The Crisis Response & Recovery Cycle (CRRC)
Preparation for Psychological First Aid
Some of the information presented in these slides is used
with the permission of Dr Bob Montgomery (APS Workshop
on Psychological Responses to Disasters, 23rd April 2010,
Princess Margaret Hospital, Perth, WA).
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001/
The Crisis Response and Recovery Cycle
There is a ‘typical’ Crisis Response & Recovery Cycle (CRRC) which is
common to most people experiencing a traumatic incident (e.g., a fire,
explosion, sinking, etc.,).
Recognising that the CRRC is a normal human response to a disaster is the
important first step to planning to manage psychological trauma.
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Preparing your CRRC Plans
Within your emergency response plans, there is a need to be
as prepared to manage the psychological aspects of the
catastrophic incident as you are the physical, medical,
environmental, reputational, financial and other aspects.
The objectives of Psychological First Aid (PFA) are:
1. To reduce ongoing distress in your people (anxiety and the four types of early
reactions – emotions, physical body, cognitive and behaviour);
2. To facilitate psychological recovery of survivors as quickly as possible; and
3. To reassure your people that they are not suffering psycho-pathology (e.g.,
PTSD early on).
.
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Preparing your CRRC Plans
Planning and preparation around Psychological First Aid (PFA) is simply
another leading indicator that is found in organizations with more mature
safety cultures.
INVOLVING CULTURE
We’ve got everyone involved in
making this a safe place to be.
How good is your PFA planning?
DEVOLVING CULTURE
People believe we’re serious and
individuals are taking responsibility
DIRECTING CULTURE
Safety is important and we need to
get employees to follow the rules.
REACTING CULTURE
I guess we better manage this in
order to keep our license to operate.
COMPLAINING CULTURE
Why the hell should we spend time
and money on this?
004/
PFA is required if incidents can be “catastrophic”
Fatality
Gas Present
Ignition source
Fire
Explosion
Preparation for
Psychological
First Aid
005/
Examining the Crisis Response
Crisis response – as the incident occurs (e.g., fire, explosion or sinking).
People involved in the incident will typically experience reactions in the
following order:
1. Shock;
2. Disbelief (this can’t be happening, “they must be making a movie”);
3. Realisation of problem (“OMG, it is happening”);
4. Unfeeling survival state (often reported as “frozen”); and
5. Survivor escapes/released (or person entrapped and killed).
The above may occur over a period from a few seconds to several minutes.
006/
Examining the Recovery Cycle
There is also a typical recovery cycle (RC) for survivors that
begins after the incident (e.g., fire, explosion or sinking).
Survivors and witnesses involved in the incident will typically experience:
•
Shock;
•
Depression;
•
Mood swings;
•
Anger (why me/us?);
•
Reflection (trying to make sense of what happened); and
•
Lay event to rest (incident no longer intruding).
The above cycle occurs in coming days and over several weeks to months.
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Psychological First Aid
Requirement for immediate response (“Psychological First Aid”).
Delivered immediately after the incident (at the scene) or as soon as possible
afterwards.
Basic need is to reassure survivors they are now safe.
Use “calming response” technique.
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Helping in the aftermath
Days and weeks (up to 2-3 months afterwards).
Basic need is to reassure survivors they are now safe.
Need to “normalise” the recovery cycle responses.
Shock, depression, mood swings, anger are all NORMAL reactions to a
catastrophic incident.
THIS IS ALL NORMAL. People are not going mad. Reassurance is a priority.
Basic need to deal with anxiety (resulting from the catastrophic incident).
009/
Understand that anxiety is normal
Anxiety is an unpleasant state typified by:
•
Negative emotions (fear, nervousness, tense);
•
Perceptions of unpredictability and lack of control over external events;
•
Physiological arousal (tension);
•
Maladaptive shift in attention (mind off-task in hand, false alarms, irrational
fears); and
•
Avoidance behaviour.
Need to reassure folks that anxiety is NORMAL. It is the normal response of
people to disaster situations.
