Critical Incidents and their Operational Impact
By: Jonathan D. Greenstein
As a first responder, the likelihood of being exposed to a life changing event is a near certainty. How you are able to manage the stressors and impact over time will play a significant force in your ability to remain operationally capable. Understanding the impact a critical incident can have is critical not only to the effected officer but to their coworkers, chain of command and professional practitioners who may be called upon to provide therapeutic services. Critical Incidents and their Impact Critical Incidents generally defined as highly stressful situations that have the potential to cause short and long term impacts on the psychological functioning and wellbeing. The long and short term implications include changes that can overwhelm the individual's ability to cope and continue to function normally. Other definitions 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 (Soloman, PhD) and another equally valid definition is: 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 (Drs Goldfarb and Aumiller). Based on the definition and looking at the impacts, we must appreciate that the changes in function can be extremely overwhelming and produce a heightened state of cognitive, emotional and behavioral arousal. These changes can cause a wide range of reactions including deterioration of job performance, personality changes, anxiety, grief reactions, depressive states and suicidal ideations. These manifestations can occur at any time following exposure to a critical incident. Numerous clinical studies have been conducted and have concluded that the effects of critical incident stress vary from person to person. It is important to understand both from a personal and external perspective that experiencing the range of emotions tied to critical incidents is perfectly normal and should be expected. Absence of a manifestation is not an indicator of internal fortitude, but simply that individuals reaction. Simply put; it is normal to have a reaction, just as it is normal to not. The following range of reactions may be felt or observed following a critical incident: physical manifestations; behavioral changes; cognitive functioning; spiritual; and interpersonal. The range and depth are unique to the individual and can cover the spectrum regardless of the depth of the individuals exposure to the critical incident. These reactions can, as noted previously, occur shortly after the incident, gradually, or years following.
Can the impact be mitigated beforehand? I would venture to say that as with the unique impacts each incident plays upon the individual, so does any preparatory actions and their ability to potentially mitigate the reaction a person may have down the road. So much plays into an individuals reaction that measures taken beforehand may or may not have an impact. If anything, I advocate training to recognize that having a reaction is acceptable and how to seek remedy. While volumes have been written about developing the warrior mindset and how that helps prepare for conflict, little has been done to address the after effects. I would proffer that as a trainee progresses through their vocational training, they will begin to appreciate the potential psychological impact a particular incident will impart itself upon their psyche. They will likely develop a mental roadmap and form the ability to compartmentalize stressors. While this is fine in an academic setting, they may inadvertently reroute stressors and fail to recognize their potentially negative impacts. They may bury feelings only to have them suddenly become overwhelming. This is where the trainee and mentor must honestly convey the need to recognize stressors and how to effectively address them. We must distance ourselves from the rhetoric of old that maintained the outdated concept of only the weak feel stress. Too often we hold onto these faulty principles and bury the natural emotions that as humans we will likely experience following an incident. While I appreciate the need to remain detached and clinical as we perform our duties, we must accept the fact that the sights, sounds, smells and impact of an incident will affect us. Granted, there is no common denominator or flowchart that will tell us who will feel what and when; but we must understand that in even a small measure, we will be affected. As we train for and practice our response to the wide range of incidents that befall law enforcement professionals, we should take the time to also address the potential personal impacts those cases may impart upon us. While we can dissect the course of actions for an active shooter incident; delving into tactical movement, coordinated fire, move and cover and target neutralization, do we take the time to discuss and appreciate the after effects such a response will have? I would venture to say that that it is unlikely that we do. Perhaps this is due to the previously mentioned old-school thinking that as cope we must be tough and move on following a particularly gruesome call. I say that this should be part of the elemental training and not an afterthought.
Recognizing Indicators Following exposure to a critical incident, the individual may present with or experience a wide range of symptoms. The following is a general guideline and as noted throughout this article, they may or may not be present, their degree may vary greatly and could be itinerant. Physical: Fatigue, Nausea, Muscle tremors, Twitches, Chest Pains, Difficulty Breathing, Rapid Heart-rate, Headaches, Vomiting, Grinding of Teeth, General Weakness, Dizziness, Profuse Sweating and Chills. Cognitive: Placing Blaming, Confusion, Attention Deficit, Hyper or Subdued Alertness, Hyper Vigilance Problems with Concentration, Memory Lapses, Amnesia, Lack of Spatial Awareness, Disturbed Thinking, Nightmares, Reoccurring Images and related. Emotional: Anxiety, Feelings of Guilt, Grief, Denial, Extreme Panic, Emotional shock, Uncertainty, Depression, Inappropriate Behaviors, Feeling Overwhelmed, Anger, Irritability and Agitation. Behavioral: Change in Routine, Change in Speech or Speech Patterns, Withdrawal, Emotional Outburst, Suspiciousness or Paranoia, Loss or Increase in Appetite, Changes to typical Alcohol Consumption, Illicit Drug Use, Antisocial Behavior or Actions, Increased Startle Reflex Reaction, Restlessness, Change in Sexual Functioning, Non-specific pains and sudden changes in health. Peer Support and Recognition The symptoms of stress borne out of a critical incident or the accumulation of years of exposure may come on suddenly or as a gradual process, as such, it is critical that we recognize the indicators and how to work towards a remedy. While most agencies have critical incident debriefings and monitoring programs that strive to identify both near term manifestations and those occurring over the course of a career, it is you and your fellow officer that serves as the first line of defense and salvation from the potential hard these stressors can cause. The immediate impacts may be overlooked due to a fellow officers own self management of critical incident stress, this is where debriefing and monitoring plays a key role. It helps the individual and coworkers recognize some of the signs of critical stress points and how to seek remedy with honor. It is however the long term stress and its impact that call for peer recognition and support. Months or even years can pass before the cumulative effects of stress present themselves. Studies show that for the sufferer of cumulative stress, they may be the most difficult to reach because of the disassociation from one particular incident and the presence of overwhelming stress. As a close colleague, you may be in the best position to recognize changes in behavior. These changes can include performance, capability and outlook.
