Question 1 · Law, Ethics & Human Factors · Moderate
Two days after a road traffic collision in which three children died, an ambulance service wellbeing lead proposes a single structured group session for every responder who attended. Each person will be asked to recount the event in detail and describe their emotional reactions, with the stated aim of preventing post-traumatic stress disorder (PTSD). Several crew members are sleeping poorly but are otherwise functioning normally and want to keep working. According to NICE guideline NG116 on post-traumatic stress disorder (2018), which is the most appropriate approach?
- AGive the single-session debriefing to everyone who attended, before their next shift
- BGive the debriefing only to those reporting symptoms, repeating it if they persist
- CRequire every responder to write a detailed reflective account before the next shift
- DRefer everyone for trauma-focused cognitive behavioural therapy (CBT), symptoms or not
- EOffer no debriefing; consider active monitoring, with follow-up within one month
Show answer
Answer: E
Offer no debriefing; consider active monitoring, with follow-up within one month
NICE NG116 says do not offer psychologically-focused debriefing for the prevention or treatment of PTSD (recommendation 1.6.5). A single early session in which people recount the event and their emotional reactions, aimed at preventing PTSD, is exactly that — whether offered to everyone or only to those with symptoms. For people with subthreshold symptoms within a month of a traumatic event, NG116 recommends considering active monitoring and arranging follow-up contact within one month (1.6.4). Individual trauma-focused CBT in the first month is for adults with acute stress disorder or clinically important symptoms of PTSD (1.6.15), not for everyone exposed. A compulsory written account of the event is another way of making people relive it, and nothing in the guideline supports it. None of this stops the service holding an operational debrief: the Oxford Handbook describes an immediate operational debrief to identify key lessons after a major incident. That is a review of the response, not a psychological intervention.
Where this comes from
- NICE NG116 Post-traumatic stress disorderNICE, December 2018·1.6 Prevention: psychologically-focused debriefing“Do not offer psychologically-focused debriefing for the prevention or treatment of PTSD.”Open at this sentence
- NICE NG116 Post-traumatic stress disorderNICE, December 2018·1.6 Prevention: active monitoring“Consider active monitoring for people with subthreshold symptoms of PTSD within 1 month”Open at this sentence
- NICE NG116 Post-traumatic stress disorderNICE, December 2018·1.6 Prevention: follow-up within a month“Arrange follow-up contact to take place within 1 month.”Open at this sentence
- NICE NG116 Post-traumatic stress disorderNICE, December 2018·1.6 Prevention: trauma-focused CBT in the first month“adults who have acute stress disorder or clinically important symptoms of PTSD”Open at this sentence
- Oxford Handbook of Pre-Hospital Carep. 576Ch. 10 Major incident management and triage · Major incident: recovery“An immediate operational debrief is usually held to identify key lessons”