about stress management, and consultation. [3] This technique was first implemented by Jeff Mitchell, of the International Critical Incident Stress Foundation, in 1983 to treat emergency care workers in the mental health profession. These debriefings were created to prevent worsening of the stress and also promote recovery. Judith Herman, author of Trauma & Recovery, identified three critical conditions that must be satisfied in order to progress toward recovery: 1) safety, 2) remembrance and mourning, and 3) reconnection. Safety is achieved when victims learn to feel relaxed and trust in the recovery process by recognizing there are disturbed emotions. "Remembrance and mourning" of the critical incident is necessary in order for the victim to move toward recovery. "Reconnection" occurs when the victim feels they are emotionally stable enough to pursue stress management and recovery. [8]

Problem-solving appraisals were tested as another possible method for coping with critical incident stress. The first successful testing of this technique was done by Sarah Baker and Karen Williams in the United Kingdom, using a testing group of stressed firefighters. These firefighters filled out anonymous self-report questionnaires that gauged their level of stress. The research results supported the hypothesis that problem-solving appraisals serve a moderating function between work stress and psychological distress. [9]

A study published in 2008, [10] suggests dealing with the traumatic event immediately after it occurring proved beneficial in emergency medical technicians (EMTs). The intervention methods that were the most important to these EMT participants were supervisor support and a timeout period. A supportive supervisor was looked at with appreciation while a non-supportive supervisor was looked at as critical. A timeout period is defined as 0.5–1 hour of time that the EMT halts working. This time can be spent alone but more frequently with peers. This time gives the EMT the opportunity to talk about the incident casually before having to do the paperwork, or talk about unrelated things to relax and decompress. The participants of this study described education, addressing barriers to support and improving chronic workplace stressors as suggestions and recommendations on what they thought helped the most when dealing with critical incidents. [10]

Prevention

No evidence has been shown to completely prevent incident stress. There have been studies showing there are ways to greatly reduce the impact front line workers experience. Responders must take care of themselves for their own safety and to maintain the safety of others. Monitoring by conversations or observations could identify early signs for responders. Maintaining health on-site and following the incident are key. Steps that could help reduce stress after an incident: [11]

Epidemiologic data from current studies

See also

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences, with extreme examples being violence, rape, or a terrorist attack. The event must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se.

Acute stress reaction is a psychological response to a terrifying, traumatic or surprising experience. It may bring about delayed stress reactions if not correctly addressed. Acute stress may present in reactions which include but are not limited to: intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. Reactions may be exhibited for days or weeks after the traumatic event.

Complex post-traumatic stress disorder (CPTSD) is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Gender is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. There are no marked gender differences in the diagnosis rates of disorders like schizophrenia and bipolar disorder. Men are at risk to suffer from post-traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post-traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post-traumatic stress disorder.

Critical incident stress management (CISM) has been misunderstood and unfairly criticized as a controversial, non-empirical, adaptive, short-term psychological helping-process that focused solely on an immediate and identifiable problem. Much of the "controversy" stems from confusion of terms. The overall ICISF Model of Critical Incident Stress Management includes several tactics to help mitigate the effects of a critical incident. It includes pre-incident preparedness to acute crisis management through post-crisis follow-up. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder (PTSD). The term CISM is frequently confused with one of the group intervention tactics under the model. That is the Critical Incident Stress Debriefing (CISD).

Debriefing is a report of a mission or project or the information so obtained. It is a structured process following an exercise or event that reviews the actions taken. As a technical term, it implies a specific and active intervention process that has developed with more formal meanings such as operational debriefing. It is classified into different types, which include military, experiential, and psychological debriefing, among others.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).

Psychological first aid (PFA) is a technique designed to reduce the occurrence of post-traumatic stress disorder. It was developed by the National Center for Post Traumatic Stress Disorder (NC-PTSD), a section of the United States Department of Veterans Affairs, in 2006. It has been endorsed and used by the International Federation of Red Cross and Red Crescent Societies, Community Emergency Response Team (CERT), the American Psychological Association (APA) and many others. It was developed in a two-day intensive collaboration, involving more than 25 disaster mental health researchers, an online survey of the first cohort that used PFA and repeated reviews of the draft.

Operational stress injury or OSI is a non-clinical, non-medical term referring to a persistent psychological difficulty caused by traumatic experiences or prolonged high stress or fatigue during service as a military member or first responder. The term does not replace any individual diagnoses or disorders, but rather describes a category of mental health concerns linked to the particular challenges that these military members or first responders encounter in their service. There is not yet a single fixed definition. The term was first conceptualized within the Canadian Armed Forces to help foster understanding of the broader mental health challenges faced by military members who have been impacted by traumatic experiences and who face difficulty as a result. OSI encompasses a number of the diagnoses found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification system, with the common thread being a linkage to the operational experiences of the afflicted. The term has gained traction outside of the military community as an appropriate way to describe similar challenges suffered by those whose work regularly exposes them to trauma, particularly front line emergency first responders such as but not limited to police, firefighters, paramedics, correctional officers, and emergency dispatchers. The term, at present mostly used within Canada, is increasingly significant in the development of legislation, policy, treatments and benefits in the military and first responder communities.

