1. The Aftermath of Major Trauma – Coping with Critical Incidents in Radiology. Kathy Colgan New Zealand

2. New Zealand Herald Murdered Rotorua toddler Nia Glassie slipped through the net of protective agencies to suffer horrific abuse undetected, says a coroner investigating her case. Nia was killed in 2007 by her mother's partner, Wiremu Curtis, who spun her on clothes lines, stuck her in a clothes dryer and threw her on her head in mock wrestling moves. By Michael Dickison 5:30 AM Tuesday Aug 24, 2010

8. Critical Incident: Defined as O Sudden unexpected events occurring in the place of work which cause an individual to have strong emotional, spiritual, cognitive, physical and / or behavioural reactions as the result of a particular event. Lakes District Health Board Policy document, 2012

9. Influencing Factors O individual’s life and / or work experiences O normal coping mechanisms O current state of health or welfare O number of exposures to traumatic incidents O perceptions of organisation support (or not) may all impact the severity of emotional distress

12. Critical Incident Stress Defined as: O The emotional stress experienced by individuals secondary to their exposure to a specific incident or number of incidents. (Blacklock 2012)

13. O Stress debriefing is designed to support “emotionally healthy people who are experiencing acute, normal stress reactions to abnormal traumatic events. Mitchell et al 2003

14. Debriefing O Verbalise distress O Form appropriate concepts about stress reactions before false interpretations of the experience are formed O Return to normal functioning

15. Critical Incident Debriefing Discussions can include: O Summary of events O Initial call sequence O Management of trauma event O Patient outcome O Specific group involvement O Opportunity for participants to describe involvement O Clinical management of process O Emotional factors

16. NICE Guidelines 2005 recommend the good practice of providing practical and social support and guidance to anyone following a traumatic incident

17. Staff Survey Select the types of critical incidents you have been involved in? O Cardiac Arrest O Trauma O Multi-trauma O Suicide Attempt O Fatality in ED O Non Accidental Injury (NAI) O Other (please specify)

18. Sample Questions O Have you been directly involved in a critical incident in your workplace? O Did you have an opportunity to attend an Incident Debriefing session following the event? O Timeframe in which debriefing occurred?

19. Have you experienced any of the following stress triggers following these events? O Anxiety O Nervousness O Deep sadness O Anger O Other _______ Do any of these feelings stay with you longer than you might expect? O Yes O No O Comment_____________________________

20. Debriefing O Requested by staff on the floor O Team leader determines in consultation with team if need is immediate – defusing O Formal debriefing process instigated

21. Defusing O Held immediately after incident & prior to shift end O Provides ‘emotional first aid’ to staff involved in incident ensuring they are able to continue to end of shift O Used to eliminate or identify the need for a formal critical incident debriefing session

22. Participation To determine staff involvement O Use patient discharge summaries to isolate clinical investigations performed & likely staff involved O Invite involved staff either by phone or through immediate team leaders or managers O Ensure appropriate managers are aware to allow staff release for attendance

23. Leadership O Trained personnel O Skills to review case presentation & clinical management of patient O Facilitation skills to encourage staff members to talk about their reactions O Ability to recognise critical incident stress & staff stress related aspects O Knowledge to identify those who require referral to other support agencies

25. STUFF Co.NZ A seven-year-old girl savaged by four dogs was bitten more than 100 times all over her body, her medical team says. At a media briefing this afternoon, plastic surgeon Dr Zac Moaveni said the attack was horrific and sustained, and that Sakurako would have been conscious throughout the attack and the medical process afterwards. Sakurako had extensive injuries to her face and all her limbs. The injuries were complex as dog bites involved crushing injuries as well as the cuts. Ian Steward 7 March 2014 (Fairfax Media)

26. “A holistic approach to community resilience through a well planned and implemented critical incident stress management programmes has been shown in the literature to promote self help and self efficacy of individuals and organisations”. Guenther (2012)

27. References: O Blacklock, E. (2012). Interventions following a critical incident: Developing a Critical Incident Stress Management Team. Archives of Psychiatric Nursing; 26(1): 2-8. O Guenthner, D.H. (2012). Emergency and crisis management: Critical incident stress management for first responders and business organisations. Journal of Business Continuity and Emergency Planning; 5 (4), 1-19. O Mitchell, A.M., Sakraida, T.J., & Karmeg, K. (2003). Critical Incident Stress Debriefing: Implications for Best Practice. Disaster Manage Response; 1 (2):46- 51.

28. References O Regel, S. (2007). Post-trauma support in the workplace: the current status and practice of critical incident stress management (CISM) and psychological debriefing (PD) within organizations in the UK. Occupational Medicine; 57:411– 416. O Theophilos, T., Magyar, J., and Babl, F.E. (2009). Debriefing critical incidents in the paediatric emergency department: Current practice and perceived needs in Australia and New Zealand. Emergency Medicine Australasia 21, 479-483.

29. References: O Resource Guide for Critical Incident stress and debriefing in Human Service Agencies, May 1997, Human Resources Branch, Victorian Government Department of Human Services, retrieved 3 May 2014 from: http://www.health.vic.gov.au/archive/archive2004/9 6ma124/downloads/96ma124.pdf http://www.health.vic.gov.au/archive/archive2004/9 6ma124/downloads/96ma124.pdf

30. References O Lakes District Health Board Protocol: Health and Safety Procedures Manual - Document No: 81428 (2012) – Critical Incident Debriefing Policy. O Lakes District Health Board Protocol: Management and Administration Manual Document No: 365593 – Emergency Management Policy.