professor susan klein director, aberdeen centre for trauma research institute for health &...

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


intensity duration level of dysfunction delayed onset

Abnormal reactions determined by…


anxiety

depression

substance misuse

post-traumatic stress disorder (PTSD)

Mental conditions


PTSD

Primary features are: experience of an abnormally stressful event

persistent re-experiencing of that event

persistent avoidance of reminders

persistent hyperarousal

NB: Symptoms must have lasted for 1 month


Variability of PTSD rates

air crash survivors54%

witnesses to air crash50-100%

natural disasters2-50%

oil disaster (10 years)24%

rape65%

Gulf War (1991)1-3%

NB: Higher in womenHigher after acts of violence


Bereavement and grief

different “losses”

employer’s role

contemporary changes

faiths, cultures and rituals

At risk and vulnerability factors

• trauma

• victim

• environment

Trauma

sudden/unexpectedman madeprolonged exposuremultiple

deaths/mutilation (perceived) threat to

lifeproximity special meaning

Victim

severity/meaning of injury

severity of acute reactions

previous trauma (complex)

psychiatric history concurrent life

stressors

Environment

lack of support

reactions of others

At risk factors: operational

exposure to death, injury & suffering

inadequate PPEpoor dietsleep losswork overload

helplessnessthreat to lifeconflict of

interestanger/criticism“double

jeopardy”


leadership organisation briefing & preparation meaningful duties

Protective factors - operational

physical welfare good

communication appreciation


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)


Evidence Informed Guidelines


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


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


(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


Psychological First Aid

comfort, console

protect physically

physical needs

constructive action

accurate information

links

support

emotional expression

security & control

direct towards support

triage


Clues might need help

excessive denialdissociationover-indulgenceirritabilitytearfulness

guiltunexplained physical

symptomsimpaired work

performancepersonality “change”


“Russian Roulette”

risk-takinginvincibledemonstrate coping

abilityself-punishmentrecapture the “buzz”

credible

empathic

less intrusive

accessible

Peer support is...


“infection”

embarrassment

confidentiality issues

career issues

But it may be missing because of...


CISD

(Everly & Mitchell, 1997)

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


TRiM

(Greenberg et al, 2005)

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


time out

Self help

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


Lessons Learned

Develop and augment psychosocial resilience:

implement effective organisational practices

acknowledge and respect diversity of reactions across cultures/ages

protect and promote social/community relationships


Lessons Learned

beware of hidden victims/ “ripple effect”

do not “medicalize”implement triage using best

evidence-based interventionsprovide accurate informationsignpost access to additional

services


www.stish.org

ENGAGE… with the Institute for Health and Welfare Research at RGU

Wednesday 30th October 20135.30pm – 8.30pmRiverside East, Garthdee Campus

Discover how our research expertise can benefit your organisation through collaboration and consultancy

including: occupational health & safety Meet our experts, tour our brand new purpose-built facilities

and explore available funding opportunities. Register at: www.rgu.ac.uk/engage

Institute for Health & Welfare Research

http://www.rgu.ac.uk/engage

professor susan klein director, aberdeen centre for trauma research institute for health &...

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