Timing may not actually be everything, but it’s pretty critical when you’re trying to provide effective behavioral health support after a highly traumatic event. Our impulse was to be there for as many team members as possible within the first 24 to 72 hours to help lessen any lasting psychological effects from this MCI. We knew that people would need witnesses for their emotional distress, support for their recovery process and ideas on how to heal. However, the realities of scheduling debriefings for a 24/7/365 workforce with its shift changes, varying work schedules and different levels of need was not a simple process -- at least not in the first few days.
Day 2: We started facilitating “open” debriefings called Team Member and Physician Support Groups for anyone who, regardless of role or department, wanted to connect with others to talk about what happened, to share reactions and to express concerns. Our hospital’s physician coach, who had decades of clinical experience, instantly allied with our team and helped facilitate these debriefings every two hours, around the clock for a 24-hour period of time. As debriefing facilitators, our jobs were to hold the space in which people could talk about how stunned they felt, how angry they felt and how scared they felt in a world where massacres were happening more frequently. We fostered conversation about how to regroup psychologically.
I continued checking in with key department managers to find out how their teams were doing and got responses that fell along a continuum from “Yeah, this really hit us hard and we want to bring you in” to “We’re fine, thanks, this is just what we do.” Really? A hundred people were just shot next to our hospital, half of them died, the other half were in our hospital; we thought there’d been an active shooter inside the hospital; police, FBI, media and family members were crawling all over the place; and helicopters were still hovering overhead. It felt as though the modern understanding that psychological support really can help reduce long-term effects was bumping into the bravado of certain groups. So I knew that I’d have to find another way to offer these particular groups well-deserved support.
Day 3: Our EAP counselors and some of our HR professionals began calling the managers of our behind-the-scenes departments such as telecommunications, patient transporters, patient access and the blood bank to find out how their teams were doing. We also checked in with our other hospitals to identify any critical needs that they might be having, and it eased our minds to know there were chaplains at each site to provide some needed up-close-and-personal care.
Days 3-9: Our debriefing schedule downshifted to four open debriefings a day, including times for those on night shifts, and we began facilitating department-specific debriefings (as opposed to those that could be attended by any team member).
To reach the thousands of team members who didn’t attend debriefings, we sent out corporate-wide messages that acknowledged what had happened and the different ways that this MCI was likely affecting our Orlando Health work family. We offered individual sessions at the EAP and sent out educational materials through our intranet on such topics as 1) normal reactions to a traumatic event, 2) the need for self-care in the healing process and 3) tips for managers on helping their teams after a crisis.
It wasn’t until day 5 that our ORMC ED/Nurses were ready to talk. More than 30 members from this team gathered to discharge wave upon wave of shock, sadness and tears. They got real. For two hours, they told stories about what they’d experienced in the ED that night, they comforted one another, they shared such deep respect for one another, and they even allowed for an occasional wave of laughter to dilute the emotional intensity of the conversation. This team’s willingness to connect so profoundly with one another made for a remarkable, perfect debriefing, and I left in awe that such people existed.
Days 10 – 13: We were still providing 2 debriefings per day, knowing that some folks needed more time before they were ready to talk. Outside counselors, who had been brought in to supplement what our own team could offer, continued to sit in HR offices and classrooms to provide drop-in sessions. They also helped by debriefing outlying areas within our system, and we appreciated their contributions.
We sent out more system-wide messages that addressed Grief and Loss as well as the subject of PTSD which, though not formally diagnosed until three months after a traumatic event, was a topic that we felt team members should understand.
Day 14: By the two-week mark, the statistics that I kept regarding the collective efforts of our EAP, our physician coach and our chaplains showed that we’d provided 44 debriefings and supported nearly 1,200 team members with some form of direct contact (not including individual EAP counseling sessions).
1 Month: We tried offering weekly support groups for those who had been more directly affected by the MCI — perhaps because they’d been regulars at the Pulse nightclub or because they’d lost someone dear to them, but by this time people really just wanted individual sessions.
6 Months and One Year: On these anniversary dates, we sent out EAP messages reminding people that we were there for them should the dates trigger emotions that were related to June 12, 2016.
