Caring For Employees Exposed to the Traumatic Events on the 7th July 2005 in London
Caring For Employees Exposed to the Traumatic Events on the 7th July 2005 in London
My team of 5 OHA's were based across England Scotland and Wales with three administration assistants. There were three hundred and twenty one BTP officers and staff directly involved in one or more aspects of dealing with the 7/7 bombings.
Exposure
The activities employees were involved in:
Presence of the bombs
Helping members of the public and walking wounded in getting to safety
Supporting the injured public in the trains while waiting for Paramedics
First aid support
Body recovery
Enquiries from the public
Police investigations
Working in collaboration with other emergency services
On the 21st July there was a second suicide attempt in London
Setting up and managing cordons.
My approach was to assess the physical and psychological risks to the employees exposed and to put mechanisms in place which would help reduce these health risks. For the purpose of this paper my focus is on the psychological risks of PTSD to employees exposed to the bombings.
It was clear in the initial hours after the bombs went off that it was OHA's, who had the transferrable skills across the physical and psychological health conditions, which was required to meet the needs of British Transport Police. On the day we approached an OHA Team in an NHS trust in the London area who provided the additional resources required.
Duty of Care
Our main priority initially was to ensure the safety of individual's, both employees and members of the public. We had to ensure our moral and legal duty of care for the employees exposed to these tragic events and their aftermath. In relation to PTSD there was no case law at that time confirming this duty of the employer however there was historically a number of cases of stress at work where the courts found the employer negligent in their duty of care . In addition the HSE have provided guidelines to employers which the courts would take into consideration in their judgments. British Transport Police took the view that it was their moral obligation to support the well being of BTP's employees and do all it could to prevent PTSD from developing in any of their employees taking a risk assessment approach.
It is now worth noting that the High Court case (Mc Clurg and others v Chief Constable of the Royal Ulster Constabulary, 2007) found that the Chief Constable of the Police Service of Northern Ireland (currently known as Police Service of Northern Ireland) was liable for damages for psychological and psychiatric injury sustained by officers exposed to trauma and that such damages were foreseeable from 1986 when cases began to be identified by Occupational Health.
Post Traumatic Stress Disorder
Definition of a traumatic event - The person has been exposed to a traumatic event in which both the following occur:
The person experienced, witnessed, or was confronted by an event{s} that involved actual or threatened death or serious injury, or threat to the physical integrity of self or others
The person's response involved intense fear, helplessness or horror.
National Institute for Clinical Excellence {NICE} states:
Post Traumatic Stress Disorder {PTSD} develops following a stressful event or situation of an extremely threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone
PTSD does not therefore develop following those upsetting situations that are described as 'traumatic' in every day language, for eg divorce, loss of job, or failing and exam
The condition can affect all ages and around 25-39% of people exposed to a traumatic event go on to develop PTSD
It is important to remember that most people exposed to a traumatic event will find after a month or six weeks their symptoms will settle and they will have no long term affects
During this time there is a period of watchful waiting and assessment
Sometimes it is worth noting that symptoms of PTSD may not present until years after the event
If assessment shows the symptoms are not improving then interventions need to happen and appropriate treatment arranged.
Symptoms
Re-experiencing
Avoidance
Hyperarousal
Emotional numbing
In addition Individuals may also suffer from symptoms of anxiety and or depression and they may also abuse alcohol.
Treatment for PTSD
PTSD is a treatable condition even if symptoms present years after the incident
Counselling, debriefing, medication is not recommended
It is very important that those around the individual are sensitive and supportive to them. If this does not happen then this will affect their recovery by slowing it down
First it is important to inform the individual about the symptoms of PTSD
Following assessment, treatment should be discussed and the individual's preference should be seriously considered
Trauma focused cognitive behavioural therapy should be offered to those with severe PTSD on an out patient basis
This should be accompanied with eye movement desensitisation and reprocessing {EMDR}
It is important to note that following a traumatic event most individuals exposed to the event will initially experience symptoms. However, these symptoms for most individuals will settle down with time and if necessary with treatment.
So my approach was in the initial hours/days after the event to ensure employees physical and emotional well being was assessed and appropriate support provided. This assessment was in the form of BP check, peak flow check, enquiries on hearing, and general well being check.
In the second week following the bombings we moved forward by assessing employees exposed for symptoms of PTSD. Where their assessment found raised symptoms of PTSD they were referred to the National Trauma Centre for their treatment. A programme to this affect was set up during the following weeks after the bombings. This was followed through with an evaluation of our work at six, twelve and eighteen months after the event.
Evaluation
Once the buy in from management was given to carry out an evaluation this was then carried out by the OHA's despite the huge demand on their time and the day job having to go on. This showed that the occupational health assessments were viewed as either quite helpful or extremely helpful by 85% of the employees and 89% of employees found the first line debriefing provided by Occupational Health helpful. Twenty six employees were referred to the national trauma centre and six self referred. Of those who attended twelve were sadly diagnosed with PTSD and provided with appropriate treatment.
Burnadette Dunne is a Specialist Practitioner atCOPE, the UK's premier occupational Health and Saftey, Occupational Ergonomics andOccupational Psychology specialists.
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