Going off the rails

With the hindsight of Paddington and other major incidents, this article
highlights key psychosocial issues arsing for those responding to disasters, by
Dr Anne Eyre and Mary Jacob

Oh no, not again! Was the reaction of many involved in the Southall rail
crash who, within the first weeks of the inquiry, heard the first news reports
of the fatal rail crash at Ladbroke Grove, outside Paddington. "Oh no, not
again!" we all uttered after the Hatfield crash, coming as it did in the
wake of the first anniversary of Paddington.

These events and reactions to them remind us of the importance of thinking
about disasters in terms of a whole cycle of events from planning (pre-event)
through to learning and applying lessons (post-event), rather than just
focusing on the impact stage and the immediate aftermath. Good disaster
management involves responding to all phases of this disaster cycle: in terms
of planning, responding, reviewing, evaluating and improving preparedness. This
fundamental principle became abundantly clear to those who managed the
occupational health response to the Paddington disaster within the Metropolitan
Police with hindsight afforded by recent rail disasters.

Human aspects lag behind

Many organisations prepare for disasters in predominantly technical and
operational terms, focusing, for example, on business recovery in relation to
IT systems and the operational management of a disaster. Planning and
responding to the human aspects in the event of a major incident or disaster
often lag behind this emphasis on the physical and technical dimensions of the
workplace, even when organisations recognise in principle that their human
resources are their most important asset. Part of the reason for this is our
assumption that "it won’t happen here" which explains why one of the
most common reactions of those first hearing of an incident involving their
staff is shock and disbelief. At such times of initial chaos and confusion the
need for clear, appropriate and workable disaster plans and staff support is
most fundamental, particularly as the OH department of an organisation will be
expected to play an important role in staff support.

The first response of OH managers hearing news of the Paddington disaster
was to consider the best way of providing additional proactive support to line
managers in charge of the practical response and, through them, to those
officers working directly at the disaster site. Applying the lessons learnt from
the Southall disaster, where frontline support had been less obvious, the
importance of facilitating and being seen to provide up-front support from the
start was recognised.

The Metropolitan Police Directorate of Occupational Health received dozens
of requests for advice and support in the first few hours and days from a
variety of sources and levels within the organisation. They ranged from
individual officers and stations with direct involvement in the major incident
response, to co-ordinators of specialist teams, personnel managers and senior
operational and strategic commanders. The fact that all levels of staff were
asking for help highlighted the increasing awareness of the psychosocial
effects of responding to disasters within the police service and the
acknowledgement of the role of occupational health in meeting the needs of
disaster teams.

Physical presence important

A further lesson learnt and applied since the Southall disaster is the need
for OH personnel to be physically present providing support and consultation
alongside operational managers in the immediate aftermath. Although this
included providing psychological debriefing services, their role was much
broader than that: any managers working under the intense and extraordinary
pressure of responding to a major incident need extra support in making
decisions that will impact on both their own and others’ health, safety and
well-being. At Paddington this included decisions about staff deployment,
length of hours worked and operational debriefing. Because the review of
Southall had highlighted the importance of high-profile, proactive and visible
presence of staff support services, occupational health staff were deployed to
police stations at Paddington and Notting Hill to support and advise
operational managers.

Other occupational health departments should learn from this and build into
their own disaster contingency plans provisions for proactive psychosocial
support of all staff coping in the aftermath of a crisis.

Addressing the needs of staff and the public

For the Metropolitan Police, responding to disaster entails addressing the
needs of their own staff as well as the public. Responding to major incidents
is both rare and different to ordinary police work and hence both the support provided
and level of need are much greater than usual. According to an editorial in
Police Review (19.November 1999), "Dealing with Paddington was about
ordinary men and women being called upon to perform extraordinary tasks".
As the calls for extra assistance came in during the first few days, with
indications that up to 1,000 staff might need debriefing, it became clear that
existing resources would be stretched. As well as meeting the needs of disaster
workers, the Directorate was still expected to provide its usual trauma support
and emergency counselling service.

