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Critical Incident Stress Guide

NOTE:

The Occupational Safety and Health Act (OSH Act) requires employers to comply with hazard-specific safety and health standards. In addition, pursuant to Section 5(a)(1) of the OSH Act, employers must provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm. Emergency Preparedness Guides do not and cannot enlarge or diminish an employer's obligations under the OSH Act.

Emergency Preparedness Guides are based on presently available information, as well as current occupational safety and health provisions and standards. The procedures and practices discussed in Emergency Preparedness Guides may need to be modified when additional, relevant information becomes available or when OSH Act standards are promulgated or modified.

General Information
Does any OSHA standard apply to critical incident stress?

OSHA has no standards that apply to the hazards associated with critical incident stress. However, in the interest of the health and safety of the emergency responders and workers, the agency recommends that the following information be shared to help reduce the risks associated with critical incident stress.

What is critical incident stress?

Workers responding to emergency events and or disasters will see and experience events that will strain their ability to function. These events, which include having to witness or experience tragedy, death, serious injuries and threatening situations are called "Critical Incidents." The physical and psychological well-being of those experiencing this stress, as well as their future ability to function through a prolonged response, will depend upon how they manage this stress. Post Traumatic Stress Disorder differs from critical incident stress by lasting longer than four weeks after the event triggering the emotional, mental or physical response. Most instances of critical incident stress last between two days and four weeks.

What are some signs of critical incident stress?

The signs and symptoms of critical incident stress can be physical, emotional, cognitive, or behavioral. Individuals express stress in different ways and therefore manifest different reactions. The list below is not exhaustive but will help supervisors to identify workers who are exhibiting stress reactions.

PHYSICAL COGNITIVE EMOTIONAL BEHAVIORAL
  • Fatigue
  • Chills
  • Unusual thirst
  • Chest pain
  • Headaches
  • Dizziness
  • Uncertainty
  • Confusion
  • Nightmares
  • Poor attention
  • decision making ability
  • Poor concentration, memory
  • Poor problem solving ability
  • Grief
  • Fear
  • Guilt
  • Intense anger
  • Apprehension and depression
  • Irritability
  • Chronic anxiety
  • Inability to rest
  • Withdrawal
  • Antisocial behavior
  • Increased alcohol consumption
  • Change in communications
  • Loss/increase in appetite
What can be done immediately?

During the emergency phase of the response, monitoring of employees by simple conversation and observation may help to identify early signs for some responders. The following steps can help to reduce significant stress detected early in the response:

  • Limit exposure to noise and odors.
  • Dictate an immediate 15 minute rest break.
  • Provide non-caffeinated fluids to drink.
  • Provide low sugar and low fat food.
  • Get the person to talk about his or her feelings.
  • Do not rush the person back to work.
What is Critical Incident Stress Management?

Critical Incident Stress Management is system of education, prevention and mitigation of the effects from exposure to highly stressful critical incidents. It is handled most effectively by specially trained individuals, such as crisis intervention specialists.

What is Critical Incident Stress Debriefing?

Critical Incident Stress Debriefing (CISD) is a facilitator-led group process conducted soon after a traumatic event with individuals considered to be under stress from trauma exposure. When structured, the process usually (but not always) consists of seven steps: Introduction; Fact Phase; Thought Phase; Reaction Phase; Symptom Phase; Teaching Phase; and Re-entry Phase. During the group process, participants are encouraged to describe their experience of the incident and its aftermath, followed by a presentation on common stress reactions and stress management. This early intervention process supports recovery by providing group support and linking employees to further counseling and treatment services if they become necessary.

References

King County, Washington CIS Management

Tips for Managing and Preventing Stress - A Guide for Emergency Response and Public Safety Workers (PDF). US Department of Health and Human Services, Substance Abuse and Mental Health Services Agency (SAMHSA).

Training Manual for Mental Health and Human Service Workers in Major Disasters. US Department of Health and Human Services, Substance Abuse and Mental Health Services Agency (SAMHSA).

International Critical Incident Stress Foundation (ICISF)

A Primer on Critical Incident Stress Management (CISM)

Protecting Emergency Responders, Volume 3. National Institute for Occupational Safety and Health (NIOSH) Publication No. 2004-144.


*Accessibility Assistance: Contact OSHA's Directorate of Technical Support and Emergency Management at (202) 693-2300 for assistance accessing PDF materials.

All other documents, that are not PDF materials or formatted for the web, are available as Microsoft Office® formats and videos and are noted accordingly. If additional assistance is needed with reading, reviewing or accessing these documents or any figures and illustrations, please also contact OSHA's Directorate of Technical Support and Emergency Management at (202) 693-2300.

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