The evolution of crisis care and response in the field of traumatology in the past 95 years has been profound. In recent years, the results of trauma research have greatly influenced accepted best practices. This article contains the most current information available. 

 

Trauma has overtaken mental illness and AODA issues as a public health problem in America. It is believed that about 90% of our population will be exposed to a traumatic event during their lifetime. This includes about 40% traumatic event exposure for children and adolescents. Each year about one million persons are victims of violent crime at work.

We will review a brief history of trauma, discuss critical incident stress, and look at the focus of interventions including psychological first aid and other key concepts.

Trauma is a Greek work meaning “wound” of the mind, soul, and spirit. Recent research into the American Civil War medical charts confirmed that soldiers suffered with PTSD symptoms. Our current history starts with World War I.   In 1915 a British military psychiatrist named Charles Myres, coined the term “shell shock.” During World War II that term was changed to “battle fatigue.” During the Second World War the U.S. military developed the first successful intervention for battle fatigue; R & R.   That intervention was “rest and recuperation.” It was during the Korean War that more advances were made to deal with battle fatigue. Mobile Army Surgical Hospital was developed. MASH became a household term when the number one TV series aired during the 1970’s.

 

The Vietnam War brought another change for the term trauma. In 1980 Charles Figley Ph.D. led research which identified “Post Traumatic Stress Reaction.” In 1983 Charles Figley identified the concept “critical incident stress.” That same year Jeffery Mitchell developed the CIS Management Debriefing model. In 1993 traumatology was recognized as a science as defined by Charles Figley. Charles Figley was the first president of the International Society for Traumatic Stress Studies.

 

In the current wars in Iraq and Afghanistan the military use the term “combat stress” to describe battle trauma of the mind and spirit.

Critical incident stress happens when an individual or group experiences a traumatic event that causes a significant stress reaction.   The stress reaction can be physical, cognitive, emotional, behavioral, spiritual, or a combination of the above. The long-term or delayed effects (consequences) of a critical incident are collectively called post-traumatic stress.

 

Today, in the aftermath of a traumatic event the focus is on post traumatic growth, not psychopathology. The focus is on individual recovery and not the development of illness and disorders. A majority of traumatized individuals who develop post traumatic stress reactions do not develop PTSD Disorder. This understanding is foundational for helping people recover and preventing long term problems.

With the advancement of theory and research in the field of traumatology the traditional CIS Management/Debriefing Model has been replaced by the Psychological First Aid Model. This new model increases the potential for recovery by avoiding intervention that can re-traumatize people.

 

Psychological First Aid (PFA) is an approach used to help children, adolescents, adults, and families in the aftermath of trauma, disaster, and terrorism. The goals of Psychological First Aid/Critical Incident Stress Response are to reduce initial distress caused by a traumatic event, to help people cope, adapt, and recover, and to help prevent long-term consequences.

As providers of trauma services, we need to always remind ourselves: “Do no harm while doing you best.” We need to help people normalize their reactions. We need to provide safety, comfort, compassion, and support. Avoid retraumatizing them. Provide both confidential and private services. Interventions should be separated from job- related critiques or evaluations. 

 

For emergency workers: medical, law enforcement, fire, emergency medical services, etc., recovery is often more successful when these professionals are educated about critical incident stress response as part of their ongoing training. 

 

After a traumatic event it is helpful for individuals to develop a “personal self-care plan.” This is a time for them to take extra care of themselves. Rest, moderate exercise, and healthy diet significantly help the recovery process. Ask them to avoid stimulants such as caffeine, chocolate and nicotine. They should also avoid depressants such as alcohol. Instead seek out comfortable surroundings. Noises, violent movies and violent video games often slow the recovery process. Tell them it is a good idea to set boundaries with people who are not helpful. Activities that promote peace of mind and relaxation both physically and emotionally enhance recovery. Suggest to them that whatever they do, moderation is good, but excessiveness is usually bad. 

People need time to recover. Most reactions will be short term. Explain to them that as long as the intensity of their reactions and the frequency of their reactions slowly decrease over time, they are making positive progress toward recovery. If their reactions do not diminish over time, they need to consider professional help. In seeking help, look for a provider who is “trauma informed” and who have received training regarding psychological first aide.

 

Gary Yeast has 35 years of clinical and graduate teaching experience in behavioral health. For the last 22 years, he has specialized in trauma, disaster, and terrorism mental health services. In addition to his private practice, he works at Associated Employee Assistance Services. Gary also provides services for Critical Incident Stress Service, Crisis Care Network and the American Red Cross. Gary lives in Wausau, Wisconsin.