Critical Incident and Trauma Debriefing

What is a critical incident?

A critical incident is any event or that occurs suddenly, is unexpected, presents a threat, and causes a significant emotional response. Understanding normal responses to these unusual events can help you cope effectively with your feelings, thoughts and behaviors, and help you along the pathway to recovery.

Critical incidents could include harm, or the threat of harm to yourself or other people around you, or severe injury or death. Examples might include:

  • an accident or injury;
  • a natural disaster;
  • a fire, bomb threat, or hold up; or
  • an assault.

Understanding normal responses to abnormal events can help you understand and cope with your feelings, thoughts and behaviors, and help your recovery.

What are the impacts of critical incidents?

Most people experience a range of responses to a critical incident. There is no predictable pattern to the effects you may experience, however a common initial reaction is shock. Shock is a helpful, protective reaction which can make you feel dazed or slowed. Other normal responses which follow can include physical and emotional responses, and changes to your behavior and thinking.

Normal physical responses can include:

  • Faster heart rate, higher blood pressure and more rapid breathing
  • Nausea or vomiting;
  • Shaking, twitching, or tense muscles;
  • Feeling weak or dizzy, or fainting;
  • Feeling cold and clammy, or hot and sweaty.
  • Uncontrollable sobbing

Symptoms which require immediate medical attention include chest pain, difficulty breathing, or symptoms of shock.

Normal behavioural responses include:

  • Change in your appetite, activity levels, sleep and sexual behavior - you may have increases or decreases in these;
  • You can't relax, and actions which show you are jumpy, nervous or on guard;
  • Social changes such as withdrawing from people, or increased conflict with family or friends;
  • Being less communicative or talking too much at times;
  • Emotional outbursts;
  • Increased use of drugs or alcohol;
  • Feeling restless or as though you want to change your situation or get away from things

Sometimes your family, colleagues or friends will notice changes in your behavior. It is important to listen to others in case they notice changes in your behavior before you do.

Emotional responses can include:

  • Feeling nervous, jumpy or on guard;
  • anxiety and agitation;
  • fear and panic
  • shock and numbness;
  • feeling uptight and unable to relax;
  • feeling detached or 'on the outside looking in';
  • irritable, angry or enraged;
  • distress, sadness or grief,
  • guilty or ashamed, a lack of pleasure from things that you usually enjoy;

Some people just feel on edge in certain circumstances, others can feel overwhelmed and that they have lost control of their emotions. These experiences can occur immediately or be delayed, they can pass quickly or linger.

Changes to your thinking can include:

  • Confusion and inability to concentrate or remember things;
  • Can't think clearly or make decisions;
  • difficulty remembering the incident or you keep on trying to remember the event;
  • preoccupied with the event and sudden memories of the event;
  • you may be preoccupied with how the event happened and who is to blame;
  • you may be excessively worried about other people who were affected;

What should I do if I experience a critical incident?

Following a critical incident the most important immediate need is to be safe and supported. Once physical safety is achieved most people will find that they become aware of their responses to the incident.

  • Remember that you are normal, and that it is normal to have strong reactions to distressing events.
  • Talk to someone. It is important that people that you live with or close family or friends are aware that you have experienced a critical incident. You can also talk to a counsellor or consult your general practitioner. Spending time with people and sharing your feelings and supporting others can help you to manage your responses to the incident.
  • Maintain as normal a schedule as possible, trying to sleep, exercise, and eat a healthy balanced diet at the normal times.
  • Spend time doing things that you enjoy
  • Allow and accept your feelings, and allow yourself to express your feelings in helpful ways. A counsellor can help you do this if you are unsure.

Don't:

  • Conceal the incident from others
  • Try to block it out completely or block out your feelings;
  • Make any major life decisions or changes
  • Use drugs or alcohol to switch off

Recovery from critical Incidents

Reactions and recovery times are different for each person. Things which might influence the length of time required for recovery might include:

The emotional impact of the incident and how long the threat is present: Events that last longer or have long term impacts on safety or security can often take longer to resolve. For example, people who have been impacted by bushfires and lost their homes and community infrastructure such as roads, electricity, water supply and phones had longer periods of stress following the actual fire incident, and felt worse.

