Drivers Fitness Clear Vision

Two people should attend to make a notification of unexpected sudden deaths. Normally both of the people attending should be police officers although there are circumstances in which an officer might be accompanied by a member of the clergy, a doctor, a family friend or even a traumatic bereavement support worker.

It can be preferable for a familiar face to be present to offer immediate support, as long as this does not cause any delay.

It is best for at least one of the notifying officers to be of the same gender as the bereaved and generally it is considered that a female/ male combination of officers works best.

If the notifying officers travel in separate vehicles this increases their flexibility after the message has been delivered, for example, one of them could leave to collect a close friend, relative or child to be with the bereaved person.

When a pair of officers attends to notify the bereaved, they should prepare themselves in advance by ensuring that they both know the names of the person who has died and the person who has been bereaved. They should decide in advance who will deliver the message itself.

If the notification team can't find the survivor, they should not tell neighbors or leave notes of the notification on the door. It is suggested that the best course of action is to just leave word for the survivor to contact a specific officer.


The Contact Phase

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  Never send an inexperienced person to deliver a notification of sudden death
  
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  The person who notifies should be someone who is experienced in inter-personal relations (e.g., a clergyperson) or someone who has either received a notification of death at some point or has been a notifying agent at least once.
  
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  The second person in attendance may be a medical examiner, victim services counselor, family doctor, family clergy or a close friend of the survivor.
  
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  Some of the advantages of having two or more people deliver the notification are:
  
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    Gives emotional support for the notification team.
    
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    Allows a representative to remain at the house if the other officer needs to leave.
    
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    Provides the opportunity for an uninterrupted notification.
    
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  Anyone who could be described as a ‘primary bereaved person’, such as a partner, parent or child of the person who has died, should be informed face to face.
  
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  Human presence is an important factor, as there is an immediate need for compassion and support. On learning that a loved one has been killed in an unexpected, violent manner, many people suffer severe traumatic shock reactions and the officer carrying out the notification may be the only person available to offer support.
  
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  Telephonic notification is not an acceptable practice. It is also important that no personal details be passed by insecure radio links – the situation can only be made worse if someone who has been bereaved finds out first from the media or third parties of the loss of their loved one.
  

When do we notify?

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  All ‘primary bereaved’ people should be notified as soon as possible after the event.
  
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  No matter what the time of day or night, there is no benefit in saving the news till a ‘better’ time. There is no good time, full stop and research shows that many bereaved people resent any unnecessary delay in informing them.
  
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  When someone has been critically injured in a crash; prompt notification can be even more important - it might give a loved one the chance to see the injured person in hospital before they die.
  
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  While there should be no unnecessary delay in carrying out a death notification, it is crucial that there is a very high degree of certainty of the identity of the person who has died.
  

The Communication:

The Iowa model states, “Your presence and compassion are the two most important resources you bring to death notification”.

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  Those who notify should clearly identify themselves, present their credentials and ask to come in
  
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  They must relate the message directly and in plain language—survivors are served best by telling them directly what happened
  
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  Survivors should be informed of the death, speaking slowly and carefully giving details that are available – and then calmly answer questions the survivors may have.
  
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  The message should be short and to the point. The bearer should simply say that they have bad news and then tell the survivor(s) that their loved one is dead.
  
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  The simplest of details should be provided – that the person is dead, place of death, brief description of how they died, and where the deceased is located.
  
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  Remember that no matter how well the deliverer of bad news may do his or her job, the survivor will in most cases accept the news with great difficulty.
  
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  The importance of human contact is a paramount need. Treat the bereaved with dignity. Look them in the eye.
  
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  The bereaved will re-live this moment time after time even if they don't seem to be absorbing all the details as you tell them.
  
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  They will remember body attitudes and emotions. Be gentle, sensitive and supportive.
  
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  Try to avoid offering explanations, interpretations, conjecture or passing judgment. Offer to return in a day or two for further sharing of information, feelings, etc.
  
