What about the emotional wellbeing of staff and patients? Planning for major incidents

The threat of major incidents has increased anxiety among young people and emergency care health professionals. In this blog, we discuss the impact of major incidents on mental health and outline how health professionals can make sure they are prepared.

The perceived threat of terror attacks in recent years has been felt across the nation, and sadly the need for robust major incident planning has become all too apparent. Professionals recounting their experiences of last year's attacks in London and Manchester are, rightly, a common feature on conference agendas, spreading what they have learnt while putting their plans into practice.

There are common themes to many of the stories shared from these attacks: "this worked..", "that didn't...", "we've made changes to this...". The usefulness of WhatsApp has featured heavily as has discussion of the mental health of patients and health professionals.

National guidance provides a framework for the biopsychosocial and mental health care of people affected by major incidents. But this blog asks what preparation is made to consider the emotional health needs of staff and patients involved in major incidents and what impact social media brings to the management and ongoing arrangements that are required.

"Last year there were loads of terrorist attacks, no one knew what to do and still got hurt"

RCPCH &Us Voice Bank 2018

Supporting emotional wellbeing in the long term

On the London Bridge terror attack, health professionals reflected that the mental health burden as a result of the incidents manifested several months after the event itself. Initially people kept going, but as the whirlwind died down something had to give. It wasn't only those directly involved who were affected; those that hadn't been present on the night also suffered. They had treated the patients, had met the families, but they also had a sense of 'missing out'.

Trusts and Health Boards should have plans in place to care for their staff and support their mental health for the long term in the aftermath of an attack.

While the main purpose of a major incident plan is to lay out what is required to coordinate a response to a critical or major incident, often there is little mention of the provision of emotional support services to care for the people involved in and around major incidents.

On 22 May 2017, a suicide bomber killed 23 people and injured 139 others as they left an Ariana Grande concert at the Manchester Arena. Over half the victims were young people, the majority girls between the ages of eight and 20 years. That night in the Royal Manchester Children's Hospital, a decision was made to bring in the on-call CAMHS doctors. This was not part of the major incident plan at the time; it now is. They spent the night supporting patients and their families.

"Emergency services should ask young people for their opinion about a major incident when you are planning"

RCPCH &Us Voice Bank 2018

Involving children and young people

We know from engaging with the RCPCH &Us network that the Manchester area attack triggered a rippled anxiety in children and young people across the UK. Children and young people are unique in that they have specific vulnerabilities and physiological, psychological and developmental needs that differ to adults.

They want to be involved, and including young people in planning and training exercises will ensure their needs are thought about at an early stage. This will in turn enhance preparedness and improve responses to major incidents.

Their input should be valued and informed by collecting qualitative and quantitative feedback in their own right. Children should be specifically considered at both strategic and operational planning for preparing and responding to major incidents.

Using social media

Social media can be a minefield. Central and North West London NHS Foundation Trust has developed useful guidance on dealing with press and social media after a major incident. It is an individual choice about what to share on personal social media accounts, but you should always be aware of the potential ramifications.

As the guidance says, be self-aware, be realistic and be professional. Major incidents will be particularly traumatic for young people, and engaging with social media can often keep the young person in the trauma or stir up bad memories.

Key points for health professionals

  • Read your institution's major incident plan, and ensure children are included.
  • Practise the major incident plan with clinical, non-clinical staff and involve young people.
  • Command, control and communicate are essential components of management.
  • Consider how your department would manage ongoing care of mass casualties.
  • Staff will require physical, social and psychological support during and after a major incident1.

Further help and information

The Intercollegiate Committee for Standards for Children and Young People in Emergency Care Settings have developed standards and guidance on major incident planning for children's health services.

Please get in touch with the Policy Lead for more information.

  • 1. Johnson C., Cosgrove, J.F. Hospital response to a major incident: Initial considerations and longer term effects. BJA Education 2016; 16(10): 329-333.