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  • 1. Tab G Chapter 1 MANAGEMENT OF CRITICAL INCIDENTS AND POST-INCIDENT ORGANIZATIONAL RECOVERY By Susan M. Sciara ABSTRACT: Despite all an employer’s efforts, it is still possible that a critical workplace violence incident could occur in a workplace. This chapter discusses what to do when a “critical incident” actually happens. This chapter describes how an employer’s response team (some employers establish a separate Crisis Management Team [CMT], while others incorporate these efforts into a broader Emergency Response Team [ERT]) can respond to a critical incident. It also outlines a number of lessons that have been learned from violent incidents, and identifies steps that organizations can take to achieve long- term organizational recovery from incidents that may occur. In addition, this chapter includes a checklist and several supplements, to provide readers with tools to begin to manage post-crisis recovery, and to evaluate the CMT’s performance. These supplements include an extensive case study describing the response by one organization to a workplace shooting. WVP 10/02 ©STP G-1 1
  • 2. Tab G Chapter 1 Since there is no way to guarantee that your workplace will remain incident-free, it is sensible to consider how you would respond to a critical incident, and the resources you would require to do so. This chapter therefore discusses the following: • incident planning process (this chapter summarizes the discussion presented in Tab C Chapter 7, Section A).1 • responsibilities of each response team member during a critical incident (Section B) • issues to consider during post-incident recovery (Section C) • issues to consider after recovery (Section D) In reviewing this chapter, keep mind the sometimes-confusing differences in terminology used by various groups of emergency planners and responders. This chapter focuses on terminology that has been developed specifically for use by Crisis Management Teams (CMT) who implement Crisis Management Plans (CMPs). However, it also provides the parallel terminology used by Emergency Response Teams (ERTs; they implement Emergency Response Plans and Integrated Contingency Plans [ICPs], usually using the Incident Command System [ICS] originally developed by fire and police responders). Tab C Chapter 7 focuses on ERT/ICP/ICS terminology while providing the CMP/CMT terminology. You will need to determine the terminology used by responders within your own organization.2 The chapter also provides a checklist and several useful supplements, including a case study of one workplace shooting response. A. Planning for a Critical Incident Long before a critical incident happens, you should have a plan in place for dealing with it. Tab C Chapter 7 provides guidance on planning and preparation for possible workplace violence, as part of broader efforts to plan responses to a range of possible incidents and emergencies. The main elements of critical incident planning are as follows: • Prepare a Crisis Management Plan (CMP)3 that does the following: identifies the range of possible events being considered, defines the membership and duties of people involved in critical incident response, including a CMT, and identifies the training and resources necessary for successful responses. 1 Readers may also wish to review the critical incident plan for K-12 schools, developed by the state of California, which is presented in I-3 Supplement 2. That plan contains many elements common to all workplaces. 2 Once you determine the terminology used in your organization you may wish to mark up this chapter to highlight the appropriate one or mark out the other. 3 Section A of Tab C Chapter 7 provides a longer discussion of basic emergency/incident planning activities. See also I-3 Supplement 2. G-1 2 WVP 10/02 ©STP
  • 3. Management of Critical Incidents The CMP should be integrated with other emergency planning efforts at the facility. For instance, Tab C Chapter 7 discusses the system of using Integrated Contingency Plans (ICPs) and how to adapt that wider system to your workplace violence prevention needs. • Establish a Crisis Management Team (CMT)1 for response to workplace violence events. The CMT may include members from the employer’s general emergency response team (see Tab C Chapter 7, especially Section A.2), and/or members of the employer’s Threat Assessment Team (TAT; see Tab B Chapter 4, and Tab E Chapter 3) as appropriate. The following lists identifies a number of typical activities that occur during crisis responses, and introduces CMT members (by defined “roles”) who typically will be involved in each:  CMT and incident response management Incident Reporter2 Incident Onsite Manager Crisis Manager  Specialized support functions during the incident response Medical Coordinator Operations Coordinator Administrative Coordinator Security Coordinator  Supporting transition from incident to recovery Communications Coordinator3 Facility Restoration Coordinator Employee Support Coordinator Once the CMT is in place and each of these roles assigned, the employer should ensure the following: • periodic reviews of workplace conditions to determine whether the CMP remains appropriate, • refresher training for CMT members to maintain their preparedness,4 and • inventories of supplies to ensure that they remain available and useable.5 1 To simplify the discussion, this chapter will refer to the response team as the Crisis Management Team, but keep in mind that many emergency responders use the terms “Emergency Response Team” and “Incident Command System” to describe the functions discussed here. 2 ERTs use the term “Notification and Report Coordinator.” 3 ERT’s also use this term, and also identify a separate Media Liaison. The same person may fill both roles. 4 See Tab C Chapter 2 for a general discussion of training. 5 A sample emergency supply inventory is provided in C-7 Supplement 3. WVP 10/02 ©STP G-1 3
