05 Aug Primary and secondary traumatization: Risk factors and warning signs
Professions where people work daily or regularly with trauma, death, suffering, violence, neglect, or threats place special demands on employees and expose them to potential negative strain. This applies both to staff working on hospital wards, in institutions and treatment facilities, in prison corridors, or in the field, as well as employees who, through office work—such as writing reports—gain insight into illnesses, suffering, or abuse. Employees can be categorized as first-line and second-line responders.
First-line responders are those directly exposed to trauma, as their work takes place at accident or crime scenes, in war zones, or in humanitarian aid areas. In accidents, this often includes police, firefighters, and ambulance personnel, and in war or aid zones, it may include soldiers, doctors, nurses, psychologists, and other aid workers. Staff at control centers and others tasked with coordinating or monitoring acute operations are also considered first-line. Many journalists and photographers also operate on the first line. First-line responders are on-site and therefore experience events with all their senses, which can be a strong impact in terms of sound, smell, and sight.
Second-line responders are those exposed to indirect trauma through subsequent contact with the traumatized individual. They are not present at, for example, accident or crime scenes, but may receive cases handed over from the first line. This may include healthcare professionals and social workers. For journalists and photographers, second-line refers to those working from the newsroom. It can also include therapists working with traumas from many years ago, such as cases involving treatment of childhood sexual abuse. Second-line responders can be further divided into two groups: those who work face-to-face with the traumatized, and those in administrative roles who handle the incident through report or record-keeping.
Trauma exposure will affect everyone in the organization—employees, leaders, and the organizational culture—which, both in daily operations and under pressure, can impair the ability to think and act clearly and professionally.
The external event
The intensity of a potentially traumatizing event’s impact on those involved depends primarily on the event itself. As discussed in the first article in this series, every human has a “breaking point”—it’s only a matter of intensity and frequency of exposure. Events may be isolated severe incidents or many smaller, long-lasting events. The latter, due to both organizational and individual habituation, can pose a particular risk if the strain is not detected in time and corrected.
Over the years, I’ve learned to pay attention to those who quietly “bleed slowly” without drama. They also need attention.
The nature of the event itself matters. Naturally occurring events are generally less stressful than man-made events, and events involving adults are less demanding than those involving children. Factors such as whether the event was anticipated also matter. Events that are foreseen—because they occur in high-risk areas or with clients/patients known to be aggressive—are less psychologically demanding than unpredictable, sudden events that occur in otherwise safe and peaceful locations. Forewarning allows psychological defenses to be prepared and for staff to act quickly and appropriately.
I was really angry. Damn it. I had worked in war zones all over the world and had now sought peace and quiet in tranquil Norway. I had deliberately removed myself from high-risk areas to gain some control. And then I stood there in Oslo with shattered office windows.
Handling the external event
Beyond the event itself, there are numerous organizational factors that affect employee risk. These include trauma training and supervision, workplace culture, high task awareness, clear roles, and work organization. Two organizations may handle the same event very differently depending on how prepared and aware they are of its impact. Individual factors related to the employee’s tasks and life also affect the risk of developing mental strain. Was the person active in the incident, or forced to remain passive? How does the person evaluate their own performance afterward, and what is their overall position in the workforce? Are they a junior or senior employee?
For completeness, it should also be noted that external factors such as the work’s status, possible complaints, and media coverage can influence the risk of mental strain for those involved.
Warning signs of mental strain
The term “mental strain” is an overarching concept for the psychological imbalance employees risk developing in high-risk jobs. Just as a ship can list physically if its cargo is improperly balanced, humans experience mental listing if demanding work is not structured in a balanced and sustainable way. A range of symptoms or warning signs may indicate that an employee is beginning to experience—or already has—mental strain. These signs can come from the body, the mind, emotions, or interpersonal relationships.
If mental strain is not detected in time, it may escalate to the point where the employee develops a stress-related condition or trauma-induced psychological disorder. The more warning signs present, the higher the risk of capsizing.
Sustainable work design
Building resilience and preventing mental strain fundamentally involves designing work sustainably. Sustainability means balancing the exploitation and protection of resources. Resources should be understood broadly as time, finances, and, most importantly, the professional and human competencies of the individual or team. An organization or individual that merely exploits resources without maintaining a sustainable balance risks stress, sick leave, and high staff turnover. Conversely, those focusing solely on protecting resources without ensuring sustainable balance risk underutilizing employees’ skills, leaving staff unchallenged and resources underused. Organizations may also lose competitive advantage to others that have achieved a better balance.
Danish
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