A critical incident is an event that is disturbing, sudden, and unexpected that causes us arousal, avoidance, and re-experiencing. Critical stress is a common reaction, in normal persons, to unusual situations. About 86% of people will have a reaction. If unmanaged 22% will have stress symptoms for six months to a year. Stressors stretch your coping mechanisms. Devastating events can overwhelm normal coping strategies and lead to unhealthy or destructive behaviors. Stress reaction may be immediate, delayed, or cumulative. Other stressors in your life may influence the process

Factors Influencing Individual Reactions Include: Coping mechanisms developed from past experiences, Degree of personal danger, Duration of exposure, Magnitude of the incident, Media interference, Ostracism by co-workers, family, or the general public, Personal relationship with the victim(s), Recent tragedies, Similar experiences, Support and understanding of fellow-workers, Support and understanding of management, Your expectations, personality, and role.

Monitor changes in your reactions. These reactions can also help you notice reactions of people that you care about. While the list is long, it does not include all possible reactions. Use it as a guide.

Physical [check with your physician}: Aches and pains, Chest pain, Chills, Difficulty breathing, Difficulty falling and staying asleep, Digestive problems, Dizziness, Eating problems, Elevated blood pressure, Exhaustion, Fainting, Fatigue, Grinding of teeth, Headaches, Hyper vigilance, Muscle tremors, Nausea, Poor coordination, Profuse sweating, Rapid heart rate, Sexual problems, Shaking or rubbery legs, Shock symptoms, Sleep disturbances (insomnia), Temporary hearing loss, Temporary impaired vision, Thirst, Tremors, Twitches, Unexpected weight gain or loss, Vomiting, or Weakness.

Cognitive: A sense of shortened future, Amnesia, Blaming someone, Comprehension problems, Concentration lapses, Confusion, Decision-making difficulties, Difficulty identifying objects or person, Difficulty with simple calculations, Disorientation of time, place or person, Disturbing memories of the event surface, Dreams or nightmares related to the event, Heightened or lowered alertness, Hypervigilance - being easily startled - jumpy, Impaired thought processes, Inability to concentrate, Inability to distinguish between trivial and important matters, Inability to remember information, Increased or decreased awareness of surrounding, Intrusive images, Loss of interest in activities previously enjoyed, Loss of memory associated with central aspects of the event, Loss of skills, Memory loss, Nightmares, Poor abstract thinking, Poor concentration, Problem solving difficulties, Reduced judgment and memory, Suspiciousness, Trouble establishing major priorities, and Uncertainty.

Emotional: Agitation, Anger, Anxiety, Apprehension, Avoidance of thoughts/feelings associated with the event, Denial - repression of feelings, Depression, Emotional outbursts, Emotional shock, Excessive suspicion/caution in dealing with others, Fear, Fear of repetition, Feeling as if the event were happening again, Feeling detached and estranged from others, Feeling keyed up and unable to relax, Feeling overwhelmed, Grief, Guilt, Helplessness, High anxiety, Hopelessness, Inappropriate or unusual emotional responses, Intense anger, Intense irritability, Loss of emotional control, Loss of loving feelings toward others, Loss of self-worth and self-confidence, Mood swings from giddiness to despair, Numbing of emotions, Panic, Psychic numbing -sublimating emotions, Psychological distress at the anniversary of the event, Restlessness, Unusual sense of vulnerability, and Withdrawal from family, friends, colleagues.

Behavioral: Absentmindedness, Antisocial acts, Avoidance of activities that recall the incident, Change in social activity, Change in speech patterns, Change in usual communications, Changes in attitude to the job, Changes in reactions to others, Erratic movements, Hyper-alert to environment, Hyper-vigilance, Inability to rest, Increased accident or complaint frequency, Increased alcohol consumption, Increased number of mistakes, Intensified pacing, Loss or increase of appetite, and Withdrawing from personal relationships.

There are some basic do's and don'ts that will help you effectively deal with your reactions to a critical incident. Some of the basic ones include:

DO'S FOR YOURSELF: Accept limitations, Alternate short physical exercise with relaxation, Be alert to unusual behavior that gets worse over time, or doesn't seem to be getting better, Check on how your peers are doing, Deal with feelings now or they'll deal with you later, Dreams and recurrent thoughts are normal and should become less painful, East regular balanced - regular meals, Get extra help, if necessary, Get rest, Give yourself permission to feel a range of things, Have a "flight surgeon" [complete] physical three to six months after the incident, Have fun - laugh, Help each other, If your progress is not to your or those close to you satisfaction - SEEK HELP, Keep major decisions to a minimum, Keep reasonably busy, Know that you are normal, Learn as much as possible about Critical Incident Stress, Maintain a normal schedule, Make short-term plans to keep you busy and interested, Reach out to people you are close to, Realize that you and others are under stress, Relax by deep breathing or deep muscle relaxation technique, Release emotions, Remember it's OK to have feelings, Remember the symptoms probably will subside, Take pride in what you have accomplished, Take time to do normal activities, Talk it out with each other, family and friends, and Talk to people you trust.

DON'TS: Act out your feelings; Automatically stay away from work, Be overly idealistic, Expect too much too soon, Have unrealistic expectations for yourself, Increase your alcohol use - if you need one -don't, Label yourself as crazy, Look for easy answers - some things just don't make sense, Make life changing decisions - now, Use more coffee or too much sugar, or Withdraw from family, friends and co-workers.

You are not alone. Attend to family and friends. You can help them. They can help you. They may be able to gauge your reactions better than you can. Be sensitive, responsive and patient to their needs and requests, Don't criticize, Don't take anger and frustration personally, Don't try to talk them out of their feelings, Encourage your family member[s] or friend[s] to talk about the incident, Family and friends are especially important, Have some private time, Help with daily tasks, Know that your family members may also have reactions to the event, Listen, Listen sympathetically --even if you don't understand their reactions to what happened, Nurture special caring of family and friends, Offer a sounding board, Offer support, Say "I'm sorry," Share how you feel, Spend time together, Try not to play "What If."