  • 4. Tab G Chapter 1 B. Responding to a Critical Incident This section provides guidelines for CMT activities during a critical incident involving workplace violence. Evaluate each suggestion for its utility. How useful a suggestion will be will depend on your situation and the nature and extent of each incident. The suggestions are not necessarily presented in the order in which they would be performed, since many activities will be happening simultaneously. Each CMT member has specific responsibilities designed to take care of people and property (in that order), and to help the organization recover to a normal state of functioning. These are described in Section B.4 below.1 1. Identifying a Critical Incident Most critical incidents occur very quickly, so the ”incident” itself is over before the organization hears about it in any formal way.2 For example, the shootings described in G-1 Supplement 1 lasted just seven minutes. As such, “critical incident response” often has a different meaning than other “incident response” activities that the organization may undertakefor example, the team responding to a fire or chemical spill encounters the incident still underway, so their response includes efforts to end and mitigate the incident. When a critical incident occurs, there will be some (hopefully brief) time period during which witnesses or first responders identify that the issue has occurred, and contact resources outside the immediate areawho might include Security, facility management, a designated CMT contact, and/or the police. By the time these contacts are made, the actual incident may be over, or it may have settled into some ongoing situation (such as a hostage taking). This period is likely to be the most chaotic and difficult to predict. This discussion focuses on quick incidents where the CMT arrives after the initial event is over although the organization may take time to ensure that the perpetrator has left, been disarmed or died, and that no extended hostage situation is developing. 1 Response team roles are also described in Tab C Chapter 7, Section A.2. 2 Incident reporting for the full range of non-critical and critical incidents is described in more detail in Tab E Chapter 1. G-1 4 WVP 10/02 ©STP
  • 5. Management of Critical Incidents 2. Activating the CMT As soon as the organization learns that an incident has occurred (or is underway), the Crisis Manager1 will activate the CMT. Depending how an organization’s internal and external reporting systems are set up, this should happen immediately after the police are contacted.2 The Crisis Manager also will decide, based on the location and situation, where to locate the Command Center.3 If emergency supplies are not already located in the Command Center, the Crisis Manager will need to make arrangements for necessary supplies and equipment to be delivered to that location. The Crisis Manager will also decide whether to have members of the CMT report to the Command Center or go directly to the scenedepending upon the situation, the Crisis Manager may decide to locate the Command Center at the scene of the incident. 3. Managing incident response Each critical incident develops differently, depending on the nature of the situation, the physical layout of the facility, numbers and locations of employees, other people onsite, and so on. However, there are some likely stages to consider. One typical sequence would be: • Critical incident commences (it may be over in a very short time, or may continue with hostage taking, search and rescue, medical responses, and so on). • Organization is informed of the incident (call to employer’s security system, law enforcement arrive in response to 911 call). • Organization initiates crisis management (including reporting to law enforcement unless this is confirmed to have happened). • CMT members mobilize and CMT begins to operate (in response to Crisis Manager if she or he is contacted first, or in response to general page from Security, or through some other notification process). • CMT conducts its incident response, as appropriate to the situation. • CMT begins transition to post-incident recovery. • Organization proceeds with post-incident recovery (and evaluation of CMT and incident response). 1 This person may also be called the Incident Commander, and in some cases this role may overlap with that of the Incident Onsite Manager (see below). Some Crisis Management Plans differentiate between an Incident Onsite Manager who focuses on dealing with the facility and people where the event has occurred, and a Crisis Manager who deals with the overall crisis and leads the crisis team. 2 See Tab C Chapter 6, and Tab E Chapter 1 for incident reporting system design and use. 3 These are also known as Emergency Operations Centers. See Tab C Chapter 7, especially Section A.2.a. WVP 10/02 ©STP G-1 5
  • 6. Tab G Chapter 1 4. CMT members’ responsibilities Once your CMT swings into action, each member should be able to pick up his or her assigned part of the responders’ burden.1 Sometimes roles and responsibilities overlap. It is vital that each member of the CMT coordinates with other members, and reports all events and actions as soon as possible to the Command Center so that developments can be tracked and documented. a. Managing the CMT and incident response Several CMT roles are designed to ensure that the CMT itself functions as planned, and that resources are made available to manage the organization’s side of incident response. • Incident Reporter2 When news of the incident first breaks, the Incident Reporter (who may be the highest ranking manager on site at the time of the incident or someone he or she has assigned this task) should immediately assume responsibility for calling for emergency help, offering any assistance the emergency personnel require, and beginning to account for all employees. Specifically, this person is responsible to ensure that the following are done: call 911 (unless it can be confirmed that this has already happened); alert other employees at the facility; direct employees to an alternate assembly area [FN: It is helpful prior to any incident to arrange with neighboring businesses to house employees during an emergency, and to instruct employees to report to this site in an emergency situation. This allows for better accounting of employees.]; ensure access to the facility for medical personnel. This can include directions to employees to watch for the ambulance, hold open doors, and direct medical personnel to the injured; secure the crime scene until the police arrive; account for all people (employees, and others such as customers, vendors, and visitors) who were onsite when the incident began. [FN: This may not be practical unless the workplace has some procedure that accounts for people coming onsite, such as a sign-in process or electronically monitored badges.] The facility will need to be searched thoroughly for people who may be hiding in closets and under desks; protect business information and valuable items (such as cash or laptop computers) that could be taken in the confusion associated with an incident; identify the most visibly affected employees in order to begin to target crisis- counseling services (see Section C below); document events as they occur (until this task is handed to the Administrative Coordinator or other member of the CMT); and brief the Incident Onsite Manager. 1 See also Tab C Chapter 7 section A.2 for a discussion of these roles. 2 In response organizations using the ICS, this role is filled by the Notification and Report Coordinator. G-1 6 WVP 10/02 ©STP
