OHS Canada 25th Anniversary Best Editorial

Down, But Not Out

March/April 1991

The death or injury of a co-worker can result in severe stress, which should be treated by a mental health professional.

By: Mark Sabourin

Ask former police officer Chris Southgate about the murder of his closest friend and he'll talk about a feeling of "complete and utter devastation." He'll tell you how he suddenly became unable to concentrate, how his appetite left him, how he couldn't sleep. He knew something was wrong, but he didn't know what. So he talked. If his nights were to be sleepless, so would his wife's.

Firefighter Ron Seymour often wishes he'd had some of Southgate's sense and talked, too. He recalls a particularly sombre morning when, following a major fire, his colleagues joined him in his room.

"We had Bloody Marys for breakfast. By 10 a.m. we were hammered."

Alcohol eased the pain Seymour felt but couldn't quite understand. He might have eventually turned to his wife for help, but he waited too long. She died. "That was the straw that broke the camel's back, he says. To his alcohol ism was soon added an addiction to tranquilizers, and the downward spiral continued.

Ron Seymour and Chris Southgate have much in common. n[ey are both employee assistance counsellors. They both are, or have been, employed in high-risk occupations. Each has been touched by tragedy far more often than anyone would dare imagine. They have suffered from critical incident stress and have chosen to deal with it in manners not uncommon to the rest of the population. They now devote much of their time to helping others understand and deal with the Pain that tragedy inevitably brings.

The concept of critical incident stress is not new, says Seymour. "Soldiers call it battle fatigue or shell shock." )Nhafs of more recent vintage is its acceptance outside of the military theatre. The idea that exposure to major traumatic incidents can have a lasting and damaging impact on the Psyche of emergency workers is rapidly gaining acceptance. But that's not where it stopsThe rest of the workforce is not immune to critical incident stress.

Outside of selected industries, management is generally unaware of the impact Of critical incidents, says Glenn French, Imperial Oil's new employee assistance program (EAP) consultant. French hopes to transplant his prior experience in a major financial institution to the workforce of his new employer. Critical incident stress is a concept well accepted by most banks, whose branch employees may at any moment confront a demand for money backed up by the threat of -violence. The bank teller's experience, however, is no different from that of the stationary engineer whose colleague is disabled by bums following a chemical spill.

A critical incident, says psychologist Dr. Bella Streiner, is any incident that causes unusually strong stress reactions. Major equipment malfunctions that occur despite the best efforts of those involved, chemical spills that pose a hazard to co-workers, threats of violence, and accidents involving the loss of a body part can all give rise to critical incident stress. The costs of ignoring it, she says, are, very high. They are costs employers and workers have been paying for centuries. And they need not.

Reactions are intensely personal

Stress reactions may be felt not only by fwitnesses to the event, but also by those Iupon whom some indirect responsibility may be placed. "The closer you are to the incident, the more at risk you are for a stress reaction, says Streiner. "But if you're the one who has lunch with the person every day, then you're equally prone."

The severity of the reaction will also be influenced by the decision-making responsibility of the individual. Consider the health and safety representative or oh&s manager,who must confront a serious accident. Incidents where "nothing worked" or that "shouldift have happened" can readily give rise to critical incident stress, she says.

The important point to remember is that stress is an intensely personal reaction. Stress occurs when an event overwhelms an individuals own coping abilities. These vary with the individual. It's not possible to predict which incidents will cause critical incident stress reactions, Streiner says. What you can be fairly certain of is that the more serious the incident, the more likely there will be some stress reaction.

It takes one to three weeks following an incident for people to begin exhibiting reactions, says Imperial Oil's Glenn French. At that point, workers suffering from critical incident stress may begin turning to the conventional EAP for help. "That's the traditional response," he says. With a critical i incident stress program in place, however, intervention occurs shortly after the incident. Workers who might have later placed a significant burden on the EAP are helped more efficiently and more effectively at the outset. And workers whose response to stress might be more damaging, through distraction at work to increased reliance on alcohol or drugs, are spared those dangers.

