Critical Incident Response as a Risk Management Tool

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Critical Incident Response as a Risk Management
Tool

• Governors Conference on Workers Compensation
  Occupational Safety Health
• June 16, 2005

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Laborers Health Safety Fund of North America

• A joint labor-management fund
• Conducts research, develops policy, provides
  technical support and disseminates information to
  LIUNA members, participating union H W funds
  the unions signatory employers
• Our focus is the following
• Workplace safety health, workers comp. health
  care cost control, injury prevention union
  member access to prescription drugs medical tx
  regulatory implementation compliance
  occupational safety health legislation,
  illnesses that impact laborers and their
  families at higher rates than the general
  population disease prevention, etc.

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Accident Facts and Figures
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• Total Fatalities - 5,575
• Fatal occupational injuries by worker
  characteristics and event or exposure, all United
  States, 2003

Transportation Contact w/ Objects Assaults
Violence Falls Exposure Fires Explosions Other
42.4 16.4 16.2 12.5 8.7 3.6 0.03
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Sex (total 5,575)
5,129
Men
446
Women
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Age
Under 16 years 16 17 years 18 19 years 20
24 years 25 34 years 35 44 years 45 54
years 55 64 years 65 years gt
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Montana Statistics 2001

• 58 work related fatalities in 2001
• Transportation 27 or 46.6
• Violent acts 13 or 22.4
• Contacts w/objects or equipment 10 or 17.2
• Males 88
• Females 12
• Fatalities highest with the 45-54 y/o

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Understanding the Traumatic Impact on the
Organization and the Individual
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1. On the Organization

• Direct Costs
• Medical
• Workers comp. claims
• Indirect Costs
• Increased workers comp claims
• Litigation
• Time lost by employees attending to the accident
• Time and cost for repair and/or replacement of
  equipment and materials
• Lower morale
• Increased absenteeism and presenteeism
• Cost of training a new crew
• Mental health issues
• Cost of tarnished image

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Indirect costs typically run from 7-20 times
greater than direct costs (depending on the
study) . How much would this be for your
organization and/or clients?
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2. Impact On the Individual

• Four basic principals of trauma related stress
• Symptoms of a stress reaction
• Emotional
• Cognitive
• Behavioral
• Physical

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Four Basic Principals of Trauma Related Stress

• Trauma is in the eye of the beholder

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• The traumatic response is a normal response to an
  abnormal event
• 3. Traumatic stress is psychobiological
• 4. What you resist persists

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Emotional

• Anxiety
• Guilt
• Grief
• Severe panic
• Fear
• Uncertainty

• Depression
• Apprehension
• Feeling overwhelmed
• Intense anger
• Irritability
• Agitation

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Cognitive

• Blaming someone
• Confusion
• Poor attention
• Poor decisions
• Heightened or lowered awareness
• Poor concentration

• Memory problems
• Hypervigilence
• Poor problem solving
• Nightmares
• Loss of time, place, or person orientation

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Behavioral

• Change in activity
• Change in speech patterns
• Withdrawal
• Emotional outbursts
• Increase or decrease in appetite
• Startle reflex intensified

• Change in sexual functioning
• Erratic movement
• Anti-social acts
• Suspiciousness/para-noia
• Pacing
• Alcohol and/or drug consumption

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Physical

• Fatigue
• Nausea
• Muscle cramps
• Twitches
• Chest pain
• Difficulty breathing
• Grinding of teeth

• Elevated blood pressure
• Rapid heartbeat
• Thirst
• Headaches
• Visual difficulties
• Profuse sweating

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Risk for Severe Stress Symptoms Based On

• Pre-morbid functioning/disposition
• Perception of social support responsiveness
• Life threatening danger or physical harm
• Exposure to gruesome death, bodily injury
• Extreme environmental/human violence or
  destruction
• Exposure to toxic contamination

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PTSD Criteria

• The person experienced, witnessed or was
  confronted with an event or events that involved
  actual or threatened death, or serious injury,
  or a threat to the physical integrity of self or
  others.

