The Crisis Response & Recovery Cycle (CRRC) Preparation for Psychological First Aid

1. The Crisis Response & Recovery Cycle (CRRC) Preparation for Psychological First Aid Some of the information presented in these slides is used with the permission of Dr Bob Montgomery (APS Workshop on Psychological Responses to Disasters, 23rd April 2010, Princess Margaret Hospital, Perth, WA).

2. THE RISK MANAGEMENT TOOL BOX TRAINING / IMPLEMENTING / IMPROVING Hazard Awareness • JHA • Risk Assessments • HSE-MS • HSE Plans • Culture Surveys

3. 001/ The Crisis Response and Recovery Cycle • There is a ‘typical’ Crisis Response & Recovery Cycle (CRRC) which is common to most people experiencing a traumatic incident (e.g., a fire, explosion, sinking, etc.,). • Recognising that the CRRC is a normal human response to a disaster is the important first step to planning to manage psychological trauma.

4. 002/ Preparing your CRRC Plans • Within your emergency response plans, there is a need to be as prepared to manage the psychological aspects of the catastrophic incident as you are the physical, medical, environmental, reputational, financial and other aspects. • The objectives of Psychological First Aid (PFA) are: • To reduce ongoing distress in your people (anxiety and the four types of early reactions – emotions, physical body, cognitive and behaviour); • To facilitate psychological recovery of survivors as quickly as possible; and • To reassure your people that they are not suffering psycho-pathology (e.g., PTSD early on). • .

5. 003/ Preparing your CRRC Plans • Planning and preparation aroundPsychological First Aid (PFA) is simply another leading indicator that is found in organizations with more mature safety cultures. • How good is your PFA planning? INVOLVING CULTURE We’ve got everyone involved in making this a safe place to be. DEVOLVING CULTURE People believe we’re serious and individuals are taking responsibility INCREASING MATURITY DIRECTING CULTURE Safety is important and we need to get employees to follow the rules. INCREASINGSAFETY REACTING CULTURE I guess we better manage this in order to keep our license to operate. COMPLAINING CULTURE Why the hell should we spend time and money on this?

6. 004/ PFA is required if incidents can be “catastrophic” • Fatality • Gas Present • Ignition source • Fire • Explosion • Preparation for Psychological First Aid

7. 005/ Examining the Crisis Response • Crisis response – as the incident occurs (e.g., fire, explosion or sinking). • People involved in the incident will typically experience reactions in the following order: • Shock; • Disbelief (this can’t be happening, “they must be making a movie”); • Realisation of problem (“OMG, it is happening”); • Unfeeling survival state (often reported as “frozen”); and • Survivor escapes/released (or person entrapped and killed). • The above may occur over a period from a few seconds to several minutes.

8. 006/ Examining the Recovery Cycle • There is also a typical recovery cycle (RC) for survivors that begins after the incident (e.g., fire, explosion or sinking). • Survivors and witnesses involved in the incident will typically experience: • Shock; • Depression; • Mood swings; • Anger (why me/us?); • Reflection (trying to make sense of what happened); and • Lay event to rest (incident no longer intruding). • The above cycle occurs in coming days and over several weeks to months.

9. 007/ Psychological First Aid • Requirement for immediate response (“Psychological First Aid”). • Delivered immediately after the incident (at the scene) or as soon as possible afterwards. • Basic need is to reassure survivors they are now safe. • Use “calming response” technique.

10. 008/ Helping in the aftermath • Days and weeks (up to 2-3 months afterwards). • Basic need is to reassure survivors they are now safe. • Need to “normalise” the recovery cycle responses. • Shock, depression, mood swings, anger are all NORMAL reactions to a catastrophic incident. • THIS IS ALL NORMAL. People are not going mad. Reassurance is a priority. • Basic need to deal with anxiety (resulting from the catastrophic incident).

