1. Mitigating the impact of trauma in the workplace: Lessons learned
Professor Susan Klein Director, Aberdeen Centre for Trauma Research Institute for Health & Welfare Research Robert Gordon University Grampian Occupational Safety & Health (GOSH) Group 16th October 2013

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

3. “Man-made Disasters” in the UK (1985-2009)
1985 Bradford City Football Club
1985 Manchester Airport (Airtours 737)
1987 “Herald of Free Enterprise”
1987 Hungerford massacre
1987 Enniskillen
1987 Kings Cross fire
1988 Piper Alpha Oil Platform
1988 Clapham Junction rail crash
1988 Lockerbie air crash
1989 Kegworth air crash
1989 Hillsborough Football Ground
1989 “Marchioness” River Boat
1996 Dunblane massacre 17
1999 Ladbroke Grove rail crash 31
2004 ICL Plastics explosion, Glasgow 8
2005 London train and bus bombings
2005 Hertfordshire oil storage terminal fire
2009 North Sea helicopter crash 16
1,157

4. Aberdeen Centre for Trauma Research
Normal reactions
Emotional
Cognitive
Physical
Social
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. Aberdeen Centre for Trauma Research
Physical conditions
musculoskeletal
dermatological
respiratory
gastrointestinal
cardiovascular
neurological (delayed?)
Aberdeen Centre for Trauma Research

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

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

9. 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 hyperarousal
NB: Symptoms must have lasted for 1 month
Aberdeen Centre for Trauma Research

10. Variability of PTSD rates
air crash survivors 54%
witnesses to air crash %
natural disasters 2-50%
oil disaster (10 years) 24%
rape 65%
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
Previous trauma – may be additive or may inoculate (if person believes coped ok with previous trauma).
Paramedic study
Best to ask last two items when screening.

15. Environment lack of support reactions of others
Peer, family, and social support = first line of help.
Other’s reactions may shape adjustment – recall “cowardice” etc of the WWI and rape victims “must have brought it on herself.

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

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

18. Aberdeen Centre for Trauma Research
Most helpful factors
(Alexander, 1993)
good preparation
good leadership/
management
attention to physical needs
clear definition of duties
purposeful duties
appreciative feedback
“black humour”
speaking to colleagues
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
(Luther & Cicchetti, 2000)
“The dynamic process wherein
individuals display positive adaptation despite experiences of significant adversity or trauma”
Aberdeen Centre for Trauma Research

23. “WATCHFUL WAITING” (NICE, 2005)

24. Aberdeen Centre for Trauma Research
Post-incident interventions
psychological first aid
peer support
critical incident stress debriefing (CISD)
trauma risk management (TRiM)
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. Aberdeen Centre for Trauma Research
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”
“Russian Roulette” (ie, taking unnecessary risks)

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

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

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

31. 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

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

33. Aberdeen Centre for Trauma Research
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. Aberdeen Centre for Trauma Research
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

36. Institute for Health & Welfare Research
ENGAGE…
with the Institute for Health and Welfare Research at RGU
Wednesday 30th October 2013
5.30pm – 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