ACEP COVID-19 Field Guide

Author: International Critical Incident Stress Foundation

You have experienced a traumatic event or a critical incident (any event that causes unusually strong emotional reactions that have the potential to interfere with the ability to function normally). Even though the event may be over, you may now be experiencing, or may experience later, some strong emotional or physical reactions. It is very common, in fact quite normal, for people to experience emotional aftershocks when they have passed through a horrible event.

Sometimes, the emotional aftershocks (or stress reactions) appear immediately after the traumatic event. Sometimes, they appear a few hours or a few days later. In some cases, weeks or months pass before the stress reactions appear.

The signs and symptoms of a stress reaction may last a few days, a few weeks, a few months, or longer, depending on the severity of the traumatic event (Table 14.2). The understanding and support of loved ones usually cause the stress reactions to pass more quickly. Occasionally, the traumatic event is so painful that professional assistance is necessary. This does not imply craziness or weakness. It simply indicates that the particular event was too powerful for the person to manage alone. 

Table 14.2 Common signs and signals of a stress reaction.

* Any of these symptoms may indicate the need for medical evaluation. When in doubt, contact a physician.

Things to try

• Within the first 24- to 48-hour period, appropriate physical exercise, alternated with relaxation, can alleviate some physical reactions.
• Structure your time; keep busy.
• You are normal and having normal reactions; don’t label yourself “crazy.”
• Talk to people; talking is the most healing medicine.
• Be aware of numbing the pain with overuse of drugs or alcohol. You don’t need to complicate this with a substance use problem.
• Reach out; people care.
• Maintain as normal a schedule as possible.
• Spend time with others.
• Help your coworkers as much as possible by sharing feelings and checking out how they are doing.
• Give yourself permission to feel upset or rotten, and share your feelings with others.
• Keep a journal; write your way through those sleepless hours.
• Do things that feel good to you.
• Realize those around you are under stress.
• Don’t make any big life changes.
• Do make as many daily decisions as possible that will give you a feeling of control over your life. That is, if someone asks you what you want to eat, answer, even if you are unsure.
• Get plenty of rest.
• Don’t try to fight reoccurring thoughts, dreams, or flashbacks. They are normal and will decrease over time and become less painful.
• Eat well-balanced and regular meals, even if you don’t feel like it.

Tips for family members and friends

• Listen carefully.
• Spend time with the traumatized person.
• Offer your assistance and a listening ear if they have not asked for help.
• Reassure them that they are safe.
• Help them with everyday tasks like cleaning, cooking, caring for the family, and minding children.
• Give them some private time.
• Don’t take their anger or other feelings personally.
• Don’t tell them that they are “lucky it wasn’t worse.” A traumatized person is not consoled by those statements. Instead, tell them that you are sorry such an event has occurred and you want to understand and assist them.