| Eastman
Kodak is one of the most recognizable names in
the corporate world. The Eastman Kodak Company
located in Rochester, New York is headquarters
for Kodak's worldwide operations. It is a complex
involving miles of buildings and thousands of
employees. In fact, there are manufacturing sites,
chemical plants and office buildings on hundreds
of acres. There are approximately 25,000 employees
in this location. Beyond Rochester, throughout
the United States, the workforce exceeds 45,000
employees. The Critical Incident Stress Management
(CISM) team at Eastman Kodak has a combined service
experience with the company of approximately 90
years. Dan McGuire became involved with Emergency
Medical Services in 1979. Dan has worked as an
Emergency Medical Technician for the last 20 years.
He joined the Monroe County Critical Incident
Stress Management (CISM) team and was promoted
to the position of Operations Team Leader in 1999.
Evelyn Sklair has been with Kodak for the past
19 years as a Certified Occupational Health Nurse-Specialist.
In this capacity, she has held several different
positions within the medical department including
clinic staff nurse, clinic team leader, medical
resource partner, case manager and she has been
involved with Emergency Medical Services as a
nationally registered paramedic. Gary Roller has
been with the Eastman Kodak Company for 28 years
as a Security Professional. He has held several
positions within the Kodak Security Organization
from Security Officer to his present position
as Manager. Charlann "Charley" Tranella
has been with Kodak's Employee Assistance Program
(EAP) for 13 years. As an EAP counselor, she interacts
with employees and family members regularly and
provides referrals for various mental health and
chemical dependency issues. Dr. Wayne Lednar is
a Physician. He serves as Eastman Kodak's Medical
Director and works closely with the crisis response
team. He is integrally involved with medical services
at the Eastman Kodak Company.
JSV: As employees of Eastman Kodak, you have developed
a unique crisis response team. I know that two
of you are members of the Monroe County Critical
Incident Stress Management (CISM) team that works
with Emergency Medical Services (EMS) personnel
who are traumatized. Can you tell me how the crisis
response team evolved at Kodak?
ES: Typically, after a critical incident, a nurse
or physician for the affected area would go over
and chat with co-workers who were present. When
I came to Eastman Kodak in 1992, our EMS responders
knew that I was an EMS person and that I had training
in CISM. So, if they went on a call for certain
traumatic incidents such as an entrapment or cardiac
arrest, they would call me. They would inform
me that the group was pretty upset and ask me
to talk with them. I would do some defusing or
debriefing or whatever was necessary to help.
After doing that a few times, it was recognized
as valuable. It appeared to truly help the people
involved. I was asked by my management to work
with the Employee Assistance Program (EAP) at
Eastman Kodak and formalize a crisis response
team here and include EAP. So I spoke with Charlann
Tranella who pursued further training and we began
as a team.
CT: As with Evelyn, I have a nursing background.
As an EAP counselor, I was often dealing with
emotional crises. So this was a natural extension
for me to go out and help in this capacity. Evelyn's
EMS experience served an important role. She could
address a number of issues that people would ask
(e.g., "Why did the EMS do...?"). The
training that we obtained in critical incident
management gave us the tools that we needed to
go through the process. We then decided that our
team needed to be incorporated into the workplace
as a medical service and we developed a business
plan. Dan McGuire and Gary Roller also had backgrounds
in the area of emergency response and we then
had our team of four.
WL: I just want to add one additional piece to
the evolution of the team. After an incident,
with individuals affected and a response team
working with them, the next question involved
the impact on supervision and management in the
work setting. Management wanted to know that employees
were getting adequate help. They also wanted to
know how the acute event would be addressed in
the aftermath. Would the employee need time away?
Would they need medical care? How could management
be more supportive to them? How would supervisors
and managers be impacted as they try to continue
with business operations given that an event had
occurred.
JSV: What process does the team use to be activated
when there is a need?
GR: Our small group is divided into two teams.
