Critical IncidentsCritical Incidents

A Normal Reaction to an A Normal Reaction to an Abnormal SituationAbnormal Situation

CRITICAL INCIDENTCRITICAL INCIDENTDefinition:Definition:• An incident that exposes you to An incident that exposes you to

actual or threatened death, serious actual or threatened death, serious injury or other threats to injury or other threats to your your physical integrity or that of physical integrity or that of others.others.

TYPICAL CRITICAL TYPICAL CRITICAL INCIDENTSINCIDENTS• Serious injury or death of a fellow employee Serious injury or death of a fellow employee

at work.at work.• Serious injury or death of a non-employee Serious injury or death of a non-employee

resulting from Railroad operations. resulting from Railroad operations. (“Trespasser”)(“Trespasser”)

• Requirement for employees to administer Requirement for employees to administer first aid for serious illness or injury (e.g. first aid for serious illness or injury (e.g. CPR or traumatic amputation.)CPR or traumatic amputation.)

TYPICAL CRITICAL TYPICAL CRITICAL INCIDENTS(continued)INCIDENTS(continued)

• Requirement for employees to Requirement for employees to remove bodies or parts of bodies.remove bodies or parts of bodies.

• Requirement for employees to wait Requirement for employees to wait with seriously ill or injured victims for with seriously ill or injured victims for the arrival of Emergency Services.the arrival of Emergency Services.

COMMON TRAUMATIC COMMON TRAUMATIC STRESS SYMPTOMSSTRESS SYMPTOMS• NightmaresNightmares• FlashbacksFlashbacks• Memory disturbancesMemory disturbances• Persistent intrusive Persistent intrusive

recollections of the recollections of the incidentincident

• GuiltGuilt

• Withdrawal from Withdrawal from family and loved onesfamily and loved ones

• Difficulty Difficulty ConcentratingConcentrating

• Depressed mood Depressed mood • Eating problemsEating problems• Heightened Heightened

awarenessawareness

COMMON TRAUMATIC COMMON TRAUMATIC STRESS SYMPTOMS STRESS SYMPTOMS (Cont.)(Cont.)

• Anger or hostility Anger or hostility which is difficult to which is difficult to controlcontrol

• Feeling “numb”or Feeling “numb”or detacheddetached

• Exaggerated Exaggerated startle responsestartle response

• Sleep problemsSleep problems• Inability to Inability to

experience experience pleasurepleasure

• Excessive Excessive Drinking Drinking or drug useor drug use

• Crying spellsCrying spells

CRITICALCRITICALINCIDENTINCIDENT

DEBRIEFINGDEBRIEFING

WHAT IT ISN’T!!!WHAT IT ISN’T!!!

• ““A VISIT TO THE A VISIT TO THE SHRINK” SHRINK”

• PSYCHOTHERAPPSYCHOTHERAPYY

• CRITIQUECRITIQUE• PART OF ANY PART OF ANY

INVESTIGATIONINVESTIGATION

• JUDGEMENTALJUDGEMENTAL• PUBLIC MEETINGPUBLIC MEETING• PART OF ANY PART OF ANY

PERSONNEL OR PERSONNEL OR MEDICAL MEDICAL RECORDRECORD

What It Is!!!What It Is!!!• 1 to 2 hour meeting led by a Masters Level 1 to 2 hour meeting led by a Masters Level

mental health professional, trained in crisis mental health professional, trained in crisis intervention, stress and the “CID” process.intervention, stress and the “CID” process.

• Usually conducted within 72 hours of the Usually conducted within 72 hours of the incident.incident.

• Structured discussion of the event to Structured discussion of the event to reduce its impact on reduce its impact on youyou..

• A confidential opportunity to provideA confidential opportunity to provideand receive group support.and receive group support.

• ProtectsProtects you you from Post Traumatic Stress from Post Traumatic Stress DisorderDisorder!!

• Helps Helps you you identify and understand intense identify and understand intense feelingsfeelings!!

• HelpsHelps you you predict and prepare for possible predict and prepare for possible emotional after effectsemotional after effects!!

• HelpsHelps you you identify supports and resources identify supports and resources!!

WHY A “C.I.D.”?WHY A “C.I.D.”?

““C.I.D.”GOALS C.I.D.”GOALS

• MINIMIZE THE IMPACT OF A MINIMIZE THE IMPACT OF A CATASTROPHIC EVENT.CATASTROPHIC EVENT.

