Response to Traumatic Events Crucial in Preventing Lasting Consequences
Originally published in Occupational Health Safety, July 1990
This is an edited version, September, 1998

Understanding Trauma

There is growing evidence that everyday stressors and traumatic stressors cause markedly different reactions and are biochemically different as well. The concept of a threshold of traumatic stress may be helpful in describing who has the greatest risk of developing a traumatic stress reaction. An individual's threshold is dependent on characteristics such as:

• Previous experience with trauma
• Age and development
• Overall mental and physical health
• Genetics
• Severity of potentially traumatic event

As a result of the difficulties in accurately determining any individual's threshold, it is very important not to make judgments about what will or will not traumatize a person. Poor judgments often mean that survivors are over or under treated.

On the other hand, it is possible to make some general guesses about what you might expect to be traumatic for "most" individuals. Survivors of sexual or physical assault, hostage incidents, severe industrial or vehicular accidents are likely to experience the psychological consequences of trauma. The observers, rescuers and supervisors may also be traumatized. For example, a man who was forced to extricate an amputated finger from a piece of machinery after an accident should be assessed for a traumatic stress response. Since those other than the direct victim of a trauma may be effected, it is very important to identify and provide post-trauma services to all potential survivors. 

Post Trauma Consequences

There are three general types of post-trauma consequences that survivors of work-related trauma experience in the hours and days following exposure to trauma. If you think back to your contacts with employees after accidents, you will probably recognize many of these things.

Reexperiencing consequences include feeling as if the incident is happening again, constant and intrusive thoughts about the event, fear or anxiety and concern about another or similar incident happening again or nightmares.

Withdrawal consequences include attempts not to think about or feel emotions connected to the incident (possibly through drinking, staying busy or not coming back to work) depression, withdrawal from family and friends, avoidance of reminders of the incident which cause increased feelings.

Other consequences including anger or irritability, sleep problems, difficulty concentrating and an exaggerated startle response.

Most people experiencing post-traumatic stress will shift between withdrawal and reexperiencing in an attempt to bring some stability and control into their life. An employee who witnessed the severe injury of a co-worker might call in sick for days after the accident. When she does return, she may be very scared, anxious and have severe nightmares. After that, this worker might stay out additional days or leave her position in an attempt to manage her post-trauma consequences.

As many as 25% of survivors of trauma experienced difficult stress reactions. In addition, long term problems can develop if post-trauma consequences are not managed. These may include substance abuse, divorce, loss of employment, severe depression and an increased rate of suicide. With immediate and effective responses to work-related trauma, most of these long term problems can be prevented and the organization can resume its activities.

Components of Trauma Recovery

For the past six years, the authors have provided post-trauma services to businesses and industries after work-related trauma. Four components seem to be necessary for post-trauma response for the prevention of long term problems.

Information
Personnel who receive accurate information about trauma and post-trauma consequences seem to make more successful recoveries. Those without information may believe that they should not be experiencing any emotional changes or are mentally ill. As you might expect, this causes increased anxiety and fear and tends to make post-trauma consequences worse. When information is available before a traumatic incident, personnel understand their responses and tend to use more effective coping skills in managing them.

Support
Personnel need support from family, co-workers and the "company." When this occurs, they feel much less isolated, distrustful and withdrawn. Small things that organizations do after traumatic incidents seem very important to personnel and help them feel as if there is truly concern for their interests. During these times, employees need to feel as if they are more than numbers and are valued beyond their output of work. These activities tend to promote increased commitment and productivity by personnel.

Ventilation
Detailed discussion of the incident with others is an important element of post-trauma recovery. Personnel who can talk about their experiences are more likely to feel supported by the listeners and others involved in the incident. They may learn important details of the event from others or may recall more of their own experience during the incident which promotes recovery. Finally, personnel who are able to articulate their experiences are more likely to understand the changes in their lives.