Evelyn and Gary are one team and Dan and Charley
are another. Each team is responsible for a given
month throughout the year. The Eastman Kodak Company
has a staffed, 24-hour Emergency Communications
Center. Should there be a need for a debriefing
or defusing, the request is forwarded to the Communications
Center. They in turn contact the team that is
on call for that given month. Our team is a truly
24/7 operation. We all carry pagers.
CT: One of the critical parts of the response
involves speaking with a supervisor first. We
must let them know what we are doing with what
group and why. We "triage" on the phone
first.
JSV: What benefits have you observed from having
a crisis response team at Eastman Kodak?
ES: We are able to keep people at work. We are
able to keep them productive. We help them quickly
(i.e., defuse situations quickly) and help them
to understand that what they are going through
is normal and that the best support they have
can be the person who is working right next to
them. This helps people keep work which lowers
lost time costs.
WL: The things that I often hear from community-based
providers is that this type of support given at
Eastman Kodak is very positive and timely. Moreover,
it all helps the quality of care for their patients,
especially in helping people to move on.
JSV: Critical Incident Stress Management (CISM)
was initially intended to be used for assisting
EMS providers after their response to a traumatic
event. Do you find that the layperson, such as
the corporate employee, is similarly affected
by a critical incident?
DM: Corporate workers have many workplace issues
that get drawn into the critical incident, such
as doing more with less, increasing responsibilities
with little or no increased remuneration, increased
deadlines and competition. They also don't have
the pre-education on management of critical incidents
that EMS, firefighters and police workers are
now getting in their training. With that said,
you need to adjust your information and techniques
to these additional stressors. I know that when
I come into work each day, I have a certain pattern
that I follow. I check my mail, messages and get
a cup of coffee and begin my normal work day.
Nothing in my workplace training has prepared
me for dealing with the death of one of my co-workers
or the serious illness of one of my colleagues.
This is a major reason why there is a need for
corporate-based crisis response teams. These things
that are happening more and more and there is
a need to be better prepared for them.
ES: Co-workers can be traumatized watching an
incident unfold. However, there may be a greater
sense of helplessness. They don't understand what
is going on when EMS gets there which increases
confusion and frustration. Many workers have never
seen a deceased person outside of a funeral home.
It can dredge up old memories of losing someone
near to them. Their loss may be perceived differently
than EMS. Their loss is not a stranger but a "work-family"
member.
WL: EMS members may question themselves and ask
"Was I skilled enough to help that person?"
A layperson might ask, "Did I fail to do
something?" Of course, the root causes of
their anxiety may vary and the answers may also
be different between the layperson and EMS worker.
JSV: How would you define a "crisis"
in the corporate sector? What types of traumatic
stressors would typically require intervention
and support? Please give me some examples.
GR: A crisis in the industrial/corporate sector
can be defined as an extraordinary event that
overwhelms the individual's normal coping capacity.
We have had employees accidentally inhale toxic
substances as well as become entrapped in machines.
Industrial accidents, cardiac arrests resulting
in death or emergency hospitalization, harassment,
seizures. These are a sampling of some of the
things that we have seen.
CT: Other types of incidents that may occur could
be a criminal act against a person, such as an
assault. Our team has been involved in all of
these situations.
JSV: In your work with employees, what are your
observations of the responses of these individuals
to such traumatic events such as a cardiac arrest
or a machine entrapment?
DM: Typically, you see heavy questioning from
employees as to what has happened to their "normal"
work site. They want to know how and why did this
happen? Is Kodak doing everything it can to protect
people? Is my workplace safe anymore? You see
fear, anger and frustration since they are simply
not prepared to come to work and experience such
an event, it's that simple. They really are affected
as to the loss of a stable work place. Who wakes
up and says to themselves "I will experience
a traumatic event today at work!"
