Report: CS-HR-04-2017, Attachment 4 Haldimand County: Emergency Services Post-Traumatic Stress Disorder Prevention Plan The Corporation of Haldimand County 45 Munsee Street North Cayuga, Ontario N0A 1E0 Date Prepared: March 24, 2017 Prepared By: Lianne Park Deputy Chief, Paramedic Services Haldimand County Mike Pittaway Coordinator, Fire Training/Health and Safety Haldimand County Katie Meyer Coordinator, Health and Safety Haldimand County
Contents Introduction...3 Scope and Application...3 Goals and Objectives...3 Focus Areas...3 1. Prevention...3 2. Intervention...4 3. Recovery and Return to Work...4 Legal Considerations...4 Awareness: What is Post-Traumatic Stress Disorder?...5 Known Risk Factors...5 Signs and Symptoms...6 1. Intrusive Memories...6 2. Avoidance...6 3. Hyper-arousal Symptoms...7 PTSD Plan - Roles and Responsibilities...8 Senior Management shall:...8 Managers and Supervisors shall:...8 Employee s shall:...9 Human Resources Division shall:...9 Joint Health and Safety Committee shall:...9 Notification and Response to Psychological Injury... 10 Early Intervention Strategies Following a Traumatic Event... 10 Responding to Signs and Symptoms of PTSD... 10 Reporting An Incident... 11 PTSD Claim (Workplace Injury)... 11 Haldimand County Anti Stigma Practices... 12 Education and Awareness... 13 Post-Traumatic Stress Disorder and Anti-Stigma Training... 13 Post Exposure Education and Awareness... 13 Initial Training Roll-Out Plans... 13 (a) Firefighter:... 13 (b) Paramedic:... 13 (c) Management:... 14 Additional Resources for Employees and Supervisors... 15 Employee Assistance Program (EAP)... 15 Volunteer Firemen s Insurance Service (VFIS)... 15 References... 15 Page 2
Introduction The Corporation of Haldimand County is committed to addressing Post Traumatic Stress Disorder (PTSD) in our workplace. This plan outlines a hands on and holistic approach to addressing PTSD and the focus of this plan is to establish foundational elements based on the prevention, intervention and recovery through return to work policies and practices. Scope and Application This program applies to all Haldimand County first responders who are exposed to emergencies and traumatic events, that are in some way connected to work, including off-site meetings, training and day to day operations. First responders are currently employed in Haldimand County s Emergency Services Division, being both Haldimand County Fire Department and Haldimand County Paramedic Services. Goals and Objectives The goal of the plan is to provide all employees information on the initiatives and programs undertaken to address PTSD prevention, intervention and recovery and return to work in the County s services. The specific objectives of the PTSD plan are to: Define the legal requirements in addressing PTSD under the Occupational Health and Safety Act. Explain how to identify and respond to PTSD injuries. Establish roles and responsibilities within the organization. Establish policies and procedures to support PTSD prevention in the organization. State crisis intervention expectations and screening protocols. Outline the organization s intervention practices and procedures, ensuring that supervisors and managers understand the intervention options that are available. Review the organization s duty to accommodate as it relates to PTSD injuries, recovery and return to work. Focus Areas 1. Prevention Prevention focuses on outlining the basic elements of health and safety management. These elements include understanding legal responsibilities, recognizing, assessing and Page 3
controlling the hazard, defining roles and responsibilities and incident reporting for Haldimand County Emergency Services. The goal is to integrate PTSD prevention practices for the promotion of a healthy and safe workplace that actively works to prevent harm to a workers mental health. 2. Intervention Intervention focuses on actions that can be taken to improve a situation. This includes ensuring that workers know how to report psychological injuries, when they occur, and are supported in doing so. It also identifies intervention options that are evidence based and that can be utilized in organizations effectively. 3. Recovery and Return to Work Recovery and Return to Work ensures that managers understand how to accommodate a worker who is suffering from PTSD and that there are clearly established roles and responsibilities for supporting workers through this process. Recovery and return to work is an important aspect of preventing future or further injury. Haldimand County is committed to working with the parties to ensure an appropriate accommodation/return work plan is completed which measures: Cognitive Demands Analysis (CDA) documentation. Cognitive Abilities Form for assessing abilities/restrictions. County-wide accommodation practices. Good working relationship with unions and employee groups allowing accommodation opportunities outside of the emergency responder role, if and when required. Legal Considerations Haldimand County understands its legal requirement under the Occupational Health and Safety Act (the Act ), to take every precaution reasonable in the circumstances for the protection of a worker [Section 25(2)(h)]. Employers are required to inform all workers about psychological hazards on the job and provide training to employees on how to prevent these hazards. Accordingly, this plan has been established to inform first responders of the risks of PTSD as well as provide information on the prevention, intervention and recovery initiatives associated with PTSD at Haldimand County. Workers, under the Act, are also required to follow policies and procedures set out by the employer, where applicable. Page 4
