Critical Incident Stress Reactions

What it is, how to recognize it, and what to do about it!

What is Critical Incident Stress? Police work can be stressful on a regular basis. While continual stress will take it's toll, Critical Incident stress is different in that it directly relates to a dramatic event or events in the life of an officer that results in a number of debilitating symptoms.

Definitions of a Critical Incident include:

Any situation beyond the realm of a persons usual experience that overwhelms his or her sense of vulnerability and or lack of control over the situation.

Roger Soloman, Ph.D

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.

Jeff Mitchell, Ph.D.

A life experience or series of experiences that so seriously upsets the balance of the individual that it creates changes in the person's emotional, cognitive or behavioral functioning.

Daniel A. Goldfarb, Ph.D. & Gary S. Aumiller, Ph.D.

Perhaps the simplest definition of Critical Incident Stress is:

A normal reaction to an abnormal event.

Critical Incidents:

Are sudden and unexpected
Disrupt our sense of control
Disrupt beliefs, values, and basic assumptions about the world in which we live, the people in it, and the work that we do
Involve the perception of a life damaging threat
May involve emotional or physical loss

The police subculture holds many myths that can lessen the officer's ability to deal with the situation. "Real men can handle it!"; "If you can't deal, find a new line of work!"; "Keep it to yourself," Don't be a baby!" The reality is that police officers, as all human beings, will experience deep emotional reactions to a critical incident. Attempts to deny this fact often cause officers to suffer in silence, not seek help, and in some instances, truly disrupt their lives and the lives of their families.

Police officers and rescue workers in general, share personality traits that can feed into the stress of a critical incident. Personality factors of Law Enforcement Personnel include:

A need to be in control
Obsessive/perfectionistic tendencies
Compulsive/traditional values -- wanting things to remain unchanged
High levels of internal motivation
Action-oriented
High need for stimulation and excitement (easily bored)
High need for immediate gratification
Tendency to take risks
Highly dedicated
Invested in the job due to months of training and preparation , view job as life long career
Identify strongly with their role as a police officer
High need to be needed

These personality factors not only make officers do a good job, but also make them more vulnerable to critical incidents. The demands of the job, in combination with these personality factors, are reasons why officers need to be more aware of stress. They also need to be especially aware of the impact stress has on their everyday functioning.

Types of critical incidents include:

Line of duty death/injury/shooting. This event highlights the officers own mortality. In an instant, an incident shatters the "myth" of invulnerability that officers often need to function on a day to day basis.
Suicide of a Co-worker. ..."It can happen to anyone...Even me!" The pressures of the job, a personal life and the toll both can take come into focus. Add to this the "If only's..." and guilt develops as well. The suicide of a co-worker can turn the officer's world upside down.
Death of a child. The innocence represented by children can have a profound impact on an officer. The death of a child can push an officer over the edge. It can disrupt the "natural order of things". It can make everything the officer stands for seem useless. Should the officer have children or worse, children the same age, "factors of identification" can add even more stress.
Prolonged failed rescue attempt. This is especially true if the officer has come to know the victim. A great deal of stress is encountered in this situation. The officer is continually focused on the "absolute necessity to succeed". The officers very reason "for being" is put on the line: someone needs him/her, their life depends on him/her. He cannot let them down! A deep sense of personnel failure, coupled with the stress of the situation, can trigger deep emotional consequences.
Mass Casualty Incidents. Multiple victims, mass confusion, shortages of manpower and resources all add to make these situations overwhelming! The enormity of the situation can merely override an officer's ability to cope.
Safety of the officer is unusually jeopardized. An officer sees the worst side of life every day. He is constantly exposed to society's underbelly. It can be difficult to maintain a view that there are any decent people out there. This is somewhat complicated since an officer faces potential danger on a daily basis. However, if an officer finds himself in a situation that focuses him on his vulnerability and lack of control, a critical incident stress reaction can be triggered.
Victim is known to responder. Seeing death and tragedy is bad enough. If the officer finds he knows the victim, this can trigger a critical incident stress reaction. He is unprepared, is close to the victim, and may believe that he/she is somehow responsible. "I should have driven faster, etc..".

Factors affecting magnitude of Response: Not all people exposed to a critical incident experience a stress reaction. In fact it appears to be consistently divided into thirds such that:

1/3 experience little to no reaction
1/3 experience moderate symptoms
1/3 experience severe symptoms

The symptoms may show up immediately after the incident. This is called an acute reaction. If symptoms are going to appear, this is as good a time for them as any. It is clear what caused the symptoms, support is usually at it's highest, and help is often sought. Often future problems are avoided when reactions are acute since the symptoms are dealt with promptly.

