Don’t panic…
But it’s time to review your response to critical incidents!
Richard Kasperczyk, MAPS
 
Alarm Bells
 
Just six days shy of the one-year anniversary of the September 11 attacks, the BBC World News featured the following headline:
 
"One-off debriefing sessions after traumatic events are ineffective – and could actually do more harm than good, researchers say."
BBC News World Edition, 5 September 2002
 
This was no mere coincidence.  Since the September 11 attacks, a growing body of research has been undertaken to examine responses to trauma and the long term effects on survivors.  The scale of these studies demanded the attention of leading professional bodies and practitioners, who have since adjusted their policies and approach.    
 
This public shift in approach has far reaching implications for employers.  Under OHS legislation, an employer is responsible for providing a work environment that is free of psychological risks.  This leaves open the potential for legal proceedings where employees have suffered trauma in the course of their employment.  Given the knowledge that is now publicly available, employers can be reasonably expected to incorporate it into their responses to critical incidents suffered by their employees at work.
 
Past practice
 
Historically, most common responses to dealing with trauma were known as Critical Incident Stress Debriefing (CISD), a specific form of psychological debriefing, which usually involved a rapid mobilisation of professionals to conduct individual or group debriefs.  A structured debrief approach typically included some recollection of the traumatic experience and subsequent emotional reactions, and education about the symptoms normally experienced after such events.  
 
The aim of such a response was obviously to reduce the negative effect of traumatic events such as the development of post-traumatic stress disorder (PTSD).  In reality, the basis of such an approach to managing trauma was anecdotal evidence or professional consensus, rather than solid evidence that it was effective.  
 
As more researchers focused their attention on this issue, there has been steadily growing evidence that the popular approach to trauma management does not work.  It does not reduce the likelihood of long term symptoms and, paradoxically, it could exacerbate the problem for some people.  
 
What we now know
 
Firstly, we now know that single-session psychological debriefing does not prevent and can even aggravate the symptoms of PTSD.  What is particularly unhelpful is re-experiencing of the traumatic experience (unless the person wishes to discuss it, is able to tolerate the associated distress and can be appropriately supported through it).  
 
However, we also know that certain responses after trauma are helpful and can reduce the likelihood of long term problems.  Most importantly, they include practical and emotional support that helps the person meet their immediate needs.  Particular information is also effective in helping them cope with their distress, relating to possible reactions they may have, where to get further help if needed.  Access to professional help if needed is also helpful.
 
One of the most comprehensive and influential studies driving this change in approach is the UK Royal Mail Group, which tracked 815 postal workers.  Following a traumatic experience at work (such as traffic accidents, armed robberies and physical assaults), individuals were observed over 13 months, measuring their symptoms at various points along this period.  They found that a higher level of perceived organisational support immediately post trauma was linked to lower symptom levels at the 3-month follow up, which in turn, were related to lower absence at 12 months.   The study concluded that a structured post-trauma support provided at the workplace was safe and effective.
 
Each person has a unique way of recovering.  Although most people recover from trauma on their own or with the help of family or and friends, some will need help in recovering.  From the employer’s point of view, inaction is not an option.  There is plenty of good evidence now available to assist employers build more effective response systems and help people recover.
 
The early intervention guidelines for adults exposed to potentially traumatic events, issued by the Australian Centre for Posttraumatic Mental Health, suggest the implementation of psychological first aid which includes the following components:  

• Provision of emotional and practical support and comfort  
  
• Meeting their immediate needs
  
• Monitoring over time
  
• Provision of information.

The guidelines also recommend structured psychological debriefing not to be offered on a routine basis.  Those who develop extreme level of distress or are at risk to themselves or others need to be referred for immediate professional intervention.  
 
What employers need to do about it
 
The UK Royal Mail study highlighted just how important the organisation’s response to trauma is; demonstrating that the way an organisation responds when employees are exposed to critical incidents can have an impact on subsequent symptom levels and unplanned absences.  
 
The latest findings have been slowly changing professionals’ approaches and clinical practice, which now needs to be now matched by employers’ awareness, policy and practice.  This includes changing their expectations of debrief providers to match established best practice.  Rather than leaving the management of their employees’ post-trauma support in the hands of a provider, employers must adopt an informed and proactive response.  It is the employers who ensure their employees are appropriately assisted after a critical incident, and thereby fulfil their duty of care, who will reduce the risk of prolonged absences, compensation claims and other litigation.  
 
To start, critical incident management policy directions need to be reviewed to ensure they reflect the latest guidelines.  It is suggested that the policies need to encompass at least the following principles:  

• Practical support is provided on the day of the incident  
   
  
• Good support is demonstrated by the organisation to the employee through:
   
  
  • Empathic, personal and immediate response from the line manager  
    
  • Ongoing practical and emotional support to deal with the situation and to get back to normal for a period of days and weeks after the incident
    
  • Follow up support meetings to ensure the communication is complete, required information is provided, reactions are monitored and any issues are addressed, for some months after the incident
    
  • Provision of information regarding where to get further support in the organisation
    
  • Provision of information about the normal reactions to trauma and coping mechanisms
    
  • Access to professional counselling services when needed.
  
  
• Monitoring of symptoms and reactions systematically, either through the involvement of professional support or through the support meetings to identify at-risk individuals
  
• Referral for appropriate treatment once the symptoms are identified to persist for 3-4 weeks after the incident, such as expressions of extreme feelings of shame, guilt or anger, abuse of alcohol/drugs, sleep difficulties or other reactions which interfere with normal work/life activities or relationships.

Each case needs to take into account the individual differences and preferences for people to cope.  Those who are in people support roles need to increase their awareness in this area and gain access to up-to-date information and resources.  
 
Of course, rewriting policy statements and documents to reflect the above principles will not in itself produce any changes if work practices do not change.  In support of such policy implementation, employers need to:

• Increase line managers’ awareness of their role in demonstrating organisational support  
  
• Increase awareness of managers and other support role personnel of the normal post-trauma symptoms and those associated with the Acute and Post-traumatic Stress Disorders and  
  
• Ensure resources are available to provide educational material and practical information to employees after trauma
  
• Develop a relationship with the providers of professional services to ensure they can respond immediately when needed
  
• Assure themselves that their providers of debrief services adhere to the latest Guidelines issued by the Australian Centre for Posttraumatic Mental Health or the UK National Institute for Health and Clinical Excellence.

 
For more information contact ResolutionsRTK Assist on 1800 350 359.
 
Richard Kasperczyk, MAPS.