Military veterans who served in Afghanistan and Iraq have drawn up a package of guidance and support to help NHS workers cope with the traumatic stress from treating patients on the frontline of the coronavirus crisis.
The advice has been drawn up by the Help for Heroes charity, initially for staff at the Nightingale emergency hospital that opened in east London this month, in the belief that NHS staff are experiencing levels of emotional intensity similar to that on the battlefield.
Carole Betteridge, a former navy nurse who ran a field hospital at Camp Bastion in Afghanistan, said the understanding of traumatic stress had changed dramatically over the past 20 years and lessons could be shared. She spent 26 years in the navy as a nurse and medical planner, and is now head of welfare and clinical services at Help for Heroes.
She said: “There are so many parallels I can see between the military experience and what NHS workers are having to deal with. This is a conflict situation and we have to make sure we care for the carers.”
Medical staff are being faced with daily life-or-death situations “far more than we did in Iraq or Afghanistan”, Betteridge said.
The most acute source of anxiety was the feeling that personal efforts had been insufficient, she said. “People in hospitals will want to be able to help everybody, to be able to save everybody, but sometimes that’s not possible, and it’s difficult to deal with. People always feel they could have done more.”
Military techniques that can help are based on clear communication at the time, a buddying up between experienced and inexperienced workers, and a proper rotation of responsibilities so certain carers are not overburdened.
Particularly important is trauma risk management, where a team who often may have have completed a 12-hour shift come together and reflect on a difficult day’s events.
Betteridge said: “You should talk about the good things and the things that didn’t go so well; discuss how you are dealing with things – and talk about your families and positive things.”
Rates of post-traumatic stress disorder (PTSD) among military veterans have risen as the phenomenon is better understood. Research from King’s College highlighted by the charity Combat Stress suggest 17% of Iraq and Afghan veterans who served in combat developed PTSD, compared with 6% in support roles.
It can take years for problems to be formally acknowledged. Historically, on average it took 13 years after leaving the military. The figure dropped sharply to four years among Afghan veterans, as opening up about mental health problems has become more socially acceptable.
Betteridge said: “The experience of the veterans is that you can’t go through that kind of conflict experience without it having some effect. The good thing is we understand these situations better now, we can sort of plan for it. I think that will lessen the effect.”
Help for Heroes was called in to help produce the material by Prof James Calder, a clinical lead at the NHS Nightingale in London, recognising that the environment was similar to a military field hospital.
Unlike a normal NHS hospital, at the Nightingale at the ExCeL centre in London Docklands, and similar facilities around the country, volunteers who do not know each other are being thrown together in an emergency situation.
Betteridge said: “It’s always harder when you don’t know the people you are working with. Try and get to know them a bit when you start, introduce yourself when you put your PPE on, buddy up, and that will help you.”
At Camp Bastion, British military medics from all three branches of the armed forces worked alongside Americans, Estonians and Danes during Betteridge’s seven months in charge during 2011.
At NHS Nightingale, medics are being drawn from local hospitals, with volunteers from St John Ambulance assisting alongside them. Cabin crew and other airline staff from EasyJet and Virgin Atlantic are expected to provide assistance.
London’s Nightingale has been used relatively lightly so far, with only a few dozen patients, because trusts in the capital have been able to cope with the numbers of coronavirus cases. But NHS officials want to increase the number of patients treated there to help the health service gradually normalise when the outbreak eases.
The Help for Heroes materials, drawn up with the help of combat veterans, are also being published online so they can be made available to all NHS workers to complement existing mental health and support schemes.
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