Traumatic Incident Stress:
Information for Emergency Response Workers

From the National Institute for Occupational Safety and Health

Disasters take many forms and demand quick response from emergency workers. They may include natural
disasters such as earthquakes or hurricanes, or they may involve manmade disasters such as technological
failures or terrorist attacks. As a member of an emergency response team, you and your team members are
at risk of experiencing what psychologists refer to as a traumatic incident—an incident that may involve
exposure to catastrophic events, severely injured children or adults, dead bodies or body parts, or the loss
of colleagues, for instance.

Traumatic incidents can produce unusually strong emotional reactions that
may interfere with your ability to function at the scene or later:

You may experience any of the physical, cognitive, emotional, or behavioral symptoms listed below in
Table 1. Some people experience emotional aftershocks weeks or months after they have passed through
a traumatic event. Others may experience these reactions while still at the scene, where they must stay
clearly focused on constantly changing hazards to maintain their own safety and to rescue injured victims.

Remember that strong emotions are normal reactions to an abnormal situation!
Table 1.—Symptoms of stress that may be experienced during or after a traumatic incident

Physical* Cognitive Emotional Behavioral
Chest pain* Confusion Anxiety Intense anger
Difficulty breathing* Nightmares Guilt Withdrawal
Shock symptoms* Disorientation Grief Emotional outburst
Fatigue Heightened or lowered Denial Temporary loss or
Nausea/vomiting alertness Severe panic (rare) increase of appetite
Dizziness Poor concentration Fear Excessive alcohol consumption
Profuse sweating Memory problems Irritability Inability to rest, pacing
Rapid heart rate Poor problem solving Loss of emotional Change in sexual functioning
Thirst Difficulty identifying control
Headaches familiar objects or people | Depression
Visual difficulties Sense of failure
Clenching of jaw Feeling overwhelmed
Nonspecific aches and pains Blaming others or self

“Seek medical attention immediately if you experience chest pain, difficulty breathing, severe pain, or symptoms of shock
(shallow breathing, rapid or weak pulse, nausea, shivering, pale and moist skin, mental confusion, and dilated pupils)

Additional Resources

Disaster Mental Health Services, Substance Abuse and Mental Health Services Administration (SAMHSA).
http:/www.mentalhealth.org/cmhs/EmergencyServices/index.htm

Tips for Talking About Disasters, SAMHSA.
Attp://www.mentalhealth.org/cmhs/EmergencyServices/after.htm

Self-Care Tips for Emergency and Disaster Response Workers, SAMHSA.
http.//www.mentalhealth.org/cmhs/EmergencyServices/response.htm

Related Links, SAMHSA,
http:/www.mentalhealth.org/cmhs/EmergencyServices/links.htm

National Center for Post Traumatic Stress Disorder (PTSD), Department of Veterans Affairs.
Attp://www.neptsd.org/
Disaster Mental Health: Dealing with the Aftereffects of Terrorism. Brief Information for the Public and the Professional
National Center for PTSD, Veterans Affairs
http://www. neptsd.org/disaster.htm!

St. Laurent, D. (1996). The nutritional needs of rescue teams. Emergency Preparedness Digest, April-June, pp. 26-27.

Please stay safe at work. OVER—>



Traumatic Incident Stress: Information for Emergency Response Workers (continued)

What You Can Do On-site

Taking care of yourself will help you to stay focused on hazards at the site and to maintain the constant
vigilance you need for your own safety. Often responders do not recognize the need to take care of
themselves and to monitor their own emotional and physical health—especially when recovery efforts stretch
into several weeks. The following guidelines contain simple methods for helping yourself. Read them while
you are at the site and again after you return home.

+ Pace yourself. Rescue and recovery efforts at the site may continue for days or weeks.

+ Take frequent rest breaks. Rescue and recovery operations take place in extremely dangerous work
environments. Mental fatigue over long shifts can place emergency workers at greatly increased risk
for injury.

Watch out for each other. Co-workers may be intently focused on a particular task and may not
notice a hazard nearby or behind.

Be conscious of those around you. Responders who are exhausted, feeling stressed, or even
temporarily distracted may place themselves and others at risk.

Maintain as normal a schedule as possible: regular eating and sleeping are crucial. Adhere to the
team schedule and rotation.

Make sure that you drink plenty of fluids such as water and juices.

Try to eat a variety of foods and increase your intake of complex carbohydrates (for example, breads
and muffins made with whole grains, granola bars).

Whenever possible, take breaks away from the work area. Eat and drink in the cleanest area available.
Recognize and accept what you cannot change—the chain of command, organizational structure,
waiting, equipment failures, etc.

Talk to people when YOU feel like it. You decide when you want to discuss your experience. Talking
about an event may be reliving it. Choose your own comfort level.

If your employer provides you with formal mental health support, use it!

Give yourself permission to feel rotten: You are in a difficult situation.

Recurring thoughts, dreams, or flashbacks are normal—do not try to fight them. They will decrease
over time.

Communicate with your loved ones at home as frequently as possible.

What You Can Do at Home

Over time, your impressions and understanding of your experience will change. This process is different for
everyone. No matter what the event or your reaction to it, you can follow some basic steps to help yourself
adjust to the experience:

Reach out—people really do care.

Reconnect with family, spiritual, and community supports.

Consider keeping a journal.

Do not make any big life decisions.

Make as many daily decisions as possible to give yourself a feeling of control over your life.
Spend time with others or alone doing the things you enjoy to refresh and recharge yourself.

Be aware that you may feel particularly fearful for your family. This is normal and will pass in time.
Remember that “getting back to normal” takes time. Gradually work back into your routine. Let
others carry more weight for a while at home and at work.

Be aware that recovery is not a straight path but a matter of two steps forward and one back. You
will make progress.

Appreciate a sense of humor in yourself and others. It is OK to laugh again.

Your family will experience the disaster along with you. You need to support each other. This is a
time for patience, understanding, and communication.

Avoid overuse of drugs or alcohol. You do not need to complicate your situation with a substance
abuse problem.

Get plenty of rest and normal exercise. Eat well-balanced, regular meals.

DHHS (NIOSH) Publication Number 2002-107