Calming force

When the occupational health team at the Metropolitan Police recognised the
need for pre-incident training it went about formulating a course which would
equip staff physically and psychologically. 
By Lara Carmel, Judy Cook and Michelle Peerboy

W hat support would your occupational health department give to an employee
whose life had just been threatened?

This is part of everyday reality for staff in the police service. Both
police officers and civil employees witness scenes of violent crimes, attend
road traffic accidents, listen to stories from victims of fire, rape and
assault and notify relatives of deceased family members on a regular basis.

The Metropolitan Police Service has long recognised that its employees have
a higher-than-average chance of experiencing trauma during the course of their
work. While a traumatic event is difficult to define, in the police service it
is considered as "an experience outside the usual range of usual human
experience and one which would be markedly distressing to almost anyone."

Support programme

For these regrettably regular traumatic events, the Met’s occupational
health service developed a trauma support programme which has been a standard
procedure since the early nineties. The programme has four main components:
education, immediate post incident action, post incident psychological
debriefing, and follow up as required.

Despite the success of the trauma support programme, the system did not
appear to answer the varied needs of staff who may be required to join
specialist body recovery and identification teams.

These teams assist after a particularly catastrophic event: for example, a
plane crash, natural disaster, or prolonged investigation of large-scale war
crimes. The police service management and occupational health professionals
recognised that team members needed care not only during and after the
incident, but that pre-incident training was also vital to help officers
understand post-traumatic stress reaction. This education could, in turn, help
prevent future ill-health.

Past experience of catastrophic events and the resulting ill-health had
demonstrated that officers involved were often scantily prepared and
ill-equipped, and supported on a rather ad hoc basis. This was no criticism of
the staff but was a reflection of the rudimentary understanding of trauma until
that time. By 1998 the police service understood more and it was the right time
to improve the systems.

Moving forward

As the occupational health service began to explore possible modification to
the trauma support programme, management at Heathrow police station examined
their contingency programme for response to a major accident. Communication was
established and planning commenced for the first partnership approach in the
formation of a new body recovery and identification team (Brit) at Heathrow.

The Metropolitan Police occupational health service has always encouraged a
team approach to healthcare. Multi-skilled teams of occupational health
advisers, occupational health practice nurses and occupational health welfare
counsellors provide advice to their delegated areas. Teams are managed by
occupational health managers who report directly to the business director of
occupational health. Each manager has portfolio responsibilities, one being the
management and coordination of the trauma support programme.

One of the three welfare counsellors designated to the Heathrow project
demonstrated a proactive stance by outlining the specific needs of a body
recovery and identification team. This was fed back to the manager with
portfolio responsibility, who prepared a departmental response and gained
sanction to the request from Heathrow for input from the occupational health
service.

Those consulted at the project meetings included the business director of
the occupational health service and the department at New Scotland Yard with
overall responsibility for body recovery policy.

OH intervention

During these meetings the need to involve an OH adviser was recognised. The
manager invited a practitioner specialising in trauma to join the pilot scheme
at Heathrow. With the occupational health team attending only one strategy
discussion for the pending first meeting at Heathrow, it was vital for the team
to use it to recognise individual boundaries and departmental limitations. This
was swiftly achieved, again demonstrating the strength of teamwork and respect
for colleagues in the occupational health service.

Several meetings were held with senior management and the training division
at Heathrow, culminating in agreement to the team’s objectives. Fortunately,
because of the good working relationships and perceived urgent need, any issues
were openly discussed and quickly resolved.

Following final sanction by senior management, the three occupational health
professionals, the manager, occupational health adviser and counsellor, then
worked together over a relatively short period to prepare materials. At this
stage, other occupational health practitioners were informed of progress and
became involved. For example, the senior safety adviser was invited to
contribute to relevant parts of the training programme.

The Heathrow project quickly began to take shape and the first series of
occupational health interventions became a reality. At this stage it was
particularly rewarding that the manager again became involved with New Scotland
Yard which was now very interested in using this concept for central and area
body recovery and identification teams.

It appeared that from the initial proactive work by a welfare counsellor,
followed by a partnership approach with much hard work and tight deadlines, an
innovative project had been achieved.

Six key stages

There were six planned stages of occupational health involvement from
pre-selection seminars to a mandatory debriefing to follow-up support.

1 Pre selection seminars

This was to be the first opportunity to start the concept of "trauma
inoculation" – talking, when appropriate, about trauma and stress at an
early stage which helped to normalise subsequent reactions and reduce adverse
effects on health. Potential reactions were described and discussion
encouraged. Attendees were all those with an interest in volunteering for the
team. Occupational health input included talking about why we were there, our
involvement at each stage, the reassurance of the confidentiality of health
information we received, reaction to trauma and human resources issues.

