ACCIDENTS

Definition
By accidents, we mean incidents that do not match the definition for transport accidents, large catastrophes and natural disasters. This plan includes (single) incidents that are potentially traumatic or which causes fatalities or light or severe physical injuries, like fall damage, traffic accidents, fire and near drowning-accidents.

1. Mobilisation phase

Objectives: Get an overview of and make contact with everyone in need of psychosocial follow-up after an accident, and begin adequate assistance as soon as possible.
Measures: The objectives are gained through clearly written routines on how to carry out notification and referral, and determining target groups for support measures and criteria for follow-up.

Notification:
•Requires updating the names and phone numbers of the individuals responsible for the starting point of the notification procedures.
•The first service (hospital, GP, the casualty, police) to come in with the victim and possible next-of-kin informs about the crisis team's services and asks if they would like to notify the crisis team.
•The crisis team is notified.
•The crisis team determines who the responsible for follow-up is, and that person contacts the affected to determine their follow-up needs.

Target group and criteria for follow-up:
•People involved in an accident that might be traumatising due to potential or actual serious injury or fatality. Note that one might develop serious psychosocial problems even though one is unharmed or just lightly injured. This plan does not target people who have suffered serious injuries (hospitalisation for more than one week), because they will receive treatment at the hospital and will be offered psychosocial follow-up there. However, they might be targeted by this plan after discharge, often in cooperation with specialist health care.
•Next-of-kin to persons who have died or been seriously injured in the accident.
•People who might have caused the accident.

2. The emergency phase

Objectives: Calm down and reduce the perceived loss of control by reducing stress, aid in controlling acute reactions and provide an overview of what happened.
Measures: The objectives are gained through clearly written routines for which measures are to be carried out, for example emotional first aid, care, information and counselling (see Measures). 

Coordination and responsibilities (suggestions):
Whoever is responsible for follow-up is also responsible for coordinating the crisis team's services with other services, for example coordinating the crisis team's services with follow-up of the injured and next-of-kin that has been initiated at the hospital – the goal being to make sure patients are followed up even after they return home.

Work form:
•Directly, through conversations to survey needs, reviewing the course of events, and support talks (see Measures).
•Indirectly, through advice and counselling given to the casualty, police, schools and workplaces about adapting to the needs of victims and next-of-kin.

Measures for directly affected and next-of-kin (suggestions):
•Ensure emotional first aid through care, protection and information (see Measures).
•Systematic review of the course of events with the involved parties. This might be modelled after debriefing or defusing (see Measures), and might be carried out individually or in groups, for example a family. Information is given about common reactions after traumatic incidents and how to dampen these (see www.krisepsyk.no / Theme Pages – Self-help methods). It is important not to encourage talking about the emotional aspects of the incident the same day as it occurred, because this can reinforce the memories of the incident. For the same reason, sleeping within the first six hours after the incident should be avoided.

Atle Dyregrov has described various self-help methods in a series of videos:
•    How to handle recurring visual memories
•    How to handle other persistent memories
•    How to handle bothersome thoughts
•    How to handle persistent feelings of guilt
•    How to handle a restless body

•Assessing the needs for referral to specialist health care, and assessing the needs for follow-up (see Mapping).
•If children are involved in the accident: Informing parents about children's reactions and needs after accidents (www.krisepsyk.no / Theme Pages – Help when one has been involved in an accident), or a person from the crisis team may, in cooperation with the parents, begin helping following this plan.
•If the accident has caused fatalities:
•Offer to accompany next-of-kin to the hospital to see the deceased and get information.
•Mobilise support from social networks, for example help them contact family and friends.
•Advice on how to carry out a wake and a funeral.
•Assess the needs for practical help with demanding caretaking duties.
•Counselling about children as next-of-kin, children and rituals (see Rituals and www.krisepsyk.no / Theme pages – Grieving children).
•Help with informing the child about what has happened. (For further suggestions about relevant measures, see Suicide, Child fatalities and www.krisepsyk.no.)

