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Billings J, Zhan Yuen Wong N, Nicholls H, Burton P, Zosmer M, Albert I, Grey N, El-Leithy S, Murphy D, Tehrani N, Wheatley J, Bloomfield MAP, Greene T. Post-incident psychosocial interventions after a traumatic incident in the workplace: a systematic review of current research evidence and clinical guidance. Eur J Psychotraumatol 2023; 14:2281751. [PMID: 38032045 PMCID: PMC10990448 DOI: 10.1080/20008066.2023.2281751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Background: After a traumatic incident in the workplace organisations want to provide support for their employees to prevent PTSD. However, what is safe and effective to offer has not yet been established, despite many organisations offering some form of intervention after a traumatic event.Objective: To systematically review the evidence for post-incident psychosocial interventions offered within one month of a workplace trauma, and to compare the content, effectiveness and acceptability of these interventions. Given the lack of a yet clearly established evidence-base in this field, we sought to examine both published empirical research as well as guidelines published by expert groups working with staff in high-risk roles.Methods: We conducted systematic searches for empirical research across bibliographic databases and searched online for clinical practice guidelines to April 2023. We were also referred to potentially relevant literature by experts in workplace trauma. Both empirical research and clinical guidelines were appraised for their quality.Results: A total of 80 research studies and 11 clinical practice guidelines were included in the review. Interventions included Critical Incident Stress Debriefing (CISD), Critical Incident Stress Management (CISM), unspecified Debriefing, Trauma Risk Management (TRiM), Psychological First Aid (PFA), EMDR, CBT and group counselling. Most research and guidance were of poor quality. The findings of this review do not demonstrate any harm caused by CISD, CISM, PFA, TRiM, EMDR, group counselling or CBT interventions when delivered in a workplace setting. However, they do not conclusively demonstrate benefits of these interventions nor do they establish superiority of any specific intervention. Generic debriefing was associated with some negative outcomes. Current clinical guidelines were inconsistent with the current research evidence base. Nevertheless, interventions were generally valued by workers.Conclusions: Better quality research and guidance is urgently needed, including more detailed exploration of the specific aspects of delivery of post-incident interventions.
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Affiliation(s)
- Jo Billings
- Division of Psychiatry, University College London, London, UK
| | | | - Helen Nicholls
- Division of Psychiatry, University College London, London, UK
| | - Peter Burton
- Division of Psychiatry, University College London, London, UK
| | - Maya Zosmer
- Division of Psychiatry, University College London, London, UK
| | - Idit Albert
- King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Nick Grey
- University of Sussex, Falmer, UK
- Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
| | | | - Dominic Murphy
- King’s College London, London, UK
- Combat Stress, London, UK
| | | | - Jon Wheatley
- Homerton Healthcare NHS Foundation Trust, London, UK
| | - Michael A. P. Bloomfield
- Division of Psychiatry, University College London, London, UK
- Camden & Islington NHS Foundation Trust, London, UK
| | - Talya Greene
- Clinical, Educational and Health Psychology, University College London, London, UK
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Scott Z, O'Curry S, Mastroyannopoulou K. The impact and experience of debriefing for clinical staff following traumatic events in clinical settings: A systematic review. J Trauma Stress 2022; 35:278-287. [PMID: 34672028 DOI: 10.1002/jts.22736] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/08/2021] [Accepted: 06/06/2021] [Indexed: 11/10/2022]
Abstract
Health care professionals are more frequently exposed to potentially traumatic events than individuals in other professions. Repeated trauma exposure can significantly impact both physical and mental health. In clinical settings, the term "debriefing" refers to a group meeting during which clinical events and decision-making are reviewed and discussed to improve clinical practice. The present review investigated the use of debriefing for clinical staff in clinical settings following exposure to direct and vicarious trauma. We examined whether the use of posttrauma debriefing impacts symptoms of distress and explored how clinical staff experience debriefing; we also investigated the factors that influence this experience. A systematic search of five electronic databases was conducted between August 31 and September 2, 2019. Included articles (N = 13) described the use of debriefing in clinical settings with clinical staff following a traumatic event. We assessed methodological quality and performed a narrative synthesis. Four studies found some evidence of the benefits of debriefing for reducing psychological sequelae to traumatic events. Seven studies commented on factors that clinical staff perceived to be important for the debriefing to feel helpful, including the being given the opportunity for reflection, gaining a shared experience, and having the right peer facilitator. Some evidence suggests that debriefing with staff working in clinical settings can reduce posttraumatic distress symptoms, and subjective evidence suggests that clinical staff members perceive debriefing to be useful. Due to the limited literature, no firm conclusions could be drawn, and further methodologically sound research is required.
