As Bob Brown talks, he recalls more of the details from the night a dozen years ago. He dropped off pizza for the boys at the plastics plant where he was production superintendent. "I remember one guy teasing me because I was dressed up on my way to a meeting." Minutes after Bob left the young man was killed in a blast while trying to hose down a chemical leak. "After we found his body I had to drive over to his family and break the news."
Working as a NASA contractor, Jeff Vincoli had one of the best views of the launch that chilly January morning. From three miles away, he stood with the families of the seven astronauts when the Challenger burst into a fireball barely more than a minute into its flight. Now every time a launch reaches that point Jeff flashes back. "It's always in the back of your mind."
As a member of the Alliance for Fire and Emergency Management, Mike Fagel arrived at what was left of the Alfred P. Murrah Federal Building in Oklahoma City 13 hours after its nine-story facing was blown away in the worst act of terrorism ever committed on U.S. soil. Two years later watching the trial on television, he says, "I'm reliving it, seeing it, breathing it, eating it. I'm not the same person anymore."
Who's at risk?This article takes a look at what constitutes a "critical incident" or "traumatic event," who might be emotionally affected and how, and what you as a safety and health practitioner can do to ease the pain. Any event powerful enough to overwhelm someone's normal coping mechanisms qualifies as a critical incident, according to Fagel. The American Psychiatric Association in the 1980s defined trauma as an extraordinary experience that would overwhelmingly terrify almost anyone. An accident, crime, or natural disaster that was fatal, life-threatening, or produced serious injury fits this definition. Victims and witnesses both are at risk. In 1994 APA's diagnostic definition was made less demanding˜even hearing about another person's suffering might be enough to trigger a stress disorder.
Industry catastrophes are obvious traumatic events. The Phillips 66 fire and explosion in Pasadena, Texas, that killed 23 workers in 1989, and the flash fire that killed 25 workers in a Hamlet, N.C., chicken plant in 1991 are well-documented tragedies. But the harrowing incidents mentioned by safety and health pros for this article occurred on a much smaller scale. A coworker dies of a heart attack at his desk.
Firefighters spend two hours trying to pull a man from the clenches of a machine as coworkers stand and watch. A young equipment operator loses two fingers on a press brake, and his set-up man feels so guilty he can't talk.
"We have a couple guys here who are still messed up years after pulling people out of a confined space hole," says one safety coordinator. It's not always death or serious injury that cause emotional wounds. Safety specialist Bob Brown recalls counselors coming in to work with employees shaken after three explosions ripped their processing unit. No one was hurt, but employees worried that they had no control over safety, he says. Another time, a maintenance accident that killed several workers in a plant ten miles away on Houston's ship channel had Brown's employees nervous and almost hyper-vigilant about checking and tagging pressure vessels.
These stories show how workplace incidents can send shock waves throughout a facility and beyond its gates. First hit are victims and their next-of-kin. Then there are those closest to the scene: witnesses, rescuers, and emergency response team members. Tremors reach employees not present but who are friends of the victim. And managers, including safety and health pros, who feel a sense of responsibility. What about secretaries and others taking phone calls from aggressive reporters, distraught family members, or curious neighbors? Or coworkers who weeks later are still opening the mail of victims and taking their calls? To be sure, not everyone reacts the same. Experts are quick to point out that what seems life-threatening to some people is not to others. Chills, nightmares, nausea, anger, fear, and many other possible reactions are not felt by everyone exposed to a traumatic incident. What's important to realize is that these responses are possible, and very natural, say experts.
The skills you need as a safety and health pro to deal with critical incidents and the emotional fallout are considerable. Putting aside the technical and strategic issues of emergency response, the rest of this article focuses on what you can do to protect the mental health of victims, responders, your employees˜and yourself. Awareness, empathy, quick-thinking, clear-thinking, fairness, and assertiveness all come into play. Gathering and sharing information is a must.
One way to analyze your role is to look at what happens after a critical incident. Here are eight typical reactions, with suggestions from peers and counseling experts on how to handle them.
As safety manager for a chemical plant, George Shirley was called at home once when a contractor suffered second- and third-degree burns on his back after being scalded by steaming water, and split open his knee after leaping 15 feet to safety. Shirley arrived on the scene 15 minutes later and the contractor still hadn't been treated.
"Everyone was standing around sick over what happened. They were totally shocked and didn't know what to do," he says.
This is where you've got to be focused. "You've got to remind yourself that there's a job to be done," says safety consultant Jeff Vincoli. "You've got to take care of the victim, and make sure no one else gets hurt trying to help."
It's also important to protect the privacy of witnesses. Vincoli recalls how quickly the families of the Challenger astronauts were taken away to avoid reporters.
