Nothing can adequately prepare organisations or individuals for the experience of a traumatic incident, because by definition it is outside normal experience. This has been vividly illustrated by those caught up in events such as the Asian tsunami (2004), the collapse of the World Trade Center, New York (2001), and numerous other tragic events that were impossible to predict.
Many victims and witnesses of violence or injury may well require professional post-trauma support to help deal with the effects of their experience.
It is therefore imperative that businesses should have plans in place to enable them to cope with the immediate and longer-term effects of employees being killed or seriously injured, should such an incident occur.
While all organisations should carry out risk assessments to determine whether employees could be at potential risk of psychiatric harm from events that they may have to deal with in the course of their work, there are some organisations whose staff, by virtue of what they do, are always potentially at risk. These include:
- armed forces and emergency services personnel
- bank staff and certain others in the financial field
- those working in retail outlets where staff may be alone in the premises outside normal opening hours
- those who have contact with the general public in circumstances where there is a greater risk of violence.
In addition, companies operating in the travel industry need to be aware of the potential for accidents, and in particular for major disasters, for which effective contingency plans should always be in place.
There are also many organisations operating within industrial sectors that are inherently hazardous. Good risk management can substantially reduce the incidence of accidents, but they may still occur. In such instances, contingency plans need to be ready to be implemented, often at short notice, to support those involved.
It is not only the people who are directly involved in an incident - ie the victims and survivors - who may suffer the effects of trauma. They can also affect those who may be indirectly involved, for example witnesses, neighbours, families and work colleagues. All these people may be traumatised to a greater or lesser degree
The following are just some examples of how individuals can become directly or indirectly exposed to traumatic incidents and possible post-trauma stress.
- Co-workers who may have to return to work immediately following a disaster will have to come to terms with the injuries and possible death of one or more colleagues, together with possible damage to workplace buildings.
The workplace may have changed dramatically, and the effect of this may have an impact on everyone in the organisation.
- There may be feelings of guilt associated with injury and loss of life.
Management and staff may feel disorientated and emotional and will be susceptible to post-trauma stress. Employees may be in a position of some turmoil for days, or possibly months, thereafter.
- The designated first-aiders in an organisation, who may have had only limited training and experience, may be called upon to deal with a major incident before the emergency services arrive. Yet the support that they themselves will require in the aftermath of the event is often overlooked.
- Such people as the train driver who experiences a person committing suicide under the wheels and the maintenance team who have to remove the human remains from the track, may be required to relive the situation when they give evidence to an inquiry - sometimes months later. This can trigger the traumatic reaction to the original incident again, and the person may be unable to close the chapter until all investigations are complete.
- A traumatic incident may also have an impact on the confidence of other employees performing similar jobs within the organisation.
- Proper consideration should also be given to people involved in potential incidents or near misses. These may include people who believe that they came close to a major accident, even where they themselves sustained no physical injury.
Anyone who has been involved in a traumatic incident is likely to have some form of reaction to it. These reactions may happen immediately, or may not occur for weeks, months, or occasionally even years afterwards.
They are likely to be worse if:
- Many people died or were injured during the incident, or death or injury was sudden, violent or happened in horrifying circumstances
- The individual has feelings of helplessness or wanting to have done more
- They do not have good support from family, friends or colleagues
- The stress resulting from the incident comes on top of other stresses in their life.
An individual's emotions are likely to be in chaos after the event, although sometimes they may feel nothing. Some of the more common emotional reactions are:
GUILT - for not having done more, or for having survived when others did not
ANGER AT WHAT HAS HAPPENED, or the injustice or senselessness of it
FEAR OF BREAKING DOWN OR LOSING CONTROL, or of a similar event happening again and being unable to cope
SHAME - for not having reacted as they might have wanted to, or for feeling helpless, emotional and wanting others to be with them
SADNESS - about the deaths, injuries and the whole circumstances of the incident. Individuals may also feel depressed without knowing why.
People are very likely to find that they cannot stop thinking about the incident, dream about it, or suffer loss of memory, concentration or motivation.
They may experience flashbacks, hate to be reminded of what happened, or have feelings that they are always on their guard or easily startled.
Individuals often experience tiredness, sleeplessness, nightmares, dizziness, palpitations, shakes, difficulty in breathing, tightness in the throat and chest, sickness, diarrhoea, menstrual problems, changes in sexual interest or eating habits, and many other symptoms - frequently without making a connection with the incident.
People may feel hurt, and their relationships with others, particularly their partner, may feel under additional strain. They may find themselves taking their anger out on their families, just when they need them the most.
All employers need to carry out risk assessments to identify any potential risk, its significance, and what measures should be implemented to prevent or minimise it. This applies to all employers, not just those working in hazardous fields. Risk assessment should focus on the level of risk, the expected type of incident and the staff roles most likely to be involved.
In many cases when there is a traumatic incident at work, the fact that most people recover naturally could lead the organisation to believe it is unnecessary to provide any form of additional support. However, this is not necessarily the case for everyone. It is essential that organisations design and implement effective systems for providing effective support to employees following a major incident.
The success of a trauma support programme is dependent on the attitude of the organisation implementing it and on a genuine concern for the welfare of employees. It may also be dependent on the employees' perception of the organisation. Does it take the possibility of an accident or violent situation occurring seriously, and if so, has the necessary risk assessment taken place and have the appropriate follow-up actions been taken?
A post-trauma support programme should include:
- Careful selection and training of staff who are to work in potentially dangerous or aggressive environments
- Well-designed emergency procedures and action plans
- An education programme detailing potential hazards
- Dedicated on-scene support
- Professional back up after the incident, aimed at providing short and long-term support, as needed.
Talking to a trained counsellor is often a great relief and can reduce much of the tension and anxiety associated with traumatic incidents. On the other hand, trying to ignore personal feelings, or avoiding talking about the incident may possibly be harmful to individuals in the long term and can lead to a storing up of problems.
When to look for help
People who have experienced a traumatic incident should be encouraged to seek professional help if they:
- feel they cannot handle intense feelings or bodily sensations; their emotions are not falling into place; or they feel chronic tension, or exhaustion
- continue to feel numb, empty or without feelings
- have to keep active in an attempt to suppress their feelings
- continue to have nightmares or are sleeping badly
- have no one to share their emotions with and feel the need to do so
- start to have accidents or their work performance suffers
- start to smoke, drink or take drugs to excess
- are suffering from depression
- cannot control their memories of the experience
- are having problems with their relationships.
It is also important to encourage individuals to remember:
- that they are basically the same person they were before the incident
- that talking about their experience and their feelings can help
- that suppressing their feelings can lead to further problems.
Ultimately, the most important objective of post trauma planning is to provide an ongoing system of support that combines pre-emptive action management and essential reactive treatment, as necessary.
Carole Spiers is a business stress consultant, Tel: 020 8954 1593, E-mail: firstname.lastname@example.org
For a free information sheet 'Understanding Post Trauma Stress', e-mail: email@example.com