Table Of ContentCRITICAL INCIDENT
STRESS
AND
TRAUMA
IN THE
WORKPLACE
RECOGNITION...RESPONSE...
RECOVERY
GERALD W. LEWIS, Ph.D.
~l Routledge
~~
Taylor&FrancisGroup
NEWYORKAND LONDON
First published 1994 by CRC Press
This edition published 2012 by Routledge
27 Church Road, Hove, East Sussex BN3 2FA
711 Third Avenue, New York, NY 10017, USA
Routledge is an imprint of the Taylor & Francis Group, an informa business
LibraryofCongressCataloging-in-PublicationData
Lewis,GeraldW., 1950-
Criticalincidentstressandtraumaintheworkplace:
recognition,response,recovery/GeraldW.Lewis.
p. cm.
Includesbibliographicalreferencesandindex.
ISBN 1-55959-054-8
1.Jobstress.2.Psychictrauma. 3.Psychiatricemergencies.
4.Industrialpsychiatry. I.Title
RC963.48.L48 1994
155.9"3-dc20 94-48263
This book contains information obtained from authentic and highly regarded sources.
Reprinted materialis quoted withpermission, and sources are indicated. A wide variety of
references are listed. Reasonable efforts havebeenmadeto publishreliable dataand infor
mation, butthe authorandthepublishercannotassumeresponsibility forthe validityofall
materialsorfortheconsequencesoftheiruse.
Neitherthisbooknoranypartmaybereproducedortransmittedinanyformorbyanymeans,
electronic or mechanical, including photocopying, microfilming, and recording, or by any
informationstorageorretrievalsystem,withoutpriorpermissioninwritingfromthepublisher.
TrademarkNotice:Productorcorporatenamesmaybetrademarksorregisteredtrademarks,
andareusedonlyforidentificationandexplanation,withoutintenttoinfringe.
© 1994byCRCPress
NoclaimtooriginalU.S. Governmentworks
InternationalStandardBookNumber1-55959-054-8
LibraryofCongressCatalogNumber94-48262
In loving memory of
my dad,
Myron "Mike" Lewis
Dedication iii
ivCriticalIncidentStressandTraumaintheWorkplace
PREFACE
In 1990, after spending several years speaking, teaching,
and responding to critical incidents, I endeavored to write a
manual on the subject ofCritical Incident Stress andTrauma.
Myobjectivewasnotto do anotherdissertationwithzillions
of quotes from mega-zillions of references documented with
pagesoffootnotes. Also, anotherobjectivewasnottouseobscure
multi-syllabic words but rather to provide relevant information.
The feedback from those who purchased copies of the
manual was very positive and forthcoming and I was extremely
grateful. Itookthatfeedback, aswellas feedback from a second
(October 1991)andthird (June 1992)versionplusnewdebriefing
experiences, and included those insights in this book. In
addition, I have included material that was generated from the
training workshops and consultation that I have conducted
during the past several years.
Thematerialpresentedistheresultoftheresearchofothers
in combination with my own impressions from my work in this
relatively new field. Whenever possible, I attempted to cite the
source ofa quote ormaterialinthebodyofthemanual. Readers
may then refer to the bibliography ifthey choose to gather more
data from the original source.
Although the book may be of interest and assistance to
individuals in private practice, the content was not written for
thosewhoseprimaryprofessionalfocus isa clinicalpractice. My
goal was to write a nuts W1d bolts manual that would be of
assistance to professionals who (1) are employed as Emergency
Service Professionals (police, fire, hospital, crisis worker); (2)
deal directlywithvictims oftraumaintheworkplace; (3) provide
assistance to Emergency Service Professionals; (4) work in
Preface v
school systems; (5) work in acute psychiatric settings; (6) are
Employee Assistance Professionals; and (7) may work in some
manner with persons who are experiencing acute trauma and
crisis.
Gerald W. Lewis, Ph.D.
