Critical incident stress

Transcription

1 CAMPUS WELLBEING AND SUPPORT SERVICE Critical incident stress INFORMATION SHEET You have experienced a traumatic event or a critical incident (any incident that causes emergency service personnel to experience unusually strong emotional reactions, which have the potential to interfere with their ability to function either at the scene or later). Even though the event may be over, you may now be experiencing or may experience later, some strong emotional or physical reactions. It is very common, in fact quite normal, for people to experience emotional aftershocks, when they have passed through a horrible event. Sometimes the emotional aftershocks (or stress reactions) appear immediately after the traumatic event. Sometimes they may appear a few hours or a few days later. And, in some cases, weeks or months may pass before the stress reactions appear. The signs and symptoms of a stress reaction may last a few days, a few weeks or a few months, and occasionally longer depending on the severity of the traumatic event. With understanding and the support of loved ones the stress reactions usually pass more quickly. Occasionally, the traumatic event is so painful that professional assistance from a counsellor may be necessary. This does not imply craziness or weakness. It simply indicates that the particular event was just too powerful for the person to manage by himself or herself. COMMON SIGNS Here are some very common signs and signals of a stress reaction: PHYSICAL Fatigue Nausea Muscle tremors Twitches Chest pain Difficulty breathing Elevated blood pressure Rapid heart rate Thirst headaches Visual difficulties Vomiting grinding of teeth Weakness Dizziness Profuse sweating Chills Shock symptoms Fainting COGNITIVE Blaming someone Confusion Poor attention Poor decisions Heightened or lowered alertness Poor concentration Memory problems Hypervigilance Difficulty identifying familiar objects or people Increased or decreased awareness of surroundings Poor problem solving Poor abstract thinking Loss of time, place or person orientation Disturbed thinking Nightmares Intrusive images EMOTIONAL Anxiety Guilt

2 Grief Denial Severe panic (rare) Emotional shock Fear Uncertainty Loss of emotional control Depression Inappropriate emotional response Apprehension Feeling overwhelmed Intense anger Irritability Agitation BEHAVIOURAL Change in activity Change in speech patterns Withdrawal Emotional outburst Suspiciousness Change in usual communications Loss or increase of appetite Alcohol consumption Inability to rest Antisocial acts Nonspecific bodily complaints Hyper alert to environment Startle reflex intensified Pacing Erratic movements Change in sexual function THINGS TO TRY: Within the first hours periods of strenuous physical exercise, alternated with relaxation, will alleviate some of the physical reactions: Structure your time - keep busy. You re normal and having normal reaction - don t label yourself crazy. Talk to people - talk is the most healing medicine. Be aware of numbing the pain with overuse of drugs or alcohol, you don t need to complicate this with a substance abuse problem. Reach out - people do care. Maintain as normal a schedule as possible. Spend time with others. Help your co-workers as much as possible by sharing feelings and checking out how they are doing. Give yourself permission to feel rotten and share your feelings with others. Keep a journal; write your way through those sleepless hours. Do things that feel good to you. Realize those around you are under stress. Don t make any big life changes. Do make as many daily decisions as possible, which will give you a feeling of control over your life, i.e., if someone asks you what you want to eat - answer him or her even if you re not sure. Get plenty of rest. Reoccurring thoughts, dreams or flashbacks are normal - don t try to fight them - they ll decrease over time and become less painful. Eat well-balanced and regular meals (even if you don t feel like it). FOR FAMILY MEMBERS & FRIENDS Listen carefully. Spend time with the traumatized person. Offer your assistance and a listening ear if they have not asked for help. Reassure them that they are safe. Help them with everyday tasks like cleaning, cooking, caring for the family, minding children. Give them some private time. Don t take their anger or other feelings personally Don t tell them that they are lucky it wasn t worse - these statements do not console traumatized people. Instead, tell them that you are sorry such an event has occurred and you want to understand and assist them. STRESS REACTIONS TO TRAUMA / DEATH It is important to remember that trauma or stress reactions are normal reactions to abnormal situations. It is difficult to predict how you or another person will respond to a traumatic event. It is important to allow yourself and others permission to have your reactions, to take care of yourself and to ask for help as best you can. Many people find it helpful to have information about what constitutes a typical reaction to trauma. Listed below are some such reactions. PHYSIOLOGICAL AND EMOTIONAL Heightened anxiety or fear about the death of others, anxiety about the future Irritability, restlessness, over-excitability Feelings of sadness, moodiness, more crying than usual