Awareness: What is Post-Traumatic Stress Disorder? PTSD can develop when someone experiences, or learns about an event involving actual or threatened death, serious injury or sexual violence. It is believed that PTSD is caused by a complex mix of: Life experiences that include the amount and severity of trauma you have experienced since early childhood. The way the brain regulates the chemicals and hormones the body releases in response to stress. Inherited mental health risks such as increased risk of anxiety or depression and inherited aspects of your personality or temperament. Traumatic Stress resulting from 4 main sources: o Trauma An impact injury: Due to events provoking Terror, horror or helplessness. o Fatigue A wear and tear Injury: Due to the accumulation of stress over time. o Grief A Loss injury: Due to the loss of people who are cared about. o Moral Injury A Loss Injury: Due to a disruption in trust in moral values. Known Risk Factors Having a job that increases your risk of being exposed to traumatic events, such as firefighting or paramedicine. Experiencing intense or long lasting trauma. Feeling helpless, horror or fear. Having experienced other trauma earlier in life, including childhood abuse or neglect. Having a lack of a good support system, such as family and friends. Dealing with additional personal stress. This may include the recent loss of a loved one, loss of job or home, etc. Having biological relatives with mental health problems, including PTSD and depression. The Four Main Categories are: o Historical: adverse childhood (abuse, neglect, violence etc.), family history, exposure to previous trauma. o Biological: Biochemistry, Hormonal. o Psychological: stress, negative distorted thinking patterns, attitudes/beliefs. o Social: lack of social support, recent negative life workplace and relationships. Page 5
PTSD can increase the risk of other mental health problems such as: Depression and anxiety. Issues with drugs and alcohol. Suicidal thoughts or actions. Signs and Symptoms Symptoms may start within 3-months of a traumatic event but can sometimes not appear until years after the event. The symptoms can make it hard for the affected person to live their everyday life and can be accompanied by depression, substance abuse, or other anxiety disorders. Following are three common symptoms associated with PTSD: 1. Intrusive Memories Also called re-experiencing symptoms, intrusive memories can start from the persons own thoughts, or can be triggered by words, objects or situations that are reminders of the traumatic event. This may include: Recurring, unwanted distressing memories of the traumatic event. Reliving the event as if it were happening again. Upsetting dreams about the event. Severe emotional distress (heart racing, hands sweating) to something that reminds you of an event. 2. Avoidance Avoidance symptoms may cause a person to change their routine such as avoiding things that remind them of the event, as well as negative changes in thinking and moods. This may include: Avoiding places, objects, activities or people that remind you of the event. Increased negative feelings about self or others. Feeling emotionally numb or an inability to experience positive or negative emotions. Feeling hopeless about the future. Losing interest in activities that were enjoyable in the past. Difficulty maintaining close relationships. Page 6
3. Hyper-arousal Symptoms These symptoms are changes in emotional reactions that are usually constant, and can make a person feel stressed, angry, overwhelmed and on guard. The symptoms may include: Irritability, feeling tense. Difficulty sleeping. Self- destructive behavior. Being easily startled or frightened Angry outbursts or aggressive behavior. Page 7
PTSD Plan - Roles and Responsibilities Senior Management shall: Become familiar with the impact that PTSD and other occupational stress injures have on first responders and the organization. Ensure that Supervisors of first responders receive training in being able to recognize signs of PTSD, along with risk factors. Supervisor training should also outline and address methodologies and resources to support staff in dealing with injuries attributed to PTSD. Ensure that first responders receive training in strategies for resiliency, mental health behavior and resources. Deal with addressing the situation directly and promptly when made aware or witness the signs and symptoms of PTSD. Ensure consistent and appropriate communication with first responders suffering from PTSD including how they, or other team members, can provide support to the worker. Provide information about the resources and options that first responders have to address PTSD, and help access the supports available as needed. Set the tone and lead by example to reduce stigma by encouraging conversations around PTSD, including prevention, intervention and recovery. Enforce the policies, procedures and plan/program to prevent PTSD. Ensure measures are in place to maintain, evaluate and update the department s programs to prevent and / or effectively address PTSD in Haldimand County. Managers and Supervisors of First Responders shall: Participate in training to be aware and be ready to address the day to day aspects of PTSD prevention, support and management of injuries. Have working knowledge in how to recognize signs and symptoms of PTSD and understand the risk factors. Provide support and resources to first responders, as needed. Identify individuals at risk of PTSD and follow proper protocol for responding to the recognition to signs and symptoms as per the program. Encourage active discussion with workers about mental health and psychological safety. Help identify control methods that support prevention of PTSD. Reduce stigma by participating in positive conversations and awareness initiatives. Ensure familiarity with County procedures and resources to accommodate a first responders suffering from PTSD. Actively participate in safe and coordinated return to work process for workers returning to the workplace following an occupational stress injury. Page 8
