Caring for caregivers after Boston bombing

‘Facilitated conversations’ ease trauma

When two bombs went off near the finish line of the Boston Marathon, hospital clinicians had one thought: I have to get to work. A surgeon who had just run 26 miles came into Beth Israel Deaconess Medical Center and prepared to operate. Nurses and doctors treating the wounded wondered about their own family and friends.

The first victims arrived at Beth Israel within 20 minutes of the blast. (Many had initial treatment by medical personnel at the scene.) The hallways quickly filled with law enforcement officers looking for eye witnesses. The lobby overflowed with people looking for missing relatives. Ambulances raced in and out. Security officers screened people coming into the facility.

“Everybody goes into their instinctual mode, doing their job and doing it very well,” says Barbara Sarnoff Lee, MSW, LICSW, the hospital’s director of social work and director of patient-family engagement.

But while hospital employees from environmental services workers to advanced practice nurses were shifting into overdrive, the hospital also thought about how to care for the caregivers, Lee says.

“The leadership recognized that you can only be in that hyper-vigilant disaster mode for so long, and we needed to think about how we can keep our workforce resilient and able to do their job – as well physically and emotionally,” she says. “We moved pretty quickly into thinking about how we would help the staff and what the staff would need.”

By the middle of the first week of the bombing, members of the social work, psychiatric and pastoral staff began holding “facilitated conversations” with employees. These conversations happened in small, natural groupings, particularly in the emergency department, ICU, and OR.

“The message we try to give people [is that] this is an abnormal event. What you are feeling, whatever it is, is a normal response to an abnormal event,” Lee says. “We want to let people know that most of what they’re thinking and feeling is normative.”

Building an emotional connection

Just the act of gathering together and talking can be therapeutic, she says. “What happens in situations like this is that people feel their world is somewhat shattered. They feel they’ve lost connection,” she says. “It’s about bringing people together to build a connection.”

Health care workers also need to know about possible physical responses. “There’s a physiologic component of trauma,” says Lee. “We talk to people about what to anticipate. People may be more irritable than they normally are. They may eat more, eat less, drink more.”

They might have trouble sleeping, or find themselves being overly startled by a loud noise. Exercise, a good sleep schedule and regular eating patterns can help people cope, she says.

In the weeks after the event, Beth Israel held multiple facilitated meetings on multiple shifts to give employees an opportunity to gather, talk, listen, and get advice. The sessions included environmental services workers, dietary staff and transporters — people who were crucial to keeping the hospital running smoothly but were not as prominent as the direct caregivers.

On the Friday of the second week after the bombing, the hospital held a 15-minute service facilitated by the hospital’s director of pastoral care. The hospital CEO and COO spoke. “They felt it was really important to pause and for senior leadership to thank employees,” says Lee. Adding a spiritual component also opened an avenue for coping. “That was just another way of taking care of people,” says Lee.

A month after the bombing, Beth