3 Feelings of numbness or detachment Survivor guilt or feelings of self-blame that you re alive Mood swings: small reminders or emotional events that seem insignificant can trigger sudden changes in mood or intense reactions COGNITIVE Difficulty concentrating Feeling confused, disoriented, distracted, not able to think as quickly or easily as usual Difficulty making decisions that normally would be easy Worrying about death or thinking about people who have died PHYSICAL Headaches Nausea or upset stomach Exaggerated startle response (easily startled) Fatigue: a lot of energy goes into grief work - it can be overwhelming and physically draining BEHAVIOURAL Hyperactivity or less activity than usual Withdrawal, social isolation Avoidance of activities or places that bring memories of the event Loss of appetite Inability to fall asleep or stay asleep, disrupted sleep, deep sadness upon awakening SHOCK AND SUFFERING Shock: a form of self-protection when faced with emotional overload. Shock may include: Disbelief Numbness, going through the motions Confusion, bewilderment Denial Isolation, withdrawal Suffering: the emotional stage when realization of the loss sinks in. Suffering may include: Sadness; Longing, missing those who have died. Depression and sadness about other things Anger; Resentment, feeling cheated, not fair, Why me?. Anger at the deceased for dying (feeling abandoned). Anger at other, unrelated things or people Fear; Worrying or obsessing about death. Worrying or obsessing about the future. Fear of anger and sadness (afraid of losing control ) Denial (attempts to avoid or contain the suffering to cope with feeling powerless) If only things were different Getting philosophical (regarding life, death, God) Getting back to business (keeping busy) Behavioural signs; Withdrawing from others. Wanting to be with others all the time, Sleep disturbances, Appetite changes, Fatigue, Lack of motivation, Anxiety, Mood swings SUGGESTIONS TO HELP YOURSELF AND OTHERS AFTER A CRITICAL INCIDENT THINGS TO DO Encourage the person to talk to you about how he or she is feeling. Don t assume that men handle this kind of trauma better than women. Tell the person how you feel: That you are sorry that they have been hurt. Remind the person that their confusing emotions are normal. Do not attempt to impose your explanation of why this has happened to the survivor. Do not tell the person that you know how she or he feels. You don t. Often such attempts are really aimed at relieving your own anxiety about how you feel about what has happened to the survivor. Be willing to say nothing. Just being there is often all that can help. Tell your friends and family how you are feeling. Even if you are not a direct victim of the trauma, remember that people who care about the survivors often become co-survivors emotionally. Monitor any unusual physical symptoms that might be interfering with your daily routine. Don t be afraid to encourage a person to ask for help, including counselling, if necessary. And don t be afraid to ask for help yourself even if you are not directly involved. Go to any court hearings, community meetings, meetings with insurance companies - any events that directly relate to the trauma. Offer to go for support. Try not to project your own feelings on those around you. Each person experiences trauma and its consequences differently. Be understanding to the pace that coping and healing occur. Don t be afraid to ask how someone is doing. Do not ask for details of the trauma. If the survivor wants to talk, listen. The best thing to do is to let the person know that you are there and that you care.