Employees shall: Comply with policies, procedures and the program. Participate, as required, in training and education about PTSD, including but not limited to, resilience, anti stigma and mental health training. Report concerns and incidents, as they occur, so that they can be investigated and addressed promptly. Listen to coworkers and encourage engagement in the program and resources, if needed. Reduce stigma by participating in positive conversations regarding psychological safety. Human Resources Division shall: Act as a resource to managers/supervisors and employees with respect to the prevention, intervention and recovery of PTSD. Liaise with managers/supervisors, treating health professionals, and WSIB representatives to assist in the management of an injury and/or coordinate a safe, early and successful return to work. Take steps to prevent further injury/illness for workers returning to work from a psychological injury/illness. Help resolve issues or disputes related to any return to work process. Emergency Services Joint Health and Safety Committee shall: Assist with workplace assessments and participate in identifying controls to reduce occupational stress injuries. Assist in monitoring workplace mental health and wellbeing issues by identifying hazards related to occupational stress and Post Traumatic Stress Disorder. Help identify controls that can be put in place to address psychological health and safety. Help reduce stigma by participating in positive conversations about psychological safety. Page 9
Notification and Response to Psychological Injury Early Intervention Strategies Following a Traumatic Event A worker, co-worker, or dispatcher may identify to the applicable Emergency Services Division Deputy Chief or on call Duty Officer that a particular call may be considered traumatic, thereby potentially exposing the first responder to a traumatic event. Per the Critical Incident Stress Management policy (OP 52), the applicable Deputy Chief or on call Duty Officer will be notified by dispatch when a traumatic incident, based on the following criteria, takes place. In each of these cases, the employee is assumed to have been exposed to a traumatic event: Death of an infant or child. Serious Injury or death of a co-worker, particularly in the line of duty, including suicide. Incidents with extreme personal threat to emergency personnel. Loss of a patient after a prolonged rescue attempt. Incidents where the victim may be known to rescue workers. Mass Casualty Incidents. Incidents that attract unusually strong media attention. Personal identification with the patient or their circumstance. Serious injury or death of an emergency service workers immediate family member. Any incident that has significant emotional power to overwhelm a rescue workers normal coping abilities. Other particularly traumatic incidents Whenever any emergency worker feels CISM services may be required. When workers are exposed to a traumatic event, the on call Duty Officer will provide the worker(s) with support and suggested resources while attempting to determine if the traumatic event has had an effect on the employee such that would cause undue stress potentially leading to PTSD. Responding to Signs and Symptoms of PTSD Managers and Supervisors of first responders are expected to know how to recognize and respond to signs and symptoms of PTSD in a worker or fellow supervisor. If the signs and symptoms are found to be present it is expected that the supervisor will: If not already completed, initiate the completion of the reporting form, making note of any early intervention strategies that have taken place. Initiate and maintain open lines of communications with the worker. Follow up with the worker asking how they or others can provide support. Page 10
Provide information around the ongoing resources available to the worker to identify and manage PTSD. Aid the worker in accessing the appropriate supports and resources (ie. provide EAP, contact information, peer support members). Encourage the worker to talk to someone they trust about what has happened. This could be co-workers identified to provide peer support, family members, friends, and/or a supervisor. Confirm that what the worker is experiencing is a normal reaction. Provide information about the signs and symptoms and when they should speak to a professional or seek additional help. Reporting An Incident All psychological injuries, including PTSD must be reported in accordance with reporting procedures and forms. Following the notification of an injury / illness, reporting may be shared with various parties, as outlined in Haldimand County Accident / Incident Reporting and Investigation Policy (HS-04), the Occupational Health and Safety Act, and in Section 5 of the Industrial Establishment Regulation. Particular importance must be given to 5(2)(j) to include steps to prevent further illness. Based on the specifics and severity of the injury, reports may be provided