Mental disorders can be a consequence of miscarriage or early pregnancy loss. Even though women can develop long-term psychiatric symptoms after a miscarriage, acknowledging the potential of mental illness is not usually considered. A mental illness can develop in women who have experienced one or more miscarriages after the event or even years later. Some data suggest that men and women can be affected up to 15 years after the loss. Though recognized as a public health problem, studies investigating the mental health status of women following miscarriage are still lacking. Posttraumatic stress disorder (PTSD) can develop in women who have experienced a miscarriage. Risks for developing PTSD after miscarriage include emotional pain, expressions of emotion, and low levels of social support. Even if relatively low levels of stress occur after the miscarriage, symptoms of PTSD including flashbacks, intrusive thoughts, dissociation and hyperarousal can later develop. Clinical depression also is associated with miscarriage. Past responses by clinicians have been to prescribe sedatives.

Post-traumatic stress disorder (PTSD) can affect about 3.6% of the U.S. population each year, and 6.8% of the U.S. population over a lifetime. 8.4% of people in the U.S. are diagnosed with substance use disorders (SUD). Of those with a diagnosis of PTSD, a co-occurring, or comorbid diagnosis of a SUD is present in 20–35% of that clinical population.

<span class="mw-page-title-main">Trauma and first responders</span> Trauma experienced by first responders

Trauma in first responders refers to the psychological trauma experienced by first responders, such as police officers, firefighters, and paramedics, often as a result of events experienced in their line of work. The nature of a first responder's occupation continuously puts them in harm's way and regularly exposes them to traumatic situations, such as people who have been harmed, injured, or killed.

Disaster psychiatry is a field of psychiatry which focuses on responding to natural disasters, climate change, school shootings, large accidents, public health emergencies, and their associated community-wide disruptions and mental health implications. All disasters, regardless of exact type, are characterized by disruption: disruption of family and community support structures, threats to personal safety, and an overwhelming of available support resources. Disaster psychiatry is a crucial component of disaster preparedness, aiming to mitigate both immediate and prolonged psychiatric challenges. Its primary objective is to diminish acute symptoms and long-term psychiatric morbidity by minimizing exposure to stressors, offering education to normalize responses to trauma, and identifying individuals vulnerable to future psychiatric illness.

<span class="mw-page-title-main">Dual representation theory</span>

Dual representation theory (DRT) is a psychological theory of post-traumatic stress disorder (PTSD) developed by Chris Brewin, Tim Dalgleish, and Stephen Joseph in 1996. This theory proposes that certain symptoms of PTSD - such as nightmares, flashbacks, and emotional disturbance - may be attributed to memory processes that occur after exposure to a traumatic event. DRT proposes the existence of two separate memory systems that run in parallel during memory formation: the verbally accessible memory system (VAM) and situationally accessible memory system (SAM). The VAM system contains information that was consciously processed and thus can be voluntarily recalled or described. In contrast, the SAM system contains unconsciously processed sensory information that cannot be voluntarily recalled. This theory suggests that the VAM system is impaired during a traumatic event because conscious attention is narrowly drawn to threat-related information. Therefore, memory of the trauma is heavily focused on fear, which affects information processing. This gives rise to PTSD symptoms such as trauma-related cognitions, appraisals, and emotions. The SAM system captures vivid sensory information during the traumatic event, which is automatically recalled through exposure to trauma-related triggers. This system is thought to be responsible for the presence of flashbacks and nightmares in PTSD symptomatology.

Psychological trauma in adultswho are older, is the overall prevalence and occurrence of trauma symptoms within the older adult population.. This should not be confused with geriatric trauma. Although there is a 90% likelihood of an older adult experiencing a traumatic event, there is a lack of research on trauma in older adult populations. This makes research trends on the complex interaction between traumatic symptom presentation and considerations specifically related to the older adult population difficult to pinpoint. This article reviews the existing literature and briefly introduces various ways, apart from the occurrence of elder abuse, that psychological trauma impacts the older adult population.