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  If appropriate write down names and telephone numbers of people they are required to contact, include your own name and number and give it to them so that they may get hold of you at a later stage.
  
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  Don't take personally any anger directed at you as the news-breaker.
  

What do we mean by “In Plain Language?”

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  Most people have very little personal contact with the police.
  
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  They will naturally assume the worst if two police officers knock at their door late at night. In such a situation, fear and panic may set in, and they may not be able to focus on what is being said to them.
  
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  The notifying officer must therefore deliver the message straight away and in simple, unequivocal, terms
  
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  The Iowa model calls for the notifying officers to identify themselves, ask to come in and get the person to sit down, confirming that they are the right person. In many cases it is the person who has been bereaved that answers the door.
  
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  They want to know immediately why the police are calling and may not want to wait until they have taken the officers through to the lounge or kitchen and sat down. In such circumstances it may be appropriate just to ask to come in and speak inside, saying that there is urgent news to pass on.
  
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  Once inside, out of view of neighbors or passers-by, the message should be delivered without delay.
  
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  A useful phrase is “I have some very bad news I must tell you”, followed by a direct statement of what has occurred, such as “Your husband has been involved in a car crash and I am sorry to have to tell you that he has died”. It is much more effective to use the words ‘dead’, ‘died’, or ‘killed’’ rather than euphemisms such as “he didn’t make it”, “she was fatally injured”, or “he’s not coming back”.
  
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  Such phrases might seem easier to utter but they are very easily misunderstood by a bereaved person in their initial shock. It will often be necessary to repeat the message or to have to convince a bereaved person that you are telling the truth.
  
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  It is really important to refer to the person who has died by their name rather than as ‘the body’ or ‘the deceased’, which can sound unsympathetic, and the bereaved person will probably find it easier to be told that their loved one will be taken “to the hospital” rather than “the mortuary”.
  
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  It will almost always be appropriate to tell someone who is bereaved “I am sorry that this has happened”.
  
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  Officers should try to react in a supportive way to the emotions of bereaved people and should also cultivate awareness of their own emotions.
  
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  It is not unnatural to feel sympathy for people who have been bereaved, and this may even be expressed by the officer shedding a tear. This is far better than attempting to suppress emotions and appearing cold, callous and uncaring.
  
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  Unless it is clear that the bereaved person and the officer share common beliefs, religion is a topic that is best left alone. Phrases such as “I know what you are going through”, “She wouldn’t have known much about it” or “He had a good innings”, which are uttered in a vain attempt to offer comfort, are not comforting.
  

After the delivery of notification

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  Unless the bereaved person specifically requests it, the officers should never just deliver their message, then leave.
  
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  Officers should allow plenty of time to provide information and support for a bereaved person and should make every effort to find and bring a close friend or relative to them.
  
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  The team can offer to make phone calls for the family or to await additional family members, clergy or friends to be with the family. A time frame should not be attached to the notification process.
  
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  There may be a need for formal identification, but even when there is not, a bereaved person may still want to see the body of the person who has died. They should always be given this option, even when the person who has died has suffered horrific injuries – an officer should never assume that someone will not want to see the body of a loved one, however badly it is damaged.
  
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  In addition to providing transport to the hospital/ mortuary, the officer can also prepare them for seeing the body by making them aware of what to expect in terms of apparent injuries.
  
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  There may be personal items belonging to the person who has died which must be preserved and returned to the ‘primary bereaved’ person/ people.
  
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  These should not be taken with the officers at the time of notification, but can be passed on later, in a caring manner and in an appropriate carrier.
  

Conclusion

The way in which a death notification is delivered and questions that are left unanswered can add several years of additional grief to the survivor’s pain and suffering. It is our duty not to add to this trauma and to follow “good practice” methods when breaking the bad news of sudden death.
Trauma Counseling
Road Safety and Trauma Counseling (Counselling)

Background Information

Trauma can be defined as a bodily and/or mental injury caused by an external agent. When a person encounters a traumatic experience, he/she becomes an injured person that suffers from physical and emotional wounds. The word “Trauma” is derived from the Greek word meaning “wound”.