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What is a Critical Incident?
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• A situation that is traumatic for the
  workers/employees involved
• Causes the worker/employee to experience a stress
  reaction
• May be different for each organization

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Possible Critical Incidents

• Industrial accidents
• Plane crashes
• Robberies
• Natural Disasters
• Layoff
• Fires
• Assaults on employees

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Critical Incidents Threaten an Organizations
Core Assets

• Finances
• Reputation
• People
• Morale
• Trust

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What role do your employees play in a critical
incident?
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Laborers serve two roles

• As workers on a job site
• Highway accidents
• Falls
• Machinery related accidents
• Transportation related accidents
• Structural collapses, etc.

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Laborers second role

• As skilled support personnel
• Terrorist attacks
• Fires
• Natural disasters
• Structural collapses
• Toxic gas releases
• explosions

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What is a critical incident for your organization
and/or clients?
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Define Risk Management and What that Means for
Your Company and/or Clients
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The way a company responds to a critical incident
can be looked at as risk management especially
where indirect costs are concerned
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Benefits of a Compassionate Response

• Promotes good will among employees
• May strengthen employee loyalty
• Increase in morale
• Acceleration of return to work
• Subsequent increase in productivity
• Prevent emotional/mental health issues
• Prevent negative coping strategies such as
  drinking and drug use

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Critical Incident Stress Management, CISM

• An intervention specifically for dealing with
  traumatic events
• A formal, highly structured and a professionally
  recognized practice
• Helps those involved in a critical incident to
  share their experiences, vent emotions, learn
  about stress reactions and symptoms
• Confidential, voluntary, educative process
• NOT therapy

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Several Types of CISM

• Crisis management briefing
• Debriefing/CISD
• Defusing
• Grief and loss session

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Crisis Management Briefing

• A large homogeneous group intervention used
  before, during, and after crisis.
• Present facts, facilitate a brief controlled
  discussion, Q A and info. on stress survival
  skills and/or other available support services.
• May be repeated as situation changes.

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Debriefing/CISD

• Proactive intervention involving a group meeting
  or discussion about a particularly distressing
  critical incident.
• Helps employees understand their reactions to an
  incident and offers techniques to mitigate the
  impact and long term effect of the incident.
• Ideal to have it conducted within 2-10 days of
  the incident.

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Defusing

• A shorter, less formal version of a debriefing.
• Best conducted within 1 to 4 hours after a
  critical incident.
• A confidential and voluntary opportunity to learn
  about stress, share reactions to an incident and
  vent emotions.
• The main purpose is to stabilize people affected
  by the incident so that they can return to their
  normal routines without unusual stress.

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Grief Loss Session

• Structured group or individual session following
  a death.
• Assists people in understanding their own grief
  reactions.
• Creates a healthy atmosphere of openness and
  dialogue around the circumstances of death.

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Follow Up Resources to Make Available to Employees

• Mental health benefits
• An employee/member assistance program
• Community services and hotlines
• Mental health resources
• Addiction services
• Ritual and memorials are normal to healing in our
  society

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The worst time to prepare for a crisis is during
one

• Define a critical incident
• Anticipate needs and evaluate resources
• Activation protocols
• Develop appropriate trainings
• I.e. BERA modules

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The Cost of Doing Nothing
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Companies that responded well to crisis
experienced recovery while those companies that
did not respond effectively experienced further
decline. There was a 22 difference in stock
price for the recoverers vs. the
non-recoverers.Study from the Oxford
University and the Sedwick Group analyzing the
impact of catastrophes on shareholder value.
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Depression Costly and Dangerous

• 200 million lost workdays
• Costs the economy 43.7 billion
• 23.8 billion lost to U.S businesses in
  absenteeism and lost productivity
• May flirt w/suicide - unsafe
• Depressed workers may be more prone to accidents
• Lack of concentration
• Fatigue
• Slow reaction time
• Poor memory

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Cost of Turning to Alcohol /or Other Drugs for
Relief

• 76 of illicit drug users are employed
• 81 of binge drinkers are employed
• gt60 know someone who came to work under the
  influence of alcohol or other drugs
• Leads to
• Increased absenteeism
• On-the job accidents
• Errors in judgment
• Legal expenses
• Medical ins. claims
• Decreased productivity

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The Potential Benefits of Looking at CISM as a
Risk Management Tool

• reduced tardiness, sick leave, absenteeism, time
  off
• reduced employee discipline problems
• reduced number of accidents and staff turnover
• reduced workers' compensation costs
• improved customer satisfaction
• increased productivity
• improved employee morale and motivation
• improved image within the community
• long-term cost-effectiveness strategies

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You do the math