  • 7. Management of Critical Incidents • Incident Onsite Manager If the Incident Reporter is not the highest-ranking official onsite, then the person who has overall day-to-day responsibility for managing the facility often becomes the Incident Onsite Manager and starts the process. More usually, however, this role focuses on managing those aspects of the incident that directly affect day-to-day functions and that still need to happen in order to help the organization begin to get back to normal. The On-Site Manager works in conjunction with the CMT. Despite the confusion of the incident scene, the continued safety of the work site must be ensured. The Incident Onsite Manager must determine whether the site needs to be closed down completely or partially, and if so, must ensure that this is accomplished smoothly and safely. For instance, if the facility has heavy machinery or utilities running that cannot safely be left unattended, the Incident Onsite Manager would be responsible for ensuring they are shut down.1 Or if it is a retail site, employees would not be in any position to wait on customers and the facility would need to be closed to the public. The Incident Onsite Manager will also have to determine whether and/or when employees will be able to resume working at the site, and whether supplementary personnel will be required. Since this person has worked closely with the employees in this facility, his or her responsibilities will also include providing information on affected employees and their families to relevant members of the CMT. Specifically, this person is responsible2 to: contact the Crisis Manager; coordinate with appropriate CMT members to ensure continued safe operations; confer with the Incident Reporter and senior management officials; determine whether to close the facility, do so when appropriate, and determine the duration of closure; determine whether to request outside staff (employees from other sites, or perhaps temporary employees or contractors) to temporarily carry out the duties of employees who have been injured or traumatized, and make the request when appropriate; coordinate with the Communications Coordinator to provide accurate information and dispel rumors about the incident to employees; coordinate with Human Resources to provide appropriate leave for employees, including those who are injured or traumatized; provide information to the Administrative Coordinator to send flowers and/or donations to families of the injured or deceased; provide transportation to employees for funerals, wakes, or other memorial services for any employees who were killed; provide information to the Crisis Manager regarding the families of traumatized, injured or deceased employees so that visits can be arranged; schedule with the Employee Support Coordinator for crisis counseling sessions, employee tributes to affected co-workers, and memorial services; and hold meetings with employees to provide them with factual information as they return to the worksite. 1 Some ERTs/CMTs identify a separate Shutdown Coordinator role to ensure safe shutdown of equipment and utilities as appropriate. 2 Tab G Chapter 2 also discusses many of these post-incident service functions. WVP 10/02 ©STP G-1 7
  • 8. Tab G Chapter 1 • Crisis Manager The Crisis Manager (or Emergency Management Director) will be at the eye of the storm. This person has a central coordinating role to play and will be the person to whom all other CMT members turn for crucial decisions that require resources beyond the call of the Incident Onsite Manager. But this person must simultaneously remain focused on the big picture. It is sensible, therefore, for the Crisis Manager to be a person with authority in the company. The Crisis Manager calls the CMT into action, and sets up the command center. In addition, the Crisis Manager is responsible for the following: gather information from the Incident Reporter and/or the Incident Onsite Manager; coordinate all activities with the Security Coordinator; activate the CMT and deploy as necessary the: - Employee Support Coordinator, - Medical Coordinator, - Communications Coordinator, - Facility Restoration Coordinator, - Administrative Coordinator, Operations Coordinator; activate Human Resources functions; activate the Command Center; document crisis activities, until this function is transferred to the Administrative Coordinator1 ensure that internal and external notifications are completed through the Communications Coordinator; meet with individual CMT members and/or hold CMT meetings as needed to monitor and evaluate the situation; track, assess, and adjust resources to meet situational needs; review and analyze the crisis response process; determine whether external support is needed; and review the situation with senior management so they are up to speed on the developments. 1 It is helpful to document the activities on a flip chart in the Command Center so that everyone can easily see what has happened and who has done what. G-1 8 WVP 10/02 ©STP
  • 9. Management of Critical Incidents b. Supporting roles Several CMT roles involve specialized support to CMT management (or the Emergency Management Group, as it may be called in your organization), employees, and outside responders during an ongoing incident or immediately after an incident. • Medical Coordinator1 The Medical Coordinator role includes not only the provision of necessary medical services, but also considerable liaison with outside medical providers, CMT members, and employee support services. Specific responsibilities include the following: confer with the Crisis Manager; work with the Security Coordinator as necessary; identify and assess medical needs; oversee the coordination of emergency medical treatment and follow-up; coordinate with the Medical Examiner or Coroner if fatalities have occurred; provide ongoing medical reports to the members of the CMT; coordinate with other CMT members for any fatality notifications; and work with the Employee Support Coordinator. • Operations Coordinator The Operations Coordinator position is created to assist the Incident Onsite Manager with some of the operational tasks that can become too overwhelming for one person who is also managing a critical incident. It may or may not be appropriate in all organizations; for example, it is useful in complex manufacturing and industrial settings. If this role comes into play during an incident, then this person typically becomes responsible for the following: confer with the Crisis Manager; identify and assess operational needs in conjunction with the Incident Onsite Manager; establish an alternate operational site, if needed; deploy employees to the alternate site; act as a liaison for operational issues between the affected site and the rest of the organization; and assist in the return to normal operations. 1 Some ERTs split these functions between a Medical/Health Coordinator and a Safety (or Environmental, Health and Safety) Coordinator. WVP 10/02 ©STP G-1 9
