Service Order
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Trauma Risk Management (TRiM)
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Document Overview: <enter text here>
1.0
2.0
3.0
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6.0
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8.0
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15.0
16.0
Application
Purpose
Serious Incident
Objectives of TRiM
Confidentially
Process and time scale for action
Selection of potential TPs
Training and continue professional development of TPs
TPs responsibilities
TRiM Leader’s (TL) responsibilities
Managers’/Supervisors’ responsibilities
TRiM Lead Manager (TLM) responsibilities
Site management at a major incident
Responsibilities of the TriM Lead
TriM/Trauma awareness training
Equality impact assessment
Ownership:
<enter text here>
Author:
<enter text here>
Issue date:
January 2015
Policy/revision date:
Policy/review date:
January 2017
PIA:
<enter text here>
Version:
<enter text here>
1.0
Application
1.1
This policy applies to all Wiltshire Fire & Rescue Service(WFRS) staff
2.0
Purpose
2.1
The aim of this policy is to effectively manage the wellbeing needs of individuals
who are or have been exposed to a traumatic event
2.2
TRiM (Trauma Risk Management) is a peer led process intended to assess the
response of a member of staff exposed to a potentially traumatic event.
2.3
There is a foreseeable risk that individuals, who have been exposed to potentially
traumatic events, could develop long-term psychological problems, including, Post
Traumatic Stress Disorder (PTSD). TRiM is the service's response to minimise that
risk.
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2.4
TRiM complies with National Institute for Clinical Excellence (NICE) Guideline 26
“The management of PTSD in adults and children in primary and secondary care.”
2.5
TRiM is delivered under licence from Captain Pete Roberts (Retired) and Major
Norman Jones, which permits foundation TRiM training to be carried out by
foundation TRiM trainers within WFRS only.
2.6
This policy includes guidelines on how the selection, training, deployment and
wellbeing of designated TRiM Practitioners (TPs) will be met. It acknowledges the
pivotal role that TPs play in assessing the psychological well-being of staff after their
involvement in a serious event
2.7
The nature of the stress response is very personal; therefore the policy
acknowledges that individuals retain a responsibility for their own well-being under
Health and Safety Law. Should they feel particularly distressed after any incident it
is ultimately their responsibility to ask for a TRiM intervention, if that has not been
offered.
2.8
The policy lead for all aspects of TRiM is the Occupational Health Unit Manager ,
who oversees this aspect of the provision of service, which is delivered by the
designated service practitioners this policy mentions the TRiM Leader (TL), it also
identifies the contact process of the duty TRiM practitioners in absence of the TL.
3.0
Serious Incident
3.1
A ‘serious incident’ is any incident with a set of circumstances that may produce a
high level of emotional arousal during, immediately post-incident or some time after
the incident. This reaction may or may not be apparent to the layperson, but is likely
to surpass the individual’s normal coping mechanism.
3.2
For the purpose of this policy, a ‘serious incident’ is identified by the following
criteria:
 where staff experience or witness serious injury, particularly involving
colleagues
 where an incident involves death, disablement, disfigurement or is perceived
as threatening to the integrity of life of an individual;
 where the incident is complex, long-lasting and/or multiple;
 where the incident has involved a member of staff in a ‘near miss’ situation;
 where an individual member of staff is demonstrating acute stress symptoms
3.3
National Health Services provide professional services for those individuals not
immediately at risk. Any individual considered at risk on account of overt mental
health concerns following an incident should access the Primary Healthcare
Services (GP, Emergency Doctor, A and E Department). Any individual distressed
during, or immediately after, a major incident will in the first instance be seen by a
TP and if necessary referred to other Health Services.
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4.0
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Objectives of TRiM
4.1
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To provide trained TPs to every area to enable them to manage staff post incident:
to enable all frontline personnel to identify those aspects of an incident which may
require TRiM intervention;
to ensure supervisors/managers have adequate guidance for the ongoing
management and support of staff;
to enable supervisors to identify at an early stage those members of staff who may
require TRiM intervention;
to provide training to those personnel who will be required to plan and implement
the TRiM strategy;
to enable supervisors to recognise the appropriate time frame within which TRiM
should be activated;
to provide information to management and staff which will enable them to recognise
normal reactions following a trauma;
to ensure TRiM interventions are documented accurately (whether
offered/accepted/declined).
5.0
Confidentially
5.1
All detail about an individual’s personal perception of the incident is confidential and
must be treated with sensitivity.
5.2
The TRiM process remains confidential until and if there is reason to believe:
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the individual may cause harm to themselves;
the individual may cause harm to others;
the individual is or has been involved in criminal activity;
the individual is or has been involved in a disciplinary matter.
5.3
The following records will be kept: details of the incident, dates of TRiM briefing,
names of those attended and/or declined, names, dates of TRiM assessments
offered and attended. Records will be stored securely at the Occupational Health
Unit (OHU), and access will be restricted to those with a responsibility for managing,
or recording TRiM intervention (OH Advisors….name) .