Some studies suggest that as much as 90 per cent of the population is susceptible to critical incident stress. Strei,ner prefers to leave predictions to the pundits. "We all come to a situation with our own unique characteristics. What I will say is that in a highly traumatic incident, such as a death at a workplace, you can anticipate that the majority of workers who were involved in that incident will have some degree of stress reaction."

Manifestations of critical incident stress may be felt at the scene of the accident. Most conmnon are feelings of shock and emotional numbness. Later, after those involved have had time to reflect upon the incident and assess its implications, more serious symptoms may appear. Sufferers may then complain of . sleeplessness, fatigue, nightmares, short attention span and guilt feelings.

The price of ignoring the problem can be heavy. If stress-related issues are not dealt with, you should expect to see a rise in tabour-management conflict and in grievances, says Streiner. You should also expect an increase in the accident frequency rate, she adds, because "people under stress are more easily distracted." Stress can also compronuse the immune system. Sick time will increase. Ron Seymour, who is a captain with the Toronto Fire Department in addition to being an EAP counsellor, recalls that it was not uncommon to see a much higher sick parade after a critical incident.

"Another consequence is that people take what I call the 'geographical cure,"' says Streiner. People who come to see their employer as uncaring are more likely to change jobs. An industry that claims a skilled labour force is its most valuable asset would be well advised to protect it, she wams. And, of course, there is the constant risk of growing dependence on alcohol or drugs.

Anger is another common reaction. "People have the belief that they should be safe in their work environment," says Streiner. When people view a human tragedy as preventable, they get angry. That anger can be directed at the employer, who may be held responsible for the event, or at any number of different targets.

AU of these symptoms can impose heavy costs on a workplace. A skilled worker who leaves his employment is difficult and expensive to replace. Decreasing productivity, increasing absenteeism and a rise in labour-management conflict will all have an impact on an employer's profitability.

Several courses of action available

Although critical incident stress can place a heavy, and often hidden, burden on a workplace, dealing with it effectively and efficiently can be a relatively simple and inexpensive process, especially for those employers who already avail themselves of employee assistance programs.

Streiner says that an effective program should include, at a minimum, the education of workers likely to be affected by critical incident stress and a wefl-developed plan of action for dealing with a critical incident should one occur. The components of this plan might range from the provision of contracted services from a reputable provider of employee assistance services to complete in-house capability.

The federal public service has had a formal protocol for dealing with critical incident stress for the past three years.

Because of the size and scope of the organization, it can rely on in-house resources.

Wayne Comeil, national consultant for the employee assistance services of Public Service Health, says that the federal program really got rolling following the 1985 crash of the Arrow Air jetliner in Gander, Nfld. "Airport workers, janitors and electricians were all involved in body recovery at Gander," says Comeil. Their reactions were studied closely, and the conclusion was quickly reached that a standardized treatment program was needed.

The federal program involves the participation of all departments that are likely to confront critical incidents. These include Parks Canada, whose employees may be involved in rescue efforts; the Coast Guard, whose crews may be involved in body recovery; and correctional service workers, customs officers and unemployment insurance counsellors, all of whom may confront threats of violence. Participants from these organizations form a loose network of people who are ready to help if called upon.

The department in which the incident occurs will take the lead role, says Corneil. Participants from other departments may be called upon to lend resources if necessary. Public Service Health ensures that all who are called upon are qualified to help. Most are mental health professionals from the employee assistance program. Peer counsellors individuals who may be viewed as peers of the affected workers may also be used, but only in a structured environment under the direction of a mental health professional. The standard therapeutic device for managing critical incident stress is debriefing. This must be led by a mental health professional, says Comeil. WeU-trained peer counsellors may provide additional support.