September 1993
viCriticalIncidentStressandTraumaintheWorkplace
TABLE OF CONTENTS
DEDICATION iii
PREFACE v
LIST OF FIGURES x
1. UNDERSTANDING STRESS AND STRESS
~AGEJ4ENT 1
GeneralConceptsofStress .... 1
BiologicalRelationships 2
StressinLife 5
Stress~anagement 8
2. CRITICALINCIDENT STRESS (CIS) 13
Crisis, Trauma, Disaster ..................................... 13
UnderstandingCriticalIncidentStress(CIS) 14
Definition 15
Release 15
~ulti-casualty 15
SingleVictimIncident ..................................... 16
SignsandSymptoms 17
Defense~echanisms 18
ReactionandTimeDelay ..................................... 19
Acute 19
Delayed 20
CumulativeorGradualCIS 20
3. DESCRIPTION OF "AT RISK" OCCUPATIONS 23
EffectsofStress 24
FactorsAffectingRisk 25
Intervention 25
Immediacy 26
Intensity 26
Instability 26
I'1formation 26
ImperilT11ent 27
Isolation 27
PublicApproval 27
CharacteristicsofIndividualsinHelpingProfessions 28
4. POST-TRAUMATIC STRESS DISORDER (PTSD) 33
DeterminantsofPTSD 34
RelationshipofCIStoPTSD 36
CaseexamplesofPTSDinClinicalPractice 36
Case 1 37
Contents vii
Case2 40
DynamicsInvolvedwithPTSD 42
Case3 43
Summary 50
5. DYNAMICSAND DEFINITIONS INVOLVED WITH
DIFFERENT TYPES OF CRISES 51
SituationalFactorsAffectingExtentofStress 52
Warning 52
NatureoftheCrisis 52
SeverityofCrisis 53
PhysicalProximity 53
PersonalFactorsAffectingIndividualsResponses 54
PsychologicalProximity 54
CopingSkills 55
Concu~entStressors 55
RoleConflict/Overload 55
PreviousExperience 56
Age 56
TemporalProximity 57
TraumaRecoveryPhases 57
Phase 1:Pre-impactPhase 57
Phase2:ImpactPhase 58
Phase3:PostImpactPhase 58
SummaryofTraumaRecoveryPhases 59
Stages inDyingandDeathExperience 59
DenialStage ............................................ 60
BargainiIlgStage 60
AngerStage 60
DepressionStage 60
AcceptanceStage 60
NormalityofTraumaReaction 61
6. CRITICALINCIDENT STRESS RESPONSE (CISR):
STRATEGIESAND INTERVENTIONS
TO DEALWITH CIS 63
Policies, Procedures, Programs(TheThreePs) 63
FortheDepartment/AgencyonanOngoingBasis 63
AsOngoingStrategiesfortheIndividualESP 66
AttheTimeoja CriticalIncident 66
IfanIndividualisExperiencingSymptomsofCIS 66
7. REACTIONS OF OTHERS 69
OpennessVersusClosurewithFamilyMembers 70
Spouse/SignificantOtherBecomestheVictim 70
DebriefingStaffandTheirFamilies ............................. 70
ESPWorkandPotentialAffectontheFamily 71
TimePlusProfessionalAssistanceNeeded 71
PrimaryI.evel 72
SecondaryI.evel 72
viiiCriticalIncidentStressandTrauma intheWorkplace
Tertiaryl.£vel 72
8. TRAUMAAND CRISIS IN THEWORKPLACE 75
ExamplesojCrisesand/orTraumaSituations 75
TraumaintheWorkplace 76
Layoffs,Downsizing, andOtherTransitionCrises ............... 78
Managers'Vulnerability 81
PrescriptionjorResolution 81
CopingwithTransition 83
CommunicationistheKey toTrust _ 84
9. GUIDELINES FOR CONDUCTING DEBRIEFINGS (AND
OTHER TYPES OF INTERVENTIONS) 85
Timingoja Debriefing 86
Pre-interventionPlanning 86
Post-interventionDiscussion 89
Componentsoja FonnalDebriefing 89
Introd..uction 90
"Painting thePicture"Phase 98
ReactionPhase ..........................................99
EducationPhase ........................................ 100
Follow-upPhase 100
OtherComponentsojtheDebriefing 100
OtherTypesojInterventions ................................. 101
ForIryuryorDeath ............... ....................... 101
ForVictimizationbyViolentCrime 101
ForSeriousfllnessorDeathojCoworker ..................... 102
ForEmployeesInvolvedina Robbery 103
ForEmployeesInvolvedina CorporateRestructuring 104
NotetoEmployeeAssistanceProjessionals 104
TheDifferenceBetweena CIS/TResponseandOtherMentalHealth
Interventions ............................................ 105
10. CRISES IN SCHOOLSETTINGS 107
SuicideamongAdolescents .................................. 108
CategoriesojSelf-harmingBehavior ........................... 108
Self-harmingGesture 109
PhysicalMutilation ...................................... 109
Self-destructiveBehavior 110
SuicideAttempt. ............................ .......... 110
SchoolProtocol ............................................ 110
ProtocoljorDeathorSuicide 114
Summary ................................................ 118
BIBLIOGRAPHY 119
INDEX 125
ABOUT THEAUTHOR 131
ABBREVIATIONS 134
Contents ix
