Operational Debrief and Support

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• Operational Debrief and Support
• for Responders
• Understanding (Managing) the Difference
• Philip Selwood

15th World CongressOn Disaster Emergency
MedicineAmsterdam 2007
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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

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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)
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General points I

• Type of event
• Natural
• Technological
• Mass violence

• Adverse impact

Least
Most
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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

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Emergency service personnel are particularly at
risk
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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

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What Happened
0806 Thames Turbo Departs Paddington
0808 Thames Turbo Passes SN109 at Red
0809 Thames Turbo collides almost Head-on
with First Great Western
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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

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Result

• Anger
• Frustration
• Management Defensiveness
• Psychological impact
• Debrief process not completed
• Consequence Management

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Case Study Two8th July 2005London Bombings

• 0850 hours

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8 years on Lessons from Paddington had been
learnt(with thanks to Tony Crabtree D/Director
HR LAS ) Tony.Crabtree_at_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

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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

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• Thankyou
• Philip Selwood