Stress and Critical Incident Stress – A Guide for the Ambulance Service

SOME DO’S AND DON’TS

It is very common, in fact quite normal, for people to experience emotional aftershocks when they have experienced a critical incident. If you are experiencing signs of excessive stress – you may find the following suggestions helpful in coping with the symptoms:

DO express your emotions & feelings.

DO identify trusted friends and colleagues to whom you can.

  • talk about what happened
  • review the experience(s)

DO look to friends and colleagues for support.

DO listen sympathetically if a colleague wants to speak with you unless it is too distressing.

DO advise colleagues who need more support where they can get appropriate help.

DO try to keep your life as normal as possible.

DO try to keep to daily routines.

DO drive more carefully.

DO be more careful around the home.

DON’T use alcohol, nicotine or other drugs to hide your feelings or manage your reactions.

DON’T simply stay away from work – seek help and support.

DON’T allow anger and irritability to mask your feelings.

DON’T bottle up feelings.

DON’T be afraid to ask for help.

DON’T think your feelings are signs of weakness

WHERE TO FIND HELP:

1. The Ambulance Service has a Peer Support Worker network and we recommend that you contact them for help and advice. For contacts, details see below.

2. By consulting your own GP.

3. The HSE also has a staff support system which you can contact directly, see link HSE link below http://www.hse.ie/eng/staff/safetywell being/eap/

4. If you require professional support, your PSW or regional coordinator can arrange to refer you on.

Don’t simply stay away from work if you are feeling down – talk to your manager and seek support through the CISM system

If you need support from the system you can contact any of the PSWs with whom you feel confident in discussing your difficulties.

WHAT IS STRESS?

Stress is a mental and physical condition which results from pressure or demands that strain or exceed our capacity or perceived capacity to cope (HSE, 2012). The greater the demand the more intense the stress reaction. Prolonged or excessive stress causes distress.

HOW DO WE KNOW WHEN WE ARE STRESSED?

Listed below are some common indicators

  • Feeling overwhelmed
  • Loss of motivation
  • Dreading going to work
  • Becoming withdrawn
  • Impaired concentration
  • Racing thoughts
  • Confusion
  • Difficulty making decisions
  • Impaired memory
  • Feelings of (Anxiety, Depression, Anger, Guilt)
  • Racing heart, breathlessness and rapid breathing
  • Feeling hot and flushed, excessive sweating
  • Dry mouth, churning the stomach
  • Diarrhoea and digestive problems
  • Frequent desire to use the toilet
  • Muscle tension
  • Restlessness, tiredness, sleep difficulties, headaches
  • Increased drinking or smoking
  • Overeating, loss of appetite
  • Loss of interest in sex
  • Self-neglect

WHAT IS CRITICAL INCIDENT STRESS (CIS)?

CIS is the stress caused by an event, or series of events, which is of such severity that it has the capacity to overwhelm our usual coping mechanisms, thereby creating significant distress and impaired functioning.

HOW DO I KNOW WHEN I AM ADVERSELY AFFECTED BY A CRITICAL INCIDENT(S)?

Prolonged or excessive levels of stress are a factor in the origins of some physical and psychological health problems.

Listed below are some common ways in which people react to incidents like this:

  • Feeling of distress
  • Feeling of sadness
  • Strong feelings of anger
  • Feeling of disillusionment
  • Feeling of guilt
  • The feeling of apprehension/anxiety/fear of:
  • losing control/breaking down or
  • something similar happening again
  • not having done all I think I could have done
  • Avoidance of the scene of incident /trauma or of anything that reminds you of it.
  • Bad dreams or nightmares
  • Distressing memories or “flashbacks” of the incident coming into your mind even though you don’t want them to.
  • Feeling “on edge” irritable, angry, under threat/ pressure.
  • Feeling emotionally fragile – unable to experience your normal range of emotions
  • Feeling cut off from your family or close friends – “I can’t talk to them” or “I don’t want to upset them”

These are all normal reactions which you may experience. They are not signs of weakness or inadequacy. Also, it is perfectly normal NOT to experience any of these emotions or not to experience them to an upsetting degree.

WHEN TO FIND HELP:

1. If you feel you cannot cope with your reactions or feelings.

2. If your stress reactions do not lessen in the two or three weeks following the event.

3. If you continue to have nightmares and poor sleep.

4. If you have no-one with whom to share your feelings when you want to do so.

5. If your relationships seem to be suffering badly, or sexual problems develop.

6. If you become clumsy or accident-prone.

7. If, in order to cope after the event, you smoke, drink or take more medication or other drugs.

8. If your work performance suffers.

9. If you are tired all the time.

10. If things get on top of you and you feel like giving up.

11. If you take it out on your family

12. If your health deteriorates.

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