April 11, 2024

Traumatic Incident Stress

Emergency workers must respond quickly to natural disasters and are at risk of experiencing stress from these traumatic incidents. Symptoms of stress can be physical, cognitive, emotional, and behavioral.

What is a traumatic incident?

A traumatic incident is one that may involve exposure to

Catastrophic events
Severely injured children or adults
Dead bodies or body parts
Loss of colleagues

Recognizing, monitoring, and maintaining workers health on-site during a traumatic incident can reduce the risk of experiencing stress.

Symptoms of Stress

Workers may experience physical, cognitive, emotional, or behavioral symptoms of stress. Some people experience these reactions immediately at the scene, while for others symptoms may occur weeks or months later.

Physical symptoms

Workers experiencing any of the following symptoms should seek IMMEDIATE medical attention:

Chest pain
Difficulty breathing
Severe pain
Symptoms of shock (shallow breathing, rapid or weak pulse, nausea, shivering, pale and moist skin, mental confusion, and dilated pupils)

Workers may also experience the following physical symptoms. If these symptoms occur over time or become severe, workers should seek medical attention. Additional physical symptoms include:

Fatigue/nonspecific aches and pains
Nausea/vomiting
Dizziness/headaches
Profuse sweating
Thirst
Visual difficulties
Clenching of jaw

Cognitive symptoms

If these symptoms occur on the scene workers may not be able to stay clearly focused to maintain their own safety or to rescue injured victims. Workers may experience momentary cognitive symptoms; however, if symptoms are chronic or interfere with daily activities, workers should seek medical attention. These symptoms include:

Confusion
Disorientation
Heightened or lowered alertness
Poor concentration
Poor problem solving
Difficulty identifying familiar objects or people
Memory problems
Nightmares

Emotional symptoms

Strong emotions are ordinary reactions to a traumatic or extraordinary situation. Workers should seek mental health support from a disaster mental health professional if symptoms or distress continue for several weeks or if they interfere with daily activities. Emotional symptoms include:

Anxiety
Guilt
Denial
Grief
Fear
Irritability
Loss of emotional control
Depression
Sense of failure
Feeling overwhelmed
Blaming others or self
Severe pain (rare)

Behavioral symptoms

As a result of a traumatic incident, workers may notice the following behavioral changes in themselves or coworkers:

Intense anger
Withdrawal
Emotional outburst
Temporary outburst
Temporary loss or increase of appetite
Excessive alcohol consumption
Inability to rest, pacing
Change in sexual function

Recommendations to monitor and mantain health on-site

Responders need to take care of their own health to maintain the constant attention they need for their own safety. Responders must be able to stay focused on the job in the dynamic, changing emergency environment. Often responders do not recognize the need to take care of themselves and to monitor their own emotional and physical health. This is especially true if recovery efforts stretch into several weeks. The following guidelines contain simple methods for workers and their team leaders to help themselves and their team members. These guidelines should be read while at the site and again after workers return home.

Control the organization and pace of the rescue and recovery efforts

Pace yourself. Rescue and recovery efforts at the site may continue for days or weeks.
Watch out for each other. Coworkers may be intently focused on a particular task and may not notice a hazard nearby or behind.
Be conscious of those around you. Responders who are exhausted, stressed, or even temporarily distracted may place themselves and others at risk.
Take frequent rest breaks. Rescue and recovery operations take place in extremely dangerous work environments. Mental fatigue, particularly over long shifts, can greatly increase emergency workers' risk of injury.

Maintain adequate nutrition and rest

Eat and sleep regularly. Maintain as normal a schedule as possible and adhere to the team schedule and rotation.
Drink plenty of fluids such as water and juices.
Try to eat a variety of foods and increase your intake of complex carbohydrates (for example, breads and muffins made with whole grains, granola bars).
Whenever possible, take breaks away from the work area. Eat and drink in the cleanest area available.