to the Emergency Services Joint Health and Safety Committee, union representatives and/or provincial representatives such as the Ministry of Labour or Workplace Safety and Insurance Board (WSIB). PTSD Claim (Workplace Injury) When reporting a PTSD claim to the WSIB, the reporting process is completed in the in the same manner as all other injuries or illnesses. For clarity, when an injury or illness occurs, the employer must submit a WSIB Form 7: Report of Injury or Illness, within three days of being notified the worker sought medical attention for a work-related injury (physical and or psychological). Critical Incident, Section 51 and 52 of the Occupational Health and Safety Act defines a Critical Incident and requires notification of a critical injury and occupational illness to the Ministry of Labour, Joint Health & Safety Committee and applicable union. Page 11
Haldimand County Anti Stigma Practices Haldimand County is committed to maintaining a workplace where employees are protected from stigma associated with mental illness. Divisions will ensure that all employees are treated with respect and dignity. This includes those suffering from mental illness and those who support other workers suffering from mental illness. Harassment and acts of discrimination will not be tolerated. Such actions would be in contravention of the Haldimand County Respect in the Workplace Policy (HR01-18). Types of behavior and acts that contribute to stigma include: Prejudicial attitudes and discriminating behavior directed towards individuals. Trivializing or belittling people suffering from PTSD, or PTSD itself. Ostracizing people who are suffering from PTSD, or their friends and supports. To support a Stigma-free workplace, Haldimand County will: Provide PTSD awareness training and education, as required. Provide an effective and fair reporting process. Lead by example. Managers and supervisors are responsible for fostering a stigma-free workplace and setting the example of appropriate behavior. Employees are responsible for treating coworkers with respect in the workplace, bringing forward complaints and cooperating with investigations into complaints, as per the Haldimand County Respect in the Workplace Policy (HR01-18). It is expected that all county employees treat all parties and situations in a sensitive and confidential manner. Page 12
Education and Awareness Post-Traumatic Stress Disorder and Anti-Stigma Training The Haldimand County Emergency Services Division is committed to providing PTSD and anti stigma awareness training to all emergency service workers within our organization. The Divisions will implement and maintain the awareness training program to ensure all first responders are familiar with signs and symptoms of PTSD. All Supervisors of first responders will receive training on how to recognize the signs and symptoms of PTSD and learn the County s expectations on how to respond to and address these signs and symptoms. Post Exposure Education and Awareness Education and awareness is offered to those who have experienced a traumatic event. This education focuses on providing information about signs and symptoms, how to access care and includes regular follow up from affected supervisors. Initial Training Roll-Out Plans (a) Firefighter: In February 2017, all Haldimand County Fire duty officers received the Road to Mental Readiness (R2MR) program. This ensures that there is always a trained R2MR duty officer available 24/7. PTSD awareness training for in station supervisors is scheduled in 2018. The goal is to complete awareness training for all in station supervisors by the end of 2018. Anti Stigma and PTSD Resource awareness will be delivered to all Firefighters in 2017 with continued education and awareness delivered through the quarterly training program, as of 2018, and an awareness campaign including but not limited to posters, brochures, safety talks, bulletins. (b) Paramedic: In March 2017, Haldimand County paramedics delivered the Road to Mental Readiness (R2MR) course to all full time and part time employees. The 4 hour course was delivered during the paramedics quarterly block training. Haldimand County is committed to delivering and Page 13
maintaining the R2MR course in the future to new paramedics, as well as refresher training for the current staff. (c) Management: All management employees in the Emergency Services Division, as well as the Coordinator, Health and Safety are trained in the R2MR course for Supervisors. This ensures that there is access to a trained R2MR supervisor on duty 24/7. Page 14
Additional Resources for Employees and Supervisors Employee Assistance Program (EAP) Haldimand County offers a confidential Employee Assistance Program, as part of the employee s compensation package. This program allows for trained counsellors in trauma to aid employees when dealing with psychological injury. Family Services Employee Assistance Program (519) 587-2441 or 1 800 265-8087 Ext. 239 Volunteer Firemen s Insurance Service (VFIS) Contact Human Resources for more information. References Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association (More information DSM-5) Ministry of Labour Act, Section 9.1(1) Occupational Health and Safety Act (OHSA )Occupational Health & Safety Act (OHSA) Bill 163, Supporting Ontario's First Responders Act Bill 163 Supporting Ontario's First Responders Act (PSD) 2016 Workplace Safety and Insurance Act (WSIA) Workplace Safety & Insurance Act (WSIA) Critical Incident Stress Management Policy (OP52) Reporting and Investigating Employee Accidents and Incidents (HS-04) Page 15