A MISSING COMPONENT IN YOUR EMERGENCY MANAGEMENT PLANS: 

THE CRITICAL INCIDENT STRESS FACTOR 

Kathleen M. Kowalski, Ph.D. 

U.S. Bureau of Mines 

P.O. Box 18070 

Pittsburgh, PA 15236 

ABSTRACT 

In emergency management, the effects of 

stress on the performance of emergency 

personnel, typically have been ignored or regarded 

as too enigmatic to quantify. This paper discusses 

the concept of Critical Incident Stress in 

responders to emergencies. It presents the 

rationale for considering stress as a significant 

factor in the management of emergencies. It is 

proposed that Critical Incident Stress Debriefing 

in a disaster can improve the effectiveness of 

response teams on site, their turnaround time on 

site, and post-disaster time off the job. Critical 

Incident Stress intervention also can mitigate 

potential deleterious emotional effects associated 

with emergency work. This paper, prepared by a 

U.S. Bureau of Mines researcher, offers some 

ideas to the mining industry in general, to mine 

rescue team trainers, and to developers of 

program simulations on the specific issue of how 

people, time, materials and space may be factored 

into a plan for emergency management. The 

impact of stress on emergency workers is, 

presented as a missing component in present 

emergency management models. 

INTRODUCTION 

A main focus in the management of 

emergencies has been on resources and logistics, 

on providing the necessary resources to meet a 

crisis within an urgent time frame; in other words, 

having what and who you need, where and when 

you need it. The necessary resources include 

trained manpower, appropriate equipment, 

available communication, plus knowledgeable and 

decisive leaders. In the mining industry, 

emergency response planners have concentrated 

on designing better and safer equipment, on 

producing rescue apparatus such as the personwearable, self-contained self-rescuers, on 

decreasing response time, on increasing training 

of mine rescue teams, and on developing escape 

plans that comply with mine safety regulations. 

Mining operators must develop escape plans that 

are designed to comply with regulations under 

30CFR Part 75 (sec 1101-23 and 1704-2). 

Immediate and appropriate response to mine 

disasters is, of course, essential. "Longer hoses 

and higher ladders" are important. New 

technology and increased training improves the 

efficiency of the rescue worker. An often missing 

consideration in mine and other disaster training 

and management programs however, is the impact 

of stress on the emergency workers themselves. 

This paper offers information and proposes how 

the effects of human stress on emergency\rescue 

workers may be factored into emergency 

management planning. 

THE RATIONALE' FOR INCLUSION 

The stress response is a normal human 

characteristic, an adaptive preparation for action 

by humans in crisis. The human organism 

survives because of the maintenance of a normal 

internal balance referred to as homeostasis. A 

physical or psychological threat tends to disrupt 

homeostasis and produce physiological reactions 

in the body. These physiological reactions 

involve the nervous and endocrine systems and 

produce various system, and organ responses. 

Specifically, stress leads to activation of the 

autonomic nervous system and to an increase or 
decrease in secretions of various hormones in the 

body. (1) 

The response to a perceived threat or danger 

is sometimes referred to as the "fight or flight" 

response. When we are under duress our hearts 

beat faster and blood is diverted to the skeletal 

muscles; one may faint from shock; temperature, 

blood pressure and respiration rate remain high; 

there is a sudden outpouring of hormones; the 

throat becomes dry, digestion stops and the 

eyesight improves. (2, 3) This response was 

useful to our early ancestors in their efforts to 

survive dangerous animals, human enemies, and 

other conditions of primitive environments. It was 

helpful when they ran into a tiger in the jungle; 

they prepared for action and responded (hopefully 

they ran!) and the body returned to normal until 

the next tiger, which might be days or weeks or 

even months later. In today's societies, the 

dangers may differ but can be equally severe and 

more complex. Modem humans are besieged with 

overlapping stressors and the constant response to 

them creates wear and tear on the mind and body. 

The National Institute for Occupational Safety 

and Health identifies occupational stress as one of 

the principal social and occupational health 

concerns of the 1990's. In response, NIOSH has 

developed a multipoint strategy for control of 

stress in the workplace and has joined forces with 

the American Psychological Association to 

translate the strategy into practical action. (4) 

The National Council on Compensation. 

