Managing Traumatic & Critical Incidents
“Serious, traumaticorcriticalincidents maybe accidental,intentionaloranaturaldisaster. Whateverthe cause,entiregroupsofpeoplecan be devastated”.
Introduction:
Individualmemberswillreactdifferentlytothesameexperience.Howeach respondisdeterminedbymanyfactors.Thereare,however,physiological, behaviouralandpsychologicalresponses,whichtendtobecommontoparticular agegroups.
Whenadeathorsignificantlossisassociatedwithatraumaticincidentitisrarefor thegrievingprocesstobeuncomplicated.Generally,individualshavetocometo termswiththeshockofthetraumabeforethegrievingprocesscanbegin.
Ingeneral,peopleofallageswillshowastheirmostfrequentsymptoms, sleepdisturbancesandnightterrors,persistentfearsaboutnormalevents, fearsoffutureincidents,lossofinterestinactivities.
ACKNOWLEDGEMENT
Theseguidelinesarearesultoftheexpertiseprovidedbythe generousstaffandpublicationsofthefollowing.
NSWDeptofEducationTraining(RydeDistrictOffice) ScoutAssociationofAustralia(QueenslandBranch)
GuidanceUnit.DepartmentofForensicMedicineWestmeadNSW IPSTraumaManagementTeam
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WhatdoIdowhenamajorcriticalincidentoccurs?
“FIRSTTHINGSFIRST”
Anyinjuredortraumatisedmembers:
1.SeekHelp.
Immediatelycontactappropriateemergencyserviceand arrangeattendance.Ensurecareandwellbeingof
thoseinvolved.
2.Notify
ImmediatelynotifytheseniormemberofRegionor BranchHQ.Adviseregardingthefactsandneedfor supportorcounselling.InthecaseofActivitiesthis notificationwouldcomefromthe“HomeLeader”.
3.Refer
AllMediaRequestsaretobereferredtoBranchHQ.
4.Supervise
HaveaResponsibleTeamMemberoverseescene.
5.Communication
EnsureRegionorBranchHQ’sarekeptfullyinformed anduptodate.AgaintheHomeLeaderhasaroleto playhere.
OthersNotInjuredbutinvolvedorObserversof
Incident.
1.Consolidate
Ensurethoseinvolved,includingobserversarekept together, until advised otherwise.
2.Remove
Ifnecessarymovethoseinvolvedtosafetyandaway fromwhatmightbeanunpleasantscene.
3.Notify
AdviseRegionorBranchHQimmediatelyproviding essentialdetailsoftheincidentandthose involved. In thecaseofActivitiesthe“HomeLeader”wouldsupport thisfunction.
BranchHQwilltakecontrolofthemanagementofthe situation.
4.Manage
Ensurespeculationandrumourisnotasubstitutefor thefacts.Ensureallinformationisafactual account of
what has happened and answer questions openly and honestly.Donotspeculate.
(DoNOTusetermsthatmaycauseconcernslater. Termssuchas“Theywereskylarking”;“Theywere misbehaving”;“beingstupid”etc.Simplestatements suchas“theyweretooclosetotheedgeandfell”are best).
Fosteranatmosphereoftrustandavoidwordsthat mightinhibitemotionalresponses.(Eg. “Act your age”, “growup”)usewordssuchas”itsnaturaltobeupset andtoshowfeelings”.
Whathappensnext?
Inthefirstfewhours,providelotsofsupport
1)Comfortandconsole.
2)Fosteratrustingopenatmosphereandanswer questions openly and honestly.
3)Saylittle.Showyoucare.Simplysittingquietly beside the person may be all that is required at this stage.
4)Provideinformationaboutwhathappenedand aboutwhatisbeingdonetohelpthoseinvolved.This helpsthepersoncometogripswithrealityandto reorient to the present.
5)Acceptsilencebutallowexpressionofinitial emotionalreactionsanguish,fear,disbelief, helplessness,andanger.
6)Listenwithunderstandingandempathy.
7)Saylittlebutuseminimalpromptsandgentle probingtoencourageexpressionoffeelings. Responsessuchas“You’vehadafrightening experience”orsimply“I’msorry”areadequate.Avoid tellingthepersonhowheorshemustbefeeling.
