Incident stress is a condition caused by acute stress which overwhelms a staff person trained to deal with critical incidents such as within the line of duty for

first responder A first responder is a person with specialized training who is among the first to arrive and provide assistance or incident resolution at the scene of an emergency, such as an accident, disaster, medical emergency, structure fire, crime, or terr ...

s, EMTs, and other similar personnel. If not recognized and treated at onset, incident stress can lead to more serious effects of

posttraumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on ...

Signs and symptoms

Signs and symptoms can manifest different reactions for each and every individual. These signs and symptoms can be emotional, physical, behavioral, or cognitive. Seeking medical attention is recommended if signs and symptoms occur over time and/or become more severe.

Symptomatology

Symptomatology associated with excessive acute or sustained stress may include cognitive impairments such as diminished memory, decision-making capacity, and attention span; emotional reactions such as

anger Anger, also known as wrath or rage, is an intense emotional state involving a strong uncomfortable and non-cooperative response to a perceived provocation, hurt or threat. A person experiencing anger will often experience physical effects, su ...

irritability Irritability (also called as crankiness) is the excitatory ability that living organisms have to respond to changes in their environment. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessi ...

guilt Guilt may refer to: *Guilt (emotion), an emotion that occurs when a person feels that they have violated a moral standard *Culpability, a legal term *Guilt (law), a legal term Music *Guilt (album), ''Guilt'' (album), a 2009 album by Mims *Guilt ( ...

fear Fear is an intensely unpleasant emotion in response to perceiving or recognizing a danger or threat. Fear causes physiological changes that may produce behavioral reactions such as mounting an aggressive response or fleeing the threat. Fear ...

paranoia Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concer ...

, and depression; and physical problems ranging from

fatigue Fatigue describes a state of tiredness that does not resolve with rest or sleep. In general usage, fatigue is synonymous with extreme tiredness or exhaustion that normally follows prolonged physical or mental activity. When it does not resolve ...

dizziness Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to disequilibrium or a non-specific feeling, such as giddiness or foolishness. Dizziness is a common medical c ...

migraine Migraine (, ) is a common neurological disorder characterized by recurrent headaches. Typically, the associated headache affects one side of the head, is pulsating in nature, may be moderate to severe in intensity, and could last from a few hou ...

headaches, and

high blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...

and

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

. Self-destructive and

antisocial behavior Antisocial may refer to: Sociology, psychiatry and psychology *Anti-social behaviour * Antisocial personality disorder *Psychopathy *Conduct disorder Law *Anti-social Behaviour Act 2003 *Anti-Social Behaviour Order *Crime and Disorder Act 1998 * ...

may also be triggered. Symptoms can vary depending on several factors, such as trauma severity, the amount of social support, and additional life stresses.

Causes

A critical incident that occurs to an individual is the starting point for incident stress if the individual is unable to cope. Critical incidents are defined as sudden, unexpected events that have an emotional impact sufficient to overwhelm the usually effective

coping skill Coping refers to conscious strategies used to reduce unpleasant emotions. Coping strategies can be cognitions or behaviours and can be individual or social. Theories of coping Hundreds of coping strategies have been proposed in an attempt to ...

s of an individual and cause significant psychological damage. Healthy

attachment Attachment may refer to: Entertainment * ''Attachments'' (novel), a 2011 novel by Rainbow Rowell * ''Attachments'' (TV series), a BBC comedy-drama that ran from 2000 to 2002 Law * Attachment (law), a means of collecting a legal judgment by lev ...

among adults is key to managing critical incident stress. Adults have four

styles: 1) fearful avoidant, 2) anxious-preoccupied, 3) dismissive avoidant, and 4) secure. ''Fearful avoidant'' adults have mixed feelings about close relationships, because they want emotional connections but are very reluctant to allow them. ''Anxious-preoccupied'' adults tend to deal with their stress by distancing themselves from the reality of the situation to avoid the emotional burden. They also tend to see themselves negatively and doubt their worth in relationships frequently. ''Dismissive avoidant'' adults view themselves as self-sufficient, and in no need of emotional connectedness. ''Secure'' adults have positive views about themselves, and feel comfortable with independence and intimacy. Secure adults typically cope better with critical incident stress, as opposed to non-secure adults, because they develop less stress by nature. Secure adults are also less likely to develop post traumatic stress disorder (PTSD). Medical emergency

