POLICE SAFETY POST-INCIDENT TRAUMATIC REACTION

12 CONSTABULARY • JANUARY 2006

The nature of police workinvolves many complexskills and has potential tocreate significant emotionalstrain for officers and staff

within their daily routine.This frequently includes

exposure to the individual stressand suffering of other people.Many conflicting demands aremade of police personnel, includ-ing physical and social difficultiescaused by shift work and irregu-lar hours.

Periods of relative inactivityat work are often followed bybursts of high and demandingactivity. There is a need to con-stantly adapt to changing situa-tions and a vast array of incidents.

Some roles have their ownparticular pressures, for example,those involving covert operations,

child protection and traffic dutiesdealing routinely with injury,mutilation and death.

However, whilst recognisingthe pressures of specialist roles, itmust equally be recognised that tobe engaged in general police workoften involves great personal riskand pressure. There is significantpotential for officers and front-linestaff to suffer severe emotionalreactions following attendance ata “critical incident”.

Critical incidents have beendescribed as events involvingdeath, serious injury, rape,assault, or personally threateningsituations.

Effective risk management ofthe potential for post-incidenttraumatic reaction has been thesubject of much debate and pub-lished opinion over recent years,with the development of an arrayof procedures and managementstrategies.

A recent research project setout to identify and evaluate trau-ma risk-management strategiesmost commonly used within theUK Police Service.

It is not uncommon for emer-gency-service personnel to expe-

rience a post-traumatic reaction,which could temporarily affecttheir performance at work and/orbehaviour at home, followingattendance at a critical incidentor from cumulative exposure overa period of time to potentially“high risk” work activities.

Take, for example, a seriousroad traffic accident, an all-too-often occurrence these days withmore and more people taking toour already overcrowded roadsystem.

Police are usually the firstemergency service in attendanceand are responsible for securingand investigating the scenewhich, in high-speed accidentswhere there has been a fatality,could include the collection ofbody parts for identification.

In one recent horrific roadaccident involving a motorcycletravelling at very high speed,resulting in a head-on collisionwith a car, an officer talked offinding an eyeball and a brokentooth lodged in the front grill ofthe car that the motorcycle hadcollided with.

Despite being an experiencedtraffic officer with a large number

of years’ service, he still felt trauma-tised by this incident and said it wasthe worst he had ever attended.

Another accident involved aJCB tractor that was being trans-ported at night on a low-loaderwhen the bucket, which had notbeen properly secured for transit,suddenly broke free and swungout across the road into the pathof oncoming traffic.

One unfortunate driver, whohad no opportunity to take evasiveaction, was decapitated. Many ofthe officers who were first to arriveat the scene spoke of the emo-tional disturbance they felt, bothat the time and subsequently.

Following investigation of the scene of such accidents, anofficer may also be nominated as family liaison officer (FLO) and will then take on the task ofinforming relatives of the fatalityof, for example, a young teenageson or daughter.

Once nominated, the dutiesof this particular officer willinclude the provision of help andsupport to assist that family incoping with the grieving processover coming months.

Officers often report becom-ing deeply involved with a familyand find difficulty under theseemotionally-charged circum-stances to detach themselvesand carry on with any degree of normality in their own livesthroughout this process.

Most officers and staff simplycope with the stresses andstrains of their work and thoughthey may experience a traumaticreaction following a critical inci-dent, it will often only result intemporary emotional upset and

disruption from which theyquickly recover.

However, potential has alsobeen recognised for police offi-cers to become re-traumatised,having already dealt with andprocessed their feelings, by having to relive the traumatic circumstances of critical incidentswhen giving evidence during asubsequent coroner’s inquest orcourt hearing.

A small proportion of allthose exposed to trauma (esti-mated at around 10%) may goon to develop longer-term symp-toms such as post-traumaticstress disorder (PTSD). Thiscould include recurrent and intru-sive recollections of the incidentin the form of “flashbacks”, vividdreams and/or hallucinations,mental images, thoughts andperceptions.

The person affected maybecome irritable, experience diffi-culty with concentrating and suffer sleep disruption. Theselonger-term symptoms may per-sist and could become debilitat-ing without the right kind of support and treatment.

The aftermath of major dis-asters – such as the terroristbombing of a Pan Am jet airlinerover Lockerbie in 1988 and the crowd disorder incident atHillsborough football stadium in1989 – has led to increasedawareness amongst police forcesof the possibility of psychiatricdamage to officers, as a conse-quence of some duties, and theimportance of providing appro-priate support mechanisms.

It has been considered that ifappropriate care and assistance

is provided within a reasonabletimeframe following the close of an incident, the potential forlonger-term effects may be miti-gated or even avoided.

Police trauma-risk manage-ment strategies have evolvedover recent years and now usual-ly consist of a combination of thefollowing elements:● Pre-crisis preparation –

awareness training/briefing● Large-scale procedures for

use after major disasters –demobilisation

● Individual acute crisis counselling – welfareofficer/employee assistanceprogramme

● Brief individual/small groupdiscussions soon after theevent that are designed toassist in acute symptomreduction – defusing

● Longer small-group discus-sions, designed to assist inachieving a sense of psycho-logical closure post-incident,usually conducted two to sevendays after the event – criticalincident stress debriefing

● Family crisis interventiontechniques – employee assistance programme

● Follow-up procedures and/orreferral for psychologicalassessment or treatment –employee assistance pro-gramme/occupational healthunit.

Study of police practicesLast year a survey of UK policeforces was undertaken with theaim of identifying the practicesand methodologies currently usedfor trauma-risk management.

