This month’s letters

Body back-up in trauma care

Dr Roman was right in his letter to highlight the need for programmes to
deal with the immediate impact and aftermath of disasters and other traumatic
incidents (OH, July).

An important aspect of the Sainsbury’s programme which was extremely
successful following the Ladbroke Grove train crash was the support provided by
the occupational health nurses and counselling psychologists.

Dr Roman comments on the importance of the level of training and experience
required to undertake psychological debriefing, assessments and trauma
counselling. The problem faced by any organisation is the lack of any real
control of this area of expertise by the relevant professional bodies.

Fortunately this issue is to be addressed by the British Psychological
Society who are about to set up a working party to develop a statement and
guidelines on critical incident debriefing.

The importance of the approach adopted by Sainsbury’s was that having undertaken
the educational presentation and group debriefing, those employees with high
levels of symptoms were continually monitored and provided with trauma
counselling and occupational health support. Debriefing is only effective when
it is part of an overall organisational care programme where the organisation
is committed to restoring employee wellbeing.

The objective of the "Call to crisis" feature was to describe the
framework of the Sainsbury’s trauma care programme. If any readers would like a
more in-depth account of the psychological interventions this has been
published in Security Journal, "Supporting Distressed Employees: How to
Survive the Disaster", Vol 13 (3) pp73-83.

Noreen Tehrani, occupational, health and counselling psychologist

Missed advice on cholesterol

Vicki Madden’s article "In Good Heart" (OH, May) seems to have
missed an important point.

While her discussion of cholesterol levels is well informed, it overlooks a
crucial change in thinking.

With the exception of very high blood pressure, active intervention or
referral should be based on an assessment of coronary heart disease risk using
all relevant risk factors. The Joint British Recommendations (Joint British
Recommendations on Prevention of Coronary Heart Disease in Clinical Practice.
Heart 1998;80 (supplement): S1-S29) answer the uncertainty addressed in this

Screening using the same techniques as your local medical providers enhances
referral confidence and reduces causes of friction. HeartXpress software
calculates coronary heart disease risk, applies current action thresholds,
manages a risk factor reduction tutorial and archives the record for future

Winston Wannop, medical director, Healthcheck Express

Any thoughts on screening

I have just finished my first year at Sheffield University studying for the
BMedSci in specialist community nursing and healthcare practice and am doing a
dissertation for my second year.

The hypothesis is "Can health screening be performed by a technician or
does it have to be a nurse?". My current thoughts are that a technician should
do the screening and the results be analysed by a nurse. Are any readers
currently using a system similar to this?

Kim Scaysbrook RGN, 6 West Lane, Edwinstowe, Mansfield, Notts, NG21 9QT

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