Employers may also opt to have their programs coordinated with other community and private sector efforts. Such a program is currently under development at Dow Chemical of Canada Inc. in Sarnia, Ont. David Poulin, medical director of Dow's Sarnia Division, is involved in a program that will see a response team and a proper infrastructure in place for the counties of Lambton and Kent. The program, driven by the needs of local emergency workers, has branched out to include an industrial component.

Debriefing teams, once selected and trained, will operate under the guidance of a mental health professional. Teams will include members of the local industrial workforce, Poulin says.

Participation of local industry is important because it ensures sensitivity to the needs of an industrial workforce. T'here are real differences between local emergency and industrial workers, Poulin says. Emergency workers, because they are so frequently exposed to tragedy, develop a certain norm for injury. For emergency workers, critical incident stress may arise from mass or exceptional casualty. In an industrial setting, however, critical incident stress can follow a single serious injury. Even for in-plant emergency response crews, serious incidents are rare.

A third option is the purchase of commercially available services. Donna Raxlen, coordinator of the trauma response team at Toronto-based Corporate Health Consultants, says that commercial providers are becoming increasingly aware of the needs of the industrial workforce. She suggests that employers with a high frequency of traumatic incidents, such as banks, have on staff a number of people who can quickly assess the depth of the trauma. They would make the initial detennination of whether or not professional services were required.

Raxien prefers to wait until 48 to 72 hours after an incident before leading the debriefing. "People are still in shock within 24 hours of the incident," she says. Raxlen meets with everyone involved in the incident. Debriefings, she says, serve two purposes: one, they let the workers know that there are certain reactions that are normal and expected; two, they provide an opportunity for people to talk about their reactions. A traumatic incident can make a person feel very helpless, very insignificant. In a group debriefing, people naturally come to support each other. That's important, says Raxlen. "People have to feel they matter."

Industry demands special measures

It's a simple concept, perhaps even too simple. People suffer grief when con fronted by tragedy and may on occasion react severely to it. But life goes on. By the time a person enters a workforce he or she likely has already been touched by tragedy and has dealt with it with some measure of success. Why are special measures needed to deal with reactions to industrial accidents?

The comparison is unfair, says psychologist Streiner. More often than not, family tragedies are, to a degree, expected events. Even when they are not, families and friends organize themselves in such a way as to lend support in inornents of need. It's ahight to cry on a brother's shoulder. It's a different thing to cry on a foreman's.

Streiner finds that critical incident stress programs seldom go wanting for participants. "I have not had a problem with people not coming for help," she says. "I have had a problem with too many people showing up. My experience has been that if you have the programs in place, there is so much internal pressure within the people that they come. 55

Perhaps the biggest problem critical incident stress confronts is its image. To the employer and the oh&s team, an accident should be met with a quick response to the obviously injured and a follow-up analysis of the causes. Witnesses who appear shaken, but otherwise healthy, exhibit no evident need for intervention.

As well, our society continues to view displays of emotion as signs of weakness, says Streiner. The industrial workforce is still predominantly male and imbued with a certain machismo. In terms of self-image, a stationary engineer may differ little from a police officer, and, according to Chris Southgate, "I never met a rookie cop who wasn't bulletproof."

That's changing, of course. Ron Seymour, for one, notes that rookie firefighters today are far better educated and far more aware of mental health than their predecessors. Similarly, managers who in the past have frowned at the small investment needed for critical incident stress management now more readily accept its value.

A program is easily established and its costs are relatively small. The benefits, all agree, are great. We invest so much in the physical well-being of our workforce and so little on its mental health, says Wayne Comeil. "But you don't hire people just for their physical presence. You hire them for their mental contributions." Dow's David Poulin is emphatic: critical incident stress within industry should be dealt with. Says Wayne Comeil to those who doubt, "If you choose to treat the issue as not serious, you do so at your own peril.

Just ask Ron Seymour. With a bellyful of Bloody Marys he didn't give a damn. Now he'll tell you.