2. Operational Debrief and Support for Responders Understanding (Managing) the Difference Philip Selwood 15th World Congress On Disaster & Emergency Medicine Amsterdam 2007

3. My background 10 years with EMS – last two years Chief Executive – 8 years as deputy in London (LAS) National lead on Civil Emergencies for UK EMS 32 years with Metropolitan Police in London wide experience in major incident management (Irish Terrorism/street riots/international terrorism) now ‘retired’ – audit of the English Ambulance Services – ‘ Emergency Preparedness’ – adviser to the Welsh Ambulance Service – Executive Coach

5. Overview Major incidents lead to adverse psychosocial reactions for: Victims Families Community Emergency service personnel A structured process is needed to assist emergency planners/responders to identify: Risk groups Resources Evidence based interventions at various phases Operational debriefs need to be managed so as minimise risks to responders With thanks to Martina Mueller Consultant Clinical Psychologist ( OBMH) (Oxfordshire and Buckinghamshire Mental Health Partnership NHS Trust)

6. General points I Type of event:  Natural  Technological  Mass violence Adverse impact Least Most

7. General points II Most people recover without treatment, psychiatric morbidity rates range from 5% - 30% Some people are more vulnerable  Gender  Prior trauma  Concurrent life stressors  Younger age?  Severity of trauma Consequences can be as devastating as the event itself  Losses  Disability / disfigurement Reactions can have a delayed onset Post-traumatic reactions can be very chronic for some A clear distinction needs to be made and understood, between operational debriefing and physiological debriefing

8. Emergency service personnel are particularly at risk

9. Case Study One Paddington Train Crash 1999 Operational Summary 31 Killed 126 Injured taken to 6 Hospitals Last body removed 5 days after crash Response  41 Ambulances  200 Operational Staff  5 Mobile Medical Teams  4 Doctors  Training School Personnel

10. What Happened 08:06 – Thames Turbo Departs Paddington 08:08 – Thames Turbo Passes SN109 at Red 08:09 – Thames Turbo collides almost Head-on with First Great Western

11. Operational Debrief Called 10 days after All operational staff invited (eg responders, managers, emergency planners) Little thought given to structure Loose agenda Outcomes ill defined Emotional needs of responders not understood

12. Result Anger Frustration Management Defensiveness Psychological impact Debrief process not completed Consequence Management

13. Case Study Two 8 th July 2005 London Bombings 08:50 hours

14. 8 years on Lessons from Paddington had been learnt ( with thanks to Tony Crabtree D/Director HR LAS ) Tony.Crabtree@lond-amb.nhs.uk Tony.Crabtree@lond-amb.nhs.uk Structure LINC workers trained and in place  Listening  Informal  Non Judgemental  Confidential TRiM (Trauma Risk Management) approach adopted * Professional counseling services available On the day Rest centre established (support available lead by Director HR) Immediate feedback obtained but fundamentally about welfare support Structured debriefs over following weeks at different levels Ongoing support over time as necessary * Royal Navy – Dr Neil Greenberg MRCPsych

15. Conclusions Need to impeccably manage the debrief process Separate out  Technical from emotional debriefing  Management debriefs from responder debrief  Offers of support in context of nature of the event e.g. London Bombings Focus Operational Debrief on  How well prepared were we  How well did we do  How can we do better next time  Be prepared for and manage the risks of emotional drift Introduce support and debrief process as part of routine activity – not crisis driven Proportionality of support is vital Not one size fits all

16. Thankyou Philip Selwood