5.4
Everyone involved in the management or monitoring of individuals engaged in the
TRiM process has a responsibility to maintain the confidentiality of the information
that they are processing. Area Managers/Heads of Departments, must ensure that
this policy is made available to everyone, and that those involved in managing or
monitoring staff post-incident are aware of their responsibilities, and must comply
with the policy.
6.0
Process and time scale for action
6.1
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Time line
Action required
0 hours
Depending on the scale of the event, contact should be established
at an early stage with the TRiM Team Leader (TL) or deputy.
Site management
strategies
Immediately post-incident Welfare Check by managers/supervisors
Control will notify TRiM practitioners of any incident they have
conducted a welfare check on via TRiM email and they will contact
practitioner on duty if necessary in case briefing needed. Trim
Practioner taking on the TRiM must then also email members to
ensure this information is noted.
Managers should consider a TRiM intervention if the criteria for TRiM
have been met.
0 – 24 hours
Managers should
Planning phase
1. contact the TL or deputy directly or via Control
2. Be prepared to make the following information available via
a telephone conversation or planning meeting:
i. details of the event
ii. details of shift pattern for the next week
iii. name, rank and service number of personnel involved (including
corporate staff)
iv. home and/or mobile telephone numbers
The TP:
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3days
+ Intervention
phase
offers a TRiM briefing for all those involved
conducts risk assessments with individuals or groups as
discussed during planning phase
refer personnel considered to be at risk to the OHU for
advice/guidance/treatment
arrange a follow-up meetings in one month and three months
following the initial assessment
The TRiM briefing consists of a presentation only. It should not
normally include an opportunity to talk about what happened during
the incident and how people feel about it (‘emotional debriefing’).
Managers/supervisors should:
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monitor staff for delayed stress reactions
encourage staff to contact the OHU and Counselling
Department if needed
make a referral to the Occupational Health Unit if concerned
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and the member of staff has been advised to make contact
with them
ensure staff who have attended the initial assessment make
themselves available for the follow-up assessment
The TP will do follow-up assessments
One month and 3
managers/supervisors continue to monitor, support and/or signpost if
months Follow-up
necessary.
7.0
Selection of potential TPs
7.1
Careful consideration is required as to the suitability of potential TPs. They must be
volunteers, have a clear and reasoned motive, reflecting genuine commitment for
wishing to train and practice as a TP, and be emotionally resilient. They will be
required to act with the highest degree of professionalism, confidentiality and
sensitivity.
7.2
Those wishing to be considered for TRiM training and deployment should apply by
submitting their interest with permission and support of their line-manager to the TL .
The applicant will then be invited to an initial meeting with the Trim Lead for
assessment and discussion regarding requirements of the service and location as
well as suitability and support and agreement of other TRiM member.
7.3
A welfare check by OHU is also recommended either before or after training, to
ensure emotional well-being. A record of this can be kept will be kept at OHU.
8.0
Training and continuing professional development of TPs
8.1
TRiM Trainers, experienced in the delivery of TRiM interventions and certificated by
the originators of TRiM, should deliver training of TPs.
8.2
The TRiM foundation course for new practitioners should consist of a minimum of
two full days and be delivered by at least two trainers, one of whom is a designated
TRiM lead.
8.3
TPs should receive yearly 2.5 hour refresher training, run and delivered by the
(Deputy) TL and a TRiM Trainer (TL)
8.4
TPs should attend the once-yearly TRiM refresher course or update workshop.
9.0
TPs responsibilities
9.1
TPs are expected to:
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identify those aspects of an incident that may have profound impact on the staff
involved;
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‘filter’ all aspects of the incident to identify personnel who may require a TRiM
intervention;
identify the most appropriate timeframe within which a management strategy should
be implemented following an incident;
identify the risk factors which may indicate that personnel may require a specialist
referral;
provide TRiM interventions where requested;
seek individual/group consent when they consider that management, Occupational
Health advice or other referral is required;
encourage individuals to seek support of their manager where appropriate;
record all instances of interventions, including those which have been declined;
decline to act as TPs if they have had any operational involvement with the
identified trauma;
inform the TL or, if not available, the TL when they are approached by area staff
with a request for an intervention;
recognise the limits of their competency and refer to managers or OH Advisers if
there are any concerns, as they are trained to risk assess and offer supportive
mentoring only;
keep details of an intervention confidential except where the boundaries of
confidentiality are crossed.
A TP is expected to: report to their TL immediately if they have any concerns about
the well-being of a member of staff;
report to the TL if they need a break from TRiM due to challenging personal
circumstances;
attend regular annual update session meeting as part of their TRiM continued
professional development commitment;
give one month’s notice of their withdrawing from TRiM and attend an exit interview
with TL or OH.