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Affiliation(s)
- Zoe Scott
- Norwich Medical School, University of East Anglia, University of East Anglia, Norwich, NR4 7TJ, United Kingdom
| | - Sara O'Curry
- Cambridge University Hospital NHS Foundation Trust, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Kiki Mastroyannopoulou
- Norwich Medical School, University of East Anglia, University of East Anglia, Norwich, NR4 7TJ, United Kingdom
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Richins MT, Gauntlett L, Tehrani N, Hesketh I, Weston D, Carter H, Amlôt R. Early Post-trauma Interventions in Organizations: A Scoping Review. Front Psychol 2020; 11:1176. [PMID: 32670143 PMCID: PMC7330139 DOI: 10.3389/fpsyg.2020.01176] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/06/2020] [Indexed: 12/02/2022] Open
Abstract
Background In some organizations, traumatic events via direct or indirect exposure are routine experiences. The National Institute for Health and Care Excellence reviews (2005; 2018) of post-traumatic stress disorder management in primary and secondary care did not address early interventions for trauma within emergency response organizations. Aims This scoping review was designed to identify research which evaluates the use of early interventions in emergency and other high-risk organizations following exposure to primary or secondary trauma and to report on the effectiveness of the early intervention models in common use. Methods A scoping review was conducted to examine early interventions for workers exposed to trauma, including emergency response, military, and humanitarian aid. Relevant data were extracted from the included studies and the outcomes were assessed using meta-ethnography. Results Fifty studies of mixed quality met the inclusion criteria for this review. A synthesis of study outcomes found that early interventions help emergency responders to manage post-incident trauma when they are delivered in a manner that (a) respects distinct organizational culture, (b) is supported by organizations and senior management, and (c) harnesses existing social cohesion and peer support systems within teams. Conclusion This review demonstrates that early interventions support emergency responders following exposure to trauma when these are tailored to the needs of the population, are supported by the host organization, and harness existing social cohesion and peer support processes within a team or unit. A number of recommendations for the delivery and evaluation of early interventions for psychological trauma in emergency response organizations were made.
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Affiliation(s)
- Matt T Richins
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection and Medical Directorate, Public Health England, London, United Kingdom
| | - Louis Gauntlett
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection and Medical Directorate, Public Health England, London, United Kingdom
| | - Noreen Tehrani
- Crisis, Disaster, and Trauma Section, British Psychological Society (Member of Standing Committee EFPA), Leicester, United Kingdom
| | - Ian Hesketh
- Alliance Manchester Business School, University of Manchester, Manchester, United Kingdom
| | - Dale Weston
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection and Medical Directorate, Public Health England, London, United Kingdom
| | - Holly Carter
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection and Medical Directorate, Public Health England, London, United Kingdom
| | - Richard Amlôt
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection and Medical Directorate, Public Health England, London, United Kingdom
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Yang CC, Chiu HC, Xiao SH, Tsai YH, Lee YC, Ku YT, Lin RS, Lin WC, Huang SJ. Iatrogenic Effect? Cautions when Utilizing an Early Health Education for Post-concussion Symptoms. Arch Clin Neuropsychol 2017; 33:131-142. [DOI: 10.1093/arclin/acx060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 06/09/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chi-Cheng Yang
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Hsiao-Chun Chiu
- Pediatric Psychiatry, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sheng-Huang Xiao
- Department of Psychology, National Chengchi University, Taipei, Taiwan
- Taipei City Hospital Ren-Ai Branch, Taipei, Taiwan
| | - Yi-Hsin Tsai
- Department of Neurosurgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yi-Chien Lee
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Yi-Ting Ku
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Rong-Syuan Lin
- Division of Clinical Psychology, Master of Behavioral Science, Department of Occupational Therapy, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Wei-Chi Lin
- Division of Clinical Psychology, Master of Behavioral Science, Department of Occupational Therapy, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
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Jaynes CL, Valdez A, Hamilton M, Haugen K, Henry C, Jones P, Werman HA, White LJ. Survivors Perceptions of Recovery following Air Medical Transport Accidents. PREHOSP EMERG CARE 2014; 19:44-52. [PMID: 24932568 DOI: 10.3109/10903127.2014.923075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract Objective: Air medical transport (AMT) teams play an essential role in the care of the critically ill and injured. Their work, however, is not without risk. Since the inception of the industry numerous AMT accidents have been reported. The objective of this research is to gain a better understanding of the post-accident sequelae for professionals who have survived AMT accidents. The hope is that this understanding will empower the industry to better support survivors and plan for the contingencies of post-accident recovery. Methods: Qualitative methods were used to explore the experience of flight crew members who have survived an AMT accident. "Accident" was defined using criteria established by the National Transportation Safety Board. Traditional focus group methodology explored the survivors' experiences following the accident. Results: Seven survivors participated in the focus group. Content analysis revealed themes in four major domains that described the experience of survivors: Physical, Psychological, Relational and Financial. Across the themes survivors reported that industry and company response varied greatly, ranging from generous support, understanding and action to make safety improvements, to little response or action and lack of attention to survivor needs. Conclusion: Planning for AMT post-accident response was identified to be lacking in scope and quality. More focused efforts are needed to assist and support the survivors as they regain both their personal and professional lives following the accident. This planning should include all stakeholders in safe transport; the individual crewmember, air medical transport companies, and the industry at large.
