It was a nice afternoon. Quiet. People were finishing their day’s work and planning their evenings. The drive home and a bit of shopping and time with friends lay ahead. Then the world disappeared in an explosion.
One international worker was killed. Another survived, seriously wounded. A year later she shows off her skill with an artificial limb and on the good days – which are more and more common – she is excited about creating a new life for herself.
Some of my colleagues were there. A year later, a couple of them are still deeply shaken.
I don’t know how I would have reacted, had I been there with them. I hope I would have been calm and helpful. But if this had been the second time in a year… or if these were my own close friends… or if there was also a child injured, the age of my son… I might not have been in the best of states. Each of our responses is unique, in each event, and whatever our reaction, it is normal.
Critical incident stress injuries
A critical incident is an event which causes a very strong emotional reaction in someone, overwhelming their ability to cope. The reactions may come immediately or some time after the event. If the reaction is long lasting it may be or become a trauma injury.
My colleagues escaped from the incident with no physical wounds but they were deeply affected. They did sustain a stress injury – a real wound, one needing attention and with the potential to become more serious if not addressed. Had you and I been there with them, what might we have seen and how could we have helped?
People being overwhelmed may have physical symptoms. They might first seem frozen. Minutes or hours later they might see shaking, nausea, crying, weakness, ‘hyperness’ or sweating. In the days after, they may have trouble with sleep and dreams, lose their appetite and be tired. Stress upsets their immune system and they may be vulnerable to colds or have stomach problems.
They may be in an unusual emotional state. They might appear to be grieving. Previously unflappable George may be shaken in his self-confidence and feeling hopeless or depressed. He may be fearful and angry – or even feeling guilty because he didn’t somehow stop the event or do something about it.
He might not be thinking straight. He could have trouble concentrating, be forgetful and find it hard to make decisions. He could be suspicious and easily startled. And through all of these symptoms he may be frightened by his own reactions and worry that he is ‘losing it’.
He needs help. What can you do for him?
Make sure his physical needs are met. Get him to a safe, calm place. Be sure that he has clean water and encourage him to drink it. Arrange for nutritious food in the days that follow and encourage him to eat, even if he doesn’t feel like it.
Reassure him that his reactions are normal, and that things will get better.
Stick around. Give him space when he wants it, but remain available for when he needs some conversation or an embrace.
Help him get in touch with friends and family who he worries will be worried.
It will help if the people he talks with about the event really understand. When he says “you know what I mean?” he needs people who can honestly respond “I know what you mean.”
Protect him from the media, the curious and others who won’t be helpful.
Don’t assume he is helpless. Involve him in decisions about his work… and understand if things take him longer to do.
Encourage him to rest, even if he is having problems sleeping. Rest will help him heal.
Also encourage him to exercise. Perhaps walk with him, or ask him to join you in a tennis or a football game. Know that exercise and breathing may allow more emotions to come to the surface, and let him express them without trying to fix anything for him. Assure him, again, that what he is feeling is normal.
Encourage him not to make major decisions right away. Let some healing take place first.
If he or you are worried about his reactions being very strong or prolonged, help him connect with a professional who can help.
Thanks. You and I would most likely have been rattled by this incident as well. Our being with him and helping may be good for all of us.
Resources
Stress Inoculation and Training: Traditional first aid training may save a life. Every team member and manager should have some. Psychological first aid training is also important, especially in higher risk or stress assignments. It gives colleagues the tools with which to respond – and helps inoculate individuals against the impact of stress. Organizations sending people to the field can make resiliency training a required element of preparation for teams and especially for managers. If there isn’t a training service near you, good resources are available on-line, for instance from the Headington Institute.
Coping with Disasters: Our work may involve entire populations that have experienced natural disasters or violence. Beyond the injuries and the losses of families and friends, these disasters involve emotional strain on a very large scale. For those who work with such populations, Dr. John Ehrenreich has written “Coping with Disasters: A Guidebook to Psychosocial Intervention.” It is available at http://www.bittersandcream.com/index.php?p=1_6_Coping-with-Disaster . Dr. Ehrenreich notes that since he wrote the guide (2001), there has been a shift away from a technique called “Critical Incident Stress Debriefing” (CISD.) He suggests that the few pages in his manual devoted to CISD be disregarded, in favour of the newer approach of Psychological First Aid. He also recommends the Headington resources for supporting those who work in humanitarian responses (see above).