Acute stress effects
The common negative experiences of acute stress that occur after an emergency include: fatigue, sadness, guilt, recurring images, intrusive thoughts. If they last up to four weeks, the individual may be suffering from acute stress disorder. However, if these symptoms last for more than a month, then the individual may be diagnosed as suffering from post-traumatic stress disorder (PTSD) (see Box 7.3).
Box 7.3 PTSD and war
Bower et al. (2005) told the story of Jim Batchelor, a wounded US army infantryman who, despite surviving a gunshot wound between the eyes, was crippled by PTSD. His symptoms included: nightmares and flashbacks, emotional numbness, irritability, difficulty sleeping, migraines, depression and inexplicable fits of rage. Every night he had a recurrent nightmare about the intense firefight in which he was wounded only four days after arriving in Baghdad.
A study by Hodge et al. (2004) of 1,709 US soldiers who had returned from serving in Iraq or Afghanistan found that, just as in the Vietnam and first Gulf war, PTSD was the most prevalent mental illness suffered by US soldiers. The prevalence of PTSD was directly related to the level of fighting to which the soldiers had been exposed. Those soldiers who had not been in an exchange of weapons fire had a PTSD incidence of 4.5%. If the soldiers had been involved in one or two firefights, the incidence doubled to 9.3%, three to five firefights resulted in an incidence of 12.7%, and more than five firefights produced an incidence of 19.3%.
PTSD and acute stress disorder can occur following an individual’s involvement in a critical incident. A critical incident is an event that is out with the usual range of experience, and challenges one’s ability to cope (e.g. exposure to violent death) (Everly and Mitchell, 2000). PTSD is a syndrome that is medically recognised as a mental disorder (American Psychiatric Association, 2000). The criteria for a diagnosis of PTSD and acute stress disorder are:
- 1. The person has been exposed to a traumatic event that involved actual or threatened death or serious injury, and the person’s response involved intense fear, helplessness or horror.
- 2. The traumatic event is persistently re-experienced (e.g. dreams, recurrent recollections, flashbacks).
- 3. Persistent avoidance of things associated with the trauma (e.g. thought, activities) and numbing (e.g. feeling of detachment, unable to show loving feelings, lack of interest in the future).
- 4. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance, or exaggerated startle response.
As described above, the symptoms of acute stress at a team level are failures in the team members to work effectively together. The effects of poor teamworking will depend upon the task the team is performing. In an emergency response situation this may lead to a failure to manage an incident effectively, resulting in increased loss of life. In a production process (e.g. nuclear power generation, offshore oil production), a failure to manage an incident may lead to increased damage to equipment, loss of production and higher risks to the crew. See Chapter 5 for more information on the effects of failures in teamworking.