  • 10. Tab G Chapter 1 • Administrative Coordinator Managing the smooth operation of the CMT is a demanding job and must be tackled with energy by the Administrative Coordinator. In addition to equipping the Command Center (see C-7 Supplement 3 for a suggested list of supplies and equipment), the Administrative Coordinator tracks and documents the actions of each CMT member, prepares progress reports, and ensures that each CMT member is kept up to date on developments. Particular responsibilities include: confer with the Crisis Manager; document the crisis and responses from inception to conclusion; provide emergency communication equipment (from inventory), and any other specialized equipment that may be needed to respond to a particular event; ensure all supply and equipment needs for the Command Center (from inventory and any other specialized equipment that may be needed to respond to a particular event); coordinate food services for the Command Center and other staffed areas; evaluate the need for additional administrative assistance; and distribute reports and updates to appropriate personnel. This person may also be assigned before or between events, to compile and maintain a Command Center staffing roster and schedule of activities, acquire and maintain emergency supplies, and perform other similar administrative oversight functions. Other organizations separate these functions out and assign them to other personnel. • Security Coordinator The Security Coordinator is responsible for ensuring that the security issues surrounding the incident response are handled smoothly. This includes the following: protect the crime scene and any evidence; gather witnesses so that law enforcement personnel can interview them; provide liaison with the employer’s security forces, and with law enforcement personnel; and provide information regarding the crime investigation to the Crisis Manager. G-1 10 WVP 10/02 ©STP
  • 11. Management of Critical Incidents c. Transitioning to post-incident recovery Several CMT roles are most concerned with post-incident recovery, although these members should be active during an incident to assist other members and to begin to characterize the situation and plan for recovery. • Communications Coordinator Serious incidents swiftly become a media event, and the task of the Communications Coordinator is to control the flow of information so that the event does not become a circus. This person must ensure that employees are kept informed and reassured, and that the media is fed timely, accurate, and appropriate information. Responsibilities include the following: Coordinate with CMT and management confer with the Crisis Manager; confer with the Security Manager; and identify and assess communication needs. Organize and coordinate internal communications prepare an initial incident message for employees, the media, and corporate headquarters; provide the Administrative Coordinator, Crisis Manager and Incident Onsite Manager with activity updates and copies of all internal and external communication; work with the Employee Support Coordinator to ensure that rumors are dispelled with accurate and timely information; prepare management to address the employees; establish a link with corporate headquarters, organizational and union leadership; and activate emergency communication procedures such as setting up an informational telephone line that employees can call to get updated information, and contacting radio and television stations to get information to employees. Manage communications with outside media receive media inquiries; organize first media briefing, including determining who will act as spokesperson for the organization, which company officials will be present, and so on; prepare press releases, media advisories, newsbreaks, and statements; and monitor and record external media coverage WVP 10/02 ©STP G-1 11
  • 12. Tab G Chapter 1 • Facility Restoration Coordinator As the crisis unfolds, the Facility Restoration Coordinator is responsible for looking to the future. What must be done to return the worksite to usable condition? Who will do it and what information will they need in order to do the job? And in the meantime, what alternative facilities can be pressed into service? The Facility Restoration Coordinator is responsible for the following: confer with the Crisis Manager; identify and assess facility and environmental needs; coordinate repairs and alterations; coordinate biological cleanup; secure alternate facilities if needed; secure temporary shelter and lavatory facilities, if needed; gather and retain custody of relevant facility blueprints in case they are needed to begin repairs promptly, or by the police in a hostage situation; and contact water, gas, and electricity suppliers as necessary. • Employee Support Coordinator At the heart of the incident are all those who have been harmed by or witnessed it. The effects can be damaging, both for the individuals concerned and for the company. The immediate task of the Employee Support Coordinator is to address and mitigate the impact on people, which makes this person responsible for the following: confer with the Crisis Manager; confer with the Security Manager; work with the Medical Coordinator; assess and coordinate the overall psychological and trauma recovery needs and activities; work with the Communications Coordinator; activate Employee Assistance Program (EAP) services;1 determine the need for additional Critical Incident Stress Management and/or other post-event counseling and humanitarian services (see Tab G Chapter 2); identify and oversee family support services for affected employees; identify the need for services for non-employees; and secure sites for recovery services. 1 EAPs are described in Tab C Chapter 5. G-1 12 WVP 10/02 ©STP
