Moving forward: Helping workers cope after they witness a serious incident

A worker sustains a severe injury in a manufacturing plant. Medical help is summoned. The jobsite is shut down for a time. Safety professionals – and OSHA inspectors – arrive to investigate the root causes of the incident.

In each step, the response is appropriate. But the ramifications of a workplace incident extend far beyond the employee who is injured or killed. Co-workers who witness the incident may experience psychological trauma when work resumes, and distractions may open the door to subsequent incidents.

Safety professionals need to be aware of the psychological fallout for employees who witness a workplace fatality or injury, experts say. Although OSHA offers recommendations on addressing critical-incident stress, it has no specific standards for helping uninjured workers who witness a serious event.

What, then, can organizations do to help affected workers regain their composure and refocus on safety as quickly as possible? What if no previous plan existed for guiding workers through such a situation?

“Dealing with trauma is difficult,” said Dr. Ted Boyce, an applied psychologist who, as the leader of the San Carlos, CA-based Center for Behavioral Safety, helps organizations prevent injuries and improve performance. “We should not be ashamed as individuals or organizations if we have not handled such situations as well as we could have in the past.”

Instead, it’s best to focus on the most effective ways to help workers going forward.

“Identifying local professionals with experience in these matters may be critical to re-establishing ‘normal’ after a death or serious injury,” Boyce said. “And treating the psychology should not be done in the absence of ensuring that process safety is in place and functioning well. In the long term, the investment will benefit the individuals experiencing trauma and also the company.”

Early response

Because every incident and every individual’s response is different, it would be difficult – if not impossible – for OSHA to establish a hard set of rules and regulations on addressing trauma.

However, the agency offers a “Critical Incident Stress Guide” for helping emergency responders and workers who witness deaths, injuries and other threatening events. Some of the same components of OSHA’s guidance might be applied to workers in other industries who experience similar incidents.

OSHA says most instances of critical-incident stress last between two days and four weeks, whereas post-traumatic stress disorder lasts longer than four weeks after the incident. Signs of critical-incident stress include:

• Physical: Fatigue, chills, unusual thirst, chest pain, headaches, dizziness
• Cognitive: Uncertainty, confusion, nightmares, poor concentration, memory problems
• Emotional: Grief, fear, guilt, intense anger, irritability, anxiety, depression
• Behavioral: Inability to rest, withdrawal, increased alcohol consumption, loss of appetite

Some simple steps may help reduce critical-incident stress shortly after an incident, OSHA states. These steps include:

• Reduce exposure to noise and odors.
• Require an immediate 15-minute rest break.
• Provide non-caffeinated drinks.
• Provide food that is low in sugar and fat.
• Encourage the individual to talk about his or her feelings.
• Avoid rushing the person back to work.
• The response is most effective when it is handled by crisis intervention specialists or other specially trained experts, according to OSHA.

Responses vary

Some workers who witness a traumatic event might develop PTSD. As is the case with critical-incident stress, workers with PTSD may exhibit behavioral changes and require help from a licensed professional.

According to the Substance Abuse and Mental Health Services Administration, PTSD was first diagnosed in soldiers and other men and women who experienced war. Other traumatic events have been linked to the disorder, which affects about 7.7 million people in the United States.

Dr. David Adams of Atlanta Medical Psychology is a licensed psychologist whose areas of expertise include work-related injuries, trauma and workplace violence. Adams said the initial responses to witnessing a co-worker’s injury or death include shock, horror and disbelief. Some individuals also might experience guilt, remorse, rage and revulsion.

Adams said a supervisor meeting with every employee, as well as meetings with those who were informed of the incident but were not direct witnesses, could serve as an initial assessment to gauge workers’ responses. The workers then could elect or be recommended to advance the discussion by meeting with employee assistance program personnel or a licensed counselor. Additional help will be necessary if the worker’s complaints include re-experiencing the event, or if the worker is avoiding the workspace or exhibiting negative behavior.

“The concept that one’s life must go on implies that an employee be returned to work and the site of the trauma,” Adams said. “This is achievable if the employee feels the cause of the trauma has been addressed and the probability of future occurrence drastically reduced or eliminated.”

Boyce pointed out that not everyone responds the same way to a negative event. Factors that influence workers’ reactions include the severity of the event; an individual’s coping abilities, values and beliefs; and a person’s support system of family, friends and colleagues.

“In addition to dealing with the psychological fallout, we must ensure that process safety measures are firmly in place and readily used by the employees they are intended to benefit,” Boyce said. “It is not enough to have a written safety program that can be shown to an inspector during an inspection. It is critical that the written program activates injury preventive behaviors that are executed regularly.”

Empowering workers

At Alston Construction, Director of Safety David Campbell believes in a collaborative approach to safety. The Atlanta-based organization requires its subcontractors to conduct weekly safety meetings with workers, and it hosts additional all-hands meetings once a week in which all of the crews gather to discuss safety.

Campbell said the reasoning behind the frequent meetings is clear.

“It’s all because of communication,” Campbell said. “It’s an open forum. It’s not just a matter of the superintendent preaching out to the workers. It’s an exchange of information back and forth.”

By developing a strong work culture and an open line of communication, employers such as Alston Construction effectively can reach out to workers after a traumatic incident.

At Alston, incidents are rare, but when they happen, the jobsite is shut down as part of a safety stand-down. Campbell and his colleagues explain to workers that someone was injured, the area has been secured and an incident investigation is underway. They also ask for anyone who has seen anything to speak up and help with the investigation.

Yet it doesn’t take an incident for Alston to ask workers for feedback.

“We really try to push our values down to let the workers know that they are safety people, and that if they see something that is unsafe, undesirable – whatever it is – that they have the authority to intervene,” Campbell said. “They should feel comfortable bringing it to the attention of the superintendent or another supervisor. Essentially, we give the authority to all the workers that they are safety people, and we rely on them to bring matters to our attention if things don’t look right.”

Without proper communication and awareness, the consequences could be stark.

“The fallout could be that it will happen on another project,” Campbell said. “We create that open line of communication – up the chain, down the chain – so that everybody is on the same page and we all cast an eye out for safety.”