Joyce Breasure, a professional counselor and past president of the American Counseling Association, adds this suggestion for dealing with shock: "Just breathe. It's one of the first things I tell people to calm them down." A shocking event can indeed take your breath away.
Anger is a common reaction to workplace accidents, says Breasure. It can be borne out of the frustration of knowing the incident could have been prevented, and not being able to do anything about it. Vincoli says what really bothered him about the Challenger disaster once the shock wore off was that "those people didn't have to die." Management's mistakes "were the epitome of why accidents happen on a grand scale." Let employees vent their anger, says Breasure. If it stays bottled up, it can explode unexpectedly on spouses or others, or be tapped into by lawyers looking to build a case.
One way of airing anger is to sit employees down and let them hash it out. It takes skill, though, to stay in the background while employees do the talking, yet keep a firm hand on the meeting so it doesn"t devolve into rumors and speculation.
Almost every safety and health pro who recounted a traumatic experience for this article said words to this effect. David Sarkus was only on the job as a safety specialist for two months when an employee was badly burned in an accident and nearly died. "My first reaction was, 'What could I have done?'" he recalls.
One safety director talks of the "self-inflicted torture" that can follow a bad incident. "You almost don't want to leave your office, wondering what people are saying behind your back."
He had these feelings last year after a lockout fatality occurred at his plant. Support came from within himself, and from others. "Shame is not a bad word," he says. You also realize that you cannot control a person's every breathing moment, he adds.
This professional put the accident in perspective by not ignoring all the positives produced by his safety system. His company's lost workday rate has been far better than the industry norm for five years running -- 300 lost workday cases have been avoided by being better than average. Perception surveys show 85 percent of employees have confidence in the operation's safety. OSHA investigators couldn't argue with the system in place for training. This kind of feedback tells you that the accident was "an anomaly," he says.
If you feel like the accident was your responsibility and you didn't do enough, go into action, says counselor Breasure. Investigate what happened. Involve those most affected by the incident, even the victim if possible. "Trying to figure it out empowers people," she says. Spirits can be lifted if the investigation finds ways to prevent similar accidents from happening again.
Preparing to give testimony as an expert witness, Jeff Vincoli interviewed "an old salt" whose arm was ripped out when a piece of machinery fell on it. "He was trying to be macho about it, telling me how he looked where his arm used to be, stuffed up the hole, and dialed 911 on his cell phone. I was freaking out just listening to him. He was trying to handle it all himself, but he was depressed, on medication, having nightmares."
"America has a culture that says we should try to do things ourselves," says Mike Fagel. After his Oklahoma City experience, Fagel says he's trying to spread the gospel that "it's OK for us to cry, to ask for help, to go to an employee assistance program."
"We're not talking about being crazy," says Bryan Farha, chairman of the Department of Counseling Psychology at Oklahoma City University. "You certainly don't have to be crazy to go see a mental health specialist." If stress signs accumulate to the point that people you trust are telling you that you need help, don't hesitate to seek out experts, he says.
Usually this isn't necessary. What's most important, say experts, is to know that various physical, mental, emotional, and behavioral disturbances are very common aftershocks of a critical incident (see sidebar). They may appear hours, days, weeks, or even months later. And they may last a few days, weeks, or months.
(Symptoms that persist longer than three months might indicate a case of post-traumatic stress disorder, according to the American Psychiatric Association. Of the 60 percent of men and 50 percent of women exposed to a potentially traumatic event, one to three percent were suffering PTSD.)
"I've never seen someone effectively block out" the visualization and the sound memory of a trauma like seeing a person's hand chewed up in a machine, says Breasure. "You have to mourn what you saw."
Depression, sadness, or mourning are part of the normal grieving process that also includes anger, denial, bargaining ("If I had acted sooner this wouldn't have happened–) and finally acceptance. Let grieving take its course, say counseling experts.
"I know how you feel," is one of the best examples of saying the wrong thing, according to Farha. You can't know another person's memories of a victim, their relationship with him or her, or the person's own life experiences that shape their reaction, "It's best just to say, "You have a right to how you're feeling. It's normal," says Farha. But if those feelings don't go away over time, it could be a sign to seek counseling, he adds.
After the initial shock, the first reaction to a traumatic event is often, "Why?" Victims, their families, coworkers, managers all need to understand "the why," says Breasure. The families of those aboard TWA Flight 800 when it crashed into the Atlantic last July will have a hard time moving on with their lives until they have answers to what happened, she says.
To know why something happened eliminates the fear of the unknown, gives us comfort, and a sense of order and being in control. This is why investigations are essential, along with sharing whatever information is uncovered. But many safety and health pros will tell you that finding the root cause is sometimes impossible.
"Why this man chose to abort the system we'll never know," says the safety manager whose facility suffered a lockout fatality. He had been trained within the last 30 days and knew the procedures and equipment he was working on. "Sometimes we just don't know why someone puts himself in front of an oncoming train," says this safety pro.