Most people will experience a trauma at some point in their lives, and as a result, some will experience debilitating symptoms that interfere with daily life. Motor vehicle accidents are considered the leading cause of posttraumatic stress disorder (PTSD) in the general population and car accidents are the number one trauma for men and the second most frequent trauma for women.

Anyone can become traumatized. Even professionals, who work with trauma, or other people close to a traumatized person, can develop symptoms of "vicarious" or "secondary" traumatization.

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Motor vehicle accidents are perhaps the most common trauma experienced by individuals.


What is emotional or psychological trauma?

Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event. When that trauma leads to Post Traumatic Stress Disorder, damage can be measured in physical changes inside the brain and to brain chemistry, which affect the person's ability to cope with stress. A traumatic event involves a single experience, or an enduring or repeating event or events that completely overwhelm the individual's ability to cope or integrate the ideas and emotions involved with that experience. The sense of being overwhelmed can be delayed by weeks or years, as the person struggles to cope with the immediate However, different people will react differently to similar events. One person may perceive an event to be traumatic that another may not, and not all people who experience a traumatic event will become psychologically traumatized.

Regardless of its source, an emotional trauma contains three common elements:

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  it was unexpected
  
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  the person was unprepared
  
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  there was nothing the person could do to prevent it from happening
  

It is not the event that determines whether something is traumatic to someone, but the individual's experience of the event. And it is not predictable how a given person will react to a particular event. For someone who is used to being in control of emotions and events, it may be surprising – even embarrassing – to discover that something like an accident or job loss can be so debilitating.

What is the difference between stress and emotional or psychological trauma?

One way to tell the difference between stress and emotional trauma is by looking at the outcome—how much residual effect an upsetting event is having on our lives, relationships, and overall functioning. Traumatic distress can be distinguished from routine stress by assessing the following:

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  how quickly upset is triggered
  
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  how frequently upset is triggered
  
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  how intensely threatening the source of upset is
  
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  how long upset lasts
  
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  how long it takes to calm down
  

If we can communicate our distress to people who care about us and can respond adequately, and if we return to a state of equilibrium following a stressful event, we are in the realm of stress. If we become frozen in a state of active emotional intensity, we are experiencing an emotional trauma—even though sometimes we may not be consciously aware of the level of distress we are experiencing.

Causes of emotional or psychological trauma:

Our brains are structured into three main parts, long observed in autopsies:

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  the cortex (the outer surface, where higher thinking skills arise; includes the frontal cortex, the most recently evolved portion of the brain)
  
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  the limbic system (the center of the brain, where emotions evolve)
  
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  the brain stem (the reptilian brain that controls basic survival functions)
  

With the development of brain scan technology, scientists can now observe and reveal that trauma actually changes the structure and function of the brain, at the point where the frontal cortex, the emotional brain and the survival brain converge.

What are the symptoms of emotional trauma experiences by accident victims?

It is important to note that developing symptoms is never a sign of weakness. People who go through traumatic experiences often have certain symptoms and problems afterward. How severe these symptoms are depends on the person, the type of trauma involved, and the emotional support they receive from others. Reactions to and symptoms of trauma can be wide and varied, and differ in severity from person to person. A traumatized individual may experience one or several of them. Sometimes these responses can be delayed, for months or even years after the event. Often people do not initially associate their symptoms with the precipitating trauma.