8)Iftheemotionalstressisintensestaywiththe personuntilothersupportpersonscantakeover.
9)Bealertforanyonewhoappearsnottorespondat alltosupportandwhomaintainsahighlevelof disturbance.Suchpersonsmayrequirereferralto specialistcounsellingormedicalattention.
10) Reassurethattheconfusedandpainfulemotional stateisanormalresponsetosuchanexperience. Assurethatothersinvolvedwhoarefeelingthesame way that itwillpassintime.Itmaybenecessaryto repeatthisfromtimetotime.
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11) Bealertfromthe“phantomincident”effectwherea personaddstohisorheranxietylevelwiththoughts
andcommentssuchas“IfI’dbeenstandingnexttohim
Iwouldhavebeenhurtkilled”and“weren’twelucky! Justimaginewhatwouldhavehappenedtousifwe..”
12) Gentlybutfirmlyremindthepersonoftherealityof whatDIDhappen.
13) Supportthepersonduringtherealitytasksofthe immediateaftermatheg.seekingandreceivingnewsof otherskilledorinjured,givingstatementstothepolice, recoveryofpersonalpossessionsfromtheincident scene.
14) Setthepersonsimplepracticaltaskstorestorea sense of present reality and of taking control of him/herself.
15) Importantlyencourageyourmemberstoforma buddysystemforongoingsupport,especiallyforthe less‘open’members.Encouragethemtoname someonetheywouldcontactwhentheyfelttheneedto talk,orfeltdown.
16)Checkthatsupportisavailablebeforetheperson leavestheincidentsceneandgoesbackintotheTroop lines.
Whatreactionsmightoccurafteratraumatic experience?
Youthmembersofscoutagereacttotraumatic experiencesinanumberofways:
Animmediatereactiontoatraumaticexperiencemay befearfulness,whichcanpersistforsometime.This resultsfrom,thechallengetotheyouthmember’s senseofsecurityandinvulnerability.
Oftenacompellingurgetoputtogetheradetailed
pictureoftheeventsoftheincidentbyrepeatedlygoing
over details with otherswhowereinvolved.
For some it may even be important to visit the scene of theincidentsometimesonmorethanoneoccasion. Thisisapartotherprocessofacceptingtherealityof theexperience.
Theywilltendtoturntotheirpeersforsupportand consolation.ThiscanbeupsettingforLeadersand parentswhomayfeelshutoutintheireffortstohelp.
Over time, a sudden memory, sound, situation, or smell maytriggerflashbacksorsuddenrecallofvivid
disturbingmentalimages.Intenseanxietyandstress maybereactivatedforashorttime.
ItisimportantfortheScoutingroutinecontinuetobeas normalaspossible. Routinebreedssecurity.
Whataresomeoftheobservablereactionsand symptoms?
PhysicalSymptoms:Headaches
Vagueaches/pains Overeating/lossofappetite Bowelproblems
Skindisorders
Sleepdisorders
BehaviouralReactions
DecreasedScoutperformance
Sadness/depression
Failuretoperformresponsibilities
Atypicalbehaviour
Lossofinterestinactivitieswithpeers
Lack of emotion
Attention- seekingbehaviour
Disruptive
Lossofinterestinpeeractivities/hobbies
Resistancetoauthority Rebelliousbehaviour Tension Illusions/hallucinations Antisocial(eg.stealing)
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Thefirstfewhourshavebeenmanaged,what happensnext?
Thetimeofgreatestreactionandneedis24to72hours afteracriticalincident.Rememberthatyoungpeople areveryresilientandwilltaketheircuefromhowtheir leadersreact.
1.Forthoseonwhomtheincidenthashadamarked impact,thisperiodischaracterisedby:
aresurgenceofintenseemotions-anger, guilt, fear,despair
intrusivethoughtsandperhapsnightmares
a need to piece together the details of the events of theincidentandtoworkthroughtheexperience
and associated emotional reactions.
2.Inordertoassistthoseinneed:
Encouragearesumptionofregularroutine,asa structuredenvironmentwillfacilitaterecovery.
Providesupportforleaders,andotherswhoarein closecontactwiththoseaffected.
