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Assessing trauma: what works for me.

Over the last 24 years in the Army, I have used tools to deal with and have been responsible for the Trauma Risk Management [TRiM] of approx. 600 soldiers in the UK and as the RSM I was the TRiM lead for approx. 2000 people when deployed on operations.

Whilst serving on operations if there was a significant incident, I would use the after-action review of the patrol as a form of vent exercise where every single soldier would tell me what they had seen and done. During the debrief I would be formulating my paperwork and my patrol reports but more to the point, I would be sifting through who had seen and done what. For example, I would be learning which one of the soldiers had picked up body parts or which of the soldiers were tasked to collect dead bodies or treat injured children. And with that done I knew, without a shadow of a doubt, where I needed to place my focus. I have conducted trauma risk assessments in many ways and in many different environments such as a shell scrape and compound in Sangin valley, sat in a 51 mortar pit in Musaqaleh, in Farm 5 on Sennybridge training area and in a smoking area in the new Kabul compound (NKC).

The point I am trying to make here really is that you need to go to them. I feel the initial risk assessment or meeting needs to be approached in a relaxed manner, without the clipboard, without the books and whilst the taking of notes may be required, keep them to a minimum. The practitioner should be current, practised and have a thorough understanding of their objectives. This will assist with buy in from whoever is going through the process. If your office is used for disciplinary actions for example, the person going through the process may feel uncomfortable or may even feel in trouble and so a neutral ground is better advised.

When approaching the subject, try to gently steer the person towards the incident or the issue whilst also asking questions to learn about their past, their present, and indeed what they want to do in the future. I would use this approach to build a rapport and help you get a picture of what is going on in their lives, find out things that you may be unaware of. Practitioners or managers that use no imagination or offer no understanding of the person's character or background may cause more harm than good. If you are assisting a person through a traumatic event whilst looking over the top of your clipboard simply ticking off the questions, you are adding little or no value and I feel this approach undermines the process and it puts your efforts to help in danger of failing.

My experience shows that if somebody is forced to talk through a traumatic incident, they do not fully engage or just put on a brave face to get the discussion over with as soon as possible. For trauma management, I think whatever method you use needs to be approached in a personal way, showing empathy, not sympathy, to what the person may be going through. The process needs to be relaxed and conducted on neutral ground with the subject feeling in control, and more importantly involved. As sad as the traumatic subject may be, an element of humour should not be discounted as a method to breech barriers and get people talking. It should never be forced upon someone to talk it through or just used as a box ticking exercise to show that your organisation is following procedure. These are people’s lives, and it is not a one size fits all.

At the end of the initial risk assessment, if you feel it is required, you should be in a good position to offer further meetings. DO NOT BE AFRAID to make the decision that further meetings are not required. If the full process is used for every incident it will lose effect within the organisation. Within your organisation you need to be careful of qualifying too many people in Trauma Management methods. If everybody is qualified the system will fail because everybody knows the next question, everybody knows what is going on and everyone becomes an expert. Having too many qualified people could blur lines and will

be counterproductive.

Types of trauma you and your team may face.

  • Acute trauma: This results from a single stressful or dangerous event.

  • Chronic trauma: This results from repeated and prolonged exposure to highly stressful events. Examples include cases of child abuse, bullying, or domestic violence.

  • Complex trauma: This results from exposure to multiple traumatic events.

  • Vicarious trauma: Is where a person develops trauma symptoms from close contact with someone who has experienced a traumatic event. Family members, mental health professionals, and others who care for those who have experienced a traumatic event are at risk of vicarious trauma. The symptoms often mirror those of PTSD.

Regardless of what trauma management method you use, I feel that the points discussed could prove useful and enhance the good work you are already doing. If you would like to discuss in more detail, please do not hesitate to get in touch.

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