Normalizing Traumatic  Stress

North Bay Regional Critical Incident Stress Management


Definition: Critical Incident Stress is a reaction experienced by those who have gone through a critical incident, ” any situation in which emergency service personnel experience any unusual or extreme emotional reaction that interferes with their ability to function normally at a scene or later.   “A normal reaction to an abnormal situation/incident”   Example: Death of a child: As a firefighter/paramedic, you respond to a SIDS call. The child is pulseless and apneic. You have a child  the same age, wearing the same pajamas, waiting for you at home. This incident may trigger stress reactions, such as: Flashbacks, nightmares, irritability, etc.


CISM is a comprehensive, integrative, multicomponent crisis intervention system. CISM is considered comprehensive because it consists of multiple crisis intervention components, which functionally span the entire temporal spectrum of a crisis. CISM interventions range from the pre-crisis through the acute crisis phase, and into the post-crisis phase. CISM is also considered comprehensive in that  it consists of interventions which may be applied to individuals, small functional groups, large groups, families, organizations, and even communities. The 7 core components of CISM are defined below.

• Pre-crisis preparation. This includes stress management education, stress resistance, and crisis mitigation training for both individuals and organizations.

• Disaster or large-scale incidents, as well as, school and community support programs including demobilizations, informational briefings, “town meetings” and staff advisement.

• Defusing. This is a 3-phase, structured small group discussion provided within hours of a crisis for purposes of assessment, triaging, and acute symptom mitigation.

• Critical Incident Stress Debriefing (CISD) refers to the “Mitchell Model” (Mitchell and Everly, 1996) 7-phase, structured group discussion, usually provided 1-10 days post crisis, and designed to mitigate acute symptoms, assess the need for follow-up, and if possible provide a sense of post-crisis psychological closure.

• One-on-One crisis intervention/counseling or psychological support throughout the full range of the crisis spectrum.

• Family crisis intervention, as well as, organizational consultation.

• Follow-up and referral mechanisms for assessment and treatment if necessary.


There is a common misunderstanding that an abnormal reaction to trauma or “psychological fall out” is primarily due to a weakness in the individual. The implication is that a healthy functioning person will be unaffected by Traumatic or Critical Incident Stress no matter how gruesome, gory, or disturbing the scene may be. With this in thinking, a person who displays symptoms of Critical Incident Stress is suspected of being a weak person or of having something inherently wrong with his/her character. The truth of the matter is that anyone, no matter how healthy, who is exposed to Critical Incident Stress may suffer emotional reactions. Approximately 80% to 85% of those exposed to a critical incident will have symptoms (although) not necessarily dysfunctional or disabling) within 24 hours. It is important for you to be aware of the stresses around you. If you experience any kind of reaction beyond what you feel is “normal”, it is important for you to do something about it.


Everyone will respond to Critical Incident Stress in their own way. Reactions to stress are perfectly normal, but not everyone experiences it in the same way. There are variables that affect all of us: our support systems, how gruesome and stressful the trauma, our emotional make-up, thoughts we had about the incident, actions during and after critical incidents, or how much the event reminds us of some personal issue. All of these have a bearing on our reactions. These stress reactions may include:

• Memory loss

• Muscle tremors

• Nausea, vomiting, or other gastrointestinal symptoms

• Tension

• Anxiety

• Sense of feeling overwhelmed

• Profuse sweating or chills

• Sleep disturbances

• Nightmares

• Dizziness, fatigue, crying

• Intrusive thoughts

• Negative feelings such as profound sadness or helplessness


It’s true that people can work through these incidents. Research has proven that healing and recovery is much more rapid when you process it in a group or with others who share your experience. The process of debriefing, whether one-on-one or in a group, is strictly confidential. It is not an operational critique; only those involved in the incident are allowed to participate. No records are made of the  debriefing. It is not psychotherapy.

Stress reduction takes practice. Some principles that may help are:

• Relax: during stressful times by deep breathing exercises with: 4 second inspiration, 4 second pause, 4 second expiration, 4 second pause.

• Eat nutritiously: fresh fruits, vegetables, and fiber. Limit your caffeine,

alcohol, and sugar intake.

• Exercise regularly: Vigorous exercise after an incident is helpful. Keep a regular sleep schedule. Stay rested. Nightmares are a common reaction to traumatic stress. Insomnia will probably resolve itself in a few days.

• Enjoy life outside of work: Accept enjoyment and diversion. Be kind to yourself, go to a movie or a play or out to dinner, ect.

• Develop support mechanisms: Share your thoughts and feelings with someone you trust. Make sure that the other person understands that you are not asking for a solution to your feelings, just an opportunity to express how you feel.