4 COPING SKILLS Depending on the critical incident and post-trauma consequences, these are examples of coping skills for debriefing participant Don t: Drink alcohol excessively Use legal or illegal substances to numb consequences Withdraw from significant others Stay away from work Reduce amount of leisure activities Use off-duty time for training immediately after the event Have unrealistic expectations for recovery Expect the incident not to bother you Look for easy answers Do: Get ample rest Maintain good diet and exercise Take time for leisure activities Recognise that these consequences are normal Find and talk to supportive peers and/or family members about the incident Spend time with family and friends Get extra help from post-trauma counselling if you need it PRESCHOOL AGE CHILDREN Behaviour such as bed-wetting, thumb sucking, baby talk, or a fear of sleeping alone may intensify in some younger children, or reappear in children who had previously outgrown them. They may complain of very real stomach cramps or headaches, and be reluctant to go to school. It s important to remember that these children are not being bad - they re afraid. Here are some suggestions to help them cope with their fears: Reassure young children that they re safe. Provide extra comfort and contact by discussing the child s fears at night, by telephoning during the day and with extra physical comforting. Get a better understanding of a child s feelings about the disaster. Discuss the disaster with them and find out each child s particular fears and concerns. Answer all questions they may ask and provide them loving comfort and care. You can work to structure children s play so that it remains constructive, serving as an outlet for them to express fear or anger. PRIMARY SCHOOL AGE CHILDREN Children this age may ask many questions about the disaster, and it s important that you try to answer them in clear and simple language. If a child is concerned about a parent who is distressed, don t tell a Remember that flashbacks are common and can be managed HELPING CHILDREN HANDLE DISASTER AND RELATED ANXIETY The following information is an extract from the NMHA Web site. For more information, visit Children sense the anxiety and tension in adults around them. And, like adults, children experience the same feelings of helplessness and lack of control that disasters can bring about. Unlike adults, however, children have little experience to help them place their current problems into perspective. Each child responds differently to disasters, depending on his or her understanding and maturity, but it s easy to see how an event like this can create a great deal of anxiety in children of all ages because they will interpret the disaster as a personal danger to themselves and those they care about. Whatever the child s age or relationship to the damage caused by disaster, it s important that you be open about the consequences for your family, and that you encourage him or her to talk about it. Quick Tips: Children need comforting and frequent reassurance that they re safe. Be honest and open about the disaster, but keep information age appropriate. Encourage children to express their feelings through talking, drawing or playing. Try to maintain your daily routines as much as possible. child not to worry - doing so will just make him or her worry more. Here are several important things to remember with school-age children: False reassurance does not help this age group. Don t say disasters will never affect your family again; children will know this isn t true. Instead, say You re safe now and I ll always try to protect you, or Adults are working very hard to make things safe. Remind children that disasters are very rare. Children s fears often get worse around bedtime, so you might want to stick around until the child falls asleep in order to make him or her feel protected. Monitor children s media viewing. Images of the disaster and the damage are extremely frightening to children, so consider limiting the amount of media coverage they see. A good way to do this without calling attention to your own concern is to regularly schedule an activity - story reading, drawing, movies, or letter writing, for example during news shows. Allow them to express themselves through play or drawing. As with younger children, school-age children sometimes find comfort in expressing themselves through playing games or drawing scenes of the disaster. Allowing them to do so, and then talking about it, gives you the chance to re-tell the ending of the game or the story they have expressed in pictures with an emphasis on personal safety.

5 Don t be afraid to say I don t know. Part of keeping discussion of the disaster open and honest is not being afraid to say you don t know how to answer a child s question. When such an occasion arises, explain to your child that disasters are extremely rare, and they cause feelings that even adults have trouble dealing with. Balance this by explaining that, even so, adults will always work very hard to keep children safe and secure. ADOLESCENTS Encourage older youth to work out their concerns about the disaster. Adolescents may try to down-play their worries. It is generally a good idea to talk about these issues, keeping the lines of communication open and remaining honest about the financial, physical and emotional impact of the disaster on your family. When adolescents are frightened, they may express their fear through acting out or regressing to younger habits. Children with existing emotional problems such as depression may require careful supervision and additional support. Monitor their media exposure to the event and information they receive on the Internet. Adolescents may turn to their friends for support. Encourage friends and families to get together and discuss the event to allay fears. FIND OUT MORE Macquarie University NSW 2109 Australia T: +61 (2) campuswellbeing@mq.edu.au CRICOS Provider 00002J