Professor Susan KleinDirector, Aberdeen Centre for Trauma Research

Institute for Health & Welfare ResearchRobert Gordon University

Grampian Occupational Safety & Health (GOSH) Group

16th October 2013

MITIGATING THE IMPACT OF TRAUMA IN THE WORKPLACE: LESSONS LEARNED

Post-traumatic stress disorder

•intrusive phenomena

•‘commonly’ avoidance

•‘often’ hyperarousal

“Man-made Disasters” in the UK (1985-2009)1985 Bradford City Football Club 561985 Manchester Airport (Airtours 737) 511987 “Herald of Free Enterprise” 1931987 Hungerford massacre 161987 Enniskillen 111987 Kings Cross fire 311988 Piper Alpha Oil Platform 1671988 Clapham Junction rail crash 361988 Lockerbie air crash 2701989 Kegworth air crash 471989 Hillsborough Football Ground 961989 “Marchioness” River Boat 511996 Dunblane massacre 171999 Ladbroke Grove rail crash 312004 ICL Plastics explosion, Glasgow 82005 London train and bus bombings 522005 Hertfordshire oil storage terminal fire 82009 North Sea helicopter crash 16

1,157

Emotional Cognitive

SocialPhysical

Normal reactions

Aberdeen Centre for Trauma Research

Normal reactions include… numbness fear depression (or elation) anger/irritability helplessness/hopelessness guilt cognitive/perceptual changes flashbacks (nightmares) avoidant behaviour hyperarousal/hypervigilance

musculoskeletal dermatological respiratory gastrointestinal cardiovascular neurological (delayed?)

Physical conditions

Aberdeen Centre for Trauma Research

intensity duration level of dysfunction delayed onset

Abnormal reactions determined by…

Aberdeen Centre for Trauma Research

anxiety depression substance misuse post-traumatic stress disorder

(PTSD)

Mental conditions

Aberdeen Centre for Trauma Research

PTSD

Primary features are: experience of an abnormally stressful event persistent re-experiencing of that event persistent avoidance of reminders persistent hyperarousalNB: Symptoms must have lasted for 1 month

Aberdeen Centre for Trauma Research

Variability of PTSD rates air crash survivors

54% witnesses to air crash

50-100% natural disasters

2-50% oil disaster (10 years)

24% rape

65% Gulf War (1991)

1-3%

NB: Higher in womenHigher after acts of violence

Aberdeen Centre for Trauma Research

Bereavement and grief

different “losses” employer’s role contemporary changes faiths, cultures and rituals

At risk and vulnerability factors• trauma• victim• environment

Trauma sudden/unexpected man made prolonged exposure multiple

deaths/mutilation (perceived) threat to

life proximity special meaning

Victim severity/meaning of

injury severity of acute

reactions previous trauma

(complex) psychiatric history concurrent life

stressors

Environment

lack of supportreactions of

others

At risk factors: operationalexposure to

death, injury & suffering

inadequate PPEpoor dietsleep losswork overload

helplessnessthreat to lifeconflict of

interestanger/criticism“double

jeopardy”

Aberdeen Centre for Trauma Research

leadership organisation briefing & preparation meaningful duties

Protective factors - operational

physical welfare good

communication appreciation

Aberdeen Centre for Trauma Research

Most helpful factors

good preparation

good leadership/

management attention to

physical needs clear definition

of duties

purposeful duties appreciative

feedback “black humour” speaking to

colleagues

(Alexander, 1993)

Aberdeen Centre for Trauma Research

Evidence Informed Guidelines

Aberdeen Centre for Trauma Research

Philosophy of Care: NATO Guidelines (2009)

Tailor services to meet needs At risk factors should guide interventions and

psychosocial responses Anticipate:

longer term needs subsequent unexpected events delayed reporting of post-traumatic

psychopathology   anniversary reactions

Aberdeen Centre for Trauma Research

First principles of intervention

avoid “over-medicalizing” avoid “over-professionalizing” evidence-based (whenever

possible) emphasise positive outcome recognise psychosocial

resilienceAberdeen Centre for Trauma Research

Psychosocial resilience

Aberdeen Centre for Trauma Research

(Luther & Cicchetti, 2000)

“The dynamic process wherein

individuals display positive adaptation despite

experiences of significant adversity or trauma”

“WATCHFUL WAITING” (NICE, 2005)

peer support critical incident stress debriefing

(CISD) trauma risk management (TRiM)

Post-incident interventions

psychological first aid

Aberdeen Centre for Trauma Research

Psychological First Aid comfort, console protect physically physical needs constructive

action accurate

information links

support emotional

expression security & control direct towards

support triage

Aberdeen Centre for Trauma Research

Clues might need helpexcessive denialdissociationover-indulgenceirritabilitytearfulness

guiltunexplained physical

symptomsimpaired work

performancepersonality “change”

Aberdeen Centre for Trauma Research

“Russian Roulette”

risk-takinginvincibledemonstrate coping

abilityself-punishmentrecapture the “buzz”

credible empathic less intrusive accessible

Peer support is...

Aberdeen Centre for Trauma Research

“infection” embarrassment confidentiality issues career issues

But it may be missing because of...

Aberdeen Centre for Trauma Research

CISD(Everly & Mitchell, 1997)

unfulfilled early promisemisuserisk of retraumatisationnot “one-off”/mandatory (NICE, 2005)

Aberdeen Centre for Trauma Research

TRiM(Greenberg et al, 2005)

use of trained peers not a treatment two assessments (3 and 28 days) screened on 10 risk factors

Aberdeen Centre for Trauma Research

time out

Self help

“real” world physical exercise sleep diet talking (selective!)

Aberdeen Centre for Trauma Research

Lessons LearnedDevelop and augment psychosocial

resilience:implement effective organisational

practicesacknowledge and respect diversity of

reactions across cultures/agesprotect and promote social/community

relationships

Aberdeen Centre for Trauma Research

Lessons Learned

beware of hidden victims/ “ripple effect”

do not “medicalize”implement triage using best

evidence-based interventionsprovide accurate informationsignpost access to additional

servicesAberdeen Centre for Trauma Research

www.stish.org

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Institute for Health & Welfare Research