A total of 54 questionnaireswere distributed to police forces.The response rate was 40 (74%),which is considered to provide avalid snapshot. The questionsused and responses received areas follows:

What procedures are currentlyused within your force for trauma-risk management and the sup-port of police officers and stafffollowing attendance at criticalincidents?

See Figure 1. Responsesreceived indicated a multi-com-ponent approach similar to thatdescribed above. The most com-mon strategy reported involvedthe use of trained/qualified inter-nal welfare officers for coun-selling (93%) with referrals madeto more in-depth psychologicaltreatment if needed.

Many forces reported variouscombinations of procedures, e.g.critical incident stress debriefing(85%) and defusing (80%).

Police Health and Safety Manager Martyn Grant of Devon and Cornwall, the media officer forAPHSA (Association of Police Health & Safety Advisors), reveals the police management ofpost-incident traumatic reaction and results of a study that identified police force practice

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Post-incident traumatic reaction: officers risk trauma when dealing with

critical incidents – shootings, murders, riots, bombings and fatal RTAs

If you have a procedure, how isit delivered?

Some 65% of forces respondedthat they only used internalresources, five per cent onlyexternal and 30% used a combi-nation of internal and externalresources to deliver the supportservices they described.

How long has the procedurebeen in place?

See Figure 2. The majority offorces surveyed (53%), had sys-tems in place for between oneand five years, a further 30% forup to 10 years, with only 17%for longer than 10 years.

How is the effectiveness of theprocedure monitored?

See Figure 3. The majority offorces (63%) monitor the effec-tiveness of their procedures byconducting follow-up interviewsof potentially traumatised officersand staff at a later stage after thecritical incident.

Very few forces (10%) had a trauma-risk management co-ordinator in place and only sevenper cent carried out any degree offormal auditing of the process.

Which employment groups doyou consider to be at significantrisk of developing a post-trau-matic psychological reaction?

See Figure 4. All forces (100%)

regarded those police officersand staff employed within pae-dophile units, who are expectedto view harrowing and disturb-ing pictures and images as partof their enforcement duties, asthe highest-risk employmentgroup.

This was closely followed bythose deployed on family liaisonofficer (FLO) duties (95%). Thegroup identified by the least

amount of forces as being vulner-able was those employed withincustody centres (48%).

However, the majority offorces stated in the free text boxprovided, they regarded allemployment groups to be at riskand many specifically identifiedgeneral patrol officers due to thefact that they are usually “firstresponders” at scenes of acci-dents and violent crime.

Figure 4 Vulnerable groups

POLICE SAFETY

JANUARY 2006 • CONSTABULARY 13

ConclusionThis survey provides a usefulinsight into the systems and procedures currently adopted bypolice forces throughout the UKfor the management of traumarisk.

It is interesting to note thehigh number of forces who statethey are using critical incidentstress debriefing (CISD) as one ofthe main planks of their manage-ment strategy.

Especially in view of the factthat this strategy has been sub-ject to much recent debate andhas been claimed in some quar-ters to actually hinder recoveryby re-traumatising individualsforced to relive the experienceduring debriefing.

It is also of note that mostforces consider all police officersand front-line staff, regardless of employment group, to be atrisk of developing post-traumareaction from exposure to criticalincidents and/or traumatic circumstances.

This view is also taken in theguidance on Stress at work pub-lished by the Association of ChiefPolice Officers (ACPO) 2001.

RecommendationsThe data revealed by the survey,combined with further researchrecently undertaken – whichincluded a review and examina-tion of current thinking and published literature – has result-ed in the formulation of the following recommendations forconsideration by the Police Ser-vice for inclusion within trauma-risk management strategies: ● Provision should be made

prior to deployment of stressawareness training and anappropriate level of briefing inorder to prepare officers andstaff for the circumstancesthey may encounter and thenatural reactions they could

experience as a result● Contingency planning for

large-scale procedures shouldbe ready for implementationfollowing major events, such as environmental disas-ters or terrorist incidents(demobilisation)

● Brief small-group or one-to-one discussions soon after acritical incident, designed foracute symptom reduction,should be considered beforeofficers finish their shift andgo home (defusing)

● Longer small-group discussionsmay be used to assist in theachievement of a sense ofpsychological closure post-incident, and assessment andfacilitation where necessary ofa referral process for furtherpsychological assistance.Usually carried out betweentwo and seven days after theevent (critical incident stressdebriefing)

● Individual acute crisis coun-selling should be made available from internalresources, force welfare officers or external providers –Employee AssistanceProgramme (EAP).

Other longer-term measuresshould also include family crisisintervention and support tech-niques, follow-up proceduresdesigned to monitor progress andmake referral for further psycho-logical assistance if considerednecessary.

If you have expertise in anypolice area that you feel shouldbe promoted more widely to the Police Service, Home Officeor Crown Prosecution Service,please email editor ChristopherLocke at chrislocke@constabularymagazine.co.uk

Figure 3 Monitoring of effectivenessFigure 2 Years in place Figure 1 Trauma-risk ManagementStrategies used in UK police forces

Force Coordinator

Formal Audit

Follow-up Interview

Other

No. of Responses

Strategy

No.

of

Forc

esEm

ploy

men

t G

roup

Paedophile Unit

FLO

Body Recovery

Firearms

SOCO

Covert Ops

Domestic Violence

Traffic

Control Room

Search Teams

Custody

0

40

35

30

25

20

15

10

5

0WO CISD Defusing Peer Sp EAP

5 10 15 20 25 30 35 40

No. of YearsN

o. o

f R

espo

nses

25

20

15

10

5

01 to 5 5 to 10 10 to 15 15+

Dealing with July bombings: physical injuries heal but what about psychological wounds to officers?