In meeting the needs arising from the disaster it was decided that all
non-urgent work be suspended. This is a difficult decision for any organisation
to make in the aftermath of a crisis since it is one that is likely to have an
impact on all staff, not just those directly involved in an incident and its
response. One of the lessons to take away from this is the need for
organisations to consider at the planning stage how they will meet not only the
extra needs arising from the disaster itself, but also their ongoing routine
work, particularly if the demands on support staff will continue for some
considerable time.

A varied and flexible approach to help

It soon became apparent that the nature of the help required by staff
responding to Paddington would need to be varied and flexible, particularly
since the personnel involved in the response were carrying out very
wide-ranging tasks within varying departments and at different levels. In keeping
with contemporary thinking, psychological debriefing was made available but
adapted to the particular demands thrown up by this incident and accompanied by
other forms of support too.

Information about the psychological and physical impacts of trauma was
distributed to officers at the end of their shifts with group debriefings
offered after their involvement in the disaster had ended rather than simply 72
hours after the incident. Flexibility here also meant responding to the fact
that the teams that worked together at the disaster site were invariably
different to usual team structures. Most teams felt strongly that they wanted
and needed to be debriefed as a team rather than separately through their own
departments. This also meant that debriefings took place in larger groups than

Oursourcing as a solution

Many organisations plan to outsource psychological debriefings in the event
of major incidents. The involvement of outsiders may have both advantages and

The Metropolitan Police’s Directorate of Occupational Health felt it
important not only to provide support itself (with some crucial support from
colleagues in county forces) but also to increase its own understanding of key
relevant operational issues likely to arise.

Drawing on its previous experiences of debriefing members of the specialist
Body Recovery and Identification Teams, it therefore attended operational
debriefs prior to conducting psychological ones. A key issue to consider here
is the value attached to debriefers’ knowledge and understanding of both the
operational and cultural issues involved within the organisational context of a
disaster, its management and its impact.

Evidence-based practice

Debates about the nature, timing and effectiveness of psychological
debriefing after disasters remain contentious, and there is a common call for
evidence-based practice in this field. The Metropolitan Police is actively
reviewing and evaluating its own occupational health services provided after
this disaster through commissioned research. This is being conducted currently
by the University of Northumbria. It is also conducting its own internal
review. This has so far flagged up the importance of considering disaster
planning beyond the single organisation’s response and capabilities.

Disasters are increasingly likely to have an impact beyond single
organisations and communities as both recent rail accidents, flooding and other
crises have shown. In societies such as the United States the idea of
developing disaster-resistant communities has extended disaster planning beyond
single organisations to much broader inter-organisational and cross-border
levels. This may well be the logical conclusion for disaster planning in
Britain in future, but organisations need firstly to ensure their own internal
plans are up-to-date and effective.

For any organisation, good disaster planning should embrace both
technical/physical and psychosocial aspects. Plans for staff support should be
simple, adaptable and easily accessible so that they are understood and
appreciated by all members of the organisation. More fundamentally, training
and awareness of the impact of sudden death, particularly on a mass scale, and
of the nature and role of occupational health services in supporting staff in
the event of disasters needs to be provided more extensively than it is at

With the benefit of hindsight, those organisations that have experienced
disasters and their aftermath are among the most active supporters of this. In
an age when we are witnessing more graphically than ever the devastating
effects of disaster alongside growing appreciation of the rights and
responsibilities of those caught up in them, organisations can no longer afford
only to be wise after the event.

It is not only trains that can go off the rails: planning for and responding
to the health and safety of personnel both before and after disasters must be
an important priority.

Dr Anne Eyre is a specialist in disaster management and Mary Jacob is a
manager directly involved in the Metropolitan Police’s Occupational Health
Service. They share a special interest in learning and applying the lessons to
be learnt from analysing the psychosocial issues arising for staff and
organisations responding to disasters.

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