Major disasters are rare, but when an accident occurs within the workplace,
the occupational health adviser may be instrumental in delivering care to those
affected, by Jenny Mason
On 16 July 2002, a helicopter carrying nine offshore oil workers and two pilots
suffered catastrophic mechanical failure and crashed into the North Sea off the
north Norfolk coast, killing all those on board.
The psychological effect on those employed within the industry was immense.
In this region, almost everyone knows of someone who is employed within the
offshore industry. It was immediately recognised that the psychological health
of those involved must be attended to in a sensitive and practical manner to
help prevent any long-term psychological ill health.
The offshore oil and gas industry employs an enormous workforce worldwide.
This is a predominantly male workforce and, in general, employees will work on
two to three-week rotations. These staff spend long periods working and living
with the same crew, and inevitably become close friends.
When a tragedy occurs in such a closeknit community, the personal sense of
loss is profound. There can also be a real sense of fear for personal safety.
In an article in Nursing Times, Hinks explained that loss can take on many
forms: loss of job, self respect, actual loss of a loved one, loss of feelings
of trust and safety and a loss of confidence in one’s own ability.1 If an
accident occurred offshore affecting a driller, those most likely to be
affected would be other drillers, as they can relate to the situation.
In this incident, because it was a helicopter crash that claimed the lives
of all on board and the only method of transportation to and from the rig is by
helicopter, all the employees became aware of their own mortality.
A team of senior management and medical staff were flown out to provide
psychological and practical support. The psychological health of those on the
platform was assessed and evaluated, and arrangements were made to send some of
the employees home.
The safety-critical issues for offshore working had to be considered. The
vast majority of staff were able to provide support for each other and remained
offshore, fully able to continue with their tasks. However, some employees
required a more in-depth form of counselling and were transferred home. An
independent, confidential counselling service was implemented and all employees
were given access to this service.
The support team consisted of a group of representatives from the companies
involved, an OH physician and an OH adviser – me.
The team was at the airport to meet those either returning from or
travelling to offshore installations. The team provided practical and emotional
support and reinforced that the counselling service was available. Assessments
to ensure fitness to return to work were made and also to identify if anyone
was at risk of potentially developing post-traumatic stress disorder.
It is now recognised that both victims and professionals involved in
disasters and other traumatic events may suffer adverse psychological after
effects.2
Post-traumatic stress disorder is a much debated subject and the benefits of
psychological debriefing following a disaster have been extensively
investigated. However, the value of contemporaneous instrumental assistance and
support – those kinds of practical help often learned better from grandmothers
than from graduate training – has increasingly been found to be useful in
disaster response (Gist, 2002).3
In saying this, Gist is suggesting that basic common sense, instinctive
intuition and personal experience are as useful as academic knowledge in
qualifying individuals to help deal with such an event. It has already been
recognised that nurses already hold the key skills in communication, empathy
and understanding, however, it is vitally important that nurses recognise when
more specialist help is required.2
For a nurse, knowing when they feel out of their depth again relies on
personal experience. However, the support provided from the occupational physician
and from the professional specialist counselling service was in place to help
provide direction.
A model outlining the principles of applying ‘psychological first aid’ (see
box, right) is an extremely useful tool. The model was initiated in preparation
for receiving Gulf War casualties in Derby and describes the common reactions
to severe stress, the principles of psychological first aid and provides
details for staff dealing with trauma victims.
There was a great sense of ‘ownership’ from those involved within the
support team towards looking after these employees. The team developed a close
bond with each other and was able to recognise and behave accordingly to the
changing emotional needs of each other as events occurred.
We were allowing the employees to offload their emotions and fears, and most
importantly, be able to demonstrate their sadness. Due to the close proximity
in which these employees work and live, they found they were able to openly
express their emotions. These are hard-working men doing heavy manual work and
many found it difficult to understand how emotional they felt. The opinion that
‘hard men don’t show their feelings’ was often voiced and the response was ‘big
boys do cry’.
It is not easy to see a man crying inconsolably, but was vitally important
to stress that this was a natural part of the grieving process and that they
should be encouraged to show their feelings.
The support team provided debriefing sessions to personnel immediately upon
returning to the airport and updated details of the accident investigation.
Information being released by the media was sometimes conflicting, so before
they returned home, they were given accurate, current information.
In order to ensure that all personnel were seen, a member of the support
team and myself met the helicopter and escorted the men back to the airport
terminal. This was done to introduce the support team but also to make a
preliminary assessment of how the men were behaving. We were looking for anyone
displaying signs of obvious anxiety, anger or those looking extremely
withdrawn.
This assessment was very subjective and much was based upon instinctive
feelings and despite the lack of scientific support, seemed to work very well.
Once the men had attended the debriefing session, they were invited to talk to
anyone within the team if they wished.
Some chose to talk in groups, while others spoke one-on-one, but the
important thing was to allow them to talk if they wanted to. There were a
variety of emotions expressed but, unsurprisingly, the most common emotions
were shock, anger, denial and survivor’s guilt.
These emotions had to be dealt with individually. Some of the men felt
guilt, as they perhaps should have been aboard the aircraft but had changed
their arrangements, or had been on the helicopter earlier on in the day.
