Cognitive-Behavioral Therapy (CBT) involves changing one's thoughts and actions, and includes systematic desensitization to reduce reactivity to a traumatic stressor
relaxation/stress reduction techniques, such as biofeedback and breathwork
hypnosis to deal with reactions often below the level of conscious awareness
An Intervention and Support Strategy could include the following:
Critical Incident Stress Management
Follow-up support and counseling
Assessment and referrals for therapy
Advice for Helpers of Road Accident Victims
Trauma Counseling is something best left in the hands of well-trained and experienced professionals. It is however important that we reflect on the “Human Needs Hierarchy” developed by Abraham Maslow, and consider the responses by “Helpers” to meet these needs. This will help us to better understand accident victims and to act responsibly around these victims and survivors.
Level One – Physical Survival
The immediate need for survivors is to survive the disaster.
Helpers have to:
plan, prepare and practice emergency response in advance
pre-arrange notification of families in the event of disaster
The accident victim has the need to feel safe
Helpers have to:
create a safe environment and empower survivors
prevent re-victimization of survivors
Level Three – Affiliation
Accident victims have a need to feel connected with others
Helpers have to:
assist survivors in connection with people of their choice
connecting these survivors with family, friends, personal health care professionals or spiritual leaders
Level Four – Self Esteem
Accident victims have a need to feel validated
Helpers have to:
confirm the self-worth of survivors by validating them and by showing respect for the survivors’ losses.
Level Five – Transcendence
Accident victims need to transcend trauma – a process whereby a commitment is made to become conscious of one’s life and its impact on the universe. It has been said that we never get over the loss of anything that becomes part of us.
Helpers can:
help to find meaning and a place for the loss in the lives of accident victims – which is a more reasonable goal!
A Warning: Dangers of Debriefing
Before rushing in like a “disaster vulture”, it is important to consider a warning:
Following traumatic events, persons involved are often asked to talk about the events soon after, sometimes even immediately after the event occurred in order to start a healing process. This practice may not garner the positive results needed to recover psychologically from a traumatic event. Victims of traumatic occurrences who were debriefed immediately after the event in general do fare better than others who received therapy at a later time.
How can debriefings make things worse?
1 -Venting emotions and reviewing experiences repeatedly in the immediate aftermath of a crisis can interfere with victims' natural adaptive instinct to distance themselves emotionally. They may start ruminating about the event--fixating on why it happened, how life is now ruined, whether revenge is possible--thus intensifying intrusive memories and overall distress.
2- Debriefing might lead people to believe that they have now received "treatment" for distress and no longer need to, or should, disclose their anxieties to family and friends. This deprives victims of the comfort and reassurance that are usually best supplied through established, intimate relationships. Paradoxically, knowing that professional debriefers are involved may even cause family and friends to hang back.
3 -By warning participants of the kinds of reactions that could develop over the coming weeks, debriefers might inadvertently prime victims to interpret otherwise normal reactions as pathological or as the beginning stages of PTSD. As the psychiatrist Simon Wessely has remarked, "The toxic effect of counseling is that some people begin to see themselves as having a mental health problem when they do not."
Conclusion:
Much attention, effort and funding have been focused on creating awareness of road safety. It is also important that we do not neglect the injured victims, survivors and the professionals who have to deal with trauma every day. The Arrive Alive Road Safety website will commit towards providing information on trauma counseling to increase awareness of this important aspect of road safety.
Tow truck operators provide a valuable service to the motoring public. They are quite often the first to arrive at the scene of an accident and have been known on many occasions to provide assistance and/or first aid to disorientated or injured accident victims. In addition to this they are quite often seen directing traffic and working with the authorities to clear the accident scene as quickly as possible to avoid further accidents and to restore normal traffic flow.
Risks and Regulating the Industry
Unfortunately there are also unscrupulous operators who are not acting within the confines of reasonableness and the public has a right to be protected against these operators. The malpractices include:
Bribing corrupt police officers to ensure they are first at the scene of an accident.
Offering free cell phones to police officers as an incentive to phone them prior to reporting an accident. [These corrupt activities may cost many seriously injured people their lives. In medical terms, there is a reference to the 'golden hour' within which medical assistance by paramedics can make the difference of being saved or not.]
Not informing the distressed motorist of all the costs involved in recovering his vehicle.
Claiming excessive recovery and storage costs.
Some operators have been known to recommend collision repair facilities not because of the quality of work they do but because they pay the tow operator a commission, generally a percentage of the repair cost (as high as 15-20%) for securing the job.
The South African Towing and Recovery Association (SATRA) and UTASA (United Towing Association of South Africa) have confirmed that many of these risks exist and identified the need for the industry to be regulated. Anybody can buy a one-ton truck and turn it into a tow truck and start operating.
SATRA has offered to assist motorists and guide them through the whole process, whether it's a breakdown or an accident. Motorists can call SATRA 24/7 for free advice and assistance arrangement on 0861 0 SATRA (0861 0 72872).