10.0 TRiM Leader’s (TL) responsibilities
10.1 There is no reason for TPs to be located in a specific area but for ease of travelling
and continuity with groups of people it is desirable for there to be both a geographic
and departmental spread of practitioners
10.2 TL’s are to:
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liaise with Control to identify incidents that may require a TRiM intervention coordination;
ensure appropriate allocation of TRiM referrals to individual TPs, taking into account
their workload, recent TRiM interventions, experience and emotional stability, as
well as the type of incident;
ensure the recording of TRiM interventions as and when they happen;
attend to the welfare of their TPs;
maintain regular contact with the practitioners;
deliver TRiM awareness presentations or task a TP to do so;
staying aware of resilience issues. This includes ensuring that appropriate
individuals are identified for the role TP and, in liaison with the TL, are mentored in
readiness for the role;
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deliver the TRiM interventions if required
11.0 Managers’/Supervisors’ responsibilities
11.1 After a serious incident line-managers/supervisors are to:
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do a ‘welfare check’ immediately following a serious incident (link to what is a
serious incident (mentioned at 5. )
inform their TL via Control immediately following a serious incident;
ensure that the TP, who will have been designated to the incident by the TL, has
contact details of all personnel involved;
liaise with the TL or TP to facilitate the organisation of a TRiM briefing and any
consequent TRiM Assessments of individuals within the time frames detailed in this
policy;
facilitate the temporary release from duty of personnel for the purpose of any TRiM
intervention;
ensure that staff identified by the TP as needing a TRiM assessment, should have
completed an operational debrief prior to the assessment;
attend to their staff’s wellbeing,. Should they wish to discuss any concerns with a
professional, they should contact their line Manager or Occupational Health
Adviser.
12.0 TRiM Lead Officer (TLO) responsibilities
12.1 TLOs are responsible for:
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releasing individuals to attend training events as per this policy;
paying out-of-pocket expenses;
providing discretionary overtime payment/time off if necessary;
releasing staff to enable them to fulfill their TRiM role as per this policy;
releasing TPs as directed in case of a Major Incident;
discussing any serious concerns about the TP in the first instance with the TL. The
TL will, in liaison with the TLO, decide on a suitable course of action, which can
include removing of the TP of the list of available practitioners.
13.0
Site management at a major incident
13.1
The TL or in their absence, Deputy TL is to:
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appoint a TRiM Incident manager (TIM), usually a TRiM Practitioner;
liaise regularly with the TIM
supervise and liaise with the designated on site officer in charge;
13.2. The TIM will be responsible for:
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liaising with and advising the Officer in charge with regards to the psychological
welfare of the officers and staff involved in the incident;
coordinating TPs, to cover the shifts and hours sufficiently;
coordinating with the Officer in charge the establishment of a separate rest area for
officers/staff within the outer incident cordon;
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13.3
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13.4
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coordinating TRiM briefings;
coordinating TRiM assessment;
the welfare of the incident TPs;
advising the OiC about moving personnel between high and low stress areas based
on a dynamic risk assessment;
inform the TP, or deputy about any concerns for officers/staff;
in practice the incident itself dictates the extent of the TRiM response and ultimate
decision making will rest with the OiC.
The Tactical Commander:
Facilitate the provision of a rest area for officers/staff as advised by the TRIM
Incident Manager;
Ensure that all staff attend a TRiM briefing before retiring from duty and going
home;
Ensure that staff are released for breaks at operationally appropriate times, with a
recommendation that staff work no longer than 4 hours without a rest period.
The TPs are to:
Ensure their availability at the site deployed for four hours at a time during a twelvehour shift;
Deliver TRiM briefings;
Identifying ‘at risk’ personnel at the earliest opportunities;
Informing the TRIM Incident Manager as soon as possible if they have any
particular concerns for an individual or signpost for support themselves.
14.0 Responsibilities of the TRiM Lead
14.1 The TRiM Lead is to:
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supervise and guide the TRiM practitioners
offer yearly welfare assessments to the TPs,
oversee the confidential storing of all TRiM related records;
liaise regularly with the TLO and the TPs to ensure a resilient and knowledgeable
response;
provide quality assurance and ensure ‘best practice’ including assuring appropriate
professional boundaries are maintained as related to the welfare of individuals
under TRiM;
keep abreast of the latest developments with regards to trauma management in the
emergency services so as to deliver the most up to date service;
ensure the latest information regarding TRiM/trauma is passed down;
fulfill the TRiM/Trauma specific CPD, including mandatory attendance of the yearly
update;
ensure training delivered is by the TRiM originators;
conduct exit interviews for TPs;
oversee availability of appropriate and up-to-date information on the intranet;
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15.0 TriM/Trauma awareness training
15.1 The following managers will receive TRiM/Trauma awareness training, as part of the
existing courses for their specific role: Watch Manager and above, Corporate
Managers in charge of departments
16.0 People impact assessment
16.1 This policy has been assessed with regard to its impact on equality. As a result of
this assessment the policy has been graded as having a low potential impact.
16.2. Link to equality impact assessment document. (or add to the bottom of page?)
Policy reference: SOP?- Trauma Risk incident Management (TRiM)
Policy owner:
Service Delivery? OH ? HR
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