Trauma Response Profile: Eastman Kodak Critical Incident Stress Management (CISM) Team, A Portrait of a Corporate Crisis Response Team

Joseph S. Volpe, Ph.D., F.A.A.E.T.S.
Director, Professional Development
Editor, Trauma Response®


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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