Encouragethepersontotalkabouthisorher currentfeelingsandfeelingsexperiencedduring andjustaftertheincident.TheresponsibleTroop Leader can help other Leaders to be sensitive to the needs of some Youth Members to talk about theiremotionalresponses.
Reassurethepersonthatintrusivethoughts, recurringnightmares,intensefeelings,mood swingsarenormalreactionsandarelikelytobe short-lived.
EncourageyouthmembersandLeaders,who show intense, need to work through the events of theincidentandtheirreactionstothem,toseek helpthroughtheirlocalmedicalpractitioner,school counsellororCommunityHealthCentre.
Irrationalfeelingsofsurvivorguiltorshameat perceivedinadequatebehavioursorlossof emotionalcontrolduringoraftertheincidentare oftenkeyissuesthatcanbeeffectivelyworked throughinagroupenvironment,overanumberof sessionsifnecessary.
Questions such as “Where were you when…?” “What did you do when….?” can be useful in a grouptohelpparticipantsunderstandtheevents better.Otherusefulactivitiesarereadingand
discussingnewspaperreportsoftheincident,and arrangingvisitstotheincidentscene.
Questionssuchas“Howdidyoufeelwhenthe incidenthappened?”or“Howdidyoufeelwhen youheardwhathappened?”and“Arethere feelingsyouexperiencenowasaresultofthe incidentthatworryyou?”areusefultogenerate explorationsoffeelings.
Wheretheincidenthasinvolveddeathorserious loss,itmaybeatthisstagethatthegrieving process begins. Where death has occurred encourage, but don’t insist or force participation in memorialservicesandattendanceatfuneralsby thoseclosetothedeceased.
WhatarethereactionstoGrieforLoss?
Firstruleistorememberthatyoungpeopleareveryresilient.YouthMembersinthisagegrouparecapable ofthinkingabstractlyaboutdeathand,withsupport, theynormallyareabletoprogressthroughthefour maintasksofmourning.
1.Acceptingtherealityoftheloss.
2.Dealingwiththepainofgrief.
3.Adjusting to the environmentwithoutthepresence of the deceased person.
4.Withdrawingemotionalenergyandre-investing thatenergyinanotherrelationship.
Thought patterns, which mark the early stages of grieving, are disbelief, helplessness, confusion, preoccupationandsometimesasenseofpresenceof thedeceasedandhallucinations.Thesemaybe accompaniedbyfrequentcryingandthetreasuringof objectswhichbelongedtothedeceased.
Behavioursfollowingbereavementaresimilartothose, whichmayoccurafteratraumaticincident.However, wheregriefisacutesomephysicalsensationsmaybe apparent.
Hollownessinthestomach Tightnessinthechestand/orthroat Drymouth
Oversensitivitytonoise
Senseofde-personalisation, nothing seems real
Breathlessness,sighing
Lack of energy.
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Whengrievingisassociatedwithatraumatic experience,reactionstotheshockofthetraumatend todominateandthegriefprocessmaynotproperly begin for several weeks.
Youthmembersintheirearlyteensmaywishtoexplore philosophicalorreligiousquestionsaboutdeath.While peersarethemostprobabletargetsforthese discussions,Leadersandparentsmaybeapproached aboutthisissue.
Generallyyouthmemberswhoareelevenandolder, shareadultunderstandingsofdeath.Theymay experiencegriefreactionsincludingshock,denial,guilt, angerandbargainingwhensomeonehasdied,and finallyacceptancebeforetheyareabletoreturntoa level of functioning similar to that evident before their loss.
Rememberitisimportantto encourage youth members,aswellasLeaders,toforma buddysystemforongoingsupport,especiallyfortheless‘open’members.
Ensureeveryonehasidentified,intheirmind,someonethey would contact if or when they felt the need to talk,orfeltdown.
So,howcanIbestsupportmembersaftera traumaticincident?
Communicatecaringandacceptance
Demonstrateasincereinterestinwhattheyouth memberissaying.Youngpeoplewillcommunicate more effectively when they feel safe, accepted and understood.
Recognise and acknowledge youth member’s feelings so that they are able to feel at ease in exploringinformationfurther.
Maintainapositiveattitudesothatyouthmembers arehelpedtoviewthefutureinahopefulway. Reassure youth members that theirfeelingsand behavioursarenormalreactionsandwillfadeintime.
