It is very common, in fact quite normal, for people to experience emotional aftershocks when they have experienced a critical incident.If you are experiencing signs of excessive stress – you may find the following suggestions helpful in coping with the symptoms:
DO express your emotions & feelings.
DO identify trusted friends and colleagues to whom you can talk about what happened & review the experience(s).
DO look to friends and colleagues for support.
DO listen sympathetically if a colleague wants to speak with you unless it is too distressing.
DO advise colleagues who need more support where they can get appropriate help.
DO try to keep your life as normal as possible.
DO try to keep to daily routines.
DO drive more carefully.
DO be more careful around the home.
DON’T use alcohol, nicotine or other drugs to hide your feelings or manage your reactions.
DON’T simply stay away from work – seek help and support.
DON’T allow anger and irritability to mask your feelings.
DONT bottle up feelings.
DON’T be afraid to ask for help.
DON’T think your feelings are signs of weakness.


1. If you feel you cannot handle intense feelings or body sensations.
2. If your stress reactions do not lessen in the weeks following the event.
3. If you continue to have nightmares and poor sleep.
4. If you have no-one with whom to share your feelings when you want to do so.
5. If your relationships seem to be suffering badly, or sexual problems develop.
6. If you become clumsy or accident-prone.
7. If after the event, you increase the use of cigarettes of alcohol, or take more medication, or use other drugs.
8. If your work performance suffers.
9. If you are tired all the time.
10. If things get on top of you and you feel like giving up; if you have thoughts of self-harm or suicide.

11. If you take it out on your family.
12. If your health deteriorates.


1. CFR Groups have a peer support network, we recommend that you contact them for
help and advice.
2. The designated point of contact within the NAS/HSE who provide CISM services can be obtained through your CFR Group lead.
3. By consulting your GP

From time to time Cardiac First Responders may be required to attend a medical emergency in their community. This input into a community may be the difference between life and death, such a commitment can be very rewarding and can make a real positive difference in a community. Knowing such volunteers are out in our communities can be a great comfort to members of the public. It’s important that when Cardiac First Responders (CFR) respond to these events they look after themselves and their safety at all times. This is a fundamental part of the CFR programmes and is reinforced in the training. Occasionally, dealing with such emergences can add extra pressure and stress to responders, which could amount to a Critical incident (CI) for the responder. It’s important that we recognise the signs and symptoms of stress and put in place strategies to help ourselves and our fellow responders. The NAS CISM Committee with the Community Engagement Officers (CEOs) has produced some helpful information and we would encourage you to take time and read through the leaflet. The NAS and CFR Groups have trained CISM Peer Support Workers (PSWs) throughout the country, who have specialised training to support their colleagues in their CFR group/ region. If you have been affected by a CI then your experience was a very personal one and this leaflet will help you to know how others have reacted in similar situations. It will also show how you can help normal healing to occur and to avoid some pitfalls.


Stress is a mental and physical condition which results from pressure or demands that strain or exceed our capacity or perceived capacity to cope (HSE, 2012). The greater the demand the more intense the stress reaction. Prolonged or excessive stress causes distress.


Everyone can have these feelings. Experience has shown that they may vary in intensity according to circumstance. Allowing these feelings to be expressed is an important part of the healing process. This will not lead to loss of control, but stopping these feelings may lead to other and possibly more complicated problems.

Listed below are some common indicators of increased stress:

• Feeling overwhelmed
• Loss of motivation
• Dreading going to work
• Becoming withdrawn
• Impaired concentration
• Racing thoughts
• Confusion
• Difficulty making
• Impaired memory
• Feelings of
• Anxiety
• Depression
• Anger
• Guilt
• Racing heart, breathlessness and rapid breathing• Feeling hot and flushed, excessive sweating
• Dry mouth, churning the stomach
• Diarrhoea and digestive problems
• Frequent desire to use the toilet
• Muscle tension
• Restlessness, tiredness, sleep
difficulties, headaches
• Increased drinking or smoking
• Overeating, loss of appetite
• Loss of interest in sex
• Self-neglect


CIS is the stress caused by an event, or series of events, which is of such severity that it has the capacity to overwhelm our usual coping mechanisms, thereby creating significant distress and impaired functioning.


Prolonged or excessive levels of stress are factors
in the origins of some physical and psychological
health problems. Listed below are some common
ways in which people react to incidents like this:
• Feeling of distress
• Feeling of sadness
• Strong feelings of anger
• Feeling of disillusionment
• Feeling of guilt
• The feeling of apprehension/anxiety/fear of: (losing control/breaking down or something similar happening again, not having done all I think I could have

• Avoidance of the scene of the incident Or of anything that reminds you of it
• Bad dreams or nightmares
• Distressing memories or “flashbacks” of the incident
• Feeling “on edge” irritable, angry, under Threat/pressure
• Feeling emotionally fragile – unable to experience your normal range of emotions
• Feeling cut off from your family or close friends – “I can’t talk to them” or “I don’t want to upset them

It can be a relief to receive other people’s physical and emotional support. Sharing with others who have had similar experience can help.