Symptoms may appear up to a few months later. Not all symptoms appear at once. After the onset of the first few (and it varies from person to person what those will be), other symptoms start to pile on. This is called a delayed reaction. It represents difficulty because there is not always a clear association between the event and the subsequent symptoms. As a result, the officer often thinks he/she is going "crazy" for no reason. They do not seek out support from family and friends. Often they will try to deny they are having symptoms to others, even to themselves. They do not seek professional help. The result may be that symptoms needlessly worsen until the officer's life has become over-complicated and outside pressure is applied to seek some form of treatment. Even at this juncture, if the symptoms are not related to the event, treatment may be ineffective. As a peer team member, you can be helpful to individuals with delayed reactions by pointing out to them that you see them having problems and that these problems may be connected to an incident that they went through.

Symptoms of stress may also appear in officers who have had repeated exposure to critical situations (i.e. emergency services). Years may elapse. Hundreds of incidents may have occurred. The officer may consider him/herself immune to stress problems. Then it hits: "a cumulative stress reaction." This may be the most difficult person to help. There is almost no association between these symptoms and the critical incidents the officer has faced. The symptoms appear to have come from "out of the blue". The officer may fear he/she has suddenly become weak or "lost it.". They question their ability to go on with the job; a job which they may love. Often seeking help does not even cross their mind. Since there is no clear single incident, friends or peer team members may not realize that the stress symptoms shown are the result of the toll taken by experiencing just too many stressful calls.

As a friend or peer, you can serve a crucial function in helping these officers. If you see symptoms appearing, and you are aware of their work history, you are in a unique position to help them put the puzzle of their symptoms together. You can help them understand that they are not "crazy" or "weak." They just need to get on the right track as any human exposed repeatedly to high levels of stress will eventually show symptoms.

As noted, not all people exposed to a critical incident will experience symptoms. This does not mean that some people are immune from the pressures of police work. In fact, a person who has been through a number of critical incidents without effect may find themselves terribly shaken by a particular call. The reverse is true. A person who took some time to recover from an incident may find that they have few symptoms after a particularly harrowing call. In fact, the effect of any call on an officer can be a complicated mixture of his/her personality, combined with specific characteristics of the call itself. Some factors that may affect an officer's response include:

The nature of the Event - How involved was the officer? How much control of the situation did he/she have? The less control -- the more traumatic the experience. What was the degree of threat or loss? How grotesque was the call? Remember, what a person considers grotesque will vary from person to person. How much did the call disrupt his/her expectations of the job/the world/people in general?
Degree of warning - The less warning often the more severe the response. Warning provides an officer with time to develop some coping strategies.
Ego Strength/Coping Style - Everyone comes to a situation with a different character and personality. The individual's personality is molded through their genetics and past experiences. Some people have stronger coping mechanisms,and higher degrees of awareness in their philosophical and spiritual life. All these characteristics will alter the effects of a critical incident.
Prior mastery of the experience - Practice makes better! Going through a hairy call successfully may make it easier to go through the experience again. The past experience helps the officer think more clearly and more positively in a similar situation. This can help not only with one's physical survival, but with the emotional survival once the call has ended.
Proximity - The closer an officer is physically to the scene the greater the impact. Proximity is also created by psychological closeness. Seeing a dead three year old girl may have more of an impact on the officer with a three year old at home. Often there may be emotional links between the scene and the officer's life for which he/she is unaware. The officer may then experience the stress symptoms, may even be able to relate it to the incident he/she just lived through, but may feel like some piece of the puzzle is missing, because they can't make the connection to their own life. Many times these links need to be discovered in order for the stress level to subside. This is an area where a professional may prove to be very helpful.
The amount of stress in ones life -- It is better not to be going through a bitter divorce when one is responding to a particularly stressful call! The amount of stress in a person's life and how it is being handled can have a tremendous impact on the effects of added stress.
Nature and degree of social support available to an officer after a critical incident -- The officer's willingness to accept support is also important. If the officer pushes people away with the idea that he/she "can handle it", then they place themselves at greater risk. This support includes all of the significant people in an officers life: peers, supervisors, professionals, and family. The family especially plays a crucial role. Their degree of support, willingness to listen, and the officer's ability to open up and talk, all factor into the degree of response to a critical incident.

So from the above, it can be seen that the likelihood and severity of an emotional response resulting from a critical incident is a combination of factors. These include both personality factors within the officer, as well as factors about the call itself, and even factors revolving around the officers current life situation.