Critical Incidents

• General Considerations
• After a Critical Incident

• First Responders
• Body Handling

• Resources
• References

OVERVIEW

GENERAL CONSIDERATIONS

Critical incidents are events outside the normal experience that pose actual or perceived threats of injury or exposure to death that can overwhelm both an individual's and organization's coping resources.

Examples of critical incidents may include:

• Natural disasters
• Acts of terrorism
• Mass casualty accidents
• Acts of violence (with and without fatalities)
• Observed traumatic deaths
• Air, Sea, Land accidents/mishaps
• Events during war

Most people (over 80%) have the resources and skills to be able to cope with traumatic events over time (3 to 12 months). One of the challenges for leaders and caregivers is that it is difficult to know who the 20% are that could benefit from additional resources. The number of traumatic exposures, existing OPTEMPO, and the strain of pre-event life stressors all contribute to the range of individual reactions.

Military units in particular have strengths and resources to buffer the impact of critical events that may not exist in civilian communities. Realistic training, engaged ethical leaders, unit cohesion, and a purposeful mission are important factors that strengthen military units and mitigate the effects of operational stress and critical incidents. Just as unit cohesion is a protective factor it can also facilitate a shared sense of loss or impact across an entire unit when one or more members are directly affected by the incident. It is important to remember that leaders are part of the unit and will experience critical events on both an individual and leader level.

The Navy and Marine Corps combined Combat and Operational Stress Control doctrine (MCRP 6-11C/NTTP 1-15M) is a primary source of information and guidance for leaders regarding operational stress and critical incident preparation. The Combat Operational Stress First Aid (COSFA) training manual is a good resource for leaders and caregivers to guide post event assessment and actions. The major points from the COSC doctrine relevant for critical incidents include:

Stress as a continuum

• Stress reactions occur on a continuum
• Not everyone is affected equally or simultaneously by any given event
• One size does not fit all and not everyone needs something to "feel better"

Four Sources of Stress Injury

• Not all stressors or events cause injury or mission impairment
• Be aware of the four types of stressors that can cause stress injury and mission impairment:
  • Life Threat/Trauma
  • Loss
  • Inner Conflict
  • Wear and Tear

There are five essential needs that people have following a critical incident:

• Safety
• Calm effective communication
• Connectedness/Positive Unit Cohesion
• The skills and resources to competently cope
• Confidence in leaders, mission, and hope for the future

Good leaders are the best medicine

• Leaders using the five core leader functions are the 80% solution
  • Strengthen
  • Mitigate
  • Identify
  • Treat
  • Reintegrate
• Team with caregiver resources as needed to address additional demands or replenish supports impacted be the event
• Training and context matter

AFTER A CRITICAL INCIDENT

Providing support for the five essential needs that people have following a critical incident helps to reduce the risk of stress injuries and enhances mission accomplishment in the face of adversity.

After a critical incident, the following are recommended:

• Evaluate
  • What are the existing strengths and vulnerabilities
  • What have the leaders already done
  • What resources are available or needed
  • Who else needs to know or can help (Chaplains, SPRINT, FFSC)
• Demonstrate concern for Sailors' well-being
• Ensure that the basic needs of survivors are met (i.e., shelter, food, safety, and security)
• Let people talk about their experience
  • Use After Action Review (AAR) in MCRP 6-11C/NTTP 1-15M Appendix E
  • Provide physical, emotional, moral safety
  • Honest communication
  • Facilitate understanding and meaning
• Minimize exposure to environmental stressors (e.g., heat, cold, noise, disturbing visual scenes, reporters and news media)
• Be attentive to the needs of family members
• Provide factual information and reduce the spread of rumors
• Continuously evaluate the environment for additional vulnerabilities and strengths
• Promote unit cohesion
• Foster resilience and promote recovery through social support mechanisms (e.g., friends, family, and religious organizations)
• Watch for post event related behavior changes between 3 to 6 months and on anniversary dates
• If additional mental health support (SPRINT, FFSC, Chaplains) is needed, refer to the COSFA Training Manual (Command Assessment Section) or MCRP 6-11C/NTTP 1-15M (Appendix O) to facilitate planning and support roles expectations.

