Critical Incident Strain

It is not uncommon for healthcare or emergency workers to request some type of critical incident stress management services following an acute incident which they label as being particularly stressful for them. The good news is that such professionals are usually very resilient.

In the 1980′s, firefighters and paramedics began recognizing "Critical Incident Stress" as a potential hazard of their work. National disaster expert Jeffrey Mitchell, Ph.D., EMT defines a "critical incident" as any situation faced by emergency service personnel that causes them to experience unusually strong emotional reactions which have the potential to interfere with their ability to function either at the scene or later. This may include the death of a co-worker on the job, the death of children, mass casualty incidents, natural disasters, rape victims, or other personal traumas that expose the individual to threats to their personal safety.

In recent years, medicine has referred to ergonomic work injuries such as carpal tunnel syndrome as a cumulative trauma disorder or repetitive strain disorder. For healthcare professionals who deal with trauma on a daily basis; there is a need to attend to the cumulative psychological stresses which result from high-intensity, adrenaline-producing and emotionally-charged work environments and can lead to burnout . Often healthcare workers in chronic illness specialties are exposed to less dramatic traumas, e.g. multiple patient deaths. Although they may be less intense, these can result in more prolonged levels of stress or cumulative stress.

Sometimes "traumatic event stress" will be superimposed on chronic "critical incident strain" situations. In medical trauma units, there is little control over the potential workflow, and this can increase perceived stress. Additionally, the families and friends of critically-ill patients are often "not at their best" due to the intensity of a situation where life and death often hang by a string. According to studies by Jeffrey V. Johnson, Ph.D. et al., 'demand-control-support models of stress' suggest that "biologically aversive strain will occur when the performance demands of a job exceed the individual and social resources for accomplishing the task involved."

"It is important to pay attention to the acute and ongoing emotional aspects of trauma as they relate to individuals performing their jobs, whether it involves a single event or prolonged exposure to a series of highly charged situations," states Jim Kendall, LCSW, Manager for the Work/Life Connections-EAP. Early intervention han help ward off Compassion Fatigue or symtoms of Burnout.

"Trauma shatters our fundamental assumptions about ourselves and about the safety of our world. The use of techniques such as defusing, demobilization, or debriefings can help the worker exposed to trauma in dealing with the emotional impact of witnessing such events." Traumatic events invoke the most basic threats…that of survival; notes author and psychologist Ronnie Janoff-Bulman, Ph.D. in her book Shattered Assumptions.

There are occasions when we are forced to recognize the risk and real possibility of serious injury, the randomness of events, and our own mortality. "Acute trauma can produce symptoms in individuals, including anxiety, fears, depression, nightmares, nausea, memory loss, identification with the victim, flashbacks, fear of repetition, fatigue, and problem-solving difficulties. "This can be a normal response to acute stress," adds Kendall. Anticipating these reactions through a psycho-educational process such as a debriefing can help reduce the intensity and longevity of stress responses." Cumulative stress can also lead to burnout or compassion fatigue which manifests itself in decreased job satisfaction and reduced performance.

For seasoned professionals, daily work with chronic illness provides a regular reminder of the fragile nature of our lives and the need to embrace each day as it comes. Managing the stressors at work and home in a healthy way involves attention to balance: physical exercise, good nutrition, productive use of leisure time to "recharge one's batteries," vacations, cognitive stimulation, and nurturing your belief system.

See how Work/Life Connections can help if an employee dies.

Keywords: Psychological First Aid, CISM, Critical Incident Stress, Debriefing, Burnout, Stress