Operational Debrief and Support for Responders

Understanding (Managing) the Difference

Philip Selwood

15th World CongressOn Disaster &

Emergency MedicineAmsterdam 2007

My background

10 years with EMS – last two years Chief Executive– 8 years as deputy in London (LAS)

National lead on Civil Emergencies for UK EMS 32 years with Metropolitan Police in London wide experience in major incident management (Irish Terrorism/street riots/international

terrorism) now ‘retired’

– audit of the English Ambulance Services– ‘ Emergency Preparedness’– adviser to the Welsh Ambulance Service– Executive Coach

Overview

Major incidents lead to adverse psychosocial reactions for:

Victims Families Community Emergency service personnel

A structured process is needed to assist emergency planners/responders to identify:

Risk groups Resources Evidence based interventions at various phases

Operational debriefs need to be managed so as

minimise risks to responders With thanks to Martina Mueller Consultant Clinical Psychologist ( OBMH)

(Oxfordshire and Buckinghamshire Mental

Health

Partnership NHS Trust)

General points I Type of event:

Natural

Technological

Mass violence

Adverse impact

Least

Most

General points II

Most people recover without treatment, psychiatric morbidity rates range from 5% - 30%

Some people are more vulnerable Gender Prior trauma Concurrent life stressors Younger age? Severity of trauma

Consequences can be as devastating as the event itself Losses Disability / disfigurement

Reactions can have a delayed onset Post-traumatic reactions can be very chronic for some A clear distinction needs to be made and understood,

between operational debriefing and physiological debriefing

Emergency service personnel are particularly at risk

Case Study One Paddington Train Crash 1999

Operational Summary 31 Killed 126 Injured taken to 6 Hospitals Last body removed 5 days after crash Response

41 Ambulances 200 Operational Staff 5 Mobile Medical Teams 4 Doctors Training School Personnel

What Happened

08:06 – Thames TurboDeparts Paddington

08:08 – Thames Turbo Passes SN109 at Red

08:09 – Thames Turbo collides almost Head-on with First Great Western

Operational Debrief

Called 10 days after All operational staff invited (eg responders,

managers, emergency planners) Little thought given to structure Loose agenda Outcomes ill defined Emotional needs of responders not

understood

Result

Anger Frustration Management Defensiveness Psychological impact Debrief process not completed Consequence Management

Case Study Two8th July 2005

London Bombings

08:50 hours

8 years on Lessons from Paddington had been learnt

(with thanks to Tony Crabtree D/Director HR LAS ) Tony.Crabtree@lond-amb.nhs.uk

Structure LINC workers trained and in place

Listening Informal Non Judgemental Confidential

TRiM (Trauma Risk Management) approach adopted * Professional counseling services available

On the day Rest centre established (support available lead by Director HR) Immediate feedback obtained but fundamentally about welfare

support Structured debriefs over following weeks at different levels Ongoing support over time as necessary

* Royal Navy – Dr Neil Greenberg MRCPsych

Conclusions

Need to impeccably manage the debrief process Separate out

Technical from emotional debriefing Management debriefs from responder debrief Offers of support in context of nature of the event e.g. London

Bombings

Focus Operational Debrief on How well prepared were we How well did we do How can we do better next time Be prepared for and manage the risks of emotional drift

Introduce support and debrief process as part of routine activity – not crisis driven

Proportionality of support is vital Not one size fits all

Thankyou

Philip Selwood