  • 13. Management of Critical Incidents C. Post-Incident Recovery The steps to post-incident recovery involve a series of decisions that must be made quickly, usually by the Crisis Manager after consultation with CMT members and with the approval of senior management. Post-incident recovery often requires a delicate balance between doing what is right and proper for the organization’s employees and getting on with business. The following offers guidance so that organizations are able to do just that.1 These decisions may vary in sequence, but generally include the following: 1. Decide how to manage the scene of the incident Since the location where the critical incident occurred will be considered a crime scene, there may be some considerable lag before the site is unconditionally released to your organization to conduct cleanup and restoration. To the extent possible, you should shield employees from the sight of the incident until cleanup is complete, in order to prevent secondary trauma. Although some employees will be drawn to the scene in order to check it out, you should always limit access to those you (or the police) need to have there. Your organization should hire a contractor to handle biological cleanup. Some companies specialize in this type of service. Even if your maintenance crew is trained in such cleanup (including protection against possible bloodborne pathogens), you put them at risk of trauma if they are cleaning up after co-workers. This could expand the damage to your organization from the incident, and initiate further workers’ compensation issues. 2. Decide how to communicate a. With employees and their families One of the best ways to reduce employees’ anxiety and control rumors is by providing accurate timely information. You may want to set up additional phone lines, since once the event hits the media, your existing phone system may be overwhelmed by incoming calls from families checking on loved ones, and media personnel requesting information. Setting up one number that employees and families can call to get updated information can be helpful. Channeling such calls to someone who has been carefully briefed on how to respond will enable you to deploy other personnel to other tasks. The number(s) can be publicized through the media and internal communications. Employees who are answering the phones need to be prepped and given a script describing how to respond to family members. Callers who are too distraught to be calmed can be transferred to an EAP counselor. 1 The discussion in this section is based on the author’s experience, gained while working for the U.S. Postal Service (USPS). USPS is an organization that has weathered many crises, from workplace shootings to anthrax to pipe bombs, and has learned a number of valuable lessons that may be helpful to other organizations. WVP 10/02 ©STP G-1 13
  • 14. Tab G Chapter 1 b. With the media You may wish to use the special information telephone line mentioned above to give updated information to the media or you may prefer to establish a separate media line. Alternatively, you may wish to have all calls from the media transferred to the Communications Coordinator’s office. Timing and presentation are important when releasing information to the media. If it is given too quickly before all the facts are in, the information could be inaccurate, which will reduce the organization’s credibility. Waiting too long can result in the media finding other ways to get the information, so you may appear evasive and/or disorganized, and the information might come from sources that will paint the organization unfavorably. Be prepared for aggressive attempts by the media to get information, including listening to phone calls, entering your facility through back doors, monitoring police calls, monitoring calls on cell phones or other communication devices, and so on. This can be especially pronounced if they think they aren’t getting enough information from the organization. You may want to think of ways to shelter employees from the media. You might allow them to come and go through alternative entrances and exits, walk them to their cars, work with the local police to help keep reporters off employees’ property, suggest employees notify their children’s schools, and so on. 3. Decide how to handle employees’ post-incident emotional and psychological needs Most experts recommend strongly that employers take a significant, active role to assist their employees. This demonstrates organizational commitment and speeds individual and organizational healing. Your organization will have to decide how to determine who needs what assistance, the kind of assistance to offer, and what steps your organization will undertake to provide that assistance. This section summarizes a number of practical issues involved in these determinations. Tab G Chapter 2 provides additional details. a. Decide whether to shut down more or all of the affected facility Some incidents affect only small portions of an employer’s facility, so it may be physically possible to continue work in other parts of the facility. However, immediately after an incident your organization should carefully consider whether to shut down more (i.e., beyond the immediate crime scene) or all of the affected facility. Do all of the employees need to be sent home or could some that were not directly involved continue to work? G-1 14 WVP 10/02 ©STP
  • 15. Management of Critical Incidents On one hand, sending employees home with pay acknowledges the seriousness of the event and sends the message that the employer cares about the employees. On the other hand, keeping some of the less affected units open may send the message that the organization will overcome this and that everyone is not automatically traumatized. You will have to decide which approach works best for your organization. b. Decide which post-incident services to provide Your organization will have to decide which emotional and psychological services to provide. This can involve difficult and controversial decisions. Currently, most Employee Assistance Programs and providers of Critical Incident Services use a Critical Incident Stress Debriefing (CISD) model as the major component of a broader approach called Critical Incident Stress Management (CISM). These approaches were developed by Jeffrey Mitchell in the late 1970s as a way to help first-line responders such as police and firefighters manage the stress of responding to catastrophic events. CISD, as developed by Mitchell1 consists of “a 7-phase structured group discussion, usually provided 1 to 10 days post crisis, and [is] designed to mitigate acute symptoms, assess the need for follow-up, and if possible provide a sense of post-crisis closure.” Participants are educated about the kinds of psychological and physical symptoms they may experience or have been experiencing and are told this is a normal reaction. Gradually this model began to be used in a variety of other settings so that now it has become the standard of care in community disasters. However, emerging research