Coping Skills
Survivors of trauma are likely to have mistaken beliefs about how to live with their experiences. For example, it is not uncommon to hear personnel saying to one another, "We've just got to get on with our lives and put this behind us." Acting in this way decreases the opportunity to discuss and process the event increasing risk for difficult nightmares, flashbacks and fear on the job. The coping skills required for effectively managing trauma are not generally known and an effective post-trauma response must include information about the development of these important skills. (Barnett-Queen and Bergmann, 1988).

Responding to Trauma

The authors have developed the Post-Trauma Recovery Program to incorporate the components of recovery in an organized response. To be most effective, it should be developed before a traumatic incident occurs.

There are at least three reasons why efforts at managing traumatic incidents required preplanning and implementation. First, the post-trauma services should occur during the first two to four days. When a response is not planned, locating the most qualified resources and planning the services is difficult. Second, in a crisis situation, decision-making and planning is difficult. Other tasks may take priority over providing support for employees. Managers and personnel directors may be traumatized and this may make it difficult for them to coordinate these activities. Third, some of the long-term consequences of trauma can be prevented by providing information before the incident occurs. Obviously, this is not possible if no plans are in place.

There are three components of the Post-Trauma Recovery Program:

1. Trauma Preparation Training
   Employees who receive information concerning post-trauma consequences and procedures for the organization's post-trauma response will be better able to manage their feelings and participate in post-trauma services. The goals of this training are to: 1) prepare personnel for the normal psychological consequences of exposure to potentially traumatic incidents; 2) teach basic recovery coping skills to be used after an incident; 3) assist in creating a supportive environment throughout the organization; and 4) describe the components, procedures and regulations associated with the post-trauma program. Duration of training can vary as long as these goals are met.
    
2. Post-Trauma Debriefings
   A debriefing is a specially designed group meeting that provides the opportunity to discuss their experiences and feelings during and after the incident. Effective post-trauma coping skills are taught and each employee creates a plan for their recovery. During the debriefing, the facilitators assess participants to determine their needs for further services in the form of post-trauma counseling. 
    
3. Post-Trauma Counseling
   Counseling sessions are extensions of debriefings and include continued discussion of the traumatic event, post-trauma consequences and the further development of coping skills. Post-trauma counseling sessions are different from many other kinds of counseling and psychotherapy in that they are almost exclusively oriented to the "here and now." Few personnel who participate in a post-trauma debriefing require further services in the form of individual counseling. Those who do generally require three to four sessions of special post-trauma counseling.

Organizations should provide a follow-up to all employees involved in a traumatic event. First, a follow-up of the debriefing should occur within four weeks to insure that employees are recovering satisfactorily. Second, employee records should be checked periodically (at least 6 months and one year) to detect any continuing difficulties in that area.

There are a variety of benefits that result from implementing a post-trauma response. A recent study of the effectiveness of post-trauma services concludes that those receiving immediate assistance had a low incidence of permanent disability, were not likely to litigate against the company and saved companies an average of $37,000 over those individuals not receiving timely help. You might also expect employees that are not experiencing emotional difficulties and more comfortable doing their jobs to have a reduced incidence of further accidents. 

There appear to be significant results in the non-financial area as well. It is our experience that employees feel very positive about their employers and believe that the company is concerned about their well-being when efforts are made to respond to traumatic incidents. This often translates into greater productivity and less absences. 

One final note: All post-trauma services should only be provided by those qualified and experienced in this area. You wouldn't choose a neurosurgeon to remove your appendix and not all mental health professionals are prepared to work with employees who have survived these incidents. Shop around and ask potential service providers about their experience and training. If they have a history of post-trauma responses, check out their references and ask about timely response, rapport with employees and ability to follow-up effectively.

The technology is now available to provide effective post-trauma services to those impacted by work related trauma. Safety professionals who learn about the impact of traumatic events at work can reduce further accidents and long term problems among survivors.
 

References:

Barnett-Queen, T. & Bergmann, L.H. 1988 "Reducing the Impact of Duty-Related Trauma." Fire Chief 56-58.

Knight, E.A. & Felts, W.M. 1988 "Comprehensive Health Programs Should Include Stress Management." Occupational Health and Safety 57, 11, 46-50.
 

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