People exhibiting signs of incident stress require professional help to avoid the more serious condition of posttraumatic stress disorder. The

DSM IV-TR The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...

describes posttraumatic stress disorder (PTSD) as having three distinct symptom clusters: 1) re-experiencing the event, 2) avoidance of stimuli associated with the event and numbing of general responsiveness, and 3) increased arousal. The first symptom cluster, ''re-experiencing the event'', is a mixture of physical and psychological reactions someone goes through after the critical event has occurred. Those includes

nightmare A nightmare, also known as a bad dream, Retrieved 11 July 2016. is an unpleasant dream that can cause a strong emotional response from the mind, typically fear but also despair, anxiety or great sadness. The dream may contain situations of d ...

s, reoccurring thoughts/ flashbacks, or

panic attack Panic attacks are sudden periods of intense fear and discomfort that may include palpitations, sweating, chest pain or chest discomfort, shortness of breath, trembling, dizziness, numbness, confusion, or a feeling of impending doom or of losing ...

s. The second symptom cluster, ''avoidance of stimuli associated with the event and numbing of general responsiveness'', occurs when someone avoids anything that could possibly trigger memories of the critical event. This includes thoughts and feelings associated with the event, and even physical stimuli such as people and places having to do with the event. The third symptom cluster, ''increased arousal'', produces anxiety-driven responses, such as trouble sleeping, excessive anger and irritability,

hypervigilance Hypervigilance (more accurately understood as Hyper-awareness) is a condition in which the nervous system is filtering sensory information and the individual is in an enhanced state of sensory sensitivity or sensory domination. The name itself is ...

, poor concentration, and exaggerated

startle response In animals, including humans, the startle response is a largely unconscious defensive response to sudden or threatening stimuli, such as sudden noise or sharp movement, and is associated with negative Affect (psychology), affect.Rammirez-Moreno, D ...

. When these symptoms persist for more than 2 weeks, a diagnosis of acute stress disorder may be appropriate. Factors, such as family psychiatric history, or childhood abuse may mediate the relationship between critical incidents and PTSD.

Management

Critical incident-stress debriefings (CISDs) have proven to be a successful coping method over the past 15 years for individuals in high-stress,

emergency response Emergency services and rescue services are organizations that ensure public safety and health by addressing and resolving different emergencies. Some of these agencies exist solely for addressing certain types of emergencies, while others deal wit ...

professions. Nearly 300 CISD teams exist in the United States, offering intervention to fire, paramedic, police, and other emergency personnel. These debriefings are designed to offer emotional reassurance, time for ventilation of feelings, education about stress management, and consultation. This technique was first implemented by Jeff Mitchell, of the International Critical Incident Stress Foundation, in 1983 to treat emergency care workers in the mental health profession. These debriefings were created to prevent worsening of the stress and also promote recovery. Judith Herman, author of ''Trauma & Recovery'', identified three critical conditions that must be satisfied in order to progress toward recovery: 1) safety, 2) remembrance and mourning, and 3) reconnection. ''Safety'' is achieved when victims learn to feel relaxed and trust in the recovery process by recognizing there are disturbed emotions. "Remembrance and mourning" of the critical incident is necessary in order for the victim to move toward recovery. "Reconnection" occurs when the victim feels they are emotionally stable enough to pursue

stress management Stress management is a wide spectrum of techniques and psychotherapies aimed at controlling a person's level of stress, especially chronic stress, usually for the purpose of and for the motive of improving everyday functioning. Stress produces num ...

and recovery. Problem-solving appraisals were tested as another possible method for coping with critical incident stress. The first successful testing of this technique was done by Sarah Baker and Karen Williams in the United Kingdom, using a testing group of stressed firefighters. These firefighters filled out anonymous self-report questionnaires that gauged their level of stress. The research results supported the hypothesis that problem-solving appraisals serve a moderating function between

work stress Occupational stress is psychological stress related to one's job. Occupational stress refers to a chronic condition. Occupational stress can be managed by understanding what the stressful conditions at work are and taking steps to remediate those ...

and psychological distress. A study published in 2008, suggests dealing with the traumatic event immediately after it occurring proved beneficial in emergency medical technicians (EMTs). The intervention methods that were the most important to these EMT participants were supervisor support and a timeout period. A supportive supervisor was looked at with appreciation while a non-supportive supervisor was looked at as critical. A timeout period is defined as 0.5–1 hour of time that the EMT halts working. This time can be spent alone but more frequently with peers. This time gives the EMT the opportunity to talk about the incident casually before having to do the paperwork, or talk about unrelated things to relax and decompress. The participants of this study described education, addressing barriers to support and improving chronic workplace stressors as suggestions and recommendations on what they thought helped the most when dealing with critical incidents.

