Emergency Management Ontario

Public Education

Fact Sheet
Critical Incident Stress

Emergency responders and public safety personnel are routinely exposed to traumatic and sometimes, life-threatening situations. Natural disasters, accidents involving children, mass casualty events, hostage situations, and terrorist attacks are some examples of events known as "critical incidents". Sometimes these critical incidents can be so traumatic, and overwhelming, that those responding to the emergency experience a significant stress reaction that affects them both physically and/or psychologically. The critical incident may interfere with the emergency responder's or public safety personnel's ability to function at the scene of the incident, and/or away from the incident scene.

Some examples of recent critical incidents are the Eastern Ontario ice storm and the Swiss Air crash off the coast of Peggy's Cove, Nova Scotia. However, not all critical incidents have to occur on this scale.

Critical Incident Stress Management (CISM) should be considered an essential element of emergency management. It is important for all emergency responders and public safety personnel to recognize the signs and symptoms of critical incident stress so they are able to take appropriate actions to mitigate their effects. It is equally important for those emergency responders and public safety personnel in management roles to implement measures to help prevent critical incident stress among their workers.

Examples of events that can trigger critical incident stress

death of a child;
suicide or unexpected death of a team member;
death or serious injury of a team member;
personal identification with circumstance or victim;
mass casualty incident;
unusual or disturbing sights, smells, and sounds;
life-threatening situations

Proactive prevention of critical incident stress

There are proactive steps that can be taken to help emergency responders and public safety personnel deal with critical incident stress before an emergency occurs.

It is imperative that emergency responders and public safety personnel be aware of the signs and symptoms of critical incident stress.

Local and remote/provincial Critical Incident Stress Management (CISM) teams must be established in advance of an emergency, as part of an emergency plan. The purpose and function of these CISM teams must be communicated to workers so that in an emergency, all workers understand the help that is available to them.

Signs and symptoms of critical incident stress

Physical

chills
thirst
fatigue
stomach ache
nausea/vomiting
fainting
twitches/tremors
difficulty breathing
dizziness/weakness
decreased co-ordination
chest pain
headaches
elevated blood pressure
rapid heart rate
muscle tremors
visual difficulties
profuse sweating
sleep disturbances

Cognitive

confusion
nightmares
uncertainty
hyper vigilance
suspiciousness
intrusinve images
poor problem solving
poor concentration
memory loss
reduced attention span
difficulty making decisions
heightened/lowered alertness
increased/decreased awareness of surroundings
placing blame
obsessed with details
flashbacks
inability to do arithmetic

Emotional

fear/anxiety
grief
guilt
panic
denial
irritability/agitation
sadness
depression
numbness
anger
apprehension
hopelessness
emotional outbursts
overwhelmed
resentment
loss of emotional control
inappropriate emotional
response

Behavioural

withdrawal/isolation
antisocial acts
argumentative
inability to rest
intensified pacing
erratic movements
change in social activity
loss/increase in appetite
accidents/illness
hyper alert to environment
increased alcohol consumption
increased drug use
increased smoking
change in speech patterns
change in usual
communications
job change

If any of these symptoms persist or become overwhelming, an individual should consult with a physician or mental health professional.

Emergency Management Ontario and Critical Incident Stress Management (CISM) Teams

Emergency Management Ontario (EMO), Ministry of Community Safety and Correctional Services, is mandated to monitor, coordinate and assist with declared emergencies, and to promote, develop, implement and maintain emergency management programs throughout Ontario. In general terms, the province supports the community and, where required, coordinates the response of provincial ministries/agencies to community emergencies.

EMO monitors and assists municipalities from the Provincial Operations Centre (POC) in Toronto. Should the emergency be large scale and/or expected to be of long duration, the POC will become functional. EMO would bring their staff, representatives from any or all provincial ministries, and federal representatives to the POC.

The POC staffing would include a provincial co-ordinator for CISM, normally the chair for the Ontario CISM Advisory Council.

The delivery of CISM team resources/services at any incident relies on the effective management of five key areas: co-ordination/command, operations, administration/finance, logistics and planning. The CISM provincial co-ordinator is responsible for the assessment of CISM needs of impacted personnel; developing a strategy and plan for CISM service delivery; implementation of the plan; reviewing strategy and plans; liaising with agencies, organizations, and governments affected or responding to the incident; and the supervision and management of the operations, administration/finance, logistics, and planning spheres of CISM.

Local CISM Resources

The CISM team(s) at or near the incident will be the first CISM personnel to be aware of any major event. For this reason, the local CISM team is expected to initiate a response to the incident. These CISM teams will:

establish an operational contact point;
appoint a CISM incident coordinator;
make an assessment of the potential CISM response needed and make the appropriate calls for assistance; and
provide services appropriate to the need and to the level possible.

If the emergency is serious enough, the municipality may declare an emergency and EMO will be notified.

Major emergency CISM response: Local CISM co-ordinator's role

The co-ordination of CISM responders can be facilitated at the local level only, or at both the local level and at a remote/provincial location such as the POC. The local CISM co-ordinator's role is to:

be the primary CISM contact for personnel involved in incident rescue, recovery, or mitigation;
provide a strategy and action plan for CISM resource; and
ensure the five management areas are being addressed.

Major emergency CISM response: Remote/provincial CISM co-ordinator's Role

The remote or provincial CISM Coordinator's role is to:

support the local role;
plan for CISM personnel acquisition and deployment;
in conjunction with the local co-ordinator, ensure the five key management areas are being addressed; and
assist in financial management, where possible.

When a major emergency has occurred and it has, or will, exhaust the local CISM team resources, the local CISM Co-ordinator will inform the provincial CISM co-ordinator. With this notification, additional resources will be located and dedicated to the local CISM co-ordinator.