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Tuesday, March 13, 2012


Hey there.  I have been involved with critical incidents for twenty years now because of my experience in the EMS, and for the last 13 years because of my education, experience, and expertise in CISM (Critical Incident Stress Managment).  If you are in the Emergency Service, a common question that is probably posed to you is, "What is the worst thing you have ever seen?"

According to the Emergency Medical Field, the top ten worst, or Terrible Ten are...

1.  Suicide of a colleague
2.  Line of duty death
3.  Serious line of duty injury
4.  Disaster/MCI
5.  Witnessed Police shooting and/or killing or wounding someone
6.  Significant event with children
7.  Relatives of known victims
8.  Prolonged incident especially with loss
9.  Excessive media interest
10.Any powerful and significant event deemed by the participant

According to the Law Enforcement Agencies the Terrible Ten are...

1.  Line of duty death
2.  Suicide of a colleague
3.  Serious work related injury
4.  Multi-casualty/disaster/terrorist event
5.  Events with a high degree of threat to the organizations personnel
6.  Significant events involving children
7.  Events in which the victim is known to the organizations personnel
8.  Events with excessive media interest
9.  Events that are prolonged and end with a negative outcome
10.  Any significant powerful, overwhelming event

This information is compiled via SOP's (Standard Operations Procedures) from several different agencies.

From my experience, and documentation, from the last 20 years, I have found to be the worst as follows...

1.  Death of a coworker who was a very good friend.
2.  Suicide of a coworker who was a very good friend.
3.  Responding on a call to a coworker, which resulted in a death.
4.  Very gruesome, multi-victim, high profile media case, with children involved.
5.  Responding to a family member that resulted in death.
6.  Responding to a coworker that involved serious illness, or injury.
7.  Responding to a call involving an acquaintance that resulted in death.
8.  Multi-victim death, high profile media case, with several witnesses to the call.
9.  Traumatic death of a child similar to own child's age.
10.Serious line of duty injury.

Why do I say that these are the worst?  It is because I have seen these incidents transpire personally, the majority of them I have done the actual intervention, and the worst is displayed by the lack of recovery by the individuals involved.  This is just my personal experience and humble opinion. 

Why do I post the Terrible Ten?  It is because I have seen, and still see, others who have not recovered from these types of incidents, and I want people to know that recovery is possible.  I know, with all my heart and soul, with out any doubt, that we can recover from these types of events.

If you do need recovery, what do you need recovery from?  When people suffer from critical incidents that affect them, they suffer from primarily emotional disarray like anger, anxiety, apprehension, depression, grief, guilt, irritability, panic, or moodiness.  They also suffer from cognitive disharmony like denial, difficulty making decisions, difficulty solving problems, disturbed thoughts, hyper-alertness, intrusive images, lack of faith in life, others, and oneself, lack of the ability to focus, memory loss, nightmares, or poor concentration.  Finally, they suffer from behavioral disorganization like avoidance, blaming, decrease/increase in appetite, decrease/increase in sleeping patterns, difficulty articulating, increase in alcohol/caffeine/drugs use/nicotine use, outburst, poor hygiene, restlessness, or withdrawal.

If you suffer from any of these difficulties, there is recovery.  What is recovery?  It is the act of returning to normal, or better yet, returning to yourself.

These signs and symptoms are not who you are!  When you overcome, or recover, from unhealthy reactions that are manifesting in your life, you destress yourself.

If you need help, email me, I would love to hear from you and help you in any way I can.


Some things to think about.



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