I attended the Emergency Planning Society’s Human Aspects Group’s workshop entitled “The Ripple Effects of Major Incidents” in Cardiff on 16th November 2017. The speakers were people with first-hand experience of responding to support those affected by major incidents or of being caught up in them themselves.
This workshop was about the people affected by an event and the practical and emotional support they may need at the time of the incident and afterwards. They may need help coming to terms with their experiences and with their losses. This is a process that could take many years.
This was unusual territory for me. I used to be a responder at site or company strategic level in the nuclear industry where, in exercises, the news that a Reception Centre had been set up was a satisfying tick in a box that required no further thought. To be fair to us we had other things to keep us busy.
It is easy to underestimate the number of people affected in an incident. For example, in a terrorist event, there are the injured that need immediate care and some who will need continuing support to cope with “life changing injuries” – a highly sanitised term for some dreadful outcomes.
Beyond the physically injured are the witnesses. Those who experience things that most of us never will; traumatic things that can lead to severe mental scars that affect every aspect of life. People who, because of their experiences, are too scared to walk along the High Street or be in a public space. People who suffer repeated flash-backs and who feel survivor-guilt. People who can’t sleep well. These are life defining phobias and conditions. Children cannot access education, adults cannot cope in the workplace. This can result in a downward spiral of increasing anger, dependency and/or despair.
There are the families of the dead, families of the injured and families of the traumatised. All have their lives changed for the worst and have to come to terms with those changes.
There are people who narrowly avoided being a direct victim. People how didn’t catch that train for a trivial reason, people who didn’t go to that concert, people who live in the next tower block along (or indeed a tower block in a distant town or city).
There are the people who responded to the incident; professionals such as the police and medical personnel, but also the bystanders who come forward to give spontaneous help. Some of these will need emotional support to help them process their experiences.
There are the people who have lost their homes or their livelihoods, either permanently or temporarily, as a result of the event and need timely practical support.
Experiences of response
Some of the speakers reported their experience of responding in the first hours and days after serious incidents and explained the role of the Families Liaison Officer and charities.
In one event an apparent lack of coordination and leadership resulted in badly designed and managed survivor and community support which quickly resulted in anger and recrimination. Later improvements in the responders’ performance improved matters but, by then, a lot of damage had been done to the relationship between the community and the authorities.
Another report of a different response was more positive. A difficult situation requiring a lot of rapid decisions, some of which stood the test of time whereas some didn’t. A lot of learning already revealed and more to come as the analysis progresses. Interestingly and encouragingly the speaker described their recovery plan as being based on the national guidance and broadly successful.
A stitch in time saves nine
A few themes emerged from the presentations and discussion.
The support on the ground for those immediately affected needs appropriate design and competent management. In the first few hours the care needed will be largely medical for a number of people and the immediate needs of comfort, shelter and sustenance for maybe more people.
Within hours to days those affected may need wider support. They may be separated from their cash, credit cards and their travel season tickets. Without immediate help they risk an escalation of consequence – jobs, or at least earnings, lost as they can’t get to work. Education disrupted for children who can’t get to school.
Loss of other documents, such as passports and identification, can quickly become a problem for some and, without the correct support and advice, they may struggle to hold their own.
Businesses may be suffering, particularly if they are based inside police cordons.
These problems can be solved. We heard from Victim Support and from the British Red Cross on the services they offer and their experiences with things that went well and things that took longer to get right. It is possible to mobilise quickly. There are individuals and organisations with experience in supporting affected communities. Each time they are called upon they can be expected to get better, if the conditions on the ground, resources and coordination allow.
A number of big questions were posed:
- How do you identify the needs of those affected and break through established procedures and budgets to provide help in a timely manner?
- What do you do if a Category 1 responder is failing to cope? (or indeed any component of the response?)
- What do you do with gifts in kind (which can be in overwhelming quantities and of a wide range of suitability)?
- How do you coordinate and get the best out of spontaneous volunteers?
- How do you manage social media in a positive way?
- Social media is both a blessing and a curse. We heard of social media platforms being set up by individuals or organisations that attempted to help those affected but which attracted advertisements from the likes of Funeral Directors and Claims Lawyers, abusive messages or were used by journalists as source material for unauthorised articles. But we also heard of the real value of enclosed systems that could be set up on platforms such as Yammer and had a debate about who should manage them for the years that they might be needed – currently the police manage some.
- Mobile phones allow families and friends to reunite without support. This does mean that the facilities set up to help reunite families see a higher proportion of bad news to good compared to the expectations of some years ago.
- Nurses trained in the SWAN end of life care techniques and the police Family Liaison Officers can provide emotional and practical support for the bereaved.
- It takes planning, experience and considerable resources and skill to set up the ideal range of support facilities for those affected in different ways by an event. Getting it wrong can quickly lead to worsening experiences, anger and lasting harm for individuals and communities.
- The media can intrude upon facilities for survivors and family and friends. They should be controlled but helped to get appropriate material for their needs.
- It is important to gather and understand data on the types of people affected and their needs as these change with time and there are humanitarian and reputational drivers to keep the gap between needs/expectations and delivery small.
- Mutual support groups within those affected can be very useful to some people trying to cope in the aftermath of trauma. The ability to discuss matters such as poor sleep, anxiety, and availability of therapy with similarly affected people can be very positive.
- People displaced from their homes and temporarily settled elsewhere benefitted from a single facility where they could access a range of help (CAB, Banks, Social Services etc.) but also greatly benefited from the opportunity to meet and chat with their neighbours (photos of sofas and coffee tables in the middle of a Sports Hall).
- It is important to try to work with social media rather than against it – In Manchester there was a social media campaign for a vigil in support of the victims and defiance of the perpetrators. Enabling this, and supporting other such moves, was seen to be very positive.
- Support may be required for many years after the event and includes, in addition to individual support, such things as organising ceremonies on key anniversaries and organising permanent memorials, both of which require careful attention to the wishes of those affected – which may not all be the same.
- Donations in kind and in cash can be overwhelming, can take considerable resources to manage and can lead to incriminations and anger if not done to everyone’s satisfaction.
- There is a need for some kind of Advocacy Service for the survivors of terrorism to ensure that they get the support they require. This includes practical help to cope with physical injuries, help with the mental injuries, financial support and help to build a life and access education and work that takes survivors’ trauma into account. (In an ideal world this would not be needed because the background social support should be managing).
There were two very moving first-hand reports from survivors of terrorists’ attacks. Both exhibited anger at the inadequacies of support they have been offered in the UK, which compares badly to some other countries, and which clearly let them both down badly.
Something is broken. Survivors are not getting the support they need. It is clearly of concern to the emergency planning community and we should not think that our job is done when the final police cordon is removed. We have some level of responsibility to ensure that those caught up in an emergency are cared for in an appropriate manner.
Dealing with urgent and continuing medical needs is the remit of the emergency services and National Health Service although organisations such as CitizenAid have identified a role for prepared bystanders. The setting up and managing facilities to cope with the practical needs of those affected within the first hours and days of the event is quite clearly, I think, part of an emergency response and within the remit of emergency planning. Guidance is clear about responsibilities.
However, it could be argued that the longer term care of people with severe physical injury, with psychological harm and permanently displaced from their homes is not within the emergency planning and response remit. The UK should be doing better in these areas but our role in making it happen is, as an organisation, probably limited to raising concerns with the authorities and, as individuals, calling to account those in authority and those with responsibility in these areas – if we could only identify them.
A few of the attendees were from Social Care and Health roles in local government. It is a pity that there was no senior representative from central government or from the mental health world as defining and solving the problem is probably beyond our pay grades and their views would have been valuable.
© Keith Pearce, 20/11/2017
K.I.Pearce asserts his right to be recognised as the author of this document.