The New Era of Post-Trauma Care
Lyle L. Labardee, M.S., B.C.E.T.S., B.C.S.C.R.

The American Academy of Experts in Traumatic Stress serves a timely and important role in providing standards of psychological care for those who regularly work with survivors. The development of new models for the delivery of crisis intervention, the heightened frequency and visibility of traumatic events throughout the past 15 years, and organizational trends in proactive medical management and ethical leadership have converged to create a need for the rapid and widespread delivery of post-trauma psychological care. The success of such a mission, given the varying disciplines involved, requires clearly defined standards of practice by which all providers from first responders to doctors may assist victims of trauma in a coordinated and effective manner.

Identified by George S. Everly, Jr., Ph.D. and Jeffrey T. Mitchell, Ph.D. as the harbinger of "A New Era and Standard of Care in Crisis Intervention," Critical Incident Stress Management is representative of the fruit of the renaissance of crisis intervention now sweeping throughout municipalities, corporations, and schools. Federal and state level governments as well as numerous agencies such as the National Transportation Agency (NTSB), the Federal Emergency Management Agency (FEMA), the American Red Cross, and non-profit providers such as the National Organization of Victims Assistance (NOVA) have all significantly expanded their roles in the delivery of post-trauma psychological care.

Coinciding and, in some ways driving these advancements in post-trauma psychological care has been a decade of unprecedented media exposure to enormous loss and human suffering secondary to natural and man-made disasters. This heightened awareness and sensitivity to the needs of those caught in the grips of traumatic events has also served to advance new federal laws, recommendations, and recent court rulings calling for higher levels of accountability and standards for attending to the emotional needs of trauma victims.

Firm and unrelenting appeal to the U.S. Congress by family members voicing outrage at public hearings over the insensitivity and mishandling of the response by airlines following disasters such as USAir flight 427 in Pittsburgh, and ValuJet resulted in sweeping changes with regard to how the National Transportation Safety Board, the American Red Cross and airline companies respond to victims of disaster. The new protocols, appearing in The Aviation Disaster Family Assistance Act of 1996 clearly establishes the NTSB as the agency in charge of managing airline disaster sites and expands the role of the American Red Cross to "provide for the emotional well being of the families of survivors and those whose lives are lost in an aviation disaster." Moreover, airline companies must now comply with a long list of "assurances" under the Act to ensure proper response to family members including prompt notification and the provision of crisis care services as needed.

Likewise, family members and loved ones of many of those victimized by the 18,000 workplace assaults and 20 homicides occurring in the U.S. workplace every week, as reported by the National Institute for Occupational Safety and Health in its June 1996 report on Violence in the Workplace, have also played an important role in how organizations respond to traumatic incidents. After two years of review and input by victim advocates and industry leaders, the U.S. Department of Labor and the Occupational Safety and Health Administration published in April of 1998 its Recommendations for Violence Prevention Programs in Late-Night Retail Establishment (OSHA 3153). These recommendations serve to guide employers in the development of violence prevention plans, advises employers to "arrange appropriate treatment for victimized employees," and identifies Critical Incident Stress Management as an "emerging trend" in interventions used to reduce psychological trauma and stress among victims and witnesses.

Striving to meet the needs of the nations 38 million crime victims, the U.S. Department of Justice, Office for Victims of Crime released New Directions from the Field: Victims Rights and Services for the 21st Century. This compilation of more than 250 recommendations produced through the input of over 1,000 individuals from different professions includes the recommendation that "federal and state laws should be amended to ensure that the government covers mental health counseling costs for crime victims."

Where state statutes cease, the employers responsibility increases. The Ohio Supreme Court recently ruled in Bunger vs. Lawson Co. that - in the absence of a workers compensation remedy - a convenience store clerk may sue her employer for negligence for alleged psychological injuries she suffered after a gunman robbed the store where she worked.

All told, these rulings, recommendations and laws have served to set a tone of sensitivity and accountability for addressing the needs of those victimized by traumatic events. Where employers and insurers once viewed post-trauma psychological care as an unnecessary and costly "therapy" that could in fact imply liability, today, those who practice proactive risk management and ethical leadership immediately acknowledge traumatic events and take responsibility for providing an immediate response to the psychological needs of those exposed to traumatic events. In fact, the crisis management communications, medical management and post-trauma crisis intervention that follow most traumatic incidents may now be most effectively delivered in the context of a single yet essential and comprehensive risk management tool referred to as "crisis care management." Today, federal and state agencies, school districts, municipalities employers, EAP providers, third party (claims) administrators, and insurers increasingly look to professionals trained in post-trauma psychological care to meet the needs of those exposed to traumatic incidents and to assist in the delivery of crisis care management services.

Now more than ever, those charged with the responsibility of answering the call to provide care for victims of trauma look to the Academy for the leadership, vision, and professional standards that will guide the advancement of care provided by those who regularly work with survivors of trauma.

©1999 by The American Academy of Experts in Traumatic Stress, Inc.