Health Promotion Northwest

Health Notes
A Newsletter for Employees

In this issue:

  • Critical Incident Stress

  • Grief & Loss

 

Critical Incident Stress Debriefing (CISD);
A Response to Traumatic Events

Critical Incident Stress Debriefing is probably fairly well known from its use with the survivors of airplane crashes and other very publicized events such as the Oklahoma City bombing. Today it is being used in New York and Washington D.C. Serious workplace injuries, accidents, or acts of violence (such as robberies) are some of the typical events which might be experienced as “Critical Incidents”. The counselors at Health Promotion Northwest receive ongoing training from Crisis Management International (an organization which coordinates a network of crisis and disaster mental health professionals in major cities throughout the U.S., Canada, and Europe). We also volunteer locally and coordinate EAP services to work with the Whatcom/Skagit Industrial Critical Incident Stress Management Program and the Emergency Medical Services CISM Program.

Q: What is Critical Incident Stress?
A: Every animal, including humans, responds dynamically to a crisis. In a “fight or flight” response a deer being attacked by a cougar is going to have changes in hormone levels, blood circulation, pupil dilation - and if digestion or hair growth was going on, that may get put on hold. Humans respond the same way, but with people we can also identify a cognitive stress reaction. It is not uncommon to hear people say that all they saw was the gun - or the exit sign - or their role in CPR. We tend to get a sort of tunnel vision and time is often experienced as expanded or contracted. It may seem like hours before help arrives or the event might seem to have happened in the blink of an eye. In short, we often do not have a great foundation of memory for looking back and reflecting upon a highly stressful or traumatic event. After the event it is not uncommon to have some normal (yet uncomfortable) related symptoms, such as:

  • Physical: fatigue, insomnia, nightmares, startle reactions...
  • Cognitive: difficulty with concentration, problem solving, decision making, memory problems, flashbacks, isolation...
  • Emotional: depression, guilt, anxiety, fear, numbness, helplessness, amnesia, anger (scapegoating, irritability, frustration, violent fantasies)...
Q: What happens during a formal Critical Incident Stress Debriefing?
A: In a debriefing the group of people who were affected by the incident are asked to come together in a private space. Ground rules are given that the debriefing is not a critique of performance or procedures; it is for people to be able to talk about their experience. Also, everyone is asked to agree to respect each other’s privacy by not talking unnecessarily outside the debriefing about what others have to say. A mental health professional (sometimes accompanied by peer debriefers from Industry, Emergency Medical Services, or Law Enforcement) leads the group through clearly establishing
  1. The Facts: “Who saw what first, how long until the next person came in, how far away was that?”
  2. Thoughts About the Event: “What was everyone thinking while that was happening?”
  3. Reactions Since the Event: “Since the event 48 hours ago, what has been the most difficult part of this?” “Has anyone else been having trouble sleeping?”
  4. Any Useful Teaching: “Here is what you might expect or what people have experienced after other incidents, try not to stress about the stress.”
  5. Group Closure: “Here are some other resources.” “What can everyone do to recognize this event together?”
Perhaps some of this information will help you to understand your own stress reactions and/or give yourself permission to do some extra self-care. Call us at HPN EAP if we can help.

Grief & Loss

No amount of knowledge can prepare us for bereavement. Grief is the most intense and enduring emotion we can experience. No quick fix. No short cut. An ancient African saying is "There is no way out of the desert except through it." Knowledge of the grief process gives us a very generalized map of the terrain we have to cover. Each of us will take a different route. Each will choose his or her own landmarks. Each of us will travel at our own unique speed and will navigate using the tools provided by culture, experience, and faith.

Knowledge helps us avoid the major pitfalls of grief. A knowledge of what is known of grief assures us that we have not lost all sense of sanity.

The Mechanics of Grief
    Grief Work, Stages, and Phases. Several blueprints or theories about grief have been proposed.
  • Sigmund Freud began with the concept of having to do 'grief work'. That is, a specific job should be finished before the next job begins.
  • Elizabeth Kubler Ross defined 5 overlapping stages as Denial, Anger, Bargaining, Depression, and Acceptance.
  • J.W. Worden refers to 4 tasks of mourning: Accepting the reality of the loss, experiencing the pain, adjusting to a life without your loved one and finally being able to invest your emotional energy into a new life.

Grief or Bereavement Theories are generalized maps. Each theory is an attempt by a caring investigator to understand and guide us through our pain. However, humans are unique and cannot be forced into particular patterns of behavior.

Health Promotion Northwest’s staff is available for individual, family, and/or workplace team meetings or to suggest other resources in the community. Please feel free to call.

Excerpts from Swallowed by a Snake by Tom Golden LCSW 

Health Notes is provided by Health Promotion Northwest, your employee assistance program. If you or a member of your family are experiencing personal challenges (for example: financial, marital, family, stress, depression, and/or chemical dependency), Health Promotion Northwest can help. We offer confidential counseling, evaluation and networking services as well as referrals to community resources. This service is provided through your employer at no cost to you. To contact us, call these numbers:
(360) 715-6565 or (800) 244-6142
or email Vince Foster.

Health Promotion Northwest