References

  1. ↑ "Emergency Preparedness and Response | Safety and Health Guides - Critical Incident Stress Guide | Occupational Safety and Health Administration". www.osha.gov. Retrieved 2020-03-18.
  2. ↑ "Traumatic Incident Stress | NIOSH | CDC". www.cdc.gov. 2020-02-24. Retrieved 2020-04-09.
  3. 1 2 Spitzer, W.J. & Burke, L. (1993). "A critical-incident stress debriefing program for hospital-based health care personnel". Health & Social Work. 18 (2): 149–156. doi:10.1093/hsw/18.2.149. PMID   8288143.
  4. 1 2 3 De Boer, Jacoba; et al. (2011). "Work-related critical incidents in hospital-based health care providers and the risk of post-traumatic stress symptoms, anxiety, and depression: A meta-analysis" (PDF). Social Science & Medicine. 73 (2): 316–326. doi:10.1016/j.socscimed.2011.05.009. PMC   7127421 . PMID   21696873.
  5. 1 2 Bogaerts, Stefan; Daalder, Annelies L.; Van der Knaap, Leontien M.; Kunst, Martin J. & Buschman, Jos. (2008). "Critical incident, adult attachment style, and posttraumatic stress disorder: A comparison of three groups of security workers". Social Behavior and Personality. 36 (8): 1063–1072. doi:10.2224/sbp.2008.36.8.1063.
  6. ↑ First Aid/CPR/AED for the Workplace. Yardley, PA: StayWell. 2006. p. 63.
  7. ↑ Van Patten, Isaac T. & Burke, Tod W. (2001). "Critical incident stress and the child homicide investigator". Homicide Studies. 5 (2): 131–152. doi:10.1177/1088767901005002003. S2CID   145785689.
  8. ↑ Rich, Robert (2007). "A synergistic approach". In Volkman, Victor R. (ed.). Traumatic Incident Reduction and Critical Incident Stress Management. Library of Congress Cataloging. pp. 1–139.
  9. ↑ Baker, Sarah R. & Williams, Karen (2001). "Short communication: Relation between social problem-solving appraisals, work stress and psychological distress in male firefighters". Stress and Health. 17 (4): 219–229. doi:10.1002/smi.901.
  10. 1 2 Halpern, Janice; Gurevich, Maria; Schwartz, Brian; Brazeau, Paulette (2009). "Interventions for critical incident stress in emergency medical services: a qualitative study". Stress and Health. 25 (2): 139–149. doi:10.1002/smi.1230. ISSN   1532-2998.
  11. ↑ "Emergency Preparedness and Response | Safety and Health Guides - Critical Incident Stress Guide | Occupational Safety and Health Administration". www.osha.gov. Retrieved 2020-04-09.
  12. ↑ Haglund, M. E. M.; Nestadt, P. S.; Cooper, N. S.; Southwick, S. M.; Charney, D. S. (2007). "Psychobiological mechanisms of resilience: relevance to prevention and treatment of stress-related psychopathology". Development and Psychopathology. 19 (3): 889–920. doi:10.1017/S0954579407000430. ISSN   0954-5794. PMID   17705907. S2CID   41580244.
  13. ↑ Bentley, Melissa A.; Crawford, J. Mac; Wilkins, J. R.; Fernandez, Antonio R.; Studnek, Jonathan R. (2013-07-01). "An Assessment of Depression, Anxiety, and Stress Among Nationally Certified EMS Professionals" . Prehospital Emergency Care. 17 (3): 330–338. doi:10.3109/10903127.2012.761307. ISSN   1090-3127. PMID   23414106. S2CID   12800370.
  14. ↑ Pajonk, Frank-Gerald Bernhard; Cransac, Philippe; Müller, Vincent; Teichmann, Alexander; Meyer, Wolfgang (2012). "Trauma and stress-related disorders in German emergency physicians: the predictive role of personality factors". International Journal of Emergency Mental Health. 14 (4): 257–268. ISSN   1522-4821. PMID   23980490.
  15. ↑ "What's Killing Our Medics?". REVIVING RESPONDERS. Retrieved 2020-04-09.
  16. ↑ Stanley, Ian H.; Hom, Melanie A.; Hagan, Christopher R.; Joiner, Thomas E. (2015-11-15). "Career prevalence and correlates of suicidal thoughts and behaviors among firefighters". Journal of Affective Disorders. 187: 163–171. doi:10.1016/j.jad.2015.08.007. ISSN   1573-2517. PMID   26339926.
  17. ↑ Fleischmann, Matthew H.; Strode, Pat; Broussard, Beth; Compton, Michael T. (2018-02-12). "Law enforcement officers' perceptions of and responses to traumatic events: a survey of officers completing Crisis Intervention Team training". Policing and Society. 28 (2): 149–156. doi:10.1080/10439463.2016.1234469. ISSN   1043-9463. S2CID   151950531.
  18. ↑ Bowler, Rosemarie M.; Kornblith, Erica S.; Li, Jiehui; Adams, Shane W.; Gocheva, Vihra V.; Schwarzer, Ralf; Cone, James E. (2016). "Police officers who responded to 9/11: Comorbidity of PTSD, depression, and anxiety 10–11 years later". American Journal of Industrial Medicine. 59 (6): 425–436. doi:10.1002/ajim.22588. ISSN   1097-0274. PMID   27094566.
  19. ↑ McCanlies, Erin C.; Mnatsakanova, Anna; Andrew, Michael E.; Burchfiel, Cecil M.; Violanti, John M. (2014). "Positive Psychological Factors are Associated with Lower PTSD Symptoms among Police Officers: Post Hurricane Katrina". Stress and Health. 30 (5): 405–415. doi:10.1002/smi.2615. ISSN   1532-2998. PMC   4676265 . PMID   25476965.
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