The first few days following the trauma, I partnered with EAP to provide open debriefings. Knowing that most physicians would not be comfortable in a group setting, I walked the ICU, ED and other locations to “randomly” meet physicians. This allowed for spontaneous conversation and an acknowledgment of what they had just experienced. My overriding question was, How do I minimize the likelihood of PTSD for the physicians and the residents? The six senior emergency medicine residents had all been working the night of June 12. This group was especially vulnerable due to limited experience. My direct communication with the heads of trauma, emergency medicine, surgery and graduate medical education served two purposes. It enabled coordination of individual and group debriefings, and allowed the physician to share his/her own response to the trauma in a confidential and informal setting. I brought each group together to debrief and just be together over the next six days. The initial small group was on day three. The physicians and residents were reticent to share. It was too soon. The physicians were coming off adrenalin. I used this information to set the timing of all future debriefings.
Physicians are scientists, they are trained to respond to the needs of others and compartmentalize or deny their own emotional wellbeing. At 7:00 am on day five, every resident from trauma, EM, surgery and ICU were gathered together on the insistence of the department leaders following my recommendation. Physicians from all areas of the hospital were also in attendance. The room filled to almost 80 individuals. The only non-MD present was the CEO of the health system. I had been in continuous contact with him and the COO as plans developed to support all physicians. He felt it important to show support to this most impacted group and to thank them personally. The debriefing was scheduled for one hour, it lasted for two. The session started slowly. The residents were reluctant to speak in front of the attending staff. Those who spoke described what they did, but not how they felt. I needed to take a different tact.
This group was not at all similar to the multitude of team member groups I had been facilitating. Then I asked the questions: What about your families? What about leaving them and putting yourself in harm’s way? How do you think they felt? This line of questioning opened up a flood gate. The head of surgery shared first and then one by one each attending opened up. It was the courage and openness of these leaders that allowed the residents and fellows to begin to share. Themes included shock, fear, anger, frustration and guilt. The physicians were overwhelmed with guilt. I didn’t do enough, I couldn’t save my patient because…, I wasn’t allowed to come in and help, I didn’t call my loved one etc. These feelings of guilt resonated for each physician I met subsequent to the group debriefings. At the conclusion of the gathering, one of the senior trauma surgeons insisted that each resident select a buddy. He charged them with taking care of each other, being available, checking up on each other. I continue to use this model today when working with program directors and chiefs.
As the days and weeks went on, I met with physicians and physicians in training individually, sometimes twice a week. I continued my contact with physician leadership through email, text and phone conversations that lead to continuous referrals. Making my role as coach accessible to all the physicians was important and much less threatening than the hospital providing a therapist or counselor.
The media presence was overwhelming and permeated the entire physical campus. Physicians, fellows and residents were being hounded for comments, details or just to say anything to media outlets. I knew the local and national media attention could become a hindrance to recovery. My continuous recommendation to administration was to not over expose the doctors. The senior leadership responded well to the recommendations. Specific physician leaders were identified as spokes people to interact with the media, and all others were asked to decline comment. As the weeks went on, requests for speaking engagements nationally did not slow down. The concern expressed by some physicians was somehow they might cry or show emotion. This need to “stay strong” allowed some to express to me what they were feeling and this better prepared them for their presentations. I would talk with physician leaders about how to prepare for talks and encouraged them to never go without a “buddy” to support them. This same strategy was shared with administration as they prepared to share lessons learned with other health systems.
On the six-month anniversary of the Pulse tragedy, I partnered with the chief of the medical staff to provide two sessions open to all physicians and team members. It was important that an identified leader of the medical staff share his story. He was not present the night of the Pulse shooting. His theme for the sessions was “we were all there” because those present couldn’t do what they did if the others didn’t do what they did on a daily basis. This theme of selflessness, compassion and unity went a long way in healing our community and mitigating the feelings of guilt.
The one-year anniversary was themed “resilience.” The hospitals held ceremonies and small gatherings. As physician coach, I reached back out to many of the physicians most affected by the events of June 12, 2016. Most were doing well, but some I was still supporting.