ES: The EMS person deals with cardiac arrest and
then goes onto the next call. This process may
change, however, when the incident involves a
child or an infant. "They are not supposed
to die." However, it is that same emotion
that we see in employees. People believe that
others are not supposed to die or become seriously
ill at work. When this does occur, there is a
tremendous sense of unreality about it, like a
nightmare. There is lots of concern around not
knowing what to do, agitation, frustration, helplessness
and even devastation. Workers may be very critical
of EMS, especially with how long it took them
to leave the scene. The symptoms are the same
whether the affected employee survives or dies.
The only difference seems to be the length of
time until they're feeling better. To them they
have lost a family member, not just a co-worker.
WL: Eastman Kodak is a company with good resources
and strong programs in a community with good hospitals
and good healthcare. Yet, what emerges in these
traumatic situations is the realization that our
existing healthcare system does not deal effectively
with a response to these events. The Eastman Kodak
CISM team plays an important piece and fills in
a gray area in the healthcare system. Immediate
response and psychological support will not happen
in most places like this unless we make it happen.
JSV: Although many people are exposed to traumatic
experiences in their lifetime, most do not develop
posttraumatic stress disorder (PTSD). What factors
do you believe "buffer" a person from
developing full-blown PTSD?
CT: I think that some people are more resilient
to developing trauma than others. They have better
coping skills to recover from adversity. There
is evidence that people who are resilient are
more accepting of change, more responsive to their
environment, have faith in themselves, are able
to take risks, have a basic belief system and
maintain a sense of purpose (see Harvard Women's
Health Watch, Feb 1998). Resilience may be an
innate characteristic, but also one that can be
instilled through effective role modeling and
setting of examples for children. Mental health
counseling can also be effective to treat co-morbid
problems such as depression, which can interfere
with one's ability to "bounce back"
from adversity.
WL: Social support also plays an important role
in resiliency as well. Increasingly, it is difficult
to have a balance between work and life. People
spend so many of their waking hours at work. Thus,
their work group becomes a very important part
of their life and their social support. A workgroup
that is supportive to one another, can assist
in buffering one from the effects of trauma.
JSV: What benefits have you seen, if any, from
a post-intervention response and have there been
any surprises?
DM: I've observed a swift return for those involved
in the incident, to a more normal work environment.
After such an event, we see and hear from those
involved that their work environment is disrupted
and becomes almost foreign to them. As I had indicated
earlier, one doesn't expect to go to work each
day prepared for a critical incident! With use
of our intervention, it really speeds and facilitates
the return for an employee back to the "normalcy"
of their workplace as they have come to know it.
One other benefit that stands out in my mind involves
doing debriefings with the same group of individuals.
We had a group that, within a six-month period,
had two employees who became gravely ill. Soon
after one employee became ill, so did another.
It was clearly a critical incident for them. I
recall that after this second incident, these
individuals were much better prepared for that
second incident and commented that they were able
to do a better job supporting other co-workers.
The education, debriefings and defusings that
were initially conducted had true advantages later
on.
ES: Affected work groups can become more cohesive
as a result of their unique experience encountered
all together. Some individuals have gone on to
learn CPR and First Aid. Others have made lifestyle
changes to become healthier.
CT: Oftentimes, employees who have witnessed a
traumatic event in the workplace re-experience
previous traumas, losses and grief. Our intervention
provides an opportunity to educate and normalize
the experience that people may have in the aftermath
of an event and encourages further assistance
for them (as necessary).
WL: Another observation involves the fact that
Eastman Kodak in Rochester is the world headquarters
of a worldwide corporation. We have many employees
who are not Americans and are assigned here for
a temporary period of time. We have had critical
events involving non-American employees and the
response to someone of a different culture needs
to be culturally-appropriate in response to them
and their families' needs. It is important to
be aware of the right things to say and how we
can act to be supportive of our co-worker from
a different part of the world. We want to be seen
as supportive and not produce a negative effect.
JSV: What resources do you have available if defusing
and debriefing just aren't enough for someone?