Advice for motorists when your vehicle has broken down
The motorists should not be forced into making an ill-considered decision. Even though many operators might arrive at the accident scene – it is still his decision on who should assist in the recovery of his vehicle. The National Road Traffic Act 93 of 1996 stipulates in Section 61(3) that ‘…no person shall remove a vehicle involved in an accident, except for the purpose of sufficiently allowing the passage of traffic, without the permission of the owner, driver or operator of such vehicle or a person who may lawfully take possession of such vehicle.’
The following suggestions will assist the motorist:
If you are an AA member, contact the AA to arrange the tow. The AA uses only certain towing companies that comply with a code of conduct and service levels. You also have recourse if something goes wrong.
Only use the services of the first SATRA or UTASA member to arrive at the scene of an accident. You have the right to choose to use a SATRA or UTASA member, who is bound by a contractually enforceable code of conduct, and protects you, the consumer, from being charged above market related rates.
If your vehicle is insured, contact your insurer or broker and ask for information on the procedure to follow – have this available in your vehicle at all times.
If you have insurance cover that includes towing charges, call the emergency towing assistance number (usually on a sticker provided by the insurance company).
The roadside assistance services provided by motor manufacturers and cellular service providers inevitably come at an extra cost so if you buy a new car or cell phone contract and roadside assistance forms part of the deal, make sure you are not paying extra for it if you already have this service through someone else.
If you make use of a roadside assistance product. Make sure you know your rights: in almost all cases you or your insurer will be liable to pay the costs of towing an accident-damaged vehicle.
Make sure that the accident-damaged vehicle is delivered to a repairer approved by your insurer or, if you are not insured, make sure to collect your vehicle as soon as possible to prevent the accrual of storage charges.
When dealing with recovery companies, always establish the amount to be charged for all aspects including towing, salvage and storage fees. Always agree on towing charges before your vehicle is towed or you might be in for an unpleasant surprise.
Get as much information about the tow operator as possible before you agree to the recovery - name of company, driver, and registration of tow truck, physical address and phone number (preferably not a cell phone).
Always agree on towing charges before your vehicle is towed or you might be in for an unpleasant surprise.
Do not sign anything. If the tow operator insists, make sure that it is ONLY an authorization to tow the vehicle.
Remove all valuables from the motor vehicle before it is towed away for repairs.
Emergency Response Time
Few road users are aware of the factors that could determine the time needed to respond to a vehicle accident. It is important for road users to be aware of these factors as well as steps that they can take to assist emergency teams in responding swiftly to accidents. Emergency response providers have provided information to the Arrive Alive road safety website on this topic.
What is the process of responding to an emergency call from the time it is made?
All emergency medical calls are categorised and prioritised when we receive them and resources are allocated according to the category and priority of the call as well as available resources at the time.
The process we follow is very straight forward and consistent in that we ask for caller number and name, what the emergency is (to enable categorisation and priority) and where the emergency is (all demographic information).
This information is sent to the Emergency dispatchers through our Integrated Call Taking and immediate dispatch system who then use satellite tracking to allocate the closest, most appropriate resources to the call.
Which factors play a role in determining the time before a response vehicle will arrive at an accident scene?
Several factors may influence this including:
Callers not able to tell us what the problem is.
Third party callers that are not with the patient result in further phone calls to establish the nature of the emergency.
Inaccurate demographic information - we often struggle to get accurate address details from callers.
Cross streets are not known, callers do not know what suburbs they live in or cannot give us landmarks to pass on the staff who will attend to the scene.
We often conference responders to callers to try and find the scenes.
Informal settlement streets are not captured and some of the new estates do not have their internal road systems mapped.
Meeting points are usually agreed where we then rely on a third party (friend, family, member of the public or security) to direct us to the scene.
Availability and location of resources - we send our closest available resource according to their position in relation to the incident at the time. If our own resources are not available we will ask service providers in the area to assist where we do not have resources.
Traffic - we are finding it increasingly difficult to access certain areas during peak traffic times and emergency lanes are often used by non emergency vehicles or have been allocated as additional lanes to assist traffic flow.
Some drivers are also reluctant to give way to emergency vehicles.
What can possibly the reason for any additional delays?
Additional delays do come in where resources may be directed to higher priority calls or the vehicles themselves are unable to continue responding due to being involved in accidents themselves.
Adverse weather conditions may also cause further delays as normal response driving is not possible.
Access to the scene of the emergency and the patient is also sometimes restricted - bystanders getting in the way or properties not being easy to access once the vehicles arrive.
How can the public assist in improving the possibility of emergence response vehicles arriving swiftly at accident scenes?
Several things can be done by the public.
Ensuring they have information on hand when calling - accurate address details and nature of the incident.
Landmarks are useful and if no street names exist, agree on a meeting area at a specific landmark.
Allowing emergency vehicle right of way to respond to the emergencies and giving way timeously.
Allowing access to the scene of the incident and patient/s.
Send someone to meet the vehicles, ensure that security at entrance points are made aware of emergencies in complexes, switch on some outside lights if incident is at night, clear access routes and lock away any dangerous or vicious domestic animals.
