Your own personal losses

Working in your own neighborhood

Assisting neighbors, friends, coworkers who have been injured

Not feeling safe and secure

Observe individuals to determine their level of responsiveness and whether they pose a danger to themselves or to others.

Engaging uninjured survivors in focused activity will help them cope, so give them constructive jobs to do such as organizing supplies (especially effective for disruptive survivors).

Help survivors connect to natural support systems, such as family, friends, or clergy.

Provide support by:
Listening to them talk about their feelings and their physical needs.

Empathizing. Caring responses show victims that someone else shares their feelings of pain and grief.

Actual or potential death or injury to self or others

Serious injury

Destruction of their homes, neighborhood, or valued possessions

Loss of contact with family members or close friends

Separate the family members and friends from others in a quiet, private place.

Have the person(s) sit down, if possible.

Make eye contact and use a calm, kind voice.

Use the following words to tell the family members and friends about the death: “I’m sorry, but your family member has died. I am so sorry.” It is okay to reference the deceased person’s name or their relation to the survivor if you know it.

Let the family and friends grieve.

Phase out workers gradually.

Gradually phase them from high- to low-stress areas of the incident.

For example, do not stand down and send home a team member who has just completed a high-stress operation; instead, assign them a low-stress responsibility so they can decompress gradually.

Get enough sleep

Exercise regularly

Eat a balanced diet

Balance work, play, and rest

Allow yourself to receive as well as give; you should remember that your identity is broader than that of a helper

Connect with others

Use spiritual resources

A person who identifies too strongly with a survivor may take on that survivor’s feelings.

Vicarious trauma is an “occupational hazard” for helpers.

CISD is one of several components of Critical Incident Stress Management (CISM). CISM is a short-term healing process that focuses on helping people deal with their trauma one incident at a time.

It is intended to lessen the chance of someone experiencing post-traumatic stress disorder and get them back to their daily lives as quickly as possible.

“I understand.”

“Don’t feel bad.”

“You’re strong” or “You’ll get through this.”

“Don’t cry.”

“It’s God’s will.”

“It could be worse,”

“At least you still have…”, or “Everything will be okay.”

Put him- or herself in the speaker’s shoes in order to better understand the speaker’s point of view. Draw upon past experiences, or try to imagine how the speaker is feeling. Be careful not to completely take on the speaker’s feelings.

Listen for meaning, not just words, and pay close attention to the speaker’s nonverbal communication, such as body language, facial expressions, and tone of voice.

Paraphrase the speaker periodically to make sure that you have fully understood what the speaker has said and to indicate to the speaker that you are listening. This reinforces the communication process.

Loss of appetite

Headaches or chest pain

Diarrhea, stomach pain, or nausea

Hyperactivity

Increase in alcohol or drug consumption

Nightmares

The inability to sleep

Fatigue or low energy

Cognitive functioning. Those who have suffered traumatic stress may act irrationally, in ways that are out of character for them, and have difficulty making decisions. They may have difficulty sharing or retrieving memories.

Physical health. Traumatic stress can cause a range of physical symptoms – from exhaustion to health problems.

Interpersonal relationships. Those who survive traumatic stress may undergo temporary or long-term personality changes that make interpersonal relationships difficult.

Irritability or anger

Self-blame or the blaming of others

Isolation and withdrawal

Fear of recurrence

Feeling stunned, numb, or overwhelmed

Feeling helpless

Mood swings

Sadness, depression, and grief

Denial

Concentration and memory problems

Relationship conflicts/marital discord

Cover the body; treat it with respect.

Wrap mutilated bodies tightly.

If the person has died while at the treatment area, move the body to your team’s temporary morgue. (If the person was tagged as “dead” during triage, do not remove from the incident area.)

Follow local laws and protocols for handling the deceased.

Talk with local authorities to determine the plan.