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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 16 th October 2013. Mitigating the impact of trauma in the workplace: Lessons learned .

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Mitigating the impact of trauma in the workplace: Lessons learned

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  1. Professor Susan KleinDirector, Aberdeen Centre for Trauma ResearchInstitute for Health & Welfare ResearchRobert Gordon UniversityGrampian Occupational Safety & Health (GOSH) Group16th 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 (1985-2009) 1985 Bradford City Football Club 56 1985 Manchester Airport (Airtours 737) 51 1987 “Herald of Free Enterprise” 193 1987 Hungerford massacre 16 1987 Enniskillen 11 1987 Kings Cross fire 31 1988 Piper Alpha Oil Platform 167 1988 Clapham Junction rail crash 36 1988 Lockerbie air crash 270 1989 Kegworth air crash 47 1989 Hillsborough Football Ground 96 1989 “Marchioness” River Boat 51 1996 Dunblane massacre 17 1999 Ladbroke Grove rail crash 31 2004 ICL Plastics explosion, Glasgow 8 2005 London train and bus bombings 52 2005 Hertfordshire oil storage terminal fire 8 2009 North Sea helicopter crash 16 1,157

  4. 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. 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. Mental conditions • anxiety • depression • substance misuse • post-traumatic stress disorder (PTSD) 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 survivors 54% • witnesses to air crash 50-100% • 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

  15. Environment • lack of support • reactions of others

  16. exposure to death, injury & suffering inadequate PPE poor diet sleep loss work overload helplessness threat to life conflict of interest anger/criticism “double jeopardy” At risk factors: operational 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. good preparation good leadership/ management attention to physical needs clear definition of duties purposeful duties appreciative feedback “black humour” speaking to colleagues Most helpful factors (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 (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. 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 • support • emotional expression • security & control • direct towards support • triage • comfort, console • protect physically • physical needs • constructive action • accurate information • links Aberdeen Centre for Trauma Research

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

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

  28. 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. 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. Self help • time out • “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

  35. www.stish.org

  36. ENGAGE… • with the Institute for Health andWelfare Research at RGU Wednesday 30th October 2013 5.30pm – 8.30pm Riverside East, Garthdee Campus • Discover how our research expertisecan 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

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