• What about the bystanders?

    by Jess Morton. Last modified: 15/09/14

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    As I walked past the family room, I saw a family in shock. There were no tears or the sound of sniffling. Their faces were white; the room was still & silent as I could hear the ticking of the clock on the wall. They’d just witnessed something horrible. They were brought to the ED for minor injuries and to be checked, however what was hurting them right then was not the bumps or bruises, but what they saw after. The T/L whispered as she walked past that the social worker had been paged.

    The ED social worker would come and debrief them, provide answers to their questions & ensure they were ok to go home. She would also provide advice for follow up and what they could expect to feel, think & see in the following days and in the immediate future. They were given the social workers card and other contact numbers for if they had questions or ongoing issues.

    A slightly different scenario and yet so similar is Sophie’s story. Sophie, aged 29 and a mother of two  (no, this is not me undercover), was driving home with her two boys in the back from celebrating her Dad’s birthday & witnessed a horrific car accident.  Sophie got out and as instinct takes over tried to see what she could do. As with many of these cases, the two truck drivers walked away without injury, however the driver of the small car was critically injured.

    She could only provide supportive assistance to the driver until paramedics arrived; the driver died a short time later.

    Sophie  was briefly interviewed by the police and was asked about basic mechanism of injury by the paramedics when they first arrived, but she was never given advice on what she could expect when she went home or how to seek help for that.

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    As she got back into her car and looked at her boys, she recalled the empty children’s car seats in the back of the mangled wreck and cried. She could not sleep that night, or the next. The man she had spent time with in his last hour of life was constantly on her mind. When she closed her eyes, she could see his broken body and the feeling of helplessness returned to her. When she looked at her boys, she thought of the little kids that were now without a Dad.

    It has been my experience working in public hospitals that there is almost always an on-call social worker after hours and on public holidays. They will be called to support the patient, friends & family, bystanders & staff when a critical incident occurs within the hospital or victims are brought in. They can been called in for a  sudden or traumatic death, an MCI or any other event which may need social worker input.

    But, what happens when paramedics attend an MVA scene on a darkened country road where extrication and transport may be time critical or in Sophie’s case on a busy metropolitan road in peak hour where there is pressure to clear the scene to alleviate the extended traffic delays?

    Our position as first responders is different to those in the somewhat controlled environment of the ED or hospital ward. There is no quiet waiting room with a calming Ken Duncan panoramic or a skilled social worker to debrief those that have just bared witness to a scene that they wish they never did.

    We, as prehospital emergency providers  (and future ones) come by witnesses, family and bystanders on the highway median strip, at crime scenes, public places, private homes & crowded workplaces. It is regretfully not always possible in time critical cases, appropriate or even safe to provide counseling and follow up advice for those that may be affected.

    It was less than a month after listening to Sophies’ recollection that I went on placement. It couldn’t have been coincidence that on the station table sat these wonderful little cards accompanied with a request/directive to carry them and hand on to those in the line of work we feel may benefit.

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    Providing numbers such as Lifeline and the Road Trauma Team helpline along with a blurb reassuring the witness that it can be normal to react differently and sometimes negatively to a critical incident gives that bystander the facts, numbers and means to seek assistance.

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    I have since wondered though, whether a system where paramedics and/or police who attend such events were to take the phone number of witnesses and those first on scene and were to follow them up with a phone call as standard – be it by the paramedics who attended or a trained trauma counselor that has the case details.

    Should those who by pure bad luck witness a critical incident be the ones required to seek out help and often be out of pocket for it?

    My friend did not ask to witness that MVA and the scene that confronted her was out of her control. It was not until I saw the press photo from the accident that I began to fully comprehend what she was part of that night.

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    (Photo left unidentified so to not reveal location)

    She is ok now. With the help of her father, a volunteer firefighter she sought help through an experienced trauma support officer.

    I cannot purport to know how to best ensure our bystanders are adequately debriefed. But after seeing on more than one occasion the effect that rendering assistance to someone critically (or fatally) injured has on others, I understand that it should not be overlooked. Posttraumatic stress CAN turn into a disorder and may lead the innocent bystander down a potentially preventable depressive pathway.

    I now ask YOU to tell me what you have done in the past?

    Does your service have purpose made contact cards like the ACT ambulance to pass on to witnesses?

    When you have been to incidents of any nature where you have thought that the witness may need support later on, how have you addressed this?

    What wisdom do you have for student and junior paramedics who will inevitably come across witnesses and first responders?

    Further Reading for your interest….

    http://ro.ecu.edu.au/cgi/viewcontent.cgi?article=1400&context=jephc

    http://www.courts.dotag.wa.gov.au/_files/Coping_with_witnessing_traumatic_event.pdf

    http://www.archi.net.au/resources/delivery/emergency/trauma-brochure

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    Jess Morton

    Jess Morton

    Student Paramedic.
    I am an Australian undergraduate Student Paramedic. I study part-time as I am also Mum to 2 beautiful boys. I am passionate about Friendship, Family & #FOAMed. I am keen to get more experienced as well as student Paramedics into the FOAM world to enable better access to education to result in better patient care. My interests include photography, thick shakes and sleeping in past 6am.

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    2 thoughts on “What about the bystanders?

    • KIdocs.org says:

      Wow Jess, what a good post. I want to get some of those cards.

      It is easy to deal with this in rural – although there is a far higher chance of both bystanders and responders knowing the victim (and occasionally being related to them), the subsequent surveillance and followup is easy in my role as both rural responder and local doctor.

      In the city – a little harder. As you know, our focus at the roadside is to intervene for immediately life-threatening problems with simultaneous packaging and rapid transport to hospital. I often am aware that there are bystanders present, but have no spare time (nor is it safe for patient) to peel off and offer support.

      It strikes me that WE are often offered professional support after such events. But the lay public are not.

      The cards seem an easy and ‘low hanging fruit’ solution to a common problem. Are they proprietary?

    • It’s great that consideration is being given to supporting bystanders, and I really like the idea of a Bystander Support Card.

      Just a word of caution against the idea of a follow-up phone call: although it seems counter-intuitive, the evidence is that one-off debriefing sessions either achieve nothing or (perhaps) do more harm than good (summary of evidence and WHO recommendation here: http://www.who.int/hac/techguidance/pht/13643.pdf ).

      It is part of the human experience, not psychopathology, to have an emotional reaction to severely stressful situations. Most people most of the time will not go on to develop a psychiatric disorder because of exposure to traumatic events. People draw on their supports and resources, build-up resilience and, for some people, can result in the opposite of PTSD: post-traumatic growth.

      The cards are a great idea. I would recommend the addition of an easy-to-access, easy-to-read website that elaborates on stress reactions and supports available. Something along the lines of a page that says, “That was bloody stressful! What’s next?” http://meta4RN.com/bloody

      Final thought: if the police are in the habit of collecting witness statements, I assume they’re in the habit of collecting names and contact details too. What about habitually sending an SMS version of the Bystander Support Card to all witnesses/bystanders as well? Cards and brochures are get thrown away/lost more often than mobile phones.

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