An Individual's ability to cope with stressful and emotionally challenging situations. Individuals who have handled other difficult, stressful circumstances well may find it easier to cope with, and recover from the incident.

Prior stressful or traumatic life experiences People who are faced with other stressful or emotionally challenging situations, such as health problems or relationship difficulties, may have more intense reactions to the incident and need more time to recover.

Advice for Friends and Family members:

  • Be a good listener;
  • Offer practical support;
  • Reassure the person that they are safe and OK;
  • Allow them to have privacy and space when they need it
  • Don't worry if they express strong feelings or cry;
  • Avoid things which might sound like you think the event wasn't that bad or that the person should get over it.
  • Avoid judgement about the person's actions during the event
  • Remember that they are sensitive and may misinterpret to some of the things that you say or over-react to things.
  • Be aware that their memory and concentration may be affected. Allow them to get on with their normal routines and responsibilities, but avoid expecting things which might tax their ability as they adjust after the critical incident.
  • Keep up regular, interested, caring contact.
  • If you are worried about the person's health and well-being then let them know that you are concerned and suggest that they consult a counsellor or their GP.
  • If you have any concerns about their safety then do not avoid asking about this.

When should I seek help?

Most people do not require 'psychological treatment'. These people work through their reactions by following their usual routines and with support from family and friends. They experience a reduction in the physical and emotional responses which followed the incident, and their thinkng and behavior begins to return to normal. One week after the trauma most people will have only mild symptoms. However some people do continue to experience problems after the incident. Counselling can help to resolve their reactions and assist long term adjustment and coping. You should seek help if:

  • You feel that you cannot handle the intense feelings or physical sensations;
  • The effects which followed the incident are getting worse not better;
  • You continue to experience distressing thoughts, or physical or emotional symptoms;
  • You continue to have nightmares or your sleep continues to be affected;
  • You are using increased amounts of alcohol or drugs;
  • If your reactions are hurting your relationships with other people.
  • You can get professional help. Call Positive Solutions for free confidential counselling and support

What will happen if I need more help?

Professional counselors will assist you differently according to the stage at which you seek help, and the intensity of your reactions:

Immediately following the incident Counsellors will:

  • facilitate achieving safety and personal security;
  • help you identify your immediate needs;
  • help you activate your support mechanisms;
  • help you identify and put in place coping mechanisms.

1-2 days following the event counselors will provide:

  • Psychological first aid to help reduce your distress, identify your immediate needs, identify and activate support and coping strategies.
  • Counselling to discuss the event, your role, your experience, and discuss any concerns you may have.
  • Assessment of long and short term risks, and develop a plan to monitor and manage risk.
  • Information to explain normal stress responses and help you and your family identify and understand normal responses and things to be alert for, and which might signal a need for additional help.
  • Communication with other people. This could include helping you identify what to communicate to your employer or helping you to do so.

2 - 4 weeks following the incident: Some people may require ongoing short-term monitoring and support to assist their recovery and address residual issues. Some of these people may develop an Acute Stress Disorder which is characterized by:

  • distressing memories of nightmares of the event
  • avoidance of things which remind you of the event
  • emotional numbing; and
  • physical symptoms.

Acute Stress Disorder is effectively treated with approximately 6 sessions of psychological therapy to reduce physical anxiety, and manage thoughts and behaviours. A small proportion of people may go on to develop Depression or Post Traumatic Stress Disorder which requires therapy which is more focused

Professional counsellors will provide a respectful, confidential service. They aim to help you discover the best ways of managing your problems and work to support you in ways that are tailored to your needs. Professional counselors cannot repeat any information you provide to others, including your employer, without your consent, unless someone's safety is at risk.

Information and services:

Positive Solutions

Your General Practitioner

Lifeline 131 114

Australian Psychological Society -telephone 1800 333 497

http://www.psychology.org.au/publications/tip_sheets/trauma/

Australian Centre for Posttraumatic Mental health

http://www.acpmh.unimelb.edu.au/trauma/ptsd.html

Copyright 2017. Positive Solutions: Mediation and Counseling