A critical incident can be defined as any event that has a stressful impact sufficient enough to overwhelm the usually effective coping skills of an individual. Critical incidents are abrupt, powerful events that fall outside the range of ordinary human experiences. These events can have a strong emotional impact, even on the most experienced officer or deputy. Research has shown that critical incident stress affects up to 87% of all emergency service workers at least once in their careers. Every year, thousands of law enforcement officers are involved in intense critical incidents that can have serious long-term consequences for them.
While most individuals will not develop a post-traumatic stress disorder (PTSD) after a critical incident or traumatic event, virtually every officer will experience marked reactions during and after any life threatening, harrowing or extremely distressing experience. Immediate and short-term reactions are to be expected, and are extremely common. Some individuals may experience a prolonged or a more intensified reaction(s) to a critical incident that may develop into an adjustment disorder, an acute stress disorder, or even PTSD. It is important for every law enforcement officer to learn what the frequent and usual responses to a critical stress are, how to handle his/her reactions, the symptoms of a more acute and possibly debilitating disorder, and ways to build stress resilience.
You remember your critical incident call, probably in great detail. It may have been a call that has changed your life and/or values. An officer-involved shooting, a hostage standoff, a mass suicide, an infant at the bottom of the pool, a family trapped in a burning car, a six year old versus a semi-truck, the domestic violence call from hell, a school shooting, a rape, a natural disaster, a senseless homicide, the situation that hit too close to home, the déjà vu call--the list is infinite. It is important that the definition of a critical incident remain fluid in your mind; what may affect you will not necessarily affect another officer, and vice versa. For example, an officer who has children might be affected by responding to the traumatic death of a child more than an officer who has no children.
What happens during a critical incident?
During a threatening event the body goes into an autonomic nervous system response. This is also commonly referred to as a hyperarousal state, acute stress response, or the "fight or flight" response. However, law enforcement officers generally don't have the luxury of fleeing in a life or death situation, when a treat is perceived, or the unthinkable is witnessed.
The body and mind go into overdrive during a critical incident to help deal with the situation at hand. Physical gears go into a protection mode; adrenaline is released, there is an acceleration heart and lung activity, blood vessels dilate to allow for muscle tension, pupils dilate, and intestinal functions are inhibited. Common psychological reactions include excitement, anger, disbelief, intense fear, numbness, or trembling. These reactions may be extremely strong during the incident, and are to be expected.
Following the trauma incident it is common for an individual to experience a number of disturbing thoughts, images, and feelings for a few hours to several weeks. Sometimes these reactions may be delayed. Critical incident stress manifests itself physically, cognitively, and emotionally. Although, the symptoms are unpleasant, they are also expected and are a sign that the body and mind is recovering from the stressful event.
You responded, you did your job, and the outcome was positive, unfortunate, or both. It is over, but you still feel out of sorts. No one who responds to a traumatic event is totally untouched by it; nor will anyone have the exactly same reaction to the same incident. You cannot predict how powerful an incident will be or what effects it will have on you. You may be seasoned and tough, but you are also human. Remind yourself that having physiological and/or psychological responses after a critical stressful incident are not signs of weakness or that you are going crazy, these responses are actually quite normal.
The most commonly reported reactions after a critical incident include:
- Anxiety about being involved in a similar event
- Fear for the safety of yourself or loved ones
- Preoccupation about the stressful event
- Avoidance of situations or thoughts that remind you of the incident
- Flashbacks where you mentally re-experience the event
- Physical symptoms: muscle tension, fatigue, headaches, nausea, bowel problems
- Decreased interest in usual activities, including sex and appetite
- Feelings of sad or loneliness
- Disbelief at what has happened; feeling numb, unreal, isolated, or detached from other people
- Insomnia, frequent awakening, disturbing dreams or nightmares
- Increased startle response
- Problems with concentration, or memory (especially aspects of the traumatic event)
- A misperception of time
- Guilt and/or self-doubt related to the traumatic event
- Anger or irritability at what has happened; at the senselessness of it all
What to do after experiencing critical incident stress
Immediately after the event:
- Make sure you are with people. Don't go home to an empty house.
- Talk about the incident with others. Discuss your feelings and reactions
- Remind yourself that the event is over and that you are now safe.
- If possible, get some physical exercise to burn off some of your tension and anxiety.
- Restrict caffeine and other stimulants.
- Try to eat something, even if you do not feel like eating.
- Avoid alcohol, other CNS depressants, and sleeping pills
- If you cannot sleep, get up and do something until you are tired, and then try again.
How to handle the next few days:
- Do not be afraid of your feelings.
- Remind yourself that your reactions are a normal result of trauma and will pass in time.
- Try to get back into your normal routine as soon as possible; you may need to gradually introduce yourself to tasks that seem difficult.
