A trauma-informed approach (TIA) recognizes that past trauma, whether diagnosed or undiagnosed, can play a key role in any individual’s behaviour in the present, and that recognition of this should be fully integrated into our policies, procedures, and delivery practices.
It is widely practiced in healthcare, the criminal justice system, child welfare, and elsewhere, but not in emergency management (EM). I believe it should be; and that all EM professionals should have at least a basic understanding of TIA and how it might be applied.
This is a two-part blog. In part one I provide an overview of TIA and why I believe it is so valuable as a modality. In part two I’ll go into TIA in more depth. But, first, I’d like you to meet Charlie.
A recent experience has strengthened my conviction that TIA should be integral to EM work, in all situations. I met Charlie not too long ago, shortly after she’d called 911. I was working as a paramedic with BC Emergency Health Services. She had fallen and suffered a fracture.
On the way to the hospital, Charlie (not her real name) recalled events the night of January 23, 2018 in Port Alberni, BC where she lived. She awoke at about 3 a.m. The city’s tsunami warning system had been activated in response to an earthquake off the coast of Alaska. She’d been a victim in the past of serious domestic violence and was living in a safe location unknown to her abuser.
This location also happened to be in the tsunami evacuation zone, which left Charlie facing a terrible dilemma. As a long-time resident of Port Alberni, she knew of the awesome destructive power of tsunamis, as the community had been heavily damaged by one in 1964. Fearing for her safety, she wanted to evacuate. But as the evacuation might inadvertently place her in contact with her abuser, she feared leaving.
Thankfully for Charlie, the order was lifted before she had to decide. But the impact of that night was apparent weeks later when I met her. She was still visibly upset about it.
The confluence of past and present
Hearing Charlie’s story was, for me, a lesson on the impact of past trauma in present emergency situations. Her story reminded me that, while we are answering a call for help in a present crisis, we are also often coming face-to-face with a person’s experience of trauma in the past.
When I met Charlie, in addition to working as a paramedic, I was also working on my bachelor’s degree in emergency and security management. As well, as a clinical educator, I was part of the team responsible for training paramedics across the province about TIA. Charlie’s story helped me recognize that the approach had significant implications across the EM field. It changed the way I look at everything I do when interacting with people.
It is estimated that 76% of Canadians are exposed to a significant trauma in their lifetime (Ameringen, et al., 2008). It’s conceivable that a majority of people served by emergency managers could be victims of past trauma. This only underscores the importance and value of TIA.
Untreated traumatic experiences can have long-lasting effects. They can influence people’s responses to current events or circumstances in many ways, either subtly, dramatically, or anywhere in between. An individual’s experience of past trauma can influence their feelings and perception of trust, safety, control and esteem. Their response in the present can be the result of real or perceived threats; a form of self-preservation, protection, and adaptation. Emergency managers or responders may know nothing about this – in fact, are quite likely to know nothing.
Making a difference
TIA assumes that the way we interact with people – including the subtleties of our body language and tone of our instructions – can either enhance or undermine their feelings of trust, safety, power and self-esteem. By applying TIA, we can challenge or re-evaluate assumptions we might otherwise make
that could cause unintentional harm. We can build better relationships. Working for years as a paramedic, I have been privileged to listen to thousands of stories. Listening has given me an opportunity to help people feel heard, validated, empowered, and safe.
Some may argue there’s no time for TIA in many emergencies. Certainly, each situation comes with a unique set of challenges which must be prioritized. But in many situations there is room for a trauma-informed approach that allows EM professionals to tailor their approach to interaction to a person’s particular needs. This can minimize confusion and resistance, increase effectiveness, and actually reduce the time needed to respond.
TIA will not solve all of our problems. Building it into our everyday interactions, however, will make EM professionals both more effective and efficient in many situations.
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