SPECIAL CONSIDERATIONS

FIRST RESPONDERS

First responders (e.g., Corpsmen, Fire fighters, Police/Security Forces, or a unit member when the incident occurs at the work site) may experience repeated exposure to one or more sources of stress injury. MTF, Special Psychiatric Intervention Response Team (SPRINT), mental health teams or similar services may exist on each base to assist leaders with the unit assessment or provide Combat and Operational Stress First Aid (COSFA) support to mitigate potential negative effects of critical incidents. COSFA helps leaders understand post-event unit strengths and vulnerabilities, people to understand the expected reactions to critical events, and to promote early recognition and response to potential stress injuries.

BODY HANDLING

Sailors who handle human remains following a critical incident may experience a sense of accomplishment and feel they are doing something important. However, the stressors associated with body handling may be overwhelming. These stressors may include:

• Fear of the unknown
• Fear of their reaction when facing death
• Concerns about the health and safety of loved ones
• Being exposed to bodies of fellow service members
• Being exposed to children who have died
• Being exposed to mutilated bodies

It is not uncommon for Sailors to be anxious, sad, and irritable; or to suffer from restless sleep or nightmares for days after handling human remains. Training and preparation can significantly reduce the chances that these reactions will persist over time. Prior to handling human remains, educational briefings should be conducted explaining the exact nature of the work. Emphasize that proper handling of remains is highly important to the military and to the families of the deceased. Each body handling team should clearly know their tasks and roles with activities broken down into a series of routines and drills.

Team members should be made aware of what to expect, what symptoms they may experience and they should be encouraged to seek help in coping with their responses, when needed. Team leaders should conduct team or shift AARs to share challenges and successes before members are released to rest or go home or on liberty. Regular praise and encouragement should be given emphasizing the importance of their work. Those individuals who are more experienced with body handling should be paired with those less experienced. This buddy system helps protect against feelings of fear and a sense of personal isolation.

Alcohol use should be discouraged as a coping response. Fatigue can compromise coping skills. Sufficient rest, regular breaks and shift patterns are recommended. Other activities that leaders can organize to help prevent and minimize distress from body handling include:

• Encourage members to drink plenty of fluids, eat well, and maintain good hygiene.
• Assure facilities for washing hands, clothing, personal items and taking showers after each shift.
• Plan team activities to help members relax, unwind and to stay socially connected.
• Encourage individual stress management, physical fitness, and buddy-care activities.
• Keep chaplains and other helping professionals fully informed about what is happening.

RELEVANT GUIDANCE

U.S. Marine Corps & U.S. Navy. (2010). Combat and Operational Stress Control, MCRP 6-11C/NTTP 1-15M. Quantico, VA: Marine Corps Combat Development Command.

RESOURCES

U.S. Marine Corps & U.S. Navy. (2010). Combat and Operational Stress Control, MCRP 6-11C/NTTP 1-15M. Quantico, VA: Marine Corps Combat Development Command.

Nash, W. P., Westphal, R. J., Watson, P., Litz, B. T. (2010). Combat and Operational Stress First-Aid (COSFA) Training Manual. Washington, DC: U. S. Government.

REFERENCES

U.S. Marine Corps & U.S. Navy. (2010). Combat and Operational Stress Control, MCRP 6-11C/NTTP 1-15M. Quantico, VA: Marine Corps Combat Development Command.

Nash, W. P., Westphal, R. J., Watson, P., Litz, B. T. (2010). Combat and Operational Stress First-Aid (COSFA) Training Manual. Washington, DC: U. S. Government.

Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., et al. (2007). Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry 70(4), 283-315.

Keller, R. (2002). Handling human remains following the terrorist attack on the Pentagon: experiences of 10 uniformed health care workers. Military Medicine, 167, 8-11.

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