Critical incidents

We often use the term “critical incident” rather than “traumatic incident” to reflect the subjective nature of trauma. A critical incident is an opportunity to consider the impact of an event. After all, it is the human reaction that we are managing. The International Critical Incident Stress Foundation (www.icisf.org) describes a critical incident as “a powerful traumatic event that initiates the crisis response.”

Critical Incidents come in many shapes and sizes:

• The single one-off event such as a death, serious assault or accident
• Multiple or repeated incidents as may be found across high risk occupations such as the emergency services
• Vicarious or secondary trauma, often seen in helping professionals who are continually exposed to other people’s distress and trauma. Dr Liz Royle and Cath Kerr have written and presented extensively on this subject and details can be found here.

Several other professional organisations have offered varying descriptions

• The American Psychiatric Association www.psychiatry.org/
• The World Health Organisation www.who.int
• The US National Library of Medicine www.nlm.nih.gov

However there are many factors that can be protective or increase the risk of people being affected. Some of these will fluctuate over the course of people’s lives and even through small periods of time.

Some of the indicators that a particular event may prove traumatic for those involved in it include where:

• Individual safety was compromised – there may have been actual or threatened injury or death
• Intense helplessness, loss of control or horror was experienced
• High levels of distress were provoked
• There were sudden, shocking changes to “normal” life and how things are “supposed to be”.

It is important to remember that what affects one person may not affect another. We should always therefore focus on the impact rather than the event.

Managing the impact of critical incidents can begin before it has even happened with comprehensive strategic planning to assess risks and draw up procedures followed by the training of managers and employees in skills that enable them to better respond and recover.

There has been much research into the importance of proactive strategies and preparing peer support, building resilience and creating healthy cultures. Dr Liz Royle has presented internationally on subjects such as “Working creatively to promote resilience in the uniformed services,” “Secondary Trauma in Mental Health Professionals” and “Europe-wide interventions to manage trauma in the Uniformed Services.”