Prevention

No evidence has been shown to completely prevent incident stress. There have been studies showing there are ways to greatly reduce the impact front line workers experience. Responders must take care of themselves for their own safety and to maintain the safety of others. Monitoring by conversations or observations could identify early signs for responders. Maintaining health on-site and following the incident are key. Steps that could help reduce stress after an incident: * Control of the organization and pace of the rescue and recovery efforts *Preparedness * Maintaining nutrition and rest * Monitoring mental/emotional health * Limiting noise and odor exposures * Timeout period * Non-caffeinated fluids * Low fat and low sugar food * Do not rush back to work *"The ability to successfully be able to adapt to stressors, maintaining psychological well being in the face of adversity", or "resilience", acts as a protective factor for mental and behavioral health issues

Epidemiologic data from current studies

* Depression was reported in 6.8%, with mild depression most common (3.5%), in a case-control study of certified EMS professionals * Probable PTSD was found in 16.8% of emergency physicians * 37% of fire and EMS professionals have contemplated suicide (nearly 10 times the rate of American adults, 2015) * Of 1,027 current and retired U.S. firefighters, the prevalence estimates of suicidal ideation (46.8%), plans (19.2%), and attempts (15.5%) * About 3/4 police officers reported having experienced a traumatic event, but less than half told their agency about it *There was a 24.7% prevalence of depression and a 47.7% prevalence of both depression and anxiety following police officers after 9/11 *Following a study after Hurricane Katrina, alcoholic drinks increased from 2 to 7 drinks per day for police officers

References

{{Reflist , refs= {{cite journal, author1=Baker, Sarah R., author2=Williams, Karen, name-list-style=amp, year=2001, title=Short communication: Relation between social problem-solving appraisals, work stress and psychological distress in male firefighters, journal=Stress and Health, volume=17, issue=4, pages=219–229, doi=10.1002/smi.901, url=https://www.researchgate.net/publication/236010786 {{cite journal, author1=Bogaerts, Stefan, author2=Daalder, Annelies L. , author3= Van der Knaap, Leontien M. , author4=Kunst, Martin J. , author5= Buschman, Jos., name-list-style=amp, year=2008, title=Critical incident, adult attachment style, and posttraumatic stress disorder: A comparison of three groups of security workers, journal=Social Behavior and Personality, volume=36, issue=8, pages=1063–1072, doi=10.2224/sbp.2008.36.8.1063, url=https://www.researchgate.net/publication/233514050 {{cite journal, author=De Boer, Jacoba, year=2011, title=Work-related critical incidents in hospital-based health care providers and the risk of post-traumatic stress symptoms, anxiety, and depression: A meta-analysis, journal=Social Science & Medicine, pages=316–326, doi=10.1016/j.socscimed.2011.05.009, pmid=21696873, display-authors=etal, url=http://www.beanmanaged.com/doc/pdf/arnoldbakker/articles/articles_arnold_bakker_253.pdf, volume=73, issue=2, pmc=7127421 {{cite book, author=Rich, Robert, year=2007, contribution=A synergistic approach, editor=Volkman, Victor R., title=Traumatic Incident Reduction and Critical Incident Stress Management, pages=1–139, publisher=Library of Congress Cataloging {{cite journal, author1=Spitzer, W.J. , author2= Burke, L., name-list-style=amp, year=1993, title=A critical-incident stress debriefing program for hospital-based health care personnel, journal=Health & Social Work, volume=18, issue=2, pages=149–156, pmid=8288143, doi=10.1093/hsw/18.2.149 {{cite journal, author1=Van Patten, Isaac T., author2=Burke, Tod W., name-list-style=amp, year=2001, title=Critical incident stress and the child homicide investigator, journal=Homicide Studies, volume=5, issue=2, pages=131–152, doi=10.1177/1088767901005002003, s2cid=145785689 {{cite book, title=First Aid/CPR/AED for the Workplace, publisher=StayWell, location=Yardley, PA, year=2006, page=63 Anxiety disorders Psychological stress