A cause or culprit may never be found, says Farha. "The fact is, the accident happened, and the idea is to adjust to what happened." This is easier said than done if the blame game kicks in, with managers, regulators, or attorneys looking for scapegoats. Politics of this sort are less likely in organizations that value fact-finding over fault-finding, and in Broman's words, "put their arms around everybody." Still, the search for answers can often get ugly.
Along the same lines, Farha says it's a good idea not to pin your emotional healing on the hope that justice will prevail. "We're never guaranteed justice," he says.
Looking back on that day 30 years ago when he and Tony tried to save their friend Joe's life, George Shirley says, "I got over it, Tony never did. He got the shakes whenever he got in the plant, and eventually had to transfer out."
Mental health experts have a hard time explaining why some people are more traumatized by events than others. Heredity, past experiences, and circumstances surrounding the event can all be factors. "Every brain is different, and every past is different," says Breasure.
Research indicates that people are more vulnerable to severe distress if they've experienced earlier traumas, feel partly responsible for the incident occurring, or if there are previous psychiatric problems such as personality disorders, depression, and substance abuse. A National Institute of Mental Health survey found that post-traumatic stress disorders were twice as common among alcoholics and other drug abusers, mainly because they had more traumatic experiences.
Shirley can only wonder what made him react differently than Tony, his coworker. "I didn't live a sheltered life. I was raised around butchered animals, for one thing. He was a city boy. I went right back to work afterwards, didn't do the crying and throwing up until that night. Tony took days off and it probably preyed on his mind."
"You've got to get back to business," says Jeff Vincoli, echoing the advice of many safety and health pros. "You've got to eventually move on."
"After you've paid your proper respect, you can't get caught up in it," says one safety manager. "We can't dwell on failure."
Breasure urges patience in working through the grieving process. "Our culture seems to think you can go through a catastrophe, wake up the next day and go on. It's easier said than done to remember that everyone responds differently."
Sometimes responses raise suspicions. If you think someone is play-acting emotionally to get disability benefits, win a personal injury lawsuit, or evade responsibility, Breasure says send them to a professional counselor. If someone wants to fake it, they have a whole lot of acting to do -- everything from eye movements to changes in appetite and sleep patterns to families saying they're totally different people, she says. "It's hard to bluff a professional." Mental health counselors are trained to spend hours and hours assessing signs and symptoms of traumatic distress, then helping sufferers resolve feelings by decreasing their frequency and intensity over time. Psychiatrists might use medication in some cases. Conditions can be successfully treated through a variety of approaches.
This is not the place for safety and health pros to butt in. "I see too many risks, too many liabilities to being a counselor," says Gerry Hezidencz, director of safety and risk management for Armco Steel's Butler, Pa., operation. He requires emergency medical technicians to be debriefed following serious incidents by specialists from Butler Memorial Hospital's employee assistance program. EAP services are available in group or one-on-one sessions to any employee who witnessed a serious incident.
Don't try to diagnose signs and symptoms, say experts. It's best to educate employees about what they might feel in the event of a crisis (just knowing unusual responses are normal can lessen their intensity, says Farha) and point out local professional resources like community counseling clinics and crisis management centers.
After a critical incident, your best -- and safest -- course of action might be to simply listen to victims and "secondary victims," those indirectly affected. Watch your words, say experts. To say there's a higher purpose behind the tragedy can cause spiritual confusion. To call someone a hero can backfire. Fagel says he and other volunteers in Oklahoma City didn't want that praise. "We're not heroes. The six days I spent in Oklahoma City were six days too long." According to experts such as Fagel, the keys to handling emotional disasters come down to: ·
- Being aware of the potential for mental distress ·
- Having a plan in place before any event happens ·
- Using the power of information to help employees before (education), during (directions), and after (investigative findings) a critical incident.
"You have to be prepared for these feelings," says Fagel. "You can't say this won't happen to me. We've all got things inside we've got to release."
ResourcesThe American Counseling Association (703) 823-9800.
The American Psychological Association (202) 336-5800.
The Int'l. Critical Incident Stress Foundation (410) 740-0065.
The Nat'l. Center for Post-Traumatic Stress Disorder (802) 296-5132.
Internet Mental Health www.mentalhealth.com
An abundance of articles and information on emotional trauma has been compiled by David Baldwin and can be found on the Internet at http://gladstone.uoregon.edu/~dvb/trauma.htm
Mike Fagel has written a book, Disaster Management: A Practical Approach, and frequently lectures on the subject. He's interested in building a nationwide network of critical incident management teams for industry, and can be reached at (630) 897-0551; fax (630) 897-0647; email: mjf is firstname.lastname@example.org