CT: Defusing is something that we routinely do
within the first 24 to 48 hours after a critical
incident. We continually assess the individuals
we are working with. We follow up with them within
the week and we then can easily make the connection
to our normal EAP process of assessment and referral.
As EAP counselors, we are aware of which therapists
in the community work with traumatic stress and
respond to critical incidents as well as CISM.
DM: Part of our initial process when we get activated
as teams involves contacting a requesting supervisor.
We than size up the incident in terms of severity
(i.e., triage) and need for immediate response
as opposed to a delayed response. We may have
to work around people's work schedules and calendars
and we have to be flexible at times. So, we may
first do a defusing and make an initial assessment.
In a day or two, we will make another assessment
and decide if there is a need for a full-blown
debriefing.
ES: One of the things that we need to keep in
mind is that we are all full-time employees with
full-time jobs and we incorporate critical incident
management into our life here.
JSV: How do you justify having an in-house team
when there is a county team readily available?
What are the advantages and/or disadvantages?
DM: By having an in-house team, we are better
prepared to deal with the issues that a corporate
critical incident may produce. We have complete
access to the many buildings at Eastman Kodak.
Also, workers identify with us as being "one
of their own." When the Kodak team goes in
to work with people, we are seen as "Kodak
family." This helps the comfort level go
up as opposed to bringing in an outside source
to the inside. I know that I wouldn't feel as
comfortable because I don't know these people.
Also, we do link closely with the Monroe County
CISM team (which I head up). We are able to draw
upon their resources including pastoral help,
mental health specialists, etc.. The Eastman Kodak
response team is invited to the Monroe County
Team's
bi-monthly training sessions. By doing all of
this, we build solid cross-functional links and
we are able to share resources that each team
possesses.
ES: With belt-tightening, we needed to do a "business
case" to justify our existence. Since we
were already trained, this was quite cost-effective.
Costs are related materials such as printing our
new brochure and, of course, the time that we
use for meetings and call-outs. However, advantages
would include that we know Eastman Kodak and it's
"culture." Also, as Dan mentioned, we
have easy access to most areas within Kodak. We
have experience in dealing with critical incidents
and we can respond faster. Some disadvantages
of being a small team are that we don't have as
many resources to call upon. As it turns out,
if they decided to use the county team instead
of the Kodak team, some of the first people to
be called would be Dan and I, so why not have
an internal team?
WL: Another advantage to an internal crisis response
team for a company involves extending the response
for a number of different types of traumatic events.
In the business environment, a different type
of trauma may involve a "business decision."
Examples may include a failed product launch that
was the result of a tremendous effort, downsizing
and loss of jobs, the abrupt halting of an important
research and development project. These events
are very traumatic. These things may be known
before the event happens and we may be able to
pre-empt some of the traumatic effects or prevent
some of the aftermath of such exposure by a crisis
response team working with management. You could
never get this kind of response if you were engaging
a team or resource from outside of the company.
JSV: How did executives and upper corporate management
at Eastman Kodak initially respond to the idea
of a crisis response team?
WL: They received it very well. It appeared as
a natural extension of the immediate response.
We have had an internal medical department in
the company for more than 90 years. So addressing
the needs of employees, managers, supervisors
have always been a priority. I think that they
appreciated the fact that, not only were the emergency
medical needs of employees being addressed but
also the psychological needs that came with these
traumatic incidents.
JSV: In the time you have been involved with crisis
response (and CISM), do any specific events stand
out in your memories that you believe have influenced
you both personally and professionally?
ES: Before I became involved with Eastman Kodak,
I took care of a 22-year old with anaphylaxis
who died. It was a traumatic experience for me.
Even though I had worked in the emergency room,
I never had anyone die in my arms like that. I
did not received any crisis response or CISM training
at that time. After I got my training, I realized
that I should have been defused and debriefed
after that particular incident. I became a paramedic
because of that experience. Later on, as a paramedic,
I took a call for anaphylaxis and had flashbacks.
