The many benefits of trauma risk management in accident investigation
The effect of Post-Traumatic Stress Disorder (PTSD) highlighted a need for Trauma Risk Management (TRiM) (Greenberg et al.) in the military and was initially trialled by the Royal Marines before being adopted by several other agencies. These other agencies diversified the use of this tool away from the military to the Police, Ambulance and even Commonwealth Office fields. In my previous role as a UK Defence Accident Investigator, having had the experience of TRiMs effectiveness in the combat setting, I quickly noted its need in my new role in an accident setting. The major difference in TRiMs approach is that it is not carried out by psychological professionals but by the individual’s peers. Professional psychological support may be required later, but this method allows for a larger assessment of all those potentially affected; with those who require it, passed up the chain of care. The requirement for this TRiM activity should form part of the ‘Psychological’ hazard assessment of any sight which is covered during the ‘hazard awareness’ modules on our accident investigation courses here at Cranfield University.
Having visited several accident sites early on in my previous role, I quickly identified their traumatic potential. This is not only in respect of the physical-biological remains at a crash site; but also, the stress of managing an emotionally charged accident site. TRiM training was readily available to my organisation but had yet to be applied. I took the opportunity to complete the military and civilian qualifications in this field and set about designing a structure within my accident organisation.
Initially, there was little interest in carrying out the TRiM Risk Assessments (RAs) on return from an accident site; this is a legitimate option of the process for the individual. This was overcome by simply asking for the participants to ‘humour’ the process to enable its trialling for someone else that may “really” need it. At this point, the true value of the process was realised. Individuals with no awareness of a need quickly demonstrated a need during these RAs which, although not yet significant, registered on the RA stress scale and demonstrated all was not okay. These interviews often became quite emotional and although [during my time] there was no significant psychological injury; the need appears to have been validated, and a cultural change in the organisation’s approach adopted.
The process is not bounded to your own organisation and during the early stages of investigations those involved can be signposted to their version of the process initially. In the spirit of independence of the investigation we should remain separate to this process. If their process has failed this training allows the investigator to step in and put the welfare of those involved first if required. This early assessment enables a positive effect to be achieved by investigators on day one. The process is also one that can be assessed in the analysis phase, allowing for positive comments or recommendations for improvement to be detailed and evidenced in the final report.
Interviewing skills, Human Factors knowledge and the experience of investigators make them particularly suited to this role within an organisation. It also provides a secondary benefit of allowing the investigators to practice interviewing in a more altruistic context. Another secondary effect is that of creating an early record of the individual’s risk across a complete time period. This data can be released to a psychological professional [with the individual’s agreement] if required later aiding their care; it also demonstrates the organisation has taken a proactive approach to mental health.
TRiM has benefits for all facets of accident investigation and as such should always be incorporated in some form. Many organisations carry this out naturally, without the need for a process. The danger here is that this requirement can too easily be overtaken by events, especially in the high-tempo, high-stress environment of an accident investigation response.