Insurance notes that excessive stress accounts for 

about 14% of all occupational disease 

compensation claims. (5) The amount per claim 

averages $15,000, almost twice the average 

amount paid per claim for workers with physical 

injuries. The number of stress-related worker 

compensation claims being filed across the 

country is skyrocketing. The U.S. Department of 

Commerce in 1990 reported that the claims nearly 

doubled from $13.6 billion in 1980 to $24.7 

billion in 1987 and are expected to top $90 billion 

by the turn of the century. (4) Work-related stress 

claims are the fastest growing and most costly per 

incident among claims affecting American 

commerce. (6) 

The Northwestern National Life Company 

reported that six percent of its disability cases 

were stress related in 1982; that number had 

become 13% by the end of 1990. The total 

financial cost of extreme stress to business and 

industry is difficult to document but estimates 

place it between $100 and $150 billion per year; 

600,000 workers moreover, are disabled each year 

for reasons of psychological disorders. (4)(7) 

Some workers, through conditions or choice 

of occupation, place themselves in stressful 

situations at a higher frequency rate than other 

workers. Emergency personnel such as mine 

rescue teams, firefighters, police, hospital 

emergency room personnel, EMTs and workers 

called on to respond to disasters fall in this 

category. These workers are at Figh risk to 

experience disabling occupational stress reactions 

and, at the extreme, for a diagnosis of Post 

Traumatic Stress Disorder (PTSD). (6) 

PTSD is considered to be the most severe and 

disabling variation of occupational stress.(@ The 

general public became aware of Post Traumatic 

Stress Disorder after the Vietnam War, when 

soldiers were reporting symptoms of a duration 

and intensity that called for medical intervention. 

PTSD is a medical diagnosis recognized in 1980 

by the American Psychiatric Association and 

described in the DSM IIIR, the medical diagnostic 

manual for psychiatric disorders. Symptoms 

associated with PTSD include flashbacks or 

nightmares, reliving of events, exaggerated startle 

responses, sleep disturbances, detachment or 

avoidance of close, interpersonal relationships, 

feelings of guilt, high levels of anxiety and 

depression, and impairment of concentration and 

memory. (9) 

The risk of becoming a victim of PTSD is 

mostly an outcome of having been in a high-risk, 

potentially traumatizing situation or experience. 

Individuals in high-risk populations such as 

emergency service professions are at higher than 

normal risk for PTSD. In an epidemiological 

investigation conducted by Helzer et al. it was 

discovered that the prevalence of PTSD in the 

general population of the United States was about 
1 - 2% 110). The general statistical risk of PTSD, 

however. can he misleading. For those in high 

risk professions, any single traumatic incident 

may engender symptoms of post-traumatic stress 

or fully developed PTSD, at an incidence up to 

30% or more in those who are primary or 

secondary victims. ('8) 

By definition. a traumatizing event is one that 

is outside the normal range of everyday life 

events. It is experienced bv the individual as 

overwhelming. ( 11) Traumatizing events or 

critical incidents are especially frequent among 

emergency workers. X criticai incident is one 

experienced by personnel that produces an 

emot~onai reaction with the potentla1 for inhibiting 

d worker's ability to function either at the scene 

or later. t 12) An example of a critical incident 

would be the serious injury or death of a 

colleague in the line of duty or an incident where 

the circumstances. the sights, sounds and smells 

are so distress~ng as to result in an immediate or 

delayed reaction. i~ 12) 

Researchers have identified both immediate 

and long ranse symptomatic reactions to trauma. 

I 1 I) Initially, individuals will report numbness. 

denial. avoidance of places or thnps that remind 

them of the trauma. withdrawal from social 

interaction, depression, difficulty with 

concentration and relationships. Long range, 

more acute symptoms include fearfulness. 

irritability. sleep disturbance, flashbacks and 

heightened sensitivity. These responses can 

fluctuate within an individual and be confusing , 

and disturbing. Although researchers and 

psycholo_gists who specialize in job stress 

generally agree that persons attracted to 

emergency work are. as a group, basically more 

emotionally stable than the general population, 

emergency workers. however are subject to an 

increased incidence of stress-related diseases such 

as heart disease. (13) 