11. 009/ Understand that anxiety is normal • Anxiety is an unpleasant state typified by: • Negative emotions (fear, nervousness, tense); • Perceptions of unpredictability and lack of control over external events; • Physiological arousal (tension); • Maladaptive shift in attention (mind off-task in hand, false alarms, irrational fears); and • Avoidance behaviour. • Need to reassure folks that anxiety is NORMAL. It is the normal response of people to disaster situations. • Your goal is to yourself and your folks to help people learn to manage negative emotional responses, negative perceptions, negative arousal states and negative behaviours.

12. 010/ When does anxiety become a problem? Problems emerge when Anxiety is unnecessary, excessive, avoided or prompts further maladaptive behaviour. Look for prolonged or entrenched reactions in the following: Behaviour Avoidance (of similar situations) Withdrawal (from family life, friendships, etc) Alcohol or drug usage Loss of interest – apathy Cognitive Difficulty concentrating Confusion Disorientation Flashbacks Nightmares Impaired decision-making Intrusive memory Suicidal thoughts Physical Reactions Upset stomach Headache Disturbed sleep Excessive sleep Appetite shift (hungry or not hungry) Emotions Shock Distress Sadness Fear Guilt Helplessness Anger Hopelessness

13. 011/ Objectives for the Recovery Cycle Your objective now: To reduce ongoing distress (anxiety and the 4 types of early reactions – emotions, physical, cognitive and behaviour); To facilitate psychological recovery as quickly as possible; and To reassure that the person is not suffering psychopathology (e.g., PTSD early on). All of the stress/anxiety reactions are NORMAL human reactions to a terrible incident. Only if the person is not improving over time should you be concerned (2-3 months time frame).

14. 012/ Reassure yourself that you’re normal • Reassure yourself or other people that all of the anxiety responses are NORMAL reactions and that they can be managed using appropriate techniques. • If they do not improve over short time frame, seek assistance. •  If after 2-3 months, these symptoms are still highly aroused – may indicate person is not coping and that Post-Traumatic Dress Disorder (PTSD) is developing – seek professional assistance.

15. 013/ Conclusions • Preparation and planning for the CRRC is essential in every business where “catastrophic” incidents could occur: • Planning for Psychological First Aid should become a normal part of your emergency response plans; • Managers, Supervisors and Employee’s can all deliver effective Psychological First Aid on site and in the immediate aftermath of catastrophic incidents (just as you probably now train them to provide medical first aid); • Psychological First Aid has been shown time and again to reduce ongoing distress and to facilitate rapid psychological recovery following disasters; • Training your people to deliver Psychological First Aid is critical in preparing for catastrophic incidents; and • Providing an external Employee Assistance Program (EAP) is NOT a substitute for good CRRC planning and the ability of your own people to deliver Psychological First Aid in situ.

16. 014/ What can you do now? • Audit your current preparation and planning around the psychological aspects of the Crisis Response & Recovery Cycle. • How well prepared is your business to manage traumatized people as they return to work? • 2. Audit the capability of your people to deliver Psychological First Aid in the immediate aftermath of catastrophic incidents. • Are your people trained and skilled in providing immediate Psychological First Aid? • 3. Contact a professionally registered psychologist in your local region and seek more information on how they can help with planning for the CRRC.

17. 015/ Capability to offer advice Dr Graham Marshall is a Member of the Australian Psychological Society. He holds a Masters Degree in Psychology and a Ph.D. Graham has worked for over 12 years in assisting an international network of clients to appropriately manage HSE risk, including those factors associated with psychological trauma. Besides his formal qualifications as a psychologist, Graham also holds a Diploma in Occupational Health & Safety and he is an Associate OHS-MS Auditor (RABQSA). Graham was recently presented with a WA Government Work Safe Award “in recognition of his outstanding contribution to safety and heath in the workplace.” • The Rt Hon John Kobelke (at left) presents Dr Marshall with a Work Safe Award while Don Sanders (Director of the Australian Petroleum Production and Exploration Association )(APPEA) looks on.

18. Dr Graham Marshall Australian callers: 0408 472 678 Overseas callers: +61 408 472 678 E-mail: grahammarshall@therisktoolbox.com Web: www.therisktoolbox.com Thank you