suggests that the standard form of debriefings may not always create the intended result.2 In fact, there are indications that debriefings may make some individuals worse. Since the focus of the traditional debriefing model is on psychological and physical symptoms, some participants may end up worse by focusing on these symptoms. Some debriefers act as though it is a foregone conclusion that everyone will experience psychological or physical symptoms when this is simply not the case. This kind of thinking can create the very symptoms that CISD is supposed to help avoid. Others have argued that some participants may be overwhelmed by the emotionalism of the sessions. With the number of organizations that offered debriefings after 9-11, this issue continues to be controversial. It is helpful for the CMT to discuss this issue before a crisis with the service provider that you have chosen so you’ve an understanding of the advantages and disadvantages of various types of psychological relief that can be offered to your employees. It is also helpful to find out before the fact, what kind of training and experience the provider has. Trauma counseling is a specialty in which not all mental health providers are experienced. 1 Information about CISD/CISM is hosted by the International Critical Incident Stress Foundation (ICISF), which can be reached at (410) 750-9600, or via the Internet at www.icisf.org. ICISF and others, including Dr. Gerald W. Lewis, offer training to professionals on how to use this model with violence in organizations. Dr. Lewis can be reached at www.geraldlewis.com. 2 See Tab G Chapter 2 for an in-depth discussion of CISD/CISM within the broader context of Critical Incident Services, including a discussion of some professionals’ misgivings about applying them without individualized consideration of the people affected by a particular incident. WVP 10/02 ©STP G-1 15
  • 16. Tab G Chapter 1 Fundamentally, it is important to remember that no single type of intervention can provide for everyone’s needs. Many employees who need services will not seek them out but will respond to outreach efforts. Psychological recovery services need to be customized for the individual employee. For example, employees who were directly involved as victims of violence (were held hostage or were witnesses) are most likely to need the most intensive level of support and follow-up services. Employees who were onsite at the time of the incident but did not witness the incident may need more services than those individuals who heard about it but were not present. It makes sense to concentrate your resources on those employees who are most likely to be the most profoundly affected. G-1 Supplements 2 (Critical Incident Information Form) and 3 (Feedback Form) provide useful examples of non-threatening forms that can be used to start collecting information about employees’ needs. Whatever forms of psychological recovery assistance your organization decides to offer, remember that it needs to be done in a way that does not create the very symptoms that you are trying to avoid. For example, managers telling everyone that they are traumatized can create symptoms in those who might not otherwise experience them. It is more helpful for managers and supervisors to tell employees that some people experience symptoms as a result of a critical incident and some do not.1 Either reaction is “normal.” Tell the employee who happens to experience symptoms that the symptoms are likely to pass with time and that there are simple self-help techniques that the employee can use to help the process. Crisis counselors can help them with this. Explain that a few people experience symptoms that linger and then they will need more extensive, professional treatment. Emphasize that the expectation is that employees will be fine in the long run and that the organization will provide services to help them get through some of the more difficult times in the days following the event. c. Decide who should provide the services Many organizations have EAPs to help with a range of fairly routine issues; these might include activities supporting workplace violence prevention programs.2 If your organization has an EAP it is tempting to tap these resources after a critical event. On the plus side for EAPs, the provider is usually readily available, already knows your organization and its culture, and is familiar with the mental health needs of your employees. On the other hand, using your EAP for crisis services can have a negative side. The EAP provider may not be able to respond to the magnitude of your crisis, and may find its resources so depleted by the task that serving your organization’s long-term needs becomes difficult. 1 Posttraumatic stress and other reactions are discussed in Tab G Chapter 2, and in Tab J Chapter 3. 2 EAPs are discussed in Tab C Chapter 5. G-1 16 WVP 10/02 ©STP
  • 17. Management of Critical Incidents In my experience, these potential problems are most likely to appear if the EAP is asked to provide CISD/CISM services. Many EAP providers are inexperienced and poorly trained in CISM. Another drawback is that the role of the EAP is very different than the role of the CISM team and if there is one vendor providing both, the boundaries can get very blurry. For example, CISM team members often call employees to see how they are doing and offer them services. EAP providers do not typically cold-call employees to offer their services. It is easy for both employees and managers to get confused if they see EAP personnel performing tasks that they later say they cannot do as part of the EAP. Confidentiality may be different in a CISM group than it would be in an EAP session. Fitness for duty and workers’ compensation issues can also complicate matters. My preference, based on my experience, is to use an external vendor who specializes in post-incident services to assist the immediate crisis management and work along with the EAP, and to limit the EAP to more typical EAP services. That way you have the expertise where you need it (the post-crisis team has the expertise in crisis recovery and the EAP has the expertise in the follow-up assessment and/or treatment of on-going mental health and family needs), there is coordination between the two entities, and you don’t have the fuzzy boundaries. d. Decide where to conduct post-crisis services Deciding where to conduct post-crisis services can be an important decision. There are advantages and disadvantages to conducting them at the place where the incident occurred. Since employees may be frightened to return to the scene of the event, conducting these services on-site shows that it is safe to return