Trauma and Distress

• Ask for help! You are not superhuman. Speak to others in your team (buddy, trusted team member, team leader)
• If it doesn’t come – ASK AGAIN – an early call should be to your line manager
• Don’t keep it to yourself. Contact any healthcare support organisations relevant to your staff group (many are online). The NHS Staff Support line is open from 7am - 11pm, 7 days a week
• Seek out a calm space to regroup. If this is not available, use a safe space in your mind
• Use breathing exercises to calm yourself. There are a number of resources recommended by the NHS to help with this, including Headspace and Unmind. Also see the resources at the end of this page
• It is ok to have a cry

• It is OK not to be OK - you may feel overwhelmed, shocked and numb at times
• You may have feelings of panic, notice that everything around you seems unreal, or have unusual sensations such as an out-of-body experience. These are well-recognised but temporary reactions to overwhelming stress
• You may be able to re-focus on the work task while also looking after your mind. Remember the good things you have learned before to help you when you’re stressed (and the ones to avoid)
• If it’s too much, ask to leave the immediate situation and take a bit of time out – that’s really OK. It is a sign of strength to be able to look after your needs
• Be open to offers of help. You are human and you deserve help too

• Finding ways to talk regularly with a buddy or with your team at the beginning and end of a shift can be very helpful. Talk about the tasks to be done, and afterwards discuss what has gone well and what has been challenging or demoralising
• Regular team based operational debriefing/decompression in a supportive reflective context is helpful to team learning, morale and each member’s wellbeing. This can happen through ‘Schwartz’ rounds or less formally

• Intrusive, well-meaning attempts to make people relive a traumatic incident immediately afterwards, usually by somebody outside the team itself, can increase the risk of later PTSD; it can be overwhelming
• A key issue is that people should not feel obliged to share or describe experiences if they do not want to do so
• It means that reflective practice and support within the team is important and it has to be managed sensitively

You might write letters to your future self. Capture and legitimise how you are feeling and thinking now. Recognise a future self that is not in this time. Keep them safe. They are valuable for you. (You can advise family, children and friends to do this as well; it can be an effective technique.)

• Be aware of any necessary changes to protocols that you used before COVID-19
• Understand the protocols and discuss concerns with senior staff ahead of their use

• Ask for clear instructions and guidelines from your supervisor/team leader. If they conflict with your moral values, discuss it
• Accept the things you cannot change, change the things you can, and use your wisdom to know the difference
• Don’t go to work if you are burned out but do discuss your situation with your line manager or team leader, for your sake and for the sake of your team
• Feeling alienated or even desperate? There will be help available – seek it. The NHS Staff Support helpline is available now. Also remember the Samaritans – even if you aren’t feeling suicidal right now they are there to listen and might be able to help

• Stay hydrated: water, tea, keep caffeine limited
• If it becomes too hot, tell others and take a short break
• Before you don PPE, remember you need to eat and use a toilet
• Masks and protective wear can chafe the skin: use a barrier cream on cleansed skin
• Beware of exhaustion: tell your team leader when this threatens
• Constant awareness and vigilance regarding infection control is a pressure –
  • Looking forward to a time when PPE is not necessary
  • Focus on what you can change and accept what you cannot
• Counter the physical isolation of PPE: communicate with others when you can, including of course your patients - remember they may also be feeling overwhelmed

Where is the quiet room to go for a break? If you don’t know, ask. There should be somewhere away from the immediate clinical environment.

• Working 'round the clock' and feeling that you are not doing enough
• Feeling guilty / blaming yourself / going over and over in your mind about what you could have done differently
• Using an excess of sugar and caffeine
• Becoming hypervigilant: extremely sensitive or critical of others who don’t ‘do things your way’ – this may be a sign of critical stress

• 'It’s OK to need a rest break. It’s not selfish'
• 'I mustn’t work around the clock, nor should my colleagues. Apart from anything else, we’ll become ineffective'
• 'To help others, I also need to look after myself'
• Avoid the trap of: 'Only I can do...'

• If you find them helpful, practice active stress management techniques (meditation, mindfulness, breathing and muscle tension exercises). See our Resources page for links to materials and advice to help with this
• Gratitude to others and listing the positives you experience helps during the day
• Remember: During this time of extreme stress all our good and bad coping habits tend to become exaggerated

• Ask family and friends for their advice
• Talk about your vulnerability with those in your support network (work buddy, team leader, chaplain). Consider whether you need more professional support (occupational health) or more
• Remember a trusted work buddy is somebody you can share with and vice versa

• Most people recover from distressing and traumatic experiences without specialist input, but that doesn’t mean the process isn’t painful
• It can take time. Some people need extra help to recover. This is not a sign of weakness – it can be the most conscientious, hard-working and responsible people who are hardest hit
• If things aren’t getting any better for you, talk first to family and friends or other community support. Consider using the NHS Staff Support helpline. If you can, discuss how you are feeling with your supervisor or line manager. You may feel that you need support from a hospital chaplain or your GP for professional advice. You may want to consult formal psychological support services like IAPT – you can self-refer. Remember your psychological health is just as important as your physical health
• We have a tendency to search for meaning after a traumatic or highly stressful life event. We try to work out why the event happened. Blaming somebody else or ourselves, or feeling guilty, is mostly wrong and nearly always unhelpful in getting over these experiences, but it is often difficult to deal with these feelings on our own
• It can be helpful to say to yourself or to a colleague, 'It was not your fault' or 'This happened to you, not because of you', 'You did everything you could, most people would have done the same' or 'You would never be this hard on anyone else'. This can help to counter the tendency towards guilt and self-blame
• You may want and need a longer, more thorough psychological intervention. That is quite common in these circumstances, particularly after the crisis has passed. Do ask. You deserve it. Calling a helpline, such as the NHS Staff Support helpline can be a first step for some, and you can always call Samaritans at any time. Your team leader, Occupational Health, GP or manager should also be able to direct you to further support

Breathing and Progressive Muscle Relaxation
Please see the breathing and progressive muscle relaxation techniques suggested in the references and resources section of our page on Stress and Fear

Also see the resources recommended on the NHS Help website

Additional Resources

Seal technique US Navy
Box breathing and meditation technique

Uncommon Knowledge - Mark Tyrrell
This video offers CBT techniquest that you can apply that may help you when feeling very stressed

Harvard Business Review 
"Coping with Fatigue, Fear and Panic during the crisis" This is a magazine item with good advice to use alongside the resources above

NHS Staff Support Line
Staff support line Call: 0300 131 7000
text: FRONTLINE to 85258 for 24/7 support by text
This is a confidential support line created to help staff under stress on a personal basis. It is being run by The Samaritans. It is accessible from 7am to 11pm every day of the week

Dr Alys Cole
Optimising staff preparedness, wellbeing, and functioning during the COVID-19 pandemic response