Assistyouthmemberswithoverwhelming,immediate problems initially. Success even in a small practical waywillhelptobuildtrustandconfidence.
BePatient
Allowtheyouthmembertoexpresshis/herconcerns atarate,whichispersonallycomfortable.
Be patient in gaining an understanding of the youth member’saccountoftheincident.Thestorymaybe toldinagarbledformwithdisjointedfactualand emotionalcontentflowingquickly.
Tracingbackcarefullyoveraspectsofthestory, whichcanbediscussedwithcomfort,mayassistin orderingthoughts,reducingfearsandre-establishing trust.
BeAwareofBodyLanguage
Observetheyouthmember’sbodylanguageandbe sensitivetononverbalsignalsheorshemaybe communicating,eg.toneofvoice,paceofspeech, bodypositioning.
Maintainappropriateeyecontact,leanforward slightlywhentalkingandfacetheyouthmember,to showattentionandinterest.
UseSimpleLanguage
Listencarefullyandtrytounderstandwhatthe experiencemeanswithinthecontextoftheyouth member’stotalenvironment.
Useshortsentencesandunemotionallanguage.
Useaquiet,steadyvoice,withminimalprompts,(eg. uh-huh,mmm,nods)toencouragetheyouth member.
Encouragetheyouthmembertoexpresshis/her feelingsopenly,eg.“Howdidyoufeelwhen... happened?” Use open-ended questions when seekingmoreinformationaboutfacts,issuesora
closerunderstandingoftheyouthmember’sfeelings. ClosedquestionscanbeusedwhentheLeader
wantsspecificinformation,eg.“Whoisathome now?”“WasChristineonthatbus?”
MonitorEmotional/BehaviouralStates
Provideinformationtoyouthmemberswhenthey requestitinawaythattheycanunderstand.Donot attempttohidethefacts.
Monitortheyouthmember’sphysical,emotionaland behaviouralfunctioningovertime.Enlistsupportfrom Leadersandothersifrequired.
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ManagingTraumaticCriticalIncidents
SUPPORT/COUNSELLINGREPONSESFOREACHPHASE (Leaderscan offersupportforphasesI-II-IIIbut referwhenindoubt.) (Only qualifiedcounsellorsshouldoffercounselling.)
TRAUMATICINCIDENTRESPONSESAPPROPRIATECOUNSELLINGTASKS
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PHASEI
SHOCKDISRUPTION
Dependingonseveritycan last hourstodays.
PHASE11
DENIAL/DISBELIEF
“Thisisnotreallyhappening”.
“It’snottrue”. Attitude.
PHASEIII
EMOTIONALIMPACT
24 to72 hoursafterbutcanpersistfrom6to10 weeksplusdependingon:
the situation coping skills support
skillofdebriefing. Commontofeel
anger depression
moodswingsthat reflectanxietiesabout everfeeling‘normal’again.
PHASEIV
WORKINGTHROUGH,
Trainedcounsellorswhoknowhowtodealwiththe emotionsinvolvedshouldonlycarryout‘Feelings’and
‘workingthrough’)
“WhatIf?”“Ifonly”periodinwhichpeopletryto‘de- victimise’by minimisingeffectof thetraumatising experience
PHASEV
ACCEPTANCE/RESOLUTION
Comingtotermswiththe eventasbeingasad orpainfulmemory
PHASE VI
NORMALREACTIONSLEADINGTO EMOTIONALSTABILITY.
Situationalreminderssuchasanniversariesetc. arequitenormaland shouldbeencouraged.
FORPHASE I-II-III
Listening Comforting Consoling
Encouragingasenseofsafety
Informing Empathising Reassuring Monitoring
Co-ordinating
Listeningshouldneverstop!
FORPHASEIV
Co-ordinating Structuring Workingthrough
Recognisefeelings Groupwork Reassuring Empowering Monitoring
Self-monitoring
FORPHASEV–VI
Slowlywithdrawingsupportand substitutingit withsubtlemonitoring oftheir progresstowardnormal reactionsandlife.
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Scouts Australia NSW acknowledges the contribution of Dr Warwick Bateman AM in the development of this Leader Support Guide.
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