When Ambulance paramedics attend a traumatic event, their patients health is their highest priority. However the wellbeing of those that may have witnessed or been involved in the traumatic event is also a concern. The introduction of a support brochure for people who had been witness to, been involved in, or who knew someone affected by a traumatic event provides support and guidance to those people that have been affected.

Develop a resource for paramedics to hand out to members of the community who had been involved in or witness to a traumatic event.

Paramedics, chaplains and Ambulance volunteers are regularly asked by the community for support phone numbers following a traumatic event. While a support service for Ambulance staff is widely promoted, access to support programs for the community was not widely promoted.

It was felt that providing Ambulance paramedics with a support brochure for distribution to members of the community, who were witness to, were involved in or knew someone involved in a traumatic event would be the most appropriate means of communication.

Research on available health related literature identified that although a number of resources were available to support people who had suffered trauma, stress or bereavement no such brochure was available for people who had been witness to a traumatic event.

It was for this reason that Ambulance felt it was not only necessary to recognise the significant effect witnessing a traumatic event can have on a person but also offer some guidance on how to access support while being mindful of not delaying Ambulance resources to attend medical emergencies.

Following consultation with Ambulance Clinical Development it was agreed that the support brochure should outline possible signs and symptoms that could occur from experiencing a traumatic event as well as give several 24 hour contact numbers of community support groups.

It was identified that the resource had to:

• provide signs and symptoms to recognise and acknowledge the possible effects of being a witness to a traumatic event;
• acknowledging both physical or psychological effects of being attached to a traumatic event and why they effect people differently;
• educate on the possible outcomes of being a witness to an event;
• provide advice on how to offer support to someone who may have been involved in or witnessed a traumatic event;
• provide answers to frequently asked questions;
• supply a comprehensive list of agencies able to supply counselling; and
• provide people access to appropriate 24 hour support phone numbers.

The NSW Health strategic plan highlights the need to create better experiences for people using public health services by making sure services are of high quality, appropriate, and available when and where needed. The trauma support brochure specifically addresses the need for 24 hour appropriate resources being made available to people who had been witness to, been involved in, or who knew someone affected by a traumatic event. The use of the brochure ensures patients receive appropriate treatment and follow up consultation if required therefore creating a positive and very appropriate experience.

To ensure the successful design and implementation of the support brochure Ambulance paramedics, with a focus on staff who had worked in mental health, Ambulance peer support officers and counseling agencies were consulted on content and a short list of important points developed.

It was apparent that great value needed to be placed on the understanding of people of the different reactions they may experience and that these reactions may not only be as a result of their direct involvement. It was important to recognise and give examples of the feelings that may be felt to allow people to accept and deal with these feelings appropriately. It was also important to recognise how feelings and emotions can manifest into physical complaints and again how these should be recognised, accepted and dealt with.

Using these identified areas a support brochure was developed providing a clear explanation of what it might mean to be a witness to or be involved in a traumatic event as well as listing common physical effects people may experience as a result of triggered emotions.

Obviously understanding the effects of traumatic incidences was important but wouldn’t be enough to meet our identified need. We needed to address the fundamental issue of how to help people once the need for help had been identified. Several key counselling agencies were contacted to develop a concise list of contacts who would be available to members of the public following a variety of incidents including car accidents, assaults and general abuse, rape and death. These companies had to not only show an expertise in certain areas but also be available for consultation 24 hours a day, every day of the week.

Once the text for the document was finalised an appropriate layout was provided, Ambulance opted for a simple DL, 3 x panel brochure. The size was chosen as it was determined that a large brochure could be daunting and people were less likely to read the information if it was presented in such a way.

All operational vehicles were stocked with the brochure so it could be easily accessed and offered at the scene of an incident. The brochure is also available for download on the Ambulance website and staff intranet.

The initial role out involved distribution to all Ambulance stations and sector offices. Once it was determined that the brochure was in fact a useful and widely used resource it was added to the Ambulance general stores list allowing stations to reorder on an as needs basis.

Evaluation of the brochure was measured in two ways. Firstly feedback was sought from paramedics who had used the brochure and their reactions. A clear example of the kind of feedback received can be seen in the following quotation taken from an email which was sent by a paramedic of 13 years.

Tragically during the role out of the brochure an incident occurred at a major car racing event at Mount Panorama, Bathurst where a driver was killed. As this was a popular event almost everyone in the audience had witnessed this tragedy unfold. Ambulance paramedics on scene reported that they had been able to navigate their way through the crowd handing out the brochures to everyone at the event. Their ability to do this meant they were able to offer support to thousands of people which would have otherwise been impossible. Feedback from the crowd following the event was most positive with paramedics advising people were grateful for the offer of understanding and support.

The second way of evaluation was to monitor stock levels and reordering by various ambulance stations across NSW. After the initial role out it was determined that the resource was being utilised so much it needed to be added to the Ambulance general stores list in order for stations to restock more easily.

In order to ensure continued utilisation of the brochure an internal bulletin was sent to all staff informing them of reordering procedures as well as information on its appropriate use. The brochure is also available on the staff intranet should they wish to download it.

The successful implementation of this brochure in NSW allows for it to be introduced across all Ambulance agencies throughout Australia, New Zealand and Papua New Guinea. The NSW brochure can be used as a template and adapted easily to focus on specific events in different geographical and socioeconomic areas.

Further implementation throughout other emergency services may also be possible as all three agencies deal with a range of incidents warranting the offer of such support.

A/Project Director Advanced Care, Service Development & Planning
Ambulance Service of NSW
State Headquarters, Balmain Rd, Rozelle NSW 2039
Phone: 02 9779 3801