A critical incident, by definition, is an extraordinary event that shocks our systems, challenges our usual ways of coping and thrusts us into a period in which we search for ways to adjust to the harsh reality that has touched our lives.

While critical incidents come in many forms, (such as suicide, catastrophic injury and accident, or acts of violence, terrorism or war), most involve a serious threat to life or actual death. The more closely our lives are connected to those who are hurt or have died, or the more we identify with those affected, the more severe is our personal trauma.

The ways that people respond to crisis can vary widely. Reactions are influenced by many factors, such as gender, age and culture. They are also influenced by our "stress load" at the time of the critical incident, and our mental status. The more emotionally resilient we are under normal circumstances, the better we are likely to fare when under duress.

Given the wide range of factors involved in how we respond to critical incident stress, how do we best care for ourselves during this critical period, when both our emotional and physical systems are under duress, and our choices can affect both the speed and degree of our recovery?

Some recommendations for care are universal. One cannot recover from trauma without adequate sleep and nutrition. Psychoactive substances, such as alcohol and other recreational drugs, can interfere with the psychological healing process or arrest it entirely, and should be avoided. Those with medical conditions should be monitored by trained medical personnel during the post-incident period, to insure that critical incident stress has not exacerbated their condition. The same holds true for any individual with a pre-existing psychiatric condition.

Beyond these basic (but important) recommendations, the rest must be customized to the particular individuals affected, if they are to be useful.

Let's take as an example one critical task during recovery, which is the reestablishment of a sense of safety. For some, this will mean leaving the environment in which the critical incident occurred, so that they feel less exposed to the type of trauma that brushed close to them, or taking additional safety measures within that environment. However, when environmental changes are not practical or feasible, or do not exist (such as in the case of an individual who was traumatized by random violence), feeling safe is more often a psychological phenomenon.

A sense of psychological safety will be achieved by different people in different ways. Young children often need a familiar routine to feel safe again, as well as a strong adult presence to take charge and relieve the child of concerns that they are not yet developmentally able to resolve. Routines often help adults, as well, to regain a sense that life is predictable and manageable.

Many people have a strong need for affiliation to ease feelings of insecurity and vulnerability. This can be a need for the company of others who can listen, understand and relate to the feelings evoked by the traumatic experience; or it can be the need for the calming effects of human touch, from another person who cares. For others, there is a need to turn to spiritual beliefs. For those with a strong family orientation, connecting with family members may make the traumatized individual feel less alone, and safe and secure once again.

Others will have a strong need to intellectually master the causality of the critical incident, to reestablish safety. Armed with all the information that can be gathered, the individual then feels more prepared to protect him/herself from a similar occurrence.

Other recovery tasks will also need individualization. Stress reduction regimens may be necessary, to diminish high levels of nervous system arousal and reduce stress hormone levels. These might range from exercise, to various types of relaxation exercises, to getting a massage, to psychoactive medication, to taking a vacation. Life-Stress Interventions, to reduce stresses from sources other than the trauma, (such as additional care assistance with young children or the elderly, reduction in family or marital conflict, or financial counseling), will help insure that adequate emotional, intellectual and physical resources, needed to successfully deal with the critical incident trauma, are available.

If you have the opportunity to receive formal Critical Incident Stress Management Services following the traumatic incident, the Crisis Management team can assist with the customization of of a self-care plan. There are also resources available through Employee Assistance Programs, health insurance and community mental health centers.

Roberta Cohen, LCSW is a grief counseling expert that provides critical incident stress management services.