Your goal is to yourself and your folks to help people learn to manage negative
emotional responses, negative perceptions, negative arousal states and
negative behaviours.
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When does anxiety become a problem?
Problems emerge when Anxiety is unnecessary, excessive, avoided
or prompts further maladaptive behaviour. Look for prolonged or
entrenched reactions in the following:
Emotions
Physical Reactions
Cognitive
Behaviour
Shock
Upset stomach
Difficulty concentrating
Distress
Headache
Confusion
Avoidance (of similar
situations)
Sadness
Disturbed sleep
Disorientation
Fear
Excessive sleep
Flashbacks
Withdrawal (from
family life, friendships,
etc)
Guilt
Appetite shift (hungry
or not hungry)
Nightmares
Alcohol or drug usage
Impaired decisionmaking
Loss of interest –
apathy
Helplessness
Anger
Hopelessness
Intrusive memory
Suicidal thoughts
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Objectives for the Recovery Cycle
Your objective now:
1. To reduce ongoing distress (anxiety and the 4 types of early reactions –
emotions, physical, cognitive and behaviour);
2. To facilitate psychological recovery as quickly as possible; and
3. To reassure that the person is not suffering psychopathology (e.g., PTSD
early on).
All of the stress/anxiety reactions are NORMAL human reactions to a terrible
incident.
Only if the person is not improving over time should you be concerned (2-3
months time frame).
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Reassure yourself that you’re normal
Reassure yourself or other people that all of the anxiety responses are
NORMAL reactions and that they can be managed using appropriate
techniques.
If they do not improve over short time frame, seek assistance.
If after 2-3 months, these symptoms are still highly aroused – may indicate
person is not coping and that Post-Traumatic Dress Disorder (PTSD) is
developing – seek professional assistance.
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Conclusions
Preparation and planning for the CRRC is essential in every business
where “catastrophic” incidents could occur:
•
Planning for Psychological First Aid should become a normal part of your emergency
response plans;
•
Managers, Supervisors and Employee’s can all deliver effective Psychological First
Aid on site and in the immediate aftermath of catastrophic incidents (just as you
probably now train them to provide medical first aid);
•
Psychological First Aid has been shown time and again to reduce ongoing distress
and to facilitate rapid psychological recovery following disasters;
•
Training your people to deliver Psychological First Aid is critical in preparing for
catastrophic incidents; and
•
Providing an external Employee Assistance Program (EAP) is NOT a substitute for
good CRRC planning and the ability of your own people to deliver Psychological
First Aid in situ.
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1.
Audit your current preparation and planning around the psychological aspects
of the Crisis Response & Recovery Cycle.
•
2.
How well prepared is your business to manage traumatized people as they return
to work?
Audit the capability of your people to deliver Psychological First Aid in the
immediate aftermath of catastrophic incidents.
•
3.
What can you do now?
Are your people trained and skilled in providing immediate Psychological First Aid?
Contact a professionally registered psychologist in your local region and seek
more information on how they can help with planning for the CRRC.
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Capability to offer advice
Dr Graham Marshall is a Member of the
Australian Psychological Society. He holds a
Masters Degree in Psychology and a Ph.D.
Graham has worked for over 12 years in
assisting an international network of clients to
appropriately manage HSE risk, including those
factors associated with psychological trauma.
Besides his formal qualifications as a
psychologist, Graham also holds a Diploma in
Occupational Health & Safety and he is an
Associate OHS-MS Auditor (RABQSA).
Graham was recently presented with a WA
Government Work Safe Award “in recognition of
his outstanding contribution to safety and heath
in the workplace.”
The Rt Hon John Kobelke (at left) presents Dr Marshall with a
Work Safe Award while Don Sanders (Director of the Australian
Petroleum Production and Exploration Association )(APPEA)
looks on.
Thank you
Dr Graham Marshall
Australian callers: 0408 472 678
Overseas callers: +61 408 472 678
E-mail: grahammarshall@therisktoolbox.com
Web: www.therisktoolbox.com