Events such as the Asian Tsunami, and the terrorist attacks in London, have focused the minds of the public on the issue of post trauma stress. But while the need for post trauma support and counselling for those directly affected by events such as these may be apparent, there are many more people who may also require support.



Occupational Health or Human Resources professionals, or anyone working in an employee support role, may very easily need to provide help to an employee who has lost someone, or has a friend or colleague who died or was severely injured in or traumatised by these or any other recent traumatic incident. If this is a situation in which you find yourself, the following will help you with understanding post trauma stress, the common reactions to it, and what can be done to help.

The nature of trauma

Nothing can adequately prepare organisations or individuals for the experience of a traumatic incident, because by definition it is outside ‘normal’ experience. As well as in the events described above, this was vividly illustrated by those affected at the collapse of the World Trade Centre, New York (2001) and the disasters of Canary Wharf (1996), the Manchester bombing (1996), the sinking of the Marchioness (1989), Hillsborough (1989), Kings Cross (1987) and numerous other tragic events which were impossible to have been predicted.

Many victims and witnesses of violence or injury sustained in accidents, criminal activity or natural disasters such as fires or floods, may well require professional post trauma support to help deal with the effects of their experience. Unfortunately, more and more people are the unwitting victims of violent crime both at work and in the street. For example, a young girl who has a Saturday morning job working in a supermarket and is involved in a raid on the store, may need just as much care and support as a young man who has a serious accident in his firm’s van as he carries out his delivery schedule.

At-risk groups

Whilst all organisations should carry out risk assessments to determine whether employees could be at potential risk of psychiatric harm from events that they may have to deal with in the course of their work, there are some organisations whose staff, by virtue of what they do, are always potentially at risk. These include:

•the armed forces and emergency services personnel

•bank staff and certain others in the financial field

•those working in retail outlets, off-licences and petrol stations, where staff may be alone in the premises outside normal opening hours or even all night

•those who have contact with the general public in circumstances where there is a greater risk of violence.

Companies operating in the travel industry need to be aware not only of incidents that do occur, but also the potential for accidents occurring – and in particular, major disasters for which effective contingency plans should always be in place.

There are also many organisations operating within particular industrial sectors that are inherently hazardous, and where although good risk management can substantially reduce the incidence of accidents, they may still occur. In such instances, contingency plans need to be ready to be implemented, often at short notice, to support those involved.

It is not only those people who are directly involved in an incident – i.e. victims and survivors - who may suffer the effects of trauma. It can also affect those who may be indirectly involved, e.g. witnesses, neighbours, families and work colleagues. All these people have the potential to be traumatised to a greater or lesser degree

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Although victims will inevitably be emotionally unprepared to deal with a sudden emergency or disaster, trained emergency workers will normally be less vulnerable to emotional overload as a result of extensive mental preparation and training for just such eventualities. Nevertheless, this does not preclude them from being affected and possibly traumatised by being involved.

The following are just some examples of how individuals can become directly or indirectly exposed to traumatic incidents and possible post-trauma stress:

•Co-workers who may have to return to work immediately following a disaster will have to come to terms with the injuries and possible death of one or more colleagues, together with possible damage to workplace buildings caused by fire, water, etc. The workplace may have changed dramatically and the effect of this may impact on everyone within the organisation.

•There may possibly be feelings of guilt associated with injury and loss of life. Management and staff may feel disorientated and emotional following the harrowing experiences of fellow workers, and will be susceptible to post-trauma stress. Employees may have to be relocated to other premises and be in a position of some turmoil for days, or possibly months, thereafter.

•The designated first-aiders within an organisation, who may have had only limited training and experience, will most certainly be called upon to deal with a major incident before the emergency services arrive. Yet the support that they themselves will require in the aftermath of the event is often overlooked.

•The train driver who experiences a person committing suicide under the wheels of his or her train, and the maintenance team who have to remove the human remains from the track, may be required to relive the situation when they give evidence to an inquiry - which can sometimes be months or even years later. This can trigger again the traumatic reaction to the original incident, and the person may be unable to ‘close the chapter’ until all investigations are complete.

•A traumatic incident may also impact on the confidence of other employees performing similar jobs within the organisation.