What should the public be aware of at the accident scene? - How should they behave so that emergency treatment can be delivered effectively?
Emergency services personnel need access to the scene and patients and members of the public can assist by allowing this and leaving them to do their jobs.
Once the emergency personnel arrive, leave it to them.
Safety of the public is also a top priority and they must not approach any dangerous area or situation as they may just end up adding to the casualties and increase the workload for the emergency services.
Keep updating the call centre if anything changes or you are concerned about anything else as they may need to change the level of the response or the resources allocated to it and can relay further information to the response team.
Post-Traumatic Stress After A Traffic Accident
OST-TRAUMATIC STRESS AFTER A TRAFFIC ACCIDENT
If you've been in an accident, you might have had many different feelings at the time of the accident and in the days following it. Some of these feelings might have included the following:
Shock
Trouble believing it really happened
Anger
Nervousness or worry
Fear or uneasiness
Guilt
In addition, you might keep going over the accident in your mind. You might feel like you can't stop thinking about it.
Most people who have been in an accident have some (or all) of these feelings. Sometimes, though, these feelings can be so strong that they keep you from living a normal life after the accident.
-::- What's the difference between normal feelings after an accident and feelings that are too strong? -::-
For most people who are in a traffic accident, their feelings go away over time. However, some people's feelings don't go away or they become stronger, changing the way the people think and act. Strong feelings that stay with a person for a long time and start to get in the way of everyday life are signs of a condition called post-traumatic stress. If you have post-traumatic stress, you may have some of the following problems:
An ongoing, general feeling of uneasiness
Problems driving or riding in vehicles
Not wanting to have medical tests or procedures done
Irritability, or excessive worry or anger
Nightmares or trouble sleeping
A feeling that you're not connected to other events or people
Ongoing memories of the accident that you can't stop
How can I cope with the feelings I have after my accident?
Talk to your friends and relatives about the details of the accident and how you thought, felt and acted at the time of the accident and in the days after it.
Stay active. Exercise and take part in activities (anything that doesn't bother your injuries). Your family doctor can help you figure out how much you can do safely.
Follow up with your family doctor. He or she can give you referrals to other health care providers you may need, watch over your recovery and prescribe any medicine you need.
Try to get back to your daily activities and routines. Traffic accidents make some people limit what they do. It's important to try to get back to your usual activities, even if you're uncomfortable or scared at first.
Learn to be a defensive driver. Driving or riding in cars might be hard after the accident. You can lower your risk of future accidents or injuries by driving carefully, wearing your seat belt at all times and avoiding distractions while you're driving. Never drive when you're tired. Don't drive if you've had alcohol or taken drugs or medicines that affect your judgment.
Stopping at the Scene
STOPPING THE VEHICLE
Although involvement in a motor accident is always a traumatic experience, try to remember that nearly all accidents have legal consequences. For instance, a criminal charge of driving without a license, drunken driving or culpable homicide may follow. Civil consequences may include claims for damage to property, or for personal injury, and may arise whether there is a criminal charge or not.
The law, furthermore, sets out clearly your duties if you are involved in, or contribute to, an accident on a public road in which any other person is killed or injured or suffers damage in respect of any property or animal. You must:
If a person is injured, render whatever assistance that you are capable of;
Ascertain the nature and extent of the damage sustained;
Give your name and address to any person who has reasonable grounds for requiring them, the name and address of the vehicle's owner if it is not your own and the vehicle's registration number. If you do not give this information to the police or traffic officer at the scene of the accident, you must report the collision at a police station or at an authorised office of a traffic officer within 24 hours, with your driving licence. If you could not do so because of your injuries, you must report it as soon as is reasonably practicable. (Where details are recorded at the scene by a police or traffic officer, you should have a valid driving licence in your possession. Failure to produce this licence is an offence.);
Not take any intoxicating liquor or drug having a narcotic effect unless, in the case of injury or shock, it is administered on the instructions of, or by, a medical practitioner. If you are requested by a police officer to submit yourself for examination by a medical practitioner, you may not take intoxicating liquor or a drug having a narcotic effect before the examination and before you have given the particulars and reported the accident as required in the preceding paragraph.
A driver who fails to stop after an accident when required to do so by law is liable to be prosecuted and, if convicted, fined up to R36000, or sent to prison for up to nine years, or both. If you can prove that you did not stop because you were not aware of the accident, you may avoid prosecution. If not, the courts will presume that you were aware of the accident.
You do not have to stop or report an accident if, for example, you collide with a tree and damage only your own car, and injure nobody or only yourself. If, how-ever, you damage someone else's property - a vehicle, say, or an electric-light standard - you must stop and then report the incident at the nearest police station.
Your first duty after stopping is to 'ascertain the nature and extent of any injury sustained by any person', and to assist as much as possible. If you know nothing about first aid, don't do anything that might aggravate an injury. Rendering assistance includes ensuring that qualified help - such as an ambulance or a rescue unit - is summoned. Unless you yourself are obliged to go for help, you should remain at the scene until a police officer permits you to leave. You can be criminally charged for failing to render assistance.