Monitor mental/emotional health

Recognize and accept what you cannot change—the chain of command, organizational structure, waiting, equipment failures, etc.
Talk to people when YOU feel like it. You decide when you want to discuss your experience. Talking about an event may be reliving it. Choose your own comfort level.
If your employer provided you with formal mental health support, use it!
Give yourself permission to feel rotten: You are in a difficult situation.
Recurring thoughts, dreams, or flashbacks are normal—do not try to fight them. They will decrease over time.
Communicate with your loved ones at home as frequently as possible.

Recommendations to maintain health following the incident

Over time, workers’ impressions and understanding of their experience will change. This process is different for everyone. No matter what the event or an individual’s reaction to it, workers can follow some basic steps to help themselves adjust to the experience:

Reach out—people really do care.
Reconnect with family, spiritual, and community supports.
Consider keeping a journal.
Do not make any big life decisions.
Make as many daily decisions as possible to give yourself a feeling of control over your life.
Spend time with others or alone doing the things you enjoy to refresh and recharge yourself.
Be aware that you may feel particularly fearful for your family. This is normal and will pass in time.
Remember that "getting back to normal" takes time. Gradually work back into your routine. Let others carry more weight for a while at home and at work.
Be aware that recovery is not a straight path but a matter of two steps forward and one back. You will make progress.
Appreciate a sense of humor in yourself and others. It is okay to laugh again.
Your family will experience the disaster along with you. You need to support each other. This is a time for patience, understanding, and communication.
Avoid overuse of drugs or alcohol. You do not need to complicate your situation with a substance abuse problem.
Get plenty of rest and normal exercise. Eat well-balanced, regular meals.

NIOSH publications

Traumatic Incident Stress: Information for Emergency Response Workers Publication No. 2002-107 (October, 2001) - As a member of an emergency response team, you and your team members are at risk of experiencing what psychologists refer to as a traumatic incident—an incident that may involve exposure to catastrophic events, severely injured children or adults, dead bodies or body parts, or the loss of colleagues, for instance.

A Study of Burnout in Accident Investigators in the US Mining IndustryNIOSHTIC-2 No. 20022901 (January, 2002) - The Maslach Burnout Inventory (MBI) was administered and scored for 154 Mine Safety and Health Administration (MSHA) employees from the US Department of Labor.

Toward a Typology of Dynamic and Hazardous Work EnvironmentsNIOSHTIC-2 No. 20021061 (December, 2001) - The most hazardous work environments share one feature in common: constant change. Many different, but constantly changing hazards are found in agriculture, construction, mining, and transport.

Judgment and Decision-Making Under Stress: An Overview for Emergency ManagersNIOSHTIC-2 No. 20022944 (2003) - This paper discusses human judgment and decision making under stress. The authors review selected recent literature across various disciplines and suggest a definition of stress within the context of decision making during the management of emergencies.

The Safety and Health of Emergency WorkersNIOSHTIC-2 No. 20021775 (September, 2001) - Emergency personnel, like all workers, carry out their duties within an environment composed of a set of discrete elements. First, there is the emergency itself.

Decision Making During a Simulated Mine Fire EscapeNIOSHTIC-2 No. 20022804 (1998) - Forty-eight workers who had escaped large underground coal-mine fires were interviewed using an open-ended protocol.

The Communication Triangle: Elements of an Effective Warning MessageNIOSHTIC-2 No. 20031506 (January, 2007) - The lack of good communication is a very real problem in mine emergencies. Sometimes critical information is not communicated to those who need it to make decisions.

A Human Component to Consider in Your Emergency Management Plans: The Critical Incident Stress Factor (1995)NIOSHTIC-2 No. 20024595 (1995) - In recent years the issue of human stress response in emergency workers has begun to receive attention. This paper presents a rationale for considering human stress as a significant factor in the management of emergencies.

A Human Component to Consider in Your Emergency Management Plans: The Critical Incident Stress Factor (1998)NIOSHTIC-2 No. 20032087 (1998) - In recent years the issue of human stress response in emergency workers has begun to receive attention. This paper presents a rationale for considering human stress as a significant factor in the management of emergencies.