Generally, emergency workers close ranks 

after a crisis. They prefer to talk to others in 

their unit or on their rescue team. Telltale signs 

of distress such as excessive humor. increased 

derogatory remarks against one another. 

irritability, withdrawal from others or significant 

changes in behavior are often overlooked by 

peers. Post trauma reactions are natural - though 

not necessarily healthy - responses to trauma, and 

they can be resolved. There is consensus among 

clinicians and researchers that the presence of a 

supportive environment is crucial to a positive 

resolution for the traumatized worker, i 1 1 ) 

Successful resolution of the crisis experience not 

only allows for the worker's return to product~ve 

work but can help him or her better understand a 

Figure 1.--Miner's escape through smoke 

normal response to an atypical situation. 

Emergency Service personnel generally are 

normal individuals responding to abnormal 

situations. Critical Incident Stress Debriefing is 

an organized approach to the management of the 

stress reaction. 

BACKGROUND 

Throughout history there are references to 

human stress in traumatic situations. According 

to ~Mitchell, Critical Incident Stress Debriefing 

intervention evolved from four major influences: 

military experiences. police psychology, 

emergency medical services and disasters. ( 14) 

Mitchell noted that stress reactions during war 

have been reported by historians since 603 BC. 
Thousands of combat stress victims were reported 

during the American Civil War and among 

American service personnel in the two World 

Wars. 

Police psychologists entered the emergency 

services in the mid 1960's and they have 

contributed knowledge about the personality 

profile of the emercency worker and 9 recommendations concerning the provision of 

psychological support services. Emergency 

medical services agencies began developing 

support services in 1972; the tirst programs were 

in trauma centers and large hospitals. (14) 

an incident can be invaluable. They provide 

ouidelines for optimal length of work time, b 

trequency of rest periods. maximum time at the 

scene, food. shelter and use of a CISD team. In 

addition. the provision for spouse and family 

education programs can provide significant 

support to the emergency worker. 

This fust phase of the focused on 

education, is a key component of the intervention. 

The more information people have about stress 

the better they can recognize it in themselves and 

others, and seek help. Pre-incident education can 

lesson the need for the allocation of greater 

resources for post-incident rehabilitation. (14) 

In 1983, after nine years of gound work. 

Mitchell introduced Critical Incident Stress I'd 

Debriefing (CISD). He formed CISD teams made 

up of trained mental health professionals and I 

s&cially trained peer support'personnel drawn 

from the ranks of the emergency service. in a 

1985 survey of 360 emergency workers from four 

states. 87% of the emergency responders stated 

that they had been emotionally and physically 

stressed by their work: 93% felt that the 

debrietings were helpful. (15) b I 

INTERVENTION I 

A Critical Incident Stress Debrieting team is 

peer-driven and guided by a mental health 

professional. It's work is confidential. CISD 

teams function in three areas: pre-incident. 

incident. and post-incident. ( 16) 

CISD Pre-incident 

The pre-incident functions are important and 

are mainly educational. Included are instruction 

on stress recognition and stress reduction and the 

differences between non-emergency stress and 

critical incident stress. Instruction is provided to 

both the workers and the management\cornmand 

staff. Emergency managers need to be included 

in the instruction and become informed about the 

capabilities and the limitations of CISD Teams 

and how to initiate services. 

Stress management protocols for use during 

Figure 2.--Donning SCSR's 

CISD Diirin~ an Incident 

During a critical incident. a debriefing team 

provides on-scene assistance to personnel who are 

obviously distressed. The team also may provide 

"defusings" which are shorter. unstructured 

debriefing that encourage a brief discussion of 

the events. These can significantly reduce acute 

stress. This intervention is done one to three 

hours following the event and may last up to one 

hour. If a defusing is not achieved within twelve 

hours, a full formal debriefing within three days 

of the incident is recommended. In large 

disasters, where many people are involved, after 

a unit disengages from the scene the participants 
meet with mental health professionals and are 

given information on the typical effects of critical 

incident stress and the symptoms which may or 

may not appear. They are given practical 

suggestions for stress management and allowed 

time to comment or ask questions. 