• ACCELERATE ACCELERATE NORMALNORMAL RECOVERY RECOVERY PROCESSES IN PROCESSES IN NORMALNORMAL PEOPLE PEOPLE WHO ARE EXPERIENCING WHO ARE EXPERIENCING NORMAL NORMAL REACTIONS TO REACTIONS TO ABNORMAL ABNORMAL EVENTS!EVENTS!

WHAT WILL IT COST WHAT WILL IT COST ME?ME?

• Only your time!Only your time!

• You will be paid for time you spend You will be paid for time you spend traveling to and from your reporting traveling to and from your reporting point, and for time spent at the point, and for time spent at the debriefing. debriefing.

WILL I GET TIME OFF?WILL I GET TIME OFF?

If you attend a debriefing you will be If you attend a debriefing you will be given an excused absence of given an excused absence of two two days with paydays with pay directly following the directly following the incident if you want or need it.incident if you want or need it.

WHAT HAPPENS IN A WHAT HAPPENS IN A CRITICAL INCIDENT CRITICAL INCIDENT DEBRIEFING?DEBRIEFING?

STAGE #1 STAGE #1 INTRODUCTIONINTRODUCTION

• Introduce participantsIntroduce participants

• Explain the processExplain the process

• Set and agree to ground rules Set and agree to ground rules

STAGE #2 STAGE #2 FACTSFACTS

Participant describes:Participant describes: • The incident. The incident.

• Their activities at the scene.Their activities at the scene.

• What they did, heard, saw, smelled, What they did, heard, saw, smelled, etc. (“Just the facts”)etc. (“Just the facts”)

STAGE#3 STAGE#3 THOUGHTSTHOUGHTS

Participants describe cognitive Participants describe cognitive reactions:reactions:

• Thoughts on arrival, during, and Thoughts on arrival, during, and shortly after the incident.shortly after the incident.

STAGE#4 STAGE#4 REACTIONREACTION

Participants:Participants:

• Identify the most traumatic aspects of Identify the most traumatic aspects of the event .the event .

• Identify emotional (feeling) reactions.Identify emotional (feeling) reactions.

STAGE#5 STAGE#5 SYMPTOMSSYMPTOMS

Participants:Participants:

• Identify and discuss symptoms Identify and discuss symptoms experienced during and following experienced during and following the incidentthe incident

STAGE#6 STAGE#6 TEACHINGTEACHING

• Educate regarding the stress responseEducate regarding the stress response

• Normal reactions to abnormal situationsNormal reactions to abnormal situations

• Practical suggestions to assist in recoveryPractical suggestions to assist in recovery

STAGE#7 STAGE#7 RE-ENTRYRE-ENTRY• Answer any remaining questionsAnswer any remaining questions

• List of do’s and don’ts List of do’s and don’ts

• Arrangements for follow-upArrangements for follow-up

• Re-enforce group support through exchange Re-enforce group support through exchange of phone numbers of phone numbers

WHAT YOU HAVE SAID WHAT YOU HAVE SAID ABOUT ABOUT DEBRIEFINGS!!!DEBRIEFINGS!!!• ““The fatality shook me up more than The fatality shook me up more than

I wanted to admit. The debriefing I wanted to admit. The debriefing helped me see that I would get helped me see that I would get through this OK.”through this OK.”

• ““Within a few hours of the debriefing, Within a few hours of the debriefing, I was no longer seeing the body I was no longer seeing the body whenever I closed my eyes.”whenever I closed my eyes.”

MORE OF WHAT YOU MORE OF WHAT YOU SAID!!!SAID!!!

• ““When I lost my keys , I just sat down and When I lost my keys , I just sat down and laughed. I couldn't believe it! In the debriefing laughed. I couldn't believe it! In the debriefing they told us to expect this type of memory loss. they told us to expect this type of memory loss. Before I finished laughing I remembered where I Before I finished laughing I remembered where I put the keys.”put the keys.”

• ““I was afraid I was going crazy, until I went to the I was afraid I was going crazy, until I went to the debriefing and found out that my symptoms were debriefing and found out that my symptoms were a normal reaction.”a normal reaction.”

““WHEN BAD THINGS WHEN BAD THINGS HAPPEN HAPPEN

TO GOOD PEOPLE WE TO GOOD PEOPLE WE CAN CAN

HELP!”HELP!”

MTA Metro-North Railroad EAPMTA Metro-North Railroad EAP (212) 340-2792