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Reducing Trauma's Toll

Ron served as a police officer in a major U.S. city for more than 20 years. During that time he was faced with traumatic situations on many occasions. He felt that he faced these situations as a professional and maintained a healthy balance between his work and home lives. After retiring from the police force, he accepted an administrative position with a private company, which involved no exposure to emergencies or traumatic events common to his work on the police force.

Shortly thereafter, Ron suddenly began to experience feelings of anxiety and panic, with the experiences of 20 years flooding his awareness. He had no idea what was happening to him and felt that he was going crazy. At no time during his tenure with the police force had Ron received any debriefings or education concerning the possible psychological effects of dealing with traumatic events. While it is unknown whether proactive intervention on the part of his employer would have completely prevented Ron’s experience, it certainly would have helped him understand what he was experiencing.

Managers in fields such as security and safety must be aware of trauma-related stress and find ways to assist employees in dealing with it. To help employees cope, managers must first understand what types of employees are most at risk for trauma-related stress. Then, employers must educate themselves on this type of stress and how victims respond to such emotional states. Only after taking these steps can managers help employees deal with extreme stress. 

Risk factors. Certain high-risk occupations such as police officer, firefighter, emergency medical technician, and security officer are inherently stressful jobs, and such workers are more susceptible to trauma-related stress. However, all employees in some industries are also at risk. One of the most notable is the healthcare industry. Hospitals and healthcare facilities, for example, have many employees who serve as first responders, but even receptionists and maintenance staff in these fields can encounter trauma as an everyday part of the job.

A recent survey of healthcare workers at St. Paul’s Hospital in Vancouver, Canada, found that 92 percent of workers had been assaulted in the emergency room at least once over a one-year period. Approximately 97 percent of workers had been physically threatened and 66 percent had experienced verbal abuse at least once per shift. A similar survey of 170 U.S. emergency departments revealed that 43 percent of employees reported at least one physical assault per month; 32 percent reported at least one verbal threat per day; 18 percent reported use of a weapon to threaten staff at least once per month; and 7 percent reported witnessing violence resulting in death within the previous five years.

Stress basics. It is important for anyone who manages first responders to understand the basics of trauma-related stress and be able to recognize the symptoms and indicators in personnel. While general stress and trauma-related stress may appear to be similar, they differ in significant ways. General stress arises as a result of the pressures and tensions of daily life and tends to be cumulative, relatively predictable, and often easily handled by standard stress-management strategies. Trauma-related stress is distinct in that it develops as a result of exposure to situations that fall outside the realm of normal experience, involving threatened harm to self or others, with strong emotions of horror, fear, or helplessness. Just as physical trauma is caused by a wound to the body, psychic trauma can be caused by the shock of an emotionally disturbing experience.

Symptoms of trauma-related stress can vary in type and intensity and may include: recurrent and intrusive recollections of the event including images, thoughts, or perceptions; dreams of the event; acting or feeling as if the traumatic event were recurring; intense psychological distress at exposure to cues that symbolize the traumatic event; and persistent avoidance of stimuli associated with the trauma. Stress victims may report a diminished interest in significant activities, a feeling of detachment or estrangement from others, a sense of a foreshortened future, difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance, and exaggerated startle response.

A particular psychological term, Post-Traumatic Stress Disorder (PTSD), is used when specific clinical criteria concerning symptoms are met. PTSD may exist if symptoms persist for longer than one month and cause significant distress or impairment in social, occupational, or other important areas of functioning. The severity of symptoms for PTSD varies. It tends to wax and wane, but usually diminishes over time. More than half of PTSD cases resolve within three months.

Stress response. Responses to traumatic stress are unique to each victim, with a strong subjective component. Individuals create the meaning from their experiences. Some factors affect the likelihood of developing stress reactions, such as severity of the incident, duration, proximity to the event, and frequency of exposure to traumatic events.

Personal factors affecting the impact of potentially traumatizing events include the quality of social supports, a family history of mental illness or symptoms of anxiety and depression, traumatic or abusive childhood experiences, and the individual’s mental health.

Traumatic stress reactions can develop in individuals with no predisposing conditions, particularly if the stressor is especially extreme as is the case for at-risk populations such as combat veterans, victims of natural disasters or criminal violence, or first responders.

In the case of one hospital nurse, a single incident resulted in drastic life changes. The nurse was new on her job at the hospital. While she was normally assigned to a medical floor, she was helping out that day in the emergency department. An angry man armed with a knife, obviously looking for someone he believed to be there, entered the hospital and began screaming and brandishing the knife. The nurse watched as the man approached some of the hospital employees with the knife in a threatening manner. Within a minute or two, the man headed for the exit and was subdued by several security officers. Although quite upset, the nurse continued her duties quietly and left at the conclusion of her shift. Feeling quite anxious, she spent the evening alone in her home. Unable to sleep, she had a few glasses of wine to try to unwind.

