Transcript Trauma or Stress - Grampian Occupational Health and Safety Group

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
Post-traumatic stress disorder
• intrusive phenomena
• ‘commonly’ avoidance
• ‘often’ hyperarousal
“Man-made Disasters” in the UK (1985-2009)
1985
1985
1987
1987
1987
1987
1988
1988
1988
1989
1989
1989
1996
1999
2004
2005
2005
2009
Bradford 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 crash
56
51
193
16
11
31
167
36
270
47
96
51
17
31
8
52
8
16
1,157
Normal reactions
Emotional
Cognitive
Physical
Social
Aberdeen Centre for Trauma Research
Normal reactions include…
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numbness
fear
depression (or elation)
anger/irritability
helplessness/hopelessness
guilt
cognitive/perceptual changes
flashbacks (nightmares)
avoidant behaviour
hyperarousal/hypervigilance
Physical conditions
 musculoskeletal
 dermatological
 respiratory
 gastrointestinal
 cardiovascular
 neurological (delayed?)
Aberdeen Centre for Trauma Research
Abnormal reactions determined by…
 intensity
 duration
 level of dysfunction
 delayed onset
Aberdeen Centre for Trauma Research
Mental conditions
 anxiety
 depression
 substance misuse
 post-traumatic stress disorder
(PTSD)
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
Variability of PTSD rates
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air crash survivors
witnesses to air crash
natural disasters
oil disaster (10 years)
rape
Gulf War (1991)
54%
50-100%
2-50%
24%
65%
1-3%
NB: Higher in women
Higher after acts of violence
Aberdeen Centre for Trauma Research
Bereavement and grief
 different “losses”
 employer’s role
 contemporary changes
 faiths, cultures and rituals
At risk and vulnerability factors
• trauma
• victim
• environment
Trauma
 sudden/unexpected
 man made
 prolonged exposure
 multiple deaths/mutilation
 (perceived) threat to life
 proximity
 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 PPE
poor diet
sleep loss
work overload
helplessness
threat to life
conflict of interest
anger/criticism
“double jeopardy”
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Protective factors - operational
 leadership
 physical welfare
 organisation
 good communication
 briefing & preparation  appreciation
 meaningful duties
Aberdeen Centre for Trauma Research
Most helpful factors
(Alexander, 1993)
good preparation
good leadership/
management
attention to
physical needs
 clear definition of
duties
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purposeful duties
appreciative feedback
“black humour”
speaking to colleagues
Aberdeen Centre for Trauma Research
Evidence Informed Guidelines
Aberdeen Centre for Trauma Research
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
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
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
“WATCHFUL WAITING”
(NICE, 2005)
Post-incident interventions
 psychological first aid
 peer support
 critical incident stress debriefing (CISD)
 trauma risk management (TRiM)
Aberdeen Centre for Trauma Research
Psychological First Aid
 comfort, console
 support
 protect physically
 emotional expression
 physical needs
 security & control
 constructive action
 direct towards support
 accurate
information
 triage
 links
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
“Russian Roulette”
risk-taking
invincible
demonstrate coping ability
self-punishment
recapture the “buzz”
Peer support is...
 credible
 empathic
 less intrusive
 accessible
Aberdeen Centre for Trauma Research
But it may be missing because of...
 “infection”
 embarrassment
 confidentiality issues
 career issues
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
TRiM
(Greenberg et al, 2005)
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use of trained peers
not a treatment
two assessments (3 and 28 days)
screened on 10 risk factors
Aberdeen Centre for Trauma Research
Self help
 time out
 “real” world
 physical exercise
 sleep
 diet
 talking (selective!)
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
Lessons Learned
beware of hidden victims/ “ripple effect”
do not “medicalize”
implement triage using best evidencebased interventions
provide accurate information
signpost access to additional services
Aberdeen Centre for Trauma Research
www.stish.org
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: www.rgu.ac.uk/engage
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