What Is Critical Incident Stress? How Do We Manage It?

Smoke and flames visible from the structure
Photo courtesy of Tim Olk

In the fire service, we don’t look at our actions in the line of duty from the point of reactivity. We don’t arrive on the scene of a working house fire with the apparatus in no particular order, wondering who is going to hit the hydrant and then draw straws to see who is going to advance the line in the front door. We don’t arrive at vehicle accidents with entrapment and wait until we’re looking at the patients who need our help to determine who is going to stabilize the car, who is going to operate the power tools, and who is going to make entry into the vehicle. We are prepared ahead of time for it all.

We study major incidents like September 11, 2001, and glean knowledge like the safest location for the command post and how to manage an incident on that scale. We study line-of-duty deaths and close calls, we pore over National Institute for Occupational Safety and Health reports, and we listen to the recorded radio traffic to better equip ourselves to do our job in the most effective and safe ways.

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We study incidents like the Super Sofa Store fire in Charleston, South Carolina, or the Station Night Club fire in West Warwick, Rhode Island. We engrain the past lessons learned into our minds and run training scenarios based around incidents that went catastrophically wrong. We breathe sighs of relief at close calls and vow never to let that scenario happen that way again.

From our first day as firefighters, we are training. We begin by learning how to quickly don our gear, how to connect to water supplies, and how to operate small hoselines. We throw ladders endlessly, calling out “wires” to get ourselves in the habit of checking overhead every single time. We learn how to speak clearly through our masks and how to properly talk on the radio. We learn how to navigate and respond to calls, operate safely and effectively on scene, and return to our station and return our equipment to service. But, that is where our training ends.

Critical Incident Stress Also Provides Lessons

We receive no training about what to do with the calls we can’t leave on the scene, with the memories that accompany us home. We don’t speak openly about the impact all of this has on our families, our spouses, and our children. We don’t speak openly about any of this until one of our coworkers is brought to crisis. We don’t acknowledge the toll our job can take on us until we are at the point of burnout, compassion fatigue, or unbearable cumulative stress or until we are forced to walk away from the job completely.

We wonder why first responders have high rates of addiction but are not willing to see what proactive steps we could be taking today to prevent that. We simply wonder what we could have done differently in retrospect. But the lessons surrounding critical incident stress (CIS) and the chronic trauma exposure we have are there if we would only be willing to learn them. Just as we study many major incidents from a perspective of resource management, communication, personnel accountability protocols, and strategy and tactics, we can also study them from the perspectives of CIS and how to manage it.

A Critical Call vs. a Traumatic Call

What is the difference between a critical call and a traumatic call? To put it simply, the difference is that a traumatic call is one that overwhelms our ability to cope with it. Furthermore, a traumatic call can be subjective to each of us. Some calls are objectively traumatic to an entire community, including the emergency services workers, like a mass shooting or an act of random violence. Some calls are traumatic to an entire department, like a line-of-duty death or an off-duty death of a member. Some calls are uniquely traumatic to us as individuals. For example, a call involving a child could be more traumatic for responders who are parents than for those without children. Understanding the difference between these types of calls is very important; even more important is knowing ourselves well enough to realize when something about a call is affecting our emotional and mental health.

However, we have a significant lack of education on these topics and a significant lack of tailored resources to address these issues within our unique community. Even more so, we can sometimes live and work in a culture that encourages us to stay silent. We react with apathy or even fear if a coworker opens up and tells us he is struggling. Sometimes, we simply don’t know what to do or say. We might even think that someone dealing with post-traumatic stress (PTS) or post-traumatic stress disorder (PTSD) is making it up or being overly dramatic.

The Stress Continuum

PTSD is a real, chemical change that takes place within our brains and bodies if we have survived a significant trauma. It’s a natural defense mechanism our body puts in place to protect us and keep us safe from what it deems to be threatening. PTSD is very real and is not something that should ever be dismissed, as it greatly impacts the emergency services community. PTSD is responsible for and contributes to firefighter suicides. It is an important topic to understand, and it’s vital that we actively move toward making this a less stigmatized topic.

It’s also important to understand what PTSD is not. I often hear it used as a blanket term, but it does not apply to everyone and to every situation. There is something called the “stress continuum” I speak about often, and I believe all firefighters and officers should be well-versed in it. The stress continuum consists of three forms of stress—PTS symptoms, acute stress, and PTSD.