•Proper consideration should also be given to people involved in potential incidents or ‘near misses’. These may include people who believe that they came close to a major accident or incident, even where they themselves sustained no actual damage or physical injury.

The effects of a traumatic incident

Anyone who has been involved in a traumatic incident is likely to have some form of reaction to it. These reactions may happen immediately, or may not occur for weeks, months or occasionally even years afterwards. They are likely to be worse if:

•Many people died or were injured during the incident, or death or injury was sudden, violent or happened in horrifying circumstances

•The individual has feelings of helplessness or wanting to have done more

•They do not have good support from family, friends or colleagues

•The stress resulting from the incident comes on top of other stresses in their life

Emotional reactions

An individual’s emotions or feelings are likely to be in chaos after the event, although alternatively they may feel nothing. Some of the more common emotional reactions are:

Guilt - for not having done more, or for having survived when others did not

Anger at what has happened, or the injustice or senselessness of it

Fear of breaking down or losing control, or of a similar event happening again and being unable to cope

Shame - for not having reacted as they might have wanted to, or for feeling helpless, emotional and wanting others to be with them

Sadness - about the deaths, injuries and the whole circumstances of the incident. Individuals may also feel depressed without knowing why.

Mental reactions

People are very likely to find that they cannot stop thinking about the incident, dream about it, or suffer loss of memory, concentration or motivation. They may experience flashbacks, hate to be reminded of what happened, or have feelings that they are always on their guard or easily startled.

Physical reactions

Individuals often experience tiredness, sleeplessness, nightmares, dizziness, palpitations, shakes, difficulty in breathing, tightness in the throat and chest, sickness, diarrhoea, menstrual problems, changes in sexual interest or eating habits, and many other symptoms – frequently without making a connection with the incident.

Other difficulties

People may feel hurt, and their relationships with others, particularly their partner, may feel under additional strain. They may find themselves taking their anger out on their partner or family, or emotionally withdrawing from close relationships, just when they need them the most. (It’s important to try not to do this.)

What can be done to help

Nature often heals by allowing feelings to come out and making people want to talk about them. This is very helpful, and should be encouraged if the opportunity arises.

Talking to a trained counsellor is often a great relief and can reduce much of the tension and anxiety. Trying to ignore personal feelings, or avoid thinking or talking about the incident in the belief that they can cope, may be unhelpful and possibly harmful to individuals in the long term. This can lead to a storing up of problems that will come out sooner or later - possibly creating even greater difficulties.

When to look for professional help

People who have experienced a traumatic incident should be encouraged to seek professional help if they:

•feel they cannot handle intense feelings or body sensations; their emotions are not falling into place; or they feel chronic tension, emptiness or exhaustion

•continue to feel numb, empty or without feelings

•have to keep active in an attempt to suppress their feelings

•continue to have nightmares or are sleeping badly

•have no-one to share their emotions with and feel the need to do so

•start to have accidents or their work performance suffers

•start to smoke, drink or take drugs to excess

•are suffering from exhaustion or depression

•cannot control their memories of the experience, and these are affecting their personal well-being

•or their relationships seem to be suffering, or sexual problems develop

It is also important to encourage individuals to remember:

•that they are basically the same person they were before the incident happened

•that talking about their experience and their feelings can help

•that suppressing their feelings can lead to further problems

About The Author

Carole Spiers combines three roles of broadcaster, journalist and corporate manager in the challenging field of stress management and employee wellbeing.

With 20 years as a top industry guru on stress management and wellbeing, Carole’s energy and dynamism extends to providing professional comment to media including television (BBC, ITV, Sky, NBC, CNN), print (Sunday Times, Daily Telegraph, trade and professional journals) and countless radio interviews.

A successful entrepreneur herself, Carole is the founder and MD of the Carole Spiers Group – a dynamic, niche consultancy, and the UK’s No. 1 provider of Stress Management and Employee Wellbeing from the shop floor to the Boardroom

A former Chairperson of the International Stress Management AssociationUK, Carole was instrumental in establishing National Stress Awareness Day™. Carole acts as an Expert Witness on Stress Risk Assessment before the Courts, and is the author of Tolley’s ‘Managing Stress in the Workplace’.

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