A critical incident (CI) is defined as an event outside the range of normal experience that often involves a threat to life (real or perceived) and disrupts a person’s sense of control, immediately or following the event. This can also be termed a distressing event.
Critical incident stress reactions (CISR) are stress reactions people may experience days after exposure to CI’s or following the critical event months later or years later.
Critical Incident Stress Management (CSIM) is an integrated series of pro-active and reactive post-incident interventions for the prevention and management of trauma.
In the course of a lifetime, almost everyone experiences feelings of isolation, loneliness, emotional distress or disconnection. These are normal, short-term reactions to difficult situations. In some cases, however, the duration and intensity of negative thoughts and feelings may interfere seriously with everyday life. This is when it turns into a mental illness.
As a trained practitioner, with a PhD, and diploma from both National Organization of Victim Association (NOVA) and the Mitchell Model, I am equipped to enter into traumatic situations and debrief those who have suffered through it or are suffering now because of the critical incident reaction and ongoing stress.
In my career I have engaged in many such events and have been instrumental in assisting those who are suffering by working together in therapy and eventually bringing people to a place of healing and safety within their own being and surroundings. I have had the privilege of teaching students the requirements for traumatic debriefing and in particular the emphasis of “Their pain is not our pain”.
It was an ordinary day, just like today, when the phone rang and I heard my colleague say, “We need you to go down to Toronto and debrief a number of hospital personnel tomorrow. I was well aware of the news of the day before. An individual had climbed into a van, driven down one of the busiest streets in Toronto and then without warning swerved up unto the sidewalk, aiming the vehicle at people, killing 10 and injuring more than 15 before coming to a crash. Jumping out of the vehicle, surrounded by police aiming their guns at him, he began to shout “Just kill me, just kill me”.
As I heard my colleague's voice on the other end giving me instructions for the next day and the name of the contact, I felt a sudden rush of emotion. Not sure what it was, perhaps this event was so different, perhaps more horrific than I would want to see and hear about. I just remember thinking, that it was an unusual emotional response for me, something I had not experienced before, and the beginning of emotions that would now become part of my self.
As I drove toward Toronto the next day, for the first time I began to think, What if I cannot do this? What if I fail in helping people deal with the trauma and horrific experiences? Who was I to think that I could help? These were foreign thoughts to me. I had been trained for such a day, however, I could not shake the feelings. As I made my way to the hospital I had to drive down the very street the incident took place. There along the sidewalk were piles of flowers placed in memory of loved ones. People standing, quietly, almost prayerfully, as I drove by. Pulling into the hospital I thought, “Their pain is not my pain”.
Meeting with the person in charge she ushered me to a small quiet room and discussed with me the events of the past few days and the impact on hospital personnel: from medical emergency doctors, nurses, and attendants to those sitting in the emergency room waiting for care. The police had shut don the emergency room thinking it could be a terrorist attack. No one could leave, no one could come in, no one could be helped as the wounded took priority. She also explained how many commented “This is like a war zone”. Bodies coming in broken, dismembered, and unrecognizable. People who were hit by the van had their belongings strewn across the sidewalk and came into the hospital without identification; and loved ones asking if their loved one was here - and no one was sure.
Finally, the first person came in. She began to explain her situation and how she had experienced the critical event. She lives on that street, “How will I be able to walk along there – ever”! The words riveted through me like a spear, as I remembered the flowers, the people standing still, and my emotions of grief and despair. What was wrong with me, what is happening. I am a therapist, trained, and prepared, this was not supposed to be happening.
The next several people talked about their own losses, their grief, their sorrow of this situation and other situations in their life that brought it all back. I was able to respond and discuss these events with each person. Validating, restructuring, providing empathy, just as we were trained. Discussing with them the importance of exercise, diet, and being aware of their substance use, in particular alcohol. Each person left thanking me and expressing gratitude for the time spent. I seemed to be as effective as always and felt confident that my work was done and done well.
On my way home I could feel the flood of water of their experiences wash over me as well. I began to realize that with all the training I received I was still human. For the first time I realized “Hey, give yourself a break, this was a hard one”. I may be trained but the water of the experience was the same for me as it was for them. The horrific events permeated my spirit as well. I realized some of my losses were beginning to surface as I fought back strong emotions of grief and sorrow from past events. I used my self talk exercises and meditated while driving, eyes open, of all the good things in my life. The two-hour drive home was therapeutic and by the time I arrived to see my family I felt calmer and at peace, but something had changed, perhaps forever.
The next day was just an ordinary day. As I sat waiting for my first client, I heard the door open and again the flood of thoughts swept across me. “Could I do this?” “What if I failed?” “Who am I to think I can help?” In seconds I gained my confidence and welcomed the couple in. They began to share with me, but I could hear myself within, “Really that is what is bothering you about her?” Then I heard her response and again “Wow how childish”. I realized immediately the experience of yesterday had lingered and I was having trouble being empathetic and understanding to this couple’s issues as I unknowingly was comparing them to the horror I had heard. Again, self-talk, listen to their words, empathize with them, stay focused.
Standing in line at the market buying some food, the person in front of me was arguing that the head of lettuce was .10 cents less. I found myself comparing everyday events with the critical incident and feeling emotions of anger, frustration, and thoughts of how ridiculous this person is or that person. Again, I realized the impact of the water that had washed over me and how it had impacted me as a therapist, as a professional, and yes, as a human being.
Over the next few weeks the intensity of the critical event began to fade, and my sense of confidence, inner thoughts, and emotions had returned to a familiar place within, but not quite the same. Then it dawned on me, I had become more focused in therapy, more attentive, more caring, more thoughtful. Could it be that the very experience I had of sharing in the pain had actually brought a strength to me rather than a weakness? Could it be that their pain can be my pain and it would actually be beneficial?
About the Author
Ron Hallman, Ph.D. is a registered psychotherapist in Waterloo, Canada