I sought assistance from one of our CISM-trained
psychologists. Consequently, I'm a big proponent
for CISM.
DM: As we had mentioned before, the people you
work with become like family members. You spend
more time sometimes with your co-workers than
you do with your families. In a former position,
one of our most admired and respected peers had
died very suddenly over a weekend. I remember
her saying to us on a Friday at 5:00 as she left
"Have a great weekend. I'll see you on Monday."
That following Monday morning, she wasn't at work.
I can still, to this day, see the face of my supervisor
when she had to break the news to the rest of
us. She had just gotten a call from this co-worker's
family. She had gone home and died in front of
her family. It was a terrible event and you could
have heard a pin drop. We were all close to her.
The news so stunned us that we were speechless
for several minutes. Talk about an opportunity
for our team to respond! This experience only
furthered my interest and desire to work with
the Eastman Kodak CISM team and a deeper passion
for this work.
CT: It is critical for EAP professionals to know
how to process traumatic information with people.
It is important to know how to talk with individuals
who have been involved with a motor-vehicle accident,
violence at home or in the community. To effectively
work with traumatized people, we need to understand
trauma.
JSV: Describe the feedback that you have received
from your management about the crisis response
team and those that you have interfaced with.
ES: We have had very positive feedback from the
employees. About two to three weeks post-event,
we send out a feedback form. The returns are very
good. Many respondents indicate that they are
very thankful to have had the session. They also
describe how important it was for them to hear
that others in the group were experiencing the
same thoughts and emotions as they were.
CT: Feedback has been good. It also provides an
opportunity to encourage supervisors to utilize
our services. It is often difficult for employees
to come forward with emotional issues in front
of their workgroup. Through feedback they may
learn that the intervention process is helpful
and non-threatening.
WL: Part of my role for the corporation involves
becoming quickly familiar with a significant event
anywhere in the world that involves employees
at our work sites and making sure that the right
things are happening for those involved. I will
often hear back from executive level management
how much they appreciate the timeliness and effectiveness
of the response. They are very appreciative of
the team's intervention. Management of critical
incidents (i.e., CISM) is the natural "next
step" following the medical response in assisting
workers with "moving on." One can take
this response and expand on it in a business environment.
Traumatic stress can ultimately interfere with
a product launch, research and development projects
and other business sensitive issues.
JSV: What methods have you utilized to facilitate
the spread of information and background about
the Eastman Kodak CISM team? What plans do you
have for future communications?
DM: We've had communications regarding the Eastman
Kodak CISM team through our internal supervisors
and managers informational e-mail forum. This
e-mail publication comes out monthly. In it, we
describe the crisis response team, what a critical
incident is and how to activate a crisis response
team.. We also printed our official Kodak CISM
team brochure for distribution. We also work with
and partner with our Human Resources Department,
Employee Assistance Program and education divisions
to give pre-education opportunities for Kodak
employees.
JSV: There are only four of you who are on this
team. Does that pose any problems for the future?
Where do you see the team headed in the future?
DM: With our current volumes of call-outs, our
team size is right on the mark. As we get the
"word" out about us, there may be a
time where we will need to add more team members.
As for our future goals, we will need to continue
to work on becoming the "center of excellence"
as other teams may be formed internal to Eastman
Kodak. We will need to keep up with the trends
and changes in the critical incident management
arena and become "subject-matter experts"
in corporate CISM.
WL: I think the demands will increase in terms
of the need to respond to various events. I think
the biggest need will be in pre-education. The
team may ultimately coach other teams in other
locations as they are responding to their events.
The team can become the "center of excellence"
in leadership and competency for the company.
JSV: What guidelines and efforts can other Fortune
500 companies like Eastman Kodak Company use to
develop trauma management teams for their employees?