- If you feel uncomfortable, scared or anxious, take some deep breaths and remind yourself that you are safe.
- Be kind and patient with yourself; engage in enjoyable and relaxing activities.
- Continue to talk to your family, friends and colleagues about the trauma.
- Even if you feel a bit distant from other people, do not reject genuine support.
- Work on your general stress levels; make sure that you have adequate sleep, a good diet and regular exercise.
- Practice relaxation techniques to help reduce nervous tension and insomnia.
- Remember that accidents are more common after severe stress; be more cautious in your activities.
- Allow yourself time to deal with the memories. There may be some aspects of the experience that will be difficult, if not impossible, to forget.
- If your reaction(s) continues to seriously disrupt your life, seek appropriate help.
Many law enforcement agencies have established peer support programs to assist officers with critical incident stress. Peer support officers can be extremely helpful, especially as sounding boards. Appropriately trained officers can also offer support, empathy and concern, recognize acute problems, and make appropriate referrals.
Critical incident stress and the department
After any major critical incident your department may compel or strongly encourage you to have a physical exam, be evaluated by a psychiatric clinician, or both. These are excellent ideas. This will allow you a chance to ask questions and to learn more about what is happening to you, what to expect, and what you can do to help yourself cope and reduce your symptoms. If your symptoms are acute you will be given referrals for treatment. You may be placed on routine administrative leave, depending on the incident. Use the time off productively. If you are under too much stress to return to work right away, request some time off.
Remember the purpose of the department's incident debriefing is to assess the total response to the incident by the team, usually from a tactical perspective; what went well, what didn't, what other resources could have been involved, and what should be improved upon related to future departmental responses to similar events. You may hear criticism. Don't let that bring you needlessly down; the intent of the debriefing is not to attack anyone personally. Debriefs after a traumatic incident may also bring back a rush of some very unpleasant physical and mental memories. Find a partner or peer support officer to process the debriefing afterwards. This will help you sort out your feelings. Monday morning quarterbacks will be chomping at the bit to get their two cents in; take what is helpful and ignore the rest. Remind yourself that you were the one who was there; you responded, intervened and reacted to the event to the best of your ability. The situation is now over and you are safe.
When to seek additional help
While in most instances the symptoms of critical incident stress will subside in a matter of weeks, there will be a few officers who will suffer prolonged or permanent emotional trauma that can adversely affect their mental and physical health, relationships, careers, and daily functioning. Protracted or increasing symptoms indicate that you are not coping well. Take notice if you are experiencing any of the following: you are uncomfortable in your own skin, you are chronically afraid and/or hypervigilant, you don't want to leave your safety zone; you have obsessive thoughts and compulsions to act on them. You feel profoundly depressed, hopeless, helpless, guilty, or have considered suicide. Your behavior has changed; you are more argumentative, engaging in fights, abusing alcohol or medication, or are taking increased unnecessary risks. Your mind cannot relax, you have repeated horrific nightmares, frequent intrusive explicit flashbacks, or you feel like you are not connected to yourself or your thoughts. Things don't feel real or you feel like you have lost your identity. You have persistent negative, even fatalistic, thoughts about the future. You are unable to remember significant information about the traumatic event. All of these are signs that could indicate that you are experiencing an acute adjustment or anxiety disorder, including PTSD. The earlier you seek treatment, the more promising your prognosis. Therapy, individual and group, as well as some psychotropic medications are generally effective. Commonly prescribed medications include antidepressants, anti-anxiety medications, or sedatives for sleep. Unfortunately, some of these drugs carry the potentiality of dependence.
Prevention
The most important element of combating critical incident stress is pre-incident stress education. The process should be started in the academy and continued with annual refresher courses. Education before an actual traumatic event can help an officer reduce the impact of the incident; control or recover from more reaction symptoms more readily; and allow for the recognition of an acute stress disorder in order to seek appropriate assistance more quickly.
Ways you can improve your resilience to stress:
Reactions to critical incidents are expected; there is of course no way to prevent a psychological response to future incidents. However, developing healthy coping skills and learning to be resilient may help you during times of high stress. Resilience is the ability to adapt well to stress, adversity, trauma or tragedy.
- Maintain a supportive network; talk things over with caring friends and loved ones
- Seek out humor or laughter
- Live a healthy lifestyle: a healthy diet, physical exercise, maintain a regular sleep routine
- Think positively about yourself
- Remind yourself that you can get through the next situation
- Use stress management and coping skills, such as exercise, yoga, or meditation regularly
- Make time for activities you enjoy, try new activities or find new hobbies
- Maintain family and social commitments and outings
- Find additional support as needed; a group, spiritual guidance, or therapist
- Clean up lingering daily stressors that will exacerbate the next major stressor; pay off credit card bills, send the mother in law home, change negative personal habits, etc.