Post-incident CISD 

For about 24 hours after an incident is over 

and defusings or demobilizations are complete, 

emergency personnel typically prefer not to 

discuss the event with outsiders. Emergency 

personnel may focus on reports and procedure, 

not being ready to deal with their feelings about 

the event. (15) 

As stated earlier, CISD is a psychological and 

educational support group discussion that utilizes 

a specially trained team composed of a mental 

health professional and peer support personnel. A 

CISD team after a mining disaster would be 

composed of a mental health professional and 

mine rescue team members who have been trained 

in CISD. The CISD is a carefully designed, 

structured process that progresses through seven 

phases and provides stress-reduction information. 

Participants are encouraged, but not required, to 

speak; the process is confidential. (16) 

Responders to emergencies are not always 

trained or experienced personnel. 'Sometimes 

they are individuals. who simply are "there" and 

enlisted to perform a task. In a mine fire, rank 

and file miners from other areas may be called 

upon to execute emergency assignments and 

consequently be exposed to critical incidents. An 

example of this assumption of roles in an 

emergency, is found in a U.S. Bureau of Mine's 

case study of workers' escape from an 

underground mine fire (17). The fire was 

discovered by the "fire boss" (mine examiner) 

who disengaged the trolley power and called to 

warn the shift foreman and the miners working in 

the three sections which were affected by the fire. 

The fire boss, joined by the mine foreman and the 

general assistant foreman fought the fire and 

extinguished it about an hour after discovery. 

Meanwhile, twenty-some miners escaped under 

smoke. There was no time for a mine rescue 

team to organize and respond. The individuals on 

the scene reacted to fight the fire and to execute 

the escape. All individuals called upon to fulfill 

emergency roles should be included in 

debriefings. 

Follow-up 

All defusings, demobilizations and debriefings 

are followed up in some manner ranging from a 

phone call to a follow-up meeting. 

A CISD team must be trained. It takes a special 

task force six months to a year to organize a 

CISD team. They need to be carefully recruited, 

trained, and committed to the process. (14) 

FURTHER INFORMATION 

Critical Incident Stress Debriefing teams have 

grown remarkably in the past ten years. The 

Second World Congress on Stress Trauma and 

Coping in the Emergency Services Professions, 

held in 1993 in Baltimore, MD attracted 

attenders from all over the United States and 

abroad. In January of 1994 there were 

approximately 350 CISD teams worldwide. (18) 

The studies cited here suggest that those 

responsible for the development and 

implementation of crisis management plans need 

to be aware of the importance of including 

resources for meeting the critical incident stress 

potential for their rescue workers. They 

emphasize the importance of the intentional 

creation of pre-incident education programs and a 

post-trauma workplace milieu that is conducive to 

healthy resolution of the trauma. 

Management personnel are not exempt from 

critical incident stress syndrome. As reported by 

Doepel, managers are vulnerable to traumatic 

stress reactions and need to be offered training 

and information with the rest of the emergency 

personnel. (1 1) His experience suggests that 

management, whenever possible be involved in 

the group process. He concludes that a good 

emergency plan "is enhanced by the inclusion of 

components designed to mitigate the effects of 

post-traumatic stress reactions among managers 

and employees" (1 1 p. 186). 
The following are steps for incorporating the 

human stress factor in emergency\rescue work 

into an emergency plan: 

1. Develop a collaboration between mental 

health personnel and emergency service personnel. 

Mental Health personnel should be included in 

emergency planning. (1 9) 

2. Develop an educational program for 

workers and their families including information 

on critical incident stress and interventions. (14) 

Include workers and managers in your program. 

(1 1) 

3. Allocate resources, time and space for a 

debriefing process to be conducted by trained 

personnel. (1 4) 

4. Provide for follow-up and support after the 

event. 

CONCLUSION 

This paper has considered the human stress 

factor in the work of emergency personnel and 

discussed its history and interventions. Data needs 

to be collected in this area. The following are 

some of the topics for further research and 

development: comparing personnel exposed to 

CISD with those who are not; tracking illness and 

job absenteeism before and after an event; and 

formulating training programs for specific 

populations, such as high risk mine rescue crews. 

Quarantelli noted in the research, that we are 

far from certain how much any of us understands 

about the nature of disasters, the nature of mental , 

health and the relationship between the two.(20) 

The initial step is to recognize how significant 

that relationship may be. 

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