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Professor Susan Klein Director, Aberdeen Centre for Trauma Research Institute for Health & Welfare Research Robert Gordon University Grampian Occupational.

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Presentation on theme: "Professor Susan Klein Director, Aberdeen Centre for Trauma Research Institute for Health & Welfare Research Robert Gordon University Grampian Occupational."— Presentation transcript:

1 Professor Susan Klein Director, Aberdeen Centre for Trauma Research Institute for Health & Welfare Research Robert Gordon University Grampian Occupational Safety & Health (GOSH) Group 16 th October 2013 MITIGATING THE IMPACT OF TRAUMA IN THE WORKPLACE: LESSONS LEARNED

2 Post-traumatic stress disorder intrusive phenomena ‘commonly’ avoidance ‘often’ hyperarousal

3 “ Man-made Disasters” in the UK ( ) 1985Bradford City Football Club Manchester Airport (Airtours 737) “Herald of Free Enterprise” Hungerford massacre Enniskillen Kings Cross fire Piper Alpha Oil Platform Clapham Junction rail crash Lockerbie air crash Kegworth air crash Hillsborough Football Ground “Marchioness” River Boat Dunblane massacre Ladbroke Grove rail crash ICL Plastics explosion, Glasgow London train and bus bombings Hertfordshire oil storage terminal fire North Sea helicopter crash16 1,157

4 EmotionalCognitive SocialPhysical Normal reactions Aberdeen Centre for Trauma Research

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

6  musculoskeletal  dermatological  respiratory  gastrointestinal  cardiovascular  neurological (delayed?) Physical conditions Aberdeen Centre for Trauma Research

7  intensity  duration  level of dysfunction  delayed onset Abnormal reactions determined by… Aberdeen Centre for Trauma Research

8  anxiety  depression  substance misuse  post-traumatic stress disorder (PTSD) Mental conditions Aberdeen Centre for Trauma Research

9 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 Aberdeen Centre for Trauma Research

10 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 women Higher after acts of violence Aberdeen Centre for Trauma Research

11 Bereavement and grief  different “losses”  employer’s role  contemporary changes  faiths, cultures and rituals

12 At risk and vulnerability factors trauma victim environment

13 Trauma  sudden/unexpected  man made  prolonged exposure  multiple deaths/mutilation  (perceived) threat to life  proximity  special meaning

14 Victim  severity/meaning of injury  severity of acute reactions  previous trauma (complex)  psychiatric history  concurrent life stressors

15 Environment  lack of support  reactions of others

16 At risk factors: operational  exposure to death, injury & suffering  inadequate PPE  poor diet  sleep loss  work overload  helplessness  threat to life  conflict of interest  anger/criticism  “double jeopardy” Aberdeen Centre for Trauma Research

17  leadership  organisation  briefing & preparation  meaningful duties Protective factors - operational  physical welfare  good communication  appreciation Aberdeen Centre for Trauma Research

18 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

19 Evidence Informed Guidelines Aberdeen Centre for Trauma Research

20 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

21 First principles of intervention  avoid “over-medicalizing”  avoid “over-professionalizing”  evidence-based (whenever possible)  emphasise positive outcome  recognise psychosocial resilience Aberdeen Centre for Trauma Research

22 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”

23 “ WATCHFUL WAITING” (NICE, 2005)

24  peer support  critical incident stress debriefing (CISD)  trauma risk management (TRiM) Post-incident interventions  psychological first aid Aberdeen Centre for Trauma Research

25 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

26 Clues might need help  excessive denial  dissociation  over-indulgence  irritability  tearfulness  guilt  unexplained physical symptoms  impaired work performance  personality “change” Aberdeen Centre for Trauma Research

27 “Russian Roulette”  risk-taking  invincible  demonstrate coping ability  self-punishment  recapture the “buzz”

28  credible  empathic  less intrusive  accessible Peer support is... Aberdeen Centre for Trauma Research

29  “infection”  embarrassment  confidentiality issues  career issues But it may be missing because of... Aberdeen Centre for Trauma Research

30 CISD (Everly & Mitchell, 1997)  unfulfilled early promise  misuse  risk of retraumatisation  not “one-off”/mandatory (NICE, 2005) Aberdeen Centre for Trauma Research

31 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

32  time out Self help  “real” world  physical exercise  sleep  diet  talking (selective!) Aberdeen Centre for Trauma Research

33 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 Aberdeen Centre for Trauma Research

34 Lessons Learned  beware of hidden victims/ “ripple effect”  do not “medicalize”  implement triage using best evidence- based interventions  provide accurate information  signpost access to additional services Aberdeen Centre for Trauma Research

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36 ENGAGE…  with the Institute for Health and Welfare Research at RGU Wednesday 30th October pm – 8.30pm Riverside 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: Institute for Health & Welfare Research


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