and may help employees return to work more quickly. On the other hand, if you are offering post-crisis services to family members or non-employees you may get higher attendance if they are conducted off site. Of course, space considerations may make this a moot point. e. Determine who will receive services It will be important after an incident to decide who needs post-incident services, and whether and how to provide them. Although it is most obvious that employees caught up in the incident are likely to need assistance, you should consider the following employees as well: • employees who often work with the victim(s); • employees who often work with people in the affected area; • CMT members; • debriefers. These people will need debriefing themselves. This is especially important if these services were provided by an internal EAP, whose staffers aren’t used to these situations; • senior management at the site. Supervisors and higher-level managers are often overwhelmed by a sense of guilt and responsibility for what happened. Talking about their experiences in a debriefing session or alone with a crisis counselor can relieve some of this so that they are able to make sound business decisions as the organizational recovery process continues. It also sets a good example for other employees who are more likely to accept services if their bosses are also receiving the services of the crisis counselors; and • the perpetrator and family if this person is an employee. This is likely to be an emotional issue where a great deal of anger is directed at this person. However, the perpetrator and/or his or her family may be entitled to receive certain benefits. WVP 10/02 ©STP G-1 17
  • 18. Tab G Chapter 1 Identify whether employees from other areas of the affected facility, and even other facilities, may need psychological assistance. If, for example, there is a shooting by a former employee in one branch of a bank, the employees in the main office and other branches will need some help in dealing with the situation and being assured that they are safe. As mentioned above, G-1 Supplements 2 (Critical Incident Information Form) and 3 (Feedback Form) provide useful examples of non-threatening forms that can be used to start collecting information about employees’ needs. As you decide who needs assistance, you will also have to decide whether to require employees to use some or all of the offered servicesespecially debriefings or other group/interactive services. Experts disagree on this point. Some believe that unless you mandate attendance at debriefing sessions the people who need them the most will often not attend. They recommend that you tell employees that they must attend but it is their choice whether or not to talk. The experts in this camp say that once people get in the debriefings and hear what others are saying they decide to share their experiences. On the other hand, other experts disagree and believe that debriefings should be voluntary. They believe that an employee who has witnessed a critical incident is likely to feel out of control and anything that can be done, such as having a choice to attend or not, helps increase the feelings of being back in control and are helpful in the recovery process. Another consideration is if, as some research suggests, some people get worse as a result of debriefing, what are the implications for the organization if it mandates attendance? f. Additional considerations Do not allow employees to vent during the meeting with management. Emotions will be running high and can be contagious. Often anger that is merely vented will only result in more anger. Managers can easily end up re-traumatized from the emotional beating they get from angry employees. Emotionally fragile employees may access feelings that are difficult to manage. Most managers are ill equipped to help them deal with these adequately. Instead, script the meeting so that it is focused on factual information and addresses informational questions from the employees. See G-1 Supplement 5 for the highlights of a management-led de-escalation meeting. Encourage employees to express their feelings during the debriefing sessions where they are in a small group setting with professional debriefers. Allow employees to express their concerns to management through a feedback system. This can be done through your Critical Incident Response Team. See G-1 Supplement 3 for an example of a suggestion form. G-1 18 WVP 10/02 ©STP
  • 19. Management of Critical Incidents Some other considerations are: • What kinds of dedications, memorial services or tributes will help the organization recover? • Should the event be recognized on anniversaries? • If there were deaths, how much leave should be provided and to whom do you provide it? Many employees may want to attend the wake(s), memorial services, and funeral(s). These issues are also discussed in Tab G Chapter 2. D. Issues to Consider After Post-incident Recovery As the organization recovers, it should continue to take steps to strengthen its recovery, and also to evaluate its functioning during and after the critical incident period. 1. Evaluate the CMT’s performance After every crisis, it is critical that the CMT and management evaluate their performance in a way that is conducive to learning and becoming better able to manage the next one. No matter how much practice the CMT has had, each situation is different and team members will encounter twists and turns they had not expected. It is helpful to develop a timeline of events starting with the incident so that everyone can see what happened. Many times, information that was not widely known will come out during the post-crisis meeting. See G-1 Supplement 6 for a sample post-crisis evaluation checklist. 2. Managing ongoing organizational recovery Research from large-scale disasters suggests that a community progresses through four general stages of recovery: • numb dedication, • anger-betrayal, • stoic resolve, and • integration. WVP 10/02 ©STP G-1 19