Denial was more difficult to deal with initially, as those men were saying
they were fine and totally unaffected by the incident. All that could be done
was to ensure all the men were fully aware of the support system in place and
were regularly reassessed to ensure they were as well as they claimed they
were.
The employees with a military background did seem to deal extremely well
with the tragedy. This may be as a result of military training and a resigned
acceptance that those working in the armed forces will, at certain times,
experience loss of friends and colleagues. Anger is a common emotion following
loss, and this was mainly directed at the helicopter itself rather than the oil
companies or the aircrew. At no time was the competence of the pilots ever
questioned.
Assessing those leaving for the platform took on a different angle. Having
already arrived at the airport to fly offshore, it could be presumed that these
workers had no major problems, but this was not necessarily the case. Many felt
obligated to go as they had a deep sense of commitment to their colleagues;
some were being pressured by family not to go, while others arrived at the
airport absolutely terrified.
In one incident, all the men were on board waiting to fly when a
thunderstorm struck. Only the previous day, it had been announced that the
rotor blade of the helicopter that had crashed had been hit by lightning, and
was partially to blame for the crash. Unsurprisingly, one man panicked and was
unable to fly. However, after reassurance, he flew out the following day.
Most people were very philosophical about the accident, comparing the number
of people that die on the roads to helicopter crashes. Each employee’s first flight
following the accident was a little like falling from a horse – they had to get
back on and they knew the first time would be the worst.
Those already offshore had no choice – a helicopter was their only way back
to the mainland, and like it or not, they had to get on board. For those going
back to the platforms, this created a dilemma as to whether or not they wanted
to go.
Frequent communication between the offshore medic and myself was invaluable.
He was able to advise us if anyone was particularly distressed prior to
returning home and was able to assess the general mood of everyone on the
platform. Most nurses will recognise that when dealing with a critical
incident, an element of closure is required. To obtain this, debriefing
sessions, fact-finding and the sharing of feelings needs to be addressed. It is
only after this that some form of normality can be achieved.
This principle was applied to the support team who, after dealing with the
emotional baggage of the men, were left feeling emotional and physically
drained. It had felt as if the world had stopped turning for those two weeks.
Over time these feelings resolved and with the help of specialist counselling,
individuals were able to discuss how they felt the crisis had affected them personally.
It is unlikely I will ever be required to put into use the skills and
knowledge obtained during this time, and most nurses in a similar situation
will go in with probably about as much experience as I felt that I had.
However, it is essential nurses realise they have many skills to offer that
they simply accept as being part of being a nurse.
Being able to listen, care and do as much as they can for individuals and
referring those that require more specialist care to those that can provide it
are really all the skills required.
Rose et al concluded it should be recognised that nurses already have great
skills in dealing with survivors of traumatic stress and providing needs-led
‘sleeping teams’ of specialist support workers that may be a much more
effective way of dealing with the psychological aftermath of future disasters.2
Jenny Mason is an OH nurse with experience in the construction, offshore
oil and gas industry. She currently works for Bupa Wellness, Health at Work.
References
1. You’ll Never Walk Alone – Hinks M, Nursing Times, 10 April 1991, Vol 87;
No:(15) 34-35
2. Healing the Mind – Rose J, Richards D, Nursing Times, 3 April 1991, Vol.
87; No:(14). 40-42
3. Post-trauma debriefing; the road too frequently travelled – Gist R,
Devilly G, The Lancet, Vol 360: 7 September 2002. 741-742
Common reactions after severe stress
– Severe apprehension and restlessness
– Overwhelming feelings of guilt or despair
– Continuing over-reaction to noise
– Irritability or aggressiveness
– Withdrawal and refusal to communicate
– A dazed, confused state
– Sleep disturbance or nightmares
– Hallucinations
The principles of psychological
first aid
– Reassurance that stress symptoms
are normal, will pass and are not a sign of madness
– Rest and sleep, preferably without medication as far as
possible, although this may be necessary
– Recall of traumatic experiences and personal injury with
other patients or staff – gentle encouragement to talk and sympathetic listening
– Reassurance concerning personal medical condition with, where
possible, information on friends, comrades, relatives (killed, wounded,
survivors)
– Rehabilitation by encouragement in self-care tasks, activity
and mobilisation as soon as possible
Advice for dealing with trauma
victims
– Helping yourself
– Recognise the possibility that you will experience feelings
of a greater intensity than you are used to
– Do not label them as evidence of weakness, but normal
reactions to an abnormal experience
– We have individual differences when responding to abnormal
events. Avoid comparing yourself with others
– When off duty, make special time available to relax, unwind
and do something enjoyable. Try not to become pre-occupied and over-involved
– When possible, share experiences with someone you trust; if
not another member of staff, then one of the support team
– Helping each other
– Develop good team roles and avoid uncertainty and confusion
in roles
– Practice these roles
– Know the system, particularly how it works and who to go to
for advice
– Develop supportive networks among others who are performing
similar duties
– Try to develop good working relationships with your
colleagues and avoid competitive aspects of work
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Further reading
Psychological First Aid Model,
by John Rose and David Richards
Published in Nursing Times, 3 April, Vol:87; No 14. 40-42
