The Aftermath of Major Trauma –

Coping with Critical Incidents in Radiology.

Kathy ColganNew Zealand

New Zealand HeraldMurdered Rotorua toddler Nia Glassie slipped through the net of protective agencies to suffer horrific abuse undetected, says a coroner investigating her case. Nia was killed in 2007 by her mother's partner, Wiremu Curtis, who spun her on clothes lines, stuck her in a clothes dryer and threw her on her head in mock wrestling moves. By Michael Dickison5:30 AM Tuesday Aug 24, 2010

Critical Incident:

Defined as O Sudden unexpected events occurring

in the place of work which cause an individual to have strong emotional, spiritual, cognitive, physical and / or behavioural reactions as the result of a particular event.Lakes District Health Board Policy document, 2012

Influencing FactorsO individual’s life and / or work experiences O normal coping mechanismsO current state of health or welfareO number of exposures to traumatic

incidentsO perceptions of organisation support (or

not)

may all impact the severity of emotional distress

Critical Incident Stress

Defined as:O The emotional stress experienced by

individuals secondary to their exposure to a specific incident or number of incidents.(Blacklock 2012)

OStress debriefing is designed to support “emotionally healthy people who are experiencing acute, normal stress reactions to abnormal traumatic events.Mitchell et al 2003

Debriefing

O Verbalise distressO Form appropriate concepts about

stress reactions before false interpretations of the experience are formed

O Return to normal functioning

Critical Incident Debriefing Discussions can include:

OSummary of eventsOInitial call sequenceOManagement of trauma eventOPatient outcomeOSpecific group involvementOOpportunity for participants to describe involvementOClinical management of processOEmotional factors

NICE Guidelines 2005

recommend the good practice of providing practical and social support and guidance to anyone following a traumatic incident

Staff SurveySelect the types of critical incidents you have been involved in? OCardiac ArrestOTraumaOMulti-trauma OSuicide AttemptOFatality in EDONon Accidental Injury (NAI)OOther (please specify)

Sample QuestionsO Have you been directly involved in a

critical incident in your workplace?

O Did you have an opportunity to attend an Incident Debriefing session following the event?

O Timeframe in which debriefing occurred?

Have you experienced any of the following stress triggers following these events?OAnxietyONervousnessODeep sadnessOAngerOOther _______

Do any of these feelings stay with you longer than you might expect?OYesONoOComment_____________________________

DebriefingO Requested by staff on the floorO Team leader determines in

consultation with team if need is immediate – defusing

O Formal debriefing process instigated

DefusingO Held immediately after incident &

prior to shift endO Provides ‘emotional first aid’ to staff

involved in incident ensuring they are able to continue to end of shift

O Used to eliminate or identify the need for a formal critical incident debriefing session

Participation

To determine staff involvementO Use patient discharge summaries to

isolate clinical investigations performed & likely staff involved

O Invite involved staff either by phone or through immediate team leaders or managers

O Ensure appropriate managers are aware to allow staff release for attendance

LeadershipO Trained personnelO Skills to review case presentation &

clinical management of patientO Facilitation skills to encourage staff

members to talk about their reactionsO Ability to recognise critical incident

stress & staff stress related aspects O Knowledge to identify those who

require referral to other support agencies

STUFF Co.NZA seven-year-old girl savaged by four dogs was

bitten more than 100 times all over her body, her medical team says. At a media briefing this

afternoon, plastic surgeon Dr Zac Moaveni said the attack was horrific and sustained, and that

Sakurako would have been conscious throughout the attack and the medical process afterwards.

Sakurako had extensive injuries to her face and all her limbs. The injuries were complex as dog

bites involved crushing injuries as well as the cuts.Ian Steward 7 March 2014 (Fairfax Media)

“A holistic approach to community resilience through a well planned and implemented critical incident stress management programmes has been shown in the literature to promote self help and self efficacy of individuals and organisations”.Guenther (2012)

References:O Blacklock, E. (2012). Interventions following

a critical incident: Developing a Critical Incident Stress Management Team. Archives of Psychiatric Nursing; 26(1): 2-8.

O Guenthner, D.H. (2012). Emergency and crisis management: Critical incident stress management for first responders and business organisations. Journal of Business Continuity and Emergency Planning; 5 (4), 1-19.

O Mitchell, A.M., Sakraida, T.J., & Karmeg, K. (2003). Critical Incident Stress Debriefing: Implications for Best Practice. Disaster Manage Response; 1 (2):46-51.

ReferencesO Regel, S. (2007). Post-trauma support in the

workplace: the current status and practice of critical incident stress management (CISM) and psychological debriefing (PD) within organizations in the UK. Occupational Medicine; 57:411– 416.

O Theophilos, T., Magyar, J., and Babl, F.E. (2009). Debriefing critical incidents in the paediatric emergency department: Current practice and perceived needs in Australia and New Zealand. Emergency Medicine Australasia 21, 479-483.

References:O Resource Guide for Critical Incident stress

and debriefing in Human Service Agencies, May 1997, Human Resources Branch, Victorian Government Department of Human Services, retrieved 3 May 2014 from: http://www.health.vic.gov.au/archive/archive2004/96ma124/downloads/96ma124.pdf

ReferencesO Lakes District Health Board Protocol: Health

and Safety Procedures Manual - Document No: 81428 (2012) – Critical Incident Debriefing Policy.

O Lakes District Health Board Protocol: Management and Administration Manual Document No: 365593 – Emergency Management Policy.