Over the next few weeks, the nurse remained at home after work, did not engage in her usual exercise and social routine, and drank more wine than usual in attempts to relax and sleep. She believed that because she was a nurse who was trained to deal with emergencies and focus her attention on the care of others, she should be able to shake off the effects of the incident and function normally without anyone else’s help. Although she gradually began to feel more like herself, the process was slow, and she continued to struggle with chronic mild anxiety, suspicion of others, and new concerns with issues of personal safety.

More subtle behavioral or personality patterns can also be observed in some individuals. Exposure to potentially threatening situations, especially when frequent or prolonged, can lead to a change in outlook or perspective. Managers may observe an apparent disregard for rules and procedures, with the employee viewing them as petty or restrictive. This can lead to interpersonal and management problems within the organization.

In addition to increased understanding of trauma-related stress and PTSD, mental health professionals have gained increased awareness of less severe symptoms that may manifest in persons who frequently deal with victims of various forms of trauma. In these less severe cases, first responders tend to view exposure to traumatic and threatening events and their victims as “just part of the job” and may believe that learning to maintain an emotional distance from the people and situations with which they deal professionally is always adequate. For many, though, this approach is not enough.

Stress solutions. It is possible for managers to take steps to help employees maintain a sense of emotional well-being and control. Research has demonstrated that addressing trauma-related issues proactively and in specific ways can help prevent or minimize the development of symptoms.

Ideally, management personnel should obtain appropriate training or education about trauma-related stress. If possible, this education should be focused on the unique employment setting.

In a general sense, however, the following steps are usually appropriate. First, employers must create the right atmosphere. Then, regular debriefings should be added to the work schedule. Finally, managers should help employees maintain a regular routine after a stressful event.

Create an atmosphere of safety. The first step for managers is to create a working atmosphere conducive to the sharing of concerns about stress. Employees should not be made to feel stigmatized if they acknowledge any type of psychological difficulties.

Managers should make a point of being viewed as open and available to employees. Managers should touch base with employees frequently, providing them the opportunity to discuss issues of concern. If a senior manager is unable to have this sort of personal interaction with employees, then a supervisor or some other responsible authority figure must be designated to fill in. Such emotional support is critical when managing employees who work in traumatic environments.

Conduct debriefings. Research has consistently demonstrated that debriefing is an important part of preventing and managing trauma-related stress. Because of concerns regarding stigma issues, debriefings should be mandatory after any stressful event and should be held as quickly as possible following the traumatic incident.

Company employee assistance programs (EAPs) may provide a mental health professional to conduct debriefings; if not, appropriately trained managers, supervisors, or HR personnel may do so. Participants should include all who were affected by the incident. In particularly severe situations, such as an employee death or serious injury, additional uninvolved coworkers are often included or provided a separate debriefing to deal with their emotions. It is important to include those who may be affected indirectly through their relationships with involved individuals.

Debriefings are typically held in a group format, often followed by individual meetings with more significantly affected persons. The primary purposes of the debriefing process are to allow people to verbalize their experiences during the incident and to normalize the associated thoughts, feelings, and behaviors they may have as a result of the experience. Employees will then continue to discuss the incident among themselves. These subsequent discussions are expected and serve to aid the healing process.

Briefings should also be used to remind employees of the company EAP and its purpose. The company EAP should be involved in any serious situation, and the contact information for the EAP should be available to employees at all times.

Maintain a routine. When a traumatic event has occurred, employees must be urged to give themselves time and to anticipate some difficulty. Nonetheless, it is important for employees who have experienced a traumatic incident to maintain as normal a routine as possible. Thus, while it may be necessary to take a short period of time off immediately following the incident, depending on the employee’s physical and psychological condition, “getting back on the horse” as soon as possible is generally the more effective way to combat PTSD symptom development.

Information is power when it comes to trauma-related stress. Employers should educate workers on what to expect as a result of trauma. For example, staff should be told that such emotions are normal, which can be a great relief to anyone experiencing them.

Employees should be urged to engage in healthy behaviors to cope with excessive stress. For example, getting plenty of rest and experimenting with relaxation techniques should be touted as healthy alternatives. By contrast, employees should be encouraged to avoid relying on alcohol, drugs, and excessive caffeine to deal with stress.

Employers need to actively help employees by ensuring that they avoid excessive work hours immediately after the stressful experience. Workers should also be encouraged to identify a de-stressing place such as a particularly comfortable room or a stress-reducing activity such as keeping a journal.

Employees should be trained to consult a professional if they experience disturbing physical symptoms such as chest pain or shortness of breath, if their symptoms last for more than one month, or if they have concerns that they might harm themselves or others.

Security and safety personnel, especially first responders and those in healthcare, must deal regularly with traumatic stress. Managers can help employees face up to this challenge through awareness, debriefings, counseling, and support.

Kris Clancy, Ph.D., is president of Leading Edge Consulting Group in Atlanta and a member of ASIS International.