Common personal and behavioral effects of emotional trauma:

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  substance abuse
  
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  compulsive behavior patterns
  
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  self-destructive and impulsive behavior
  
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  uncontrollable reactive thoughts
  
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  inability to make healthy professional or lifestyle choices
  
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  dissociative symptoms ("splitting off" parts of the self)
  
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  feelings of ineffectiveness, shame, despair, hopelessness
  
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  feeling permanently damaged
  
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  a loss of previously sustained beliefs
  

Common effects of emotional trauma on interpersonal relationships:

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  inability to maintain close relationships or choose appropriate friends and mates
  
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  sexual problems
  
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  hostility
  
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  arguments with family members, employers or co-workers
  
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  social withdrawal
  
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  feeling constantly threatened
  

Additional Symptoms Associated with a Severe Precipitating Event

Symptom Characteristics

Re-experiencing the trauma

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  intrusive thoughts
  
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  flashbacks or nightmares
  
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  sudden floods of emotions or images related to the traumatic event
  

Emotional numbing and avoidance

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  amnesia
  
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  avoidance of situations that resemble the initial event
  
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  detachment
  
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  depression
  
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  guilt feelings
  
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  grief reactions
  
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  an altered sense of time
  

Increased arousal

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  hyper-vigilance, jumpiness, an extreme sense of being "on guard"
  
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  overreactions, including sudden unprovoked anger
  
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  general anxiety
  
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  insomnia
  
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  obsessions with death
  

Describing possible symptoms:

After a traumatic experience, a person may re-experience the trauma mentally and physically, hence avoiding trauma reminders, as this can be uncomfortable and even painful. They may turn to alcohol and/or drugs to try and escape the feelings. Re-experiencing symptoms are a sign that the body and mind are actively struggling to cope with the traumatic experience. Emotional triggers and cues act as reminders of the trauma, and can cause anxiety and other associated emotions. Often the person can be completely unaware of what these triggers are.

In many cases this may lead a person suffering from traumatic disorders to engage in disruptive or self-destructive coping mechanisms, often without being fully aware of the nature or causes of their own actions. Consequently, intense feelings of anger may surface frequently, sometimes in very inappropriate or unexpected situations, as danger may always seem to be present. Upsetting memories such as images, thoughts, or flashbacks may haunt the person, and nightmares may be frequent. Insomnia may occur as lurking fears and insecurity keep the person vigilant and on the lookout for danger, both day and night.

In time, emotional exhaustion may set in, leading to distraction, and clear thinking may be difficult or impossible. Emotional detachment, also known as dissociation or "numbing out", can frequently occur. Dissociating from the painful emotion includes numbing all emotion, and the person may seem emotionally flat, preoccupied or distant. The person can become confused in ordinary situations and have memory problems.

Some traumatized people may feel permanently damaged when trauma symptoms don't go away and they don't believe their situation will improve. This can lead to feelings of despair, loss of self-esteem, and frequently depression. If important aspects of the person's self and world understanding have been violated, the person may call their own identity into question.

These symptoms can lead to stress or anxiety disorders, or even post traumatic stress disorder, where the person experiences flashbacks and re-experiences the emotion of the trauma as if it is actually happening.

Coping with Trauma and Emotional Stress / Treatment

Why can an event cause an emotionally traumatic response in one person and not in another? There is no clear answer to this question, but it is likely that one or more of these factors are involved:

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  the severity of the event
  
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  the individual's personal history (which may not even be recalled)
  
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  the larger meaning the event represents for the individual (which may not be immediately evident)
  
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  coping skills, values and beliefs held by the individual (some of which may have never been identified)
  
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  the reactions and support from family, friends, and/or professionals
  

What if symptoms don't go away, or appear at a later time?

Over time, even without professional treatment, symptoms of an emotional trauma generally subside, and normal daily functioning gradually returns. However, even after time has passed, sometimes the symptoms don't go away. Or they may appear to be gone, but surface again in another stressful situation. When a person's daily life functioning or life choices continue to be affected, a post-traumatic stress disorder may be the problem, requiring professional assistance.

The good news is that psychological interventions are effective in preventing many long-term effects.

Traditional approaches to treating emotional trauma include:

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  talk therapies (working out the feelings associated with the trauma)