PTS symptoms. The day of a traumatic call, say a fatal car accident involving a child or any other traumatic death, most things we feel are normal. Trouble sleeping, eating, and keeping our normal routine and feeling really preoccupied by the call are expected. Our brain is trying to process and make meaning out of a tragic incident in which we took part. You may be preoccupied or distracted by thoughts of “Did we get there fast enough?” “Did I do my job fast enough?” “Did we do absolutely everything we could to help them?” You might have trouble falling asleep that night, and you just may not feel like yourself the next day either. Usually, the further away we get from an incident like this, the closer we get back to our baseline, and the call becomes more of an afterthought.

Acute stress. Now, if we are a few weeks out from a traumatic call and these PTS symptoms are not getting better and are instead getting worse, we could be dealing with something called “acute stress.” And not until 31 days post a significant trauma could we potentially be diagnosed with PTSD. Most people are not sitting in front of a therapist on day 31, but it’s important that we understand that feeling preoccupied about a call or even dreaming about it a few days after it is completely normal and nothing to panic about.

Fire leaders want to do right by their people. They want their firefighters to be whole and happy. They want to see their people thrive in this career. Officers want to help but, just like firefighters, they aren’t taught how to deal with these issues. Leaders aren’t taught how to lead through them either. And, even more so, chiefs aren’t taught how to take care of themselves when they are leading their department through a tragedy, big or small. If you are an officer wondering how your department will cope in response to a tragedy, reach out to departments who have dealt with tragedy before.

Take, for example, the Orlando, Florida, firefighters who on the night of June 12, 2016, heard a barrage of gunfire and walked out to find their front ramp littered with bleeding bodies. Or the tragic Parkland, Florida, shooting that took place in 2018. Some of the same peer support team members responded to both of those incidents. They have a wealth of knowledge on what went well and what they would have done differently from a crisis-response perspective. From my perspective, and with what I know about the responses, departments nationwide can learn a great deal on how to properly support all of their members after incidents like these.

The fire service and our experiences in it can have a positive and a negative impact on our mental health. Positively, the fire service gives us membership in a strong community, and it gives us an incredible sense of purpose. Conversely, being a part of the fire service also gives us a unique and even chronic exposure to trauma with which we are not equipped to deal. This is not something we are prepared for, and it certainly is not something on which we train.

Speaking openly about our mental health isn’t something we can do just once. It’s not something we can spend a short amount of time on during Essentials class or during an academy. Just as we engage in continuing education on hazardous materials response, bloodborne pathogen safety, and cardiopulmonary resuscitation protocols, we must continuously be learning and creating a space for these conversations to take place without negative ramifications.

It is never too late to address the ways our lives have been impacted by a trauma or by PTSD. As firefighters, we are so used to having all the answers, putting others’ needs before our own, and being those on whom people depend. We are used to toughing our way through adversity and powering through with a smile on our face because we get to do this job that we love.

Leaders, understand that not everyone needs the same help and not everyone needs help at the same time. After critical incidents, progressive departments recognize that their personnel won’t need help just in the first few days after an incident but that some will likely need and deserve help many years after. Who needs help and who needs the most help could be determined by one’s emotional or physical proximity to a trauma or tragedy. But, it’s important not to put expectations on anyone’s healing, and it’s essential that we don’t put a timeline on the availability of resources. We can’t force anyone to get help. We can only provide them a path forward and ensure that they won’t be walking it alone.


ALI ROTHROCK is a speaker, an author, an educator, and an advocate. She has delivered more than 500 presentations nationwide. She has been in the volunteer fire service since 2005, with more than a decade as a firefighter and an emergency medical technician. She is the CEO and lead instructor for On the Job and Off, an online platform dedicated to building more resilient first responders. She is a certified trauma responder through the Association of Traumatic Stress Specialists. She has worked as a sexual assault and domestic violence counselor and has served on multiple national diversity and inclusion committees. She is the eastern division trustee for Women in Fire. She is the author of Where Hope Lives, a memoir detailing her journey through her first few years in the fire service. She is writing her second book After, which details her story of trauma recovery and features others’ stories too.

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