The Aftermath of Major
Trauma – Coping with
Critical Incidents in
Radiology.
Kathy Colgan
New Zealand
New Zealand Herald
Murdered 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 Dickison
5:30 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 Factors
O individual’s life and / or work experiences
O normal coping mechanisms
O current state of health or welfare
O number of exposures to traumatic incidents
O 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)
O Stress 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 distress
O 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:
O Summary of events
O Initial call sequence
O Management of trauma event
O Patient outcome
O Specific group involvement
O Opportunity for participants to describe
involvement
O Clinical management of process
O Emotional factors
NICE Guidelines 2005
recommend the good practice of
providing practical and social
support and guidance to anyone
following a traumatic incident
Staff Survey
Select the types of critical incidents you have
been involved in?
O Cardiac Arrest
O Trauma
O Multi-trauma
O Suicide Attempt
O Fatality in ED
O Non Accidental Injury (NAI)
O Other (please specify)
Sample Questions
O 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?
O Anxiety
O Nervousness
O Deep sadness
O Anger
O Other _______
Do any of these feelings stay with you longer than
you might expect?
O Yes
O No
O Comment_____________________________
Debriefing
O Requested by staff on the floor
O Team leader determines in consultation with
team if need is immediate – defusing
O Formal debriefing process instigated
Defusing
O Held immediately after incident & prior to
shift end
O 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 involvement
O 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
Leadership
O Trained personnel
O Skills to review case presentation & clinical
management of patient
O Facilitation skills to encourage staff
members to talk about their reactions
O Ability to recognise critical incident stress &
staff stress related aspects
O Knowledge to identify those who require
referral to other support agencies
STUFF Co.NZ
A 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):4651.
References
O 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/archive2004/9
6ma124/downloads/96ma124.pdf
References
O 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.