Ensuring the support needed after a tragedy

Wednesday, March 14, 2007

The 10 years from 1985 became known as the decade of disasters, and the importance of planning for civil emergencies was highlighted as local authority emergency planners and emergency services developed strategies for ensuring a rapid and effective response.

In the months between December 1988 and August 1989, there were five major disasters in this country, all very different in size, location and type. Yet all had one thing in common – multiple fatalities, leaving shattered and grieving families and friends to deal with the minefield of procedures and processes involved in a response to a major disaster. All, too, left traumatised survivors attempting to make sense of their horrific experiences and to rebuild their lives.

The impact of these disasters, so close together and with the loss of so many lives, was felt across the country. In the aftermath of each, the response of the emergency services and the local authority was examined and improvements in planning and training were discussed and implemented.

The emergency services invest a great deal of time in discussing training in order to provide the most effective response. If the 'blue lights' get it wrong, people die – something that is not acceptable. Over the years the responses of fire, police and ambulance have been honed to as near perfection as is possible in this very human sphere of expertise. However, immediate and ongoing emotional and psychological support is not so well established; the bereaved and survivors have suffered 'heightened pain' (Disaster Action) as a result.

In the aftermath of a disaster, Social Services are the designated lead agency to provide the 'welfare' response and to meet the emotional needs of those affected. This role was identified during research (the Allen Report) completed and published in the early 90s after the five major disasters. Although this was a recommendation of the report, there has been no legislation to support it.

The Civil Contingencies Act (2004) has introduced a legislative framework but there are still no clear guidelines as to how an appropriate service should be developed. Consequently, there are huge inconsistencies in planning and training. This can only result in unsatisfactory service provision in some geographical areas.

Emotional and practical support to individuals and the community is clearly a vital service and, if appropriately provided, will enhance resilience and increase robustness and recovery. There is evidence to support the concept that immediate and appropriate emotional 'first aid' can effectively reduce the long-term need for clinical psychological treatment. It will also offer emotional sustenance to those most in need in the immediate aftermath and so has definite humanitarian rewards. It is true to say that there are a growing number of authorities who are exploring and establishing multi-agency groups, although not all involve the Family Liaison Officers (FLOs) in that training. There is no national guidance or data to record this and no audit to show current resources. It is not possible to identify the gaps, let alone attempt to fill those gaps or to record and disseminate good practice.

Lord Justice Clarke was very clear in the recommendations of his report following the inquiry into the Marchioness disaster. Recommendation 19 states 'Local authorities' social services departments should identify individuals who can be jointly trained with FLOs to work with relatives following a disaster.' The Home Office Mass Fatalities Guidance states 'each local authority emergency planning team should prepare a specially trained, multi-agency team Crisis Support Team'; this recommendation is supported in the Humanitarian Assistance Guidance produced following the response to the London bombings.

As is evident in all the above comments, there has been a growing recognition of the need to provide improved care to those individuals affected by disaster and I have noted a number of guidance documents that have been produced in order to achieve this objective. However, there are still many gaps in service provision, and the Human Aspects Group of the Emergency Planning Society exists to assist in the identification of those gaps and also in establishing strategies for removing them.

The Human Aspects Group (HAG) of the Emergency Planning Society was formed in 1995. It comprises a range of professional and voluntary organisation representatives who have concerns about the level and quality of response to the human needs arising from major incidents. The terms of reference were decided in 1995 and have proved to be appropriate over the years. The group has sought to identify, promote and disseminate good practice in the human aspects of emergency planning and to report findings to the EPS – more recently through the Board.

The original and current aim is to increase awareness of the human aspects involved in a disaster response and to make a constructive contribution to the development of professional standards. Objectives have been met through regular seminars, which have been well attended and well received. Feedback has been positive and many delegates have attended more than one seminar.

HAG has sought to identify and develop good practice in the field of human aspects and also to identify areas of concern and issues requiring ongoing consideration. We have encouraged a critical and reflective approach amongst professional and voluntary organisations as well as inter-agency training and partnership working. We have helped to raise awareness of the needs of all those affected in a major incident. The overarching aim has been to establish a consistent and seamless service to those who have been bereaved and traumatised in tragic events.

In a major incident, there is often a conflict of interest between legal/safety/bureaucracy considerations and the needs of people affected. HAG believes that all people are entitled to: courtesy; honesty; respect for feelings; respect for religious, cultural and other personal differences and wishes; access to information and advice; the right to decline offers of help; sympathetic consideration of practical needs; access to immediate emotional support; and access to longer-term emotional support. These basic humanitarian principles should be the basis for any emergency planning and response; they are the key concepts of the Human Aspects Group.

HAG believes that the needs of people affected by a major incident should be the focus of any response, and social and psychological effects of disasters must be incorporated into every aspect of emergency planning. No single organisation has sufficient resources to readily cope with the human aspects of a major incident and therefore a multi-agency approach, drawing on a wide skills base and greater resources, is favourable eg. Crisis Support Teams.

Many local authorities now recruit and train multi-agency teams of volunteers who will work together with the police Family Liaison Officers to support those affected. However, training in human aspects of emergency planning is still patchy and standards are inconsistent. HAG has worked closely with a group set up by the Ceredigion Emergency Planning Officer. John Walters brought together a group of professionals with diverse skills and knowledge and ran several workshops to discuss the potential for developing national standards in training. A report is due to be released very soon and it explores a programme of modules to include training requirements for those who will respond in the immediate aftermath.

HAG welcomes this report, which highlights the need for consistency in terms of national standards. It recommends the need for protocols developed by responding agencies, and seeks to promote consistency in approach whilst maintaining flexibility in the methods of local delivery to reflect the needs of a community, and the different resources, strengths and capabilities of local areas.

HAG supports the work of other groups and organisations, some of which being:
• CIRAG (Critical Incident Response Advisory Group) – a working group offering expertise and advice to government departments in the medium- and the long-term response to a major emergency;
• A multi-agency working group that is exploring the potential for national standards in training for Crisis Support Teams (members include CCS, DCMS, ADSS, BRCS);
• ATOC (Association of Train Operating Companies) who are keen to engage in discussions to improve the interface linking the LA response and that provided by Incident Care Teams in the aftermath of rail incidents;
• The working party (including HAG) that produced the Humanitarian Assistance Guidance Document– HAG has recently commented on the final draft;
• Workshops funded by CCS (discretionary grant to Ceredigion) to develop national standards and training.

HAG recently organised a seminar with partners NPAG (National Performance Advisory Group). This seminar was fortunate to have a number of prestigious speakers who covered diverse aspects of a major incident response from the immediate Disaster Victim Identification processes through to the medium- and long-term meeting of psychological needs. Delegates had an opportunity to discuss issues raised during three workshop sessions.

HAG is now entering its 12th year. Many things have changed in that time and the needs of those bereaved and traumatised have become more acknowledged with many new ideas and services to support them.

The tragedy of the tsunami, which was so soon followed by the bombings on 7th July, has helped to focus Central Government, and DCMS has established the Humanitarian Assistance Unit that has a responsibility to develop and promote appropriate aftercare to those affected.

However, despite all the improvements, the report that followed the London bombings showed that there is no room for complacency. Tessa Jowell said: "The quality of help received in those first few hours and days can determine, for years to come, people's reaction to a terrible event."

HAG and other committed organisations still have work to do.