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July 28, 2015
This is the 847th Weekly Issue
This Week's Topic: “Coworkers as Victims”
Question: “He was nowhere near the employee who was killed. We need him back at work.”
Dr. Adams replies: Fellow soldiers killed in the line of duty was the foundation for what we now call acute and chronic posttraumatic stress disorder. Combatants (and civilian first responders) bear witness to the potential or actual death of coworkers. The disorder can also occur among those hearing details of the traumatic events. It can arise in family or friends when learning of the trauma. It can also arise in some as a result of cumulative exposure to those who have been injured. While the obvious goal is to return an individual to productivity, and where possible, to return him/her to the setting in which the trauma occurred, there are several important factors that may impede achieving this goal: a. Was the trauma a natural event that is unavoidable or unpredictable and/or may recur? (fire,/explosions, storms, etc) b. Was the trauma the result of man-machine interface safety failure or the absence of safety standards? And was this predictable/probable in the perceptions of the employee with one or more other individuals directly or indirectly culpable? c. Was the trauma the result of the negligence of other employees? Was an unsafe work environment created by an employee, and the trauma is seen as the result of carelessness? d. Was the trauma the result of deliberate aggression of coworker(s)? Is this, in fact, a place that was a hostile/dangerous interpersonal environment leading to someone(s) intentionally inflicting harm? The concepts of blame and need for others to be punished is characteristic of employees who feel that others were culpable for their trauma. In toto, if the employee sees the trauma as arising directly or unintentionally from the action of others, or a work-setting problem that persists, the probability of the employee returning to that setting is decreased. The initial response when witnessing injury or death of a coworker is shock, horror and disbelief. In some cases, guilt, remorse, rage and revulsion may accompany this event. Witnessing such trauma may rapidly resolve into either a transient stress reaction, a longer lasting adjustment disorder, or can become a stress-related disorder that persists for weeks, months or years. The initial assessment of the employees’ response would be a supervisor meeting with each employee who was exposed to the event as well as those who have been informed but were not direct witnesses. The employee can then elect, or be recommended, to further this discussion with EAP personnel or a licensed counselor. However, if the employee’s complaints include re-experiencing the event, avoidance of the workspace, negative cognitions and mood, and increased arousal, a psychological referral is in order. Medicating traumatized individuals with anxiolytics and/or antidepressants has been moderately effective with some patients. The concern for malingering a stress related disorder has triggered research on blood studies that may validate the employee’s report of post traumatic stress disorder. The concept that one’s life must go on implies that an employee be returned to work and the site of the trauma. This is achievable if the employee feels the cause of the trauma has been addressed and the probability of future occurrence drastically reduced or eliminated Returning to the workspace can serve to desensitize the employee to what has occurred. This can be done in a gradual manner. However, in some cases where safety standards were implemented only after the trauma, anger may prevent the return. If the trauma was the direct and deliberate result of another employee in the workspace, return to work is even less probable. Return to the workspace, while ideal, may not be readily achieved. Assignment to an alternate setting may be more viable. Printed warnings and media reports of danger have not successfully impacted careless or dangerous behaviors. Written material is easily ignored. Safety standards, safety equipment and the employer’s insistence upon compliance are more viable approaches. But whether discussing consumer, employee or patient education, individuals are capable of learning and understanding risk assessment without necessarily complying. Compound this with the effects of fatigue, distractibility, decreased vigilance, impatience and frustration, and the threat of risk is multiplied. In the post-trauma period, the concepts of safety and risk are amplified and temporarily improve awareness and vigilance. But over time, there precautions can ease, and risk increases once again. Regular safety seminars regarding man-machine interface with reference to past and potential future trauma should be implemented, and such seminars should be interactive rather than passive. In some States, the management of such trauma can be relegated to the Workers’ Compensation system. In other States, a physical injury is required to meet the standard of a work-related injury. Witnessing or learning about the trauma is not, in those States, sufficient for a workers’ compensation claim.