Critical Incident Stress Management Critical Incident Stress Management (CISM) is a process that is designed to help individuals negotiate the impact of exposure to a critical incident and the potential psychological impact that may occur. CISM works by allowing them to talk about the incident when it happens without judgment or criticism. The CISM program is peer-driven and the people facilitating the process come from all walks of life, though most are first responders or work in the mental health field. All interventions are held in confidence, meaning they are strictly confidential; the only caveat to this is if the person doing the intervention determines that the person being helped is a danger to themselves or to others. One-on-one: Personnel involved in a critical incident may request or be directed to participate in a oneon-one session. One-on-one sessions are the primary intervention tool in CISM. Peers generally conduct one-on-one sessions. Defusing: The defusing is done the day of the incident before the person(s) has a chance to sleep. The defusing is designed to assure the person/people involved that their feelings are normal, tells them what symptoms to watch for over the short term and to offer them a lifeline in the form of a telephone number where they can reach someone who they can talk to. Debriefing: Debriefings are usually the second level of intervention for those directly affected by the incident and often the first for those not directly involved. It is typically done within 72 hours of the incident and gives the individual or group the opportunity to talk about their experience, how it has affected them, brainstorm coping mechanisms, identify individuals at risk, and inform the individual or group about services available to them in their community. The final step of the debriefing is to follow up with them the day after the debriefing to ensure that they are safe and coping well or to refer the individual for professional counseling. Follow-up: The important final step is follow-up. This is generally done within the week following the debriefing by team members as a check-in. If indicators of persistent stressors are present, appropriate referrals are made. It is important to recognize that the CISM process is not an operational debriefing or a process to critique performance; it is processes through with participants discuss the overall impact of an incident, discuss potential stressors and identify resources to mitigate them. The ability to let it out and know that what they are feeling is normal and is part of the healing process. Ensure participants respect the purpose of each outlet and the confidentiality that is inherent to such an environment. Make no judgments and cast no dispersions. Depending on the critical incident and post-trauma consequences, these are examples of coping skills for debriefing participants.
As a recommendation, the following is presented as a path towards recovery following a critical incident. DO: Get ample rest. Maintain a good diet and exercise. Take time for leisure activities. Recognize that these consequences are normal. Find and talk to supportive peers and/or family members about the incident. Spend time with family and friends. Get extra help from post-trauma counseling if you need it. Remember that flashbacks are common and can be managed. DON'T: Drink alcohol excessively. Use legal or illegal substances to numb consequences. Withdraw from significant others. Stay away from work. Reduce amount of leisure activities. Use off-duty time for training immediately after the event. Have unrealistic expectations for recovery. Expect the incident not to bother you. Look for easy answers.
Conclusion Recognizing that a critical incident can affect everyone differently and what resources are available is paramount. Changing the old-school mindset that stood in the way of members seeking much needed assistance is the only path the profession should be taking. While the need to remain clinical and detached during an event, we must accept the fact that it does not make us immune from the effects of stress that come following an incident. We are humans and have emotions.
This article was written as part of a professional development exercise and is not reflective of a particular agencies policies or procedures. The author has imparted both his training and personal experiences in the development of this article, the conclusions are his own. Due to the potential impact of a critical incident upon the individual, the reader is urged to seek professional assistance to appropriately address cases of concern. About the Author: Jonathan Greenstein has been involved in law enforcement and public safety for over fifteen years; having served as a patrol officer, field training officer, watch commander and criminal investigator. He is a graduate of numerous advanced training programs to include Hostage and Crisis Negotiations, Active Shooter Response and Tactical Operations. He applies his professional experience and training to the development best practices, policy and in the law enforcement oversight and advisory role. His most recent publications include an assessment tool to identify self initiated violent actors, indicators of self radicalization, and the role of the first responder in hostage and barricade situations.
He is a member of the International Association of Hostage Negotiators (IAHN) and currently serves as the representative to the District of Columbia/National Capitol Region.
He may be contacted by email through: [Link]@[Link]