  • 20. Tab G Chapter 1 It is likely that a work community will move through these stages as well.1 Numb dedication, which is typically seen at the beginning of the recovery from the crisis, involves going about tasks without thinking of the scale, magnitude, or horror that ensued. As the organization moves into a period of anger, the steps that the organization’s leaders take can determine if the anger is channeled in constructive ways or is allowed to become destructive. As the organization continues in its recovery efforts, it moves into one of resolve to carry on the mission despite the setbacks. It eventually moves into the stage of integration where the crisis has been blended into the norms of the organization. What we have learned post 9-11 is that, much like families who experience a crisis, the healthier the organization was before the crisis, the more easily it will weather resulting chaos. As the organization recovers, it is important for management to continue to monitor the effects that the incident has had on the workforce. Members often suffer a heightened sense of anxiety, vulnerability, and uncertainty. They search for answers to questions that may be unanswerable. There is often a sense of lossloss of the people who died, loss of the relationship with the perpetrator, loss of a sense of security. Sometimes, when a violent incident happens where employees did not see it coming, they begin to question their own perceptions and judgment. There is also the concern about a recurrence. The less predictable the event was, the more vulnerable people feel. Members of the organization may even question the company’s priorities, and whether they are still applicable. They may wonder how to sustain focus and productivity as well as continue innovations without disregarding the impact of the event on its workforce. The following ideas may be helpful in trying to help your organization recover. Not all of these suggestions would be appropriate for every situation, nor would they be helpful for all organizations. It is, instead, a list of possibilities to consider whether any of them can be useful in your situation. • Continue to monitor employee feedback. This can be done through the suggestion box, through union stewards (if applicable), through generalized feedback from the EAP, and through feedback from line supervisors. See G-1 Supplements 2 and 3 for forms that could be used immediately post-event and also on an ongoing basis. • Analyze sick leave and productivity records to identify trends and work groups that may require specialized interventions. • Provide for memorial services to recognize and honor the deceased. • Create permanent memorials such as plaques, planted trees, etc. • Continue to provide information to employees through newsletters, hotlines, flyers, and postings. [continued] 1 See Tab G Chapter 2 Section C, and Tab J Chapter 3 for discussions of post-trauma reactions and their treatment. Also see the National Center for Post Traumatic Stress Disorder at www.ncptsd.com. G-1 20 WVP 10/02 ©STP
  • 21. Management of Critical Incidents • Provide 24-hour access to mental health professionals. • Develop a telephone outreach program to continue support and monitoring for those most affected. • Offer at-work seminars on topics such as “Coping with Loss and Change,” “Integrating Work and Family Life,” “Stress Management,” and so on, so that employees can increase their coping skills. • Provide anniversary recognition with employee involvement in the planning. This can send a positive message to the organization. • Use return-to-work evaluations1 so that those who need to can slowly increase their exposure to the site and tasks associated with a traumatic incident, and can be carefully monitored by the supervisor and any medical and/or mental health providers while doing so. • Provide on-site clergy to help employees deal with spiritual issues. • Schedule an employee meeting featuring a humorist who can help them look at the humor in life. • Schedule an on-site psychiatrist, who can evaluate and prescribe care (perhaps including medication) for employees who need it. • Offer on-site or telephone screening services for anxiety disorders, depression, and substance abuse. • Ensure that supervisors will be able to spend ample time with their staff members to reassure them about their concerns and answer their questions. Senior management can support this by not pulling the supervisors away from their subordinates to write lengthy reports or to prepare elaborate briefings. • Provide opportunities for employees to talk informally with each other when they feel a need to discuss the experience. A comfortable break area and flexible break times may help support this effort. • Keep employee work groups together as much as possible so that they are not isolated from their normal support network while on the job. • Provide a buffer from the media for vulnerable employees (see discussion above). • Consider hiring a consultant who specializes in helping organizations recover from traumatic events if self-help measures don’t work. 1 Fitness for Duty evaluations or similar methods may be helpful to evaluate survivors’ ability to work. WVP 10/02 ©STP G-1 21
  • 22. Tab G Chapter 1 IMPLEMENTATION CHECKLIST 1. Develop a Crisis Management Plan. Yes No Has a Crisis Management Plan been developed? t t If so, is this integrated with other emergency efforts (ICP, etc.)? t t Has a Crisis Management Team been established? t t Have CMT members been trained for the following positions? t t t Incident Reporter t Incident Onsite Manager t Medical Coordinator t Operations Coordinator t Administrative Coordinator t Security Coordinator t Communications Coordinator t Facility Restoration Coordinator t Employee Support Coordinator 2. If a critical incident occurs: Has 911 been called? t t Has the safety of the employees been ensured through evacuation or t t alternate assembly? Do the emergency personnel have access to the site? t t Has the crime scene been secured? t t Have witnesses been identified? t t Are building occupants accounted for? t t Have business valuables been secured? t t Have the most visibly affected employees been identified? t t Has it been determined whether to close the facility? t t Has the CMT been activated? t t Has the Command Center been established? t t Are outside staff necessary to maintain operations? t t Does the CMT need additional support staff? t t Is accurate information being provided to employees, other aspects of the t t organization and the media? Have employees been granted appropriate leave? t t Have employees been provided with transportation? t t Has the incident been documented? t t Are responses to the incident being documented? t t Is the medical treatment of employees being monitored? t t Have injury/fatality notifications to the families been made? t t [continued] G-1 22 WVP 10/02 ©STP
  • 23. Management of Critical Incidents Yes No Can operations resume in an alternate site? t t Does the facility require more long-term shut down? t t Are arrangements made for facility repair? t t Has a contractor been hired to provide biological cleanup? t t Have provisions for post incident recovery been made? t t 3. After a critical incident: Has the CMT’s performance been evaluated? t t Are there mechanisms to monitor organizational effects? t t WVP 10/02 ©STP G-1 23