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Macnab A, Sun C, Lowe J. Randomized, Controlled Trial of Three Levels of Critical Incident Stress Intervention. Prehosp Disaster Med 2012; 18:367-71. [PMID: 15310050 DOI: 10.1017/s1049023x00001333] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Stress debriefing following exposure to a critical incident isbecoming more prevalent. Its aim is to prevent or minimize the development of excessive stress response symptoms that lead to loss of productivity or effectiveness in the workplace or at home. There is little evidence that any form of psychological debriefing is effective. This study evaluated the effectiveness of three intervention strategies, and attempted to correlate the symptoms with the severity of the incidentand level of intervention.Methods:A randomized, controlled trial of three levels of critical stress intervention was conducted in the British Columbia Ambulance Service (BCAS), in British Columbia, Canada, among paramedics and emergency medical technicians (EMTs), reporting critical incident stress. Outcomes were measured at one week (Stanford Acute Stress Reaction Questionnaire (SASRQ), the Life Impact Score (LIS), and Schedule of Recent Events (SRE)), and at three months and six months following the intervention (Impact of Events (IE), Coping Mechanisms, LIS, and SRE).Results:Fifty calls were received during the 26-month study period (<1 per 10,000 BCAS response calls): 23 were by third parties, but the involved EMT did not call;nine were placed by crew unwilling to participate in the study; 18 subjects enrolled, but six completed no forms. No correlation was found between severity of the incident and scores on the SASRQ, IE, or LIS, or between any of these scores. There was no consistent pattern in the stress scores over time.Conclusion:Requests for critical incident stress intervention were uncommon. The need for intervention may not be as great as generally is assumed. Further randomized trials, ideally multicenter studies, are indicated.
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Affiliation(s)
- Andrew Macnab
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
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Sibley AK, Tallon JM, Day AL, Ackroyd-Stolarz S. Occupational injuries and stressors among Canadian air medical health care professionals in rotor-wing programs. Air Med J 2005; 24:252-7. [PMID: 16314280 DOI: 10.1016/j.amj.2005.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Air medical health care providers work in a unique environment that may affect occupational injury rates and patterns. Despite this knowledge, little high-quality evidence exists regarding occupational injuries specifically incurred by air medical health care professionals. We sought to characterize the epidemiology of occupational injuries experienced by Canadian rotor-wing health care providers. METHODS A survey was sent to the 4 rotor-wing programs in Canada. All crewmembers participating directly in patient care were asked to complete the survey detailing any acute occupational injuries sustained within the previous year. A series of both open- and closed-ended questions was used to collect participant demographics and information regarding any injuries sustained. RESULTS One hundred and six (40.6%) participants completed the survey. Three hundred and thirty acute injuries were reported. Hand lacerations and leg contusions were most prevalent (31 and 24 individuals incurred these injuries, respectively). Acute back injuries were also prevalent with 25 (23.6%) participants reporting at least one back injury. Overall, an injury rate of 3.2 injuries per person per year was reported. Lifting was cited as a common factor in injury (30 cases). Most injuries required little treatment, with only 17 needing physician intervention, and only 6 required more than 1 week off work. CONCLUSION Injuries among Canadian air medical crews are common, but fortunately, the majority are minor. Specific injury prevention strategies may focus on stretcher design, cabin ergonomics, and extremity protective equipment.
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Affiliation(s)
- Aaron K Sibley
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Bledsoe BE. Critical incident stress management (CISM): benefit or risk for emergency services? PREHOSP EMERG CARE 2003; 7:272-9. [PMID: 12710792 DOI: 10.1080/10903120390936941] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Critical incident stress management (CISM) has become a common practice in modern emergency services. Described in 1983 as critical incident stress debriefing (CISD), CISM was originally marketed to help emergency personnel deal with ostensibly stressful situations they would encounter as a part of their work. OBJECTIVE To review the status of the medical and psychological literature regarding the efficacy and safety of CISM. METHODS Several pertinent databases were accessed and searched for scientific articles pertaining to CISM. These were subsequently analyzed for methodology and pertinence to the study topic. RESULTS Numerous scientific articles were found concerning CISM. Several high-quality studies were identified, but many other studies lacked adequate methodology sufficient for use in an evidence-based medicine approach. Others were from trade magazines, non-refereed journals, and obscure mental health journals. Several meta-analyses and randomized controlled trials (RCTs) were found. Overall, these studies show that, at best, CISM has no effect on preventing psychiatric sequelae following a traumatic event, particularly post-traumatic stress disorder (PTSD). Furthermore, several studies report possible paradoxical worsening of stress-related symptoms in patients and personnel receiving CISM. CONCLUSIONS Despite the limitations of the existing literature base, several meta-analyses and RCTs found CISM to be ineffective in preventing PTSD. Several studies found possible iatrogenic worsening of stress-related symptoms in persons who received CISM. Because of this, CISM should be curtailed or utilized only with extreme caution in emergency services until additional high-quality studies can verify its effectiveness and provide mechanisms to limit paradoxical outcomes. It should never be a mandatory intervention.
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Affiliation(s)
- Bryan E Bledsoe
- Department of Emergency Medicine, University of North Texas Health Sciences Center, Fort Worth, Texas, USA.
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