2 Selection stage

Health questionnaire

The first task was to devise a confidential questionnaire that was
non-threatening and could be easily answered, while providing valuable and
relevant information on physical and psychological health, specific for body
recovery work. This was completed using examples of good practice and past
experience from our own occupational health practitioners and consultation with
external colleagues.

Once devised, each volunteer was required to complete the questionnaire. All
were advised there was no actual pass or fail, rather the information was a
platform for discussion at health interview. Volunteers were advised that if
they had major doubts or concerns about their wish to continue their
application, to simply leave the questionnaire.

Health interview

Following completion and forwarding of the questionnaire, each candidate was
required to attend a joint health interview with the OH adviser and OH welfare
counsellor. This was a further chance to discuss previous experience of trauma
and to talk about whether this very demanding work was right for the individual
at this time. The session aimed to be more of a discussion than an interview
and again it was hoped that those who might be more vulnerable, either
physically or psychologically would agree or choose not to continue.

3 The course

This was a particular challenge as all occupational health input needed
preparation from a zero-start with little reference material. The OH adviser
and welfare counsellor worked together to produce a design that was acceptable
to Heathrow management. Rather than deliver timed presentations on subjects
such as control of infection, we tried to link these to non occupational health
sessions. For instance, when the mechanics and procedures of collecting and
handling body parts infection control issues were discussed. The emotional
aspects were also raised.

4 Mandatory debriefing

The trauma support programme in the Metropolitan Police Service is not
mandatory at the moment. It was recognised at an early stage that for the body
recovery programme there should be occupational health and/or management
support during the incident but that immediate post incident debriefing would
be mandatory.

Acceptance of this concept was a notable success for the project team as
traditionally the traumatic support programme had always struggled for
universal acceptance. It was good to hear that the new members understood,
accepted and welcomed identification of this need.

5 Follow up

It was felt vital to offer the opportunity for regular occupational health
follow up for body recovery team members who had been required to be
operational i.e. actually attend an incident. This had not previously been an
option in any formal sense but was pursued on a rather more an ad hoc basis. It
was reported that follow up might have been helpful for past incidents.

6 Support and/or treatment

There is no doubt that body recovery work can cause severe distress, either
physically or psychologically to some participants. Although the role of the
occupational health service is not as a primary health care provider,
practitioners would be able to offer support, guidance, advice on treatment and
referral and advice on attendance at work.

Discussion

To evaluate this intervention the most valuable evaluation design would be a
randomised control; however the ethics of such design, where one group of officers
are randomised to an untrained and non-debriefed group, are doubtful.

We are fortunate that there has not yet been a need for a body recovery team
to be activated. An alternative design, non-randomised, could be implemented in
the event of a disaster. In such instance, due to the enormity of the disaster,
not only would a body recovery team be activated but it is extremely likely
that officers untrained in body recovery would assist. The OH team would then
offer them debriefing and evaluate if the symptoms of post traumatic reactions
are different to those who had the trauma inoculation training on the body
recovery course.

Following the courses at Heathrow, a self-evaluation questionnaire was
handed to each officer.

Comments included that the method of training was new to the participants.
It had been extremely interactive and they felt it had prepared them to think
about the health and safety risks to themselves both physically and
psychologically. Each officer said they had learnt the necessary skills to
identify a colleague in distress and what action to take.

After the courses, the officers took part in a mock aeroplane disaster, with
other emergency services. This demonstrated learning outcomes from the course.
The OH adviser and senior safety adviser were on-site to offer advice and
feedback. After the exercise an operational debrief took place: this included a
mock psychological debrief.

Following the initiation of the Heathrow project, the team was pleased to
see the wider adaptations of this programme. It has been used to respond to
requests for assistance from police undertaking body recovery work in Kosovo.

References

1 Alexander, DA & Wells, Andrew, 1991, Reactions of Police Officers to
Body Handling After a Major Disaster: A Before and After Comparison. British
Journal of Psychiatry 159 547-555

2 Bradden Gibling & Tait, On Site Human Resource Management Issues,
1993. Police Research Document

Further reading

Frazer DE, 1991, Occupational Health Management of Police Officers involved
in the Piper Alpha Disaster. Journal Soc Occupational Medicine 174-175

Deahl Dr Martin, unpublished at time of source. Body Recovery: War Graves
Soldiers

Lara Carmel BSc Hons RGN DOHN, is an occupational health adviser, Judy
Cook MSc RGN OHNCert is an occupational health services manager and Michelle
Peerboy BSc Hons, Dip.Counselling, Dip.HRM is an occupational health welfare
counsellor at the Metropolitan Police Occupational Health Service

This article was highly commended in last year’s Roche Diagnostics
Occupational Health Award

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