Psychological Care During Critical Incidents

My boss called. His words were placid but his tone was transmitting turbulent tides. He asked me to go the industrial plant…now. An employee had just died at the hands of another employee.

I walked to the car. I gripped the steering wheel tightly and released. I knew that I needed to be a calming presence at the plant. My emotions said put the pedal to the metal but my training said to drive the speed limit. Driving calmly afforded me the time to review past crises and rely on my training.

In the past, I have witnessed suicide in the office, a dead derelict on the office doorstep, a bomb threat, poisonous chemicals maliciously mailed to the office in which everyone had to be scrubbed by a hazmat unit, and a number of other large-and-small-scale incidents. Each incident stretched me and posed new problems to overcome. This one would be no different.

When I arrived, news reporters were everywhere. Firemen and police were on scene. Hundreds of plant workers were outside. I sought out management, found out what happened, assessed the needs,  determined what groups and individuals were most affected, set a plan, and designated a set of offices as home base. Maria from management stated that plant operations had been shut down. The good news was that the death was accidental. A plant employee did not realize that his co-worker had been in a compactor area, pressed the button, and  crushed his co-worker. The bad news was that about 1,000 employees were affected in addition to the group that discovered the death.

Concerning large groups, Critical Incident Stress Management teaches to draw concentric circles around those most centrally affected. So, I drew an outside circle representing  those outside, and interior circles representing those in the large break area, those in the office area (home base), those still in the plant, and those most centrally affected, I called in an appropriate number of psycho-social agents to cover each of the different areas.  Eventually, we did a debriefing.

Walking past the sounds of whirling machinery and compressed air sounds, Maria took me to a meeting room in which the most affected were. This group had seen their dead co-worker. No one spoke. They slumped in their chair. Their faces were flush. Everyone had a thousand-mile stare. They were in shock. Maria, another colleague of mine, and I triaged the group of nine. Without a word, it was obvious who had pressed the button as he was the only one that was doubled over with his face buried in his hands. After a short diffusing, Maria took four of them, the colleague took four, and I took the man that had pressed the button as he was the most affected

I knelt down, placing my hand on his shoulder, introduced myself, offered assurance, and asked if we could talk in private. He agreed. I practiced SAFER-R:

  • Stabilize the environment
  • Acknowledge event & emotions
  • Facilitate understanding
  • Encouage effective coping
  • Resources
  • Referral

I tried to stabilize his environment. The area was safe. I brought him some water and offered him a candy bar. We sat down in a quiet room in comfortable chairs. I acknowledged what happened and allowed space for him to talk about it. He expressed his emotions of shock, sorry, and fear. I facilitated understanding, normalized his reactions and validated him. I assessed him for suicidal ideation. At the very least, he needed to talk to a professional. I encouraged effective coping. I offered him resources and the means to get to those resources. A police investigator came in and asked  for both of us to meet with him. After some questioning, the investigator believed he was innocent. I gave him a referral and offered to help him get to the referral.  In the days that followed, the employee went into a deep depression, he felt that he had encountered a supernatural being, and he stated that he had tried to kill himself. In the end, all ended well in that the employee decided to check himself into a psychological care facility to receive professional help.

I have successfully used SAFER-R in all sorts of situations: waiting for paramedics after a car wreck, after learning about the death of a loved one, even after a child scraped her knee. It was used at ground zero on 9/11 and is effective as psychological first aid but is not intended to be used as counseling. Courses in SAFER-R are found at https://www.icisf.org.

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