DM: Firstly, recognize that there is a need for
an in-house crisis response (or CISM) team! Things
like workplace violence is increasing. But, realize
that it is not only violence but also other traumatic
events affecting employees including accidents,
illnesses, explosions, fire and the like. Also,
get early buy-in from the supervisors of the team
members. They need to understand that the initial
work of setting up a team will take the employee
away from their core work duties from time to
time. As well, be sure to look internally for
crisis management-based resources that you may
already have. Check with your medical department,
Human Resources and Employee Assistance Program
staff members. You may be surprised that you have
some well-trained individuals at hand. Be sure
to create solid links to any existing external
CISM teams. Lastly, prepare a clear and concise
business plan showing the "return of investment"
in the team. The bottom line in the corporate
world is that you will need to justify your existence
and be able to demonstrate the cost-savings of
a corporate-based team. You must prove that such
intervention can save the company money, make
a stronger and healthier company and make the
company even more competitive. Team members must
be subject matter experts. In the beginning, especially,
you need strong people familiar with techniques
like defusing and debriefing.
WL: Companies are run on the basis of information
and facts. Many companies like ours are using
"fact-based" management. Get the idea
of crisis response teams in front of executives
and leadership teams. Talk about the "health
of the company." These are "people"
issues that effect individual's health and the
workforce. There is a need to make the connection
to business and the impact of trauma. This can
drive the follow-on actions. Have a "global
performance expectation" for the corporation
on health, safety and environment issues as the
company runs its business. Make what you expect
from supervisors and managers very clear in terms
of adhering to these expectations. These kinds
of events may make it clearer for companies to
identify the issues and respond to employees needs
accordingly.
JSV: We are learning more and more about the effects
of secondary traumatic stress such that caregivers
themselves become traumatized and/or overwhelmed
through their efforts to assist others. What kind
of counseling is available for crisis response
team members?
DM: It is our internal protocol that after each
call-out is done, we do a "debriefing of
the debriefers." In fact, we have even used
an article on the Academy's website (www.aaets.org).
and handed it out to further educate our team..
We take each other's "psychological temperature."
We ask thing like "How did it go for you?"
"What didn't go well?", "What could
we have done differently?", "Was there
anyone in the room that you think will need more
support?." We also attempt to ensure that
none of us is heavily carrying the event around.
If needed, we have a great group of EAP staff
that we can go to for counseling resources including
outside providers, clergy, etc. We also have resources
from the Monroe County CISM team.
JSV: As you are aware, The American Academy of
Experts in Traumatic Stress recognizes that traumatic
events are an unfortunate part of the human experience
that professionals and workers from many fields
work with on a regular basis. What do you see
as the major advantage of an organization such
as the Academy that is dedicated to increasing
awareness and, ultimately, improving the quality
of intervention with survivors of such events
across such an eclectic group?
DM: The AAETS is an exceptional group of professionals
committed to the advancement and training of crisis/trauma
response, management and CISM techniques, procedures
and educational opportunities. It gives anyone
the chance to network with a wide and diverse
group of professionals and resources that are
truly worldwide. With the new discussion forum
on the website (www.aaets.org), one can interface
with many area specialists and be able to exchange
information and questions. The AAETS gives one
a broad-based affirmation that training in trauma
response and CISM does indeed work. It gives a
consistent stream of information that is so necessary
and is key in the teaching of survival techniques
and procedures in crisis management, not just
in the emergency services arena, but also now
in the corporate workplace. Whether it is someone
on an assembly line or a senior management level
person, training and education in crisis response
and management can help people get better, healthier
and stronger. The Academy is an incredible resource.
I have been able to talk with individuals from
other corporate-based companies on the Academy's
internet forum that read my posting who do not
have crisis response teams and want to develop
them. I know that I speak for the entire Eastman
Kodak CISM team by saying that it has been an
honor and privilege to work with you (and Dr.
Lerner). We only hope our trail-blazing at Eastman
Kodak will start things equally as great elsewhere.
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