Measures for network (suggestions):
•Measures for friends of the injured. If young people have suffered serious injuries, for example in a traffic accident, far more people than the immediate family might be affected. Groups of youngsters seldom seek help for themselves, and may struggle with many negative reactions to the incident (see Kids/Youngsters). When working with groups of friends, it is important to cooperate with next-of-kin and the injured themselves, if possible. Relevant measures include:
•Review the course of events, normalise reactions and self-help methods, and identify youngsters in need of closer follow-up.
•Information about the injury and invitation to hospital visit (if approved by the injured and their family). Many young people would like to support friends who need it, but they may be unsure of how to do it and may benefit from getting help with crossing that first threshold. Of course, this will vary greatly from one youth environment to another.
•Offer information to the school and the workplace (in accordance with the sick and the next of kin) to reduce the spreading of rumours and reduce anxiety (see Resources/cooperation).
•In case of fatalities:
•Advice about how to carry out rituals (see Rituals), for example organisation of visits to the scene of the accident (if the youngsters have not already done this themselves).
•Help seeking out next-of-kin of the deceased.
•Prepare them for the memorial service and funeral.

Measures for schools and nurseries (suggestions):
Measures should be coordinated with the school's or nursery's own plans for crises and fatalities and may include:
•Information to class or nursery group (in cooperation with next-of-kin).
•Carrying out rituals to commemorate the deceased (see Rituals and www.krisepsyk.no / Theme pages – Grieving children).
•Prepare them for participation in the funeral.
•Activities in class rooms and nurseries to let the children express thoughts and loss, for example through drawing, group talks or making something together for the family of the deceased.
•Assess the needs for adapted teaching and exemption from examinations for next-of-kin children.

Time frames and transfer to further follow-up:
•The emergency phase is defined as the first week after the incident.
•Transfer to further follow-up if considered necessary. Some measures following the emergency phase may already have been planned, like debriefing, support talks and information meetings.

3. Further follow-up

Objectives: Follow-up the affected and help them resume everyday life. Prevent the development of any traumatic experiences into psychological long-term injuries.
Measures: Objectives are achieved through clearly written routines for regular follow-up and assessment of further needs for support.

Coordination and responsibilities (suggestions):
Psychiatric nurse, community nurse (if children are involved), municipal psychologist, clergy.

Methods:
•Directly, through support talks and assessment of the needs of further referral.
•Indirectly, through advice and guidance.

Measures for directly affected and next-of-kin (suggestions):
•Support talks started by psychologists or psychiatric nurses should be continued. If the accident has caused injuries that results in loss of function, the family should be followed up with support talks focusing on:
•How the accident and possible fatalities may influence their lives together.
•How to handle everyday life.
•Mourning and reactions to the loss, changes in life prospects (one's life didn't turn out as expected).
•Further needs of practical help and relief.
•How the family functions in the new situation.
•Children's and siblings' reactions.
•In case of fatalities: Questions about the post-mortem report.
•How to deal with red-letter days and reminders.
•Mapping/screening of complicated mourning, PTSD, anxiety and depression in case of worrying symptoms. Assessing the need of referral to specialist health care (see Mapping).
•Assessing the need for extended sick note.
•For next-of-kin kids/youngsters after serious accidents, rumours and invasive questions about the injured may be troublesome and taxing. It may be necessary to help them handle this, and to help the school give this information instead so that some of the burden is lifted from the young next-of-kin.
•When young people are seriously injured: Following up friend groups and mobilise their network to make and keep contact with the injured child/youngster.
•When young people are seriously injured or deceased: Follow-up meeting for friends focusing on carrying on with life, how to support the family if desired, how to handle their own reactions, criteria for seeking further help and identify youngsters in need of further follow-up (see Children/Youngsters and Mapping).

Duration of measures:
Depends upon the consequences of the incident.
•In case the accident hasn't caused permanent, serious injuries, follow-up should continue as long as the symptoms are bothersome, and should end when the affected feel they can handle the symptoms on their own. If no improvement has happened after 1–3 months, referral to further follow-up should be considered.
•If the accident has caused serious injuries, loss of function or fatalities, the family should be followed up the first year after the accident or the dischargement of the injured. Follow-up beyond the first year may also be necessary. In case someone has suffered severe loss of function, a municipal responsibility group may have been established upon discharge or transfer to rehabilitation services. When planning further psychosocial follow-up measures, cooperation between this group and the crisis team is important.