Critical incidents are recognized disasters, individually significant events involving death or serious injury and necessitating rescue or emergency care; or other crisis situations that energize unusually strong emotions. Critical incident participants respond with predictable systemic stress reactions, involving normal and pathological grief patterns, and may develop posttraumatic stress disorder. Moderating variables that influence patterns of stress vulnerability include the following factors: the objective and subjective severity of the catastrophe; characteristics of the victim or the perceived demographic similarity of the victim to a significant other; personality characteristics; social factors; relative viability of coping strategies; and ethical or spiritual concerns. The more central and significant an experience or relationship, the more intense will be the reactions. Appropriate critical incident crisis-care can provide needed emergency mental health services, prevent the formation of some posttraumatic stress disorders, and therapeutically modulate the long-term effects of calamity for victims and emergency care providers. Effective provision of mental health services includes preincident preparedness, early intervention with psychological first aid, and postdisaster treatment using critical incident stress debriefing, grief counseling, brief multimodal therapy, referral to traditional therapy or counseling if necessary, and follow-up. Procedures and issues at each level of intervention are discussed in this article.
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