Critical Incident Response as a
Risk Management Tool
Governor’s Conference on
Workers’ Compensation &
Occupational Safety & Health
June 16, 2005
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 union’s 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.
Accident Facts and Figures
Total Fatalities* - 5,575
Transportation 2364 42.4%
Contact w/ Objects 913 16.4%
Assaults & Violence 902 16.2%
Falls 696 12.5%
Exposure 486 8.7%
Fires & Explosions 198 3.6%
Other 16 0.03%
*Fatal occupational injuries by worker characteristics and event or
exposure, all United States, 2003
Sex (total 5,575)
5,129
Men
446 92%
Women
8%
Age
Under 16 years 25
16 – 17 years 28
18 – 19 years 84
20 – 24 years 462
25 – 34 years 1018
35 – 44 years 1329
45 – 54 years 1301
55 – 64 years 802
65 years > 523
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
Understanding the Traumatic
Impact on the Organization
and the Individual
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
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?
2. Impact On the Individual
Four basic principals of trauma
related stress
Symptoms of a stress reaction
– Emotional
– Cognitive
– Behavioral
– Physical
Four Basic Principals of Trauma
Related Stress
1. Trauma is in the eye of the
beholder
2. The traumatic response is a normal
response to an abnormal event
3. Traumatic stress is psychobiological
4. What you resist persists
Emotional
Anxiety Depression
Guilt Apprehension
Grief Feeling
Severe panic overwhelmed
Fear Intense anger
Uncertainty Irritability
Agitation
Cognitive
Blaming someone Memory problems
Confusion Hypervigilence
Poor attention Poor problem
Poor decisions solving
Heightened or Nightmares
lowered awareness Loss of time, place,
Poor concentration or person
orientation
Behavioral
Change in activity Change in sexual
Change in speech functioning
patterns Erratic movement
Withdrawal Anti-social acts
Emotional outbursts Suspiciousness/para-
Increase or decrease noia
in appetite Pacing
Startle reflex Alcohol and/or drug
intensified consumption***
Physical
Fatigue Elevated blood
Nausea pressure
Muscle cramps Rapid heartbeat
Twitches Thirst
Chest pain Headaches
Difficulty breathing Visual difficulties
Grinding of teeth Profuse sweating
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
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.”
What is a Critical Incident?
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
Possible Critical Incidents
Industrial accidents
Plane crashes
Robberies
Natural Disasters
Layoff
Fires
Assaults on employees
Critical Incidents Threaten an
Organization’s Core Assets
Finances
Reputation
People
Morale
Trust
What role do your employees
play in a critical incident?
Laborers serve two roles:
As workers on a job site:
– Highway accidents
– Falls
– Machinery related accidents
– Transportation related accidents
– Structural collapses, etc.
Laborers’ second role:
As skilled support personnel:
– Terrorist attacks
– Fires
– Natural disasters
– Structural collapses
– Toxic gas releases
– explosions
What is a critical incident for
your organization and/or
clients?
Define Risk Management and
What that Means for Your
Company and/or Clients
The way a company responds to a
critical incident can be looked at as
risk management especially where
indirect costs are concerned
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
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
Several Types of CISM
Crisis management briefing
Debriefing/CISD
Defusing
Grief and loss session
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.
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.
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.
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.
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
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
The Cost of Doing Nothing
“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.
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
Cost of Turning to Alcohol &/or
Other Drugs for Relief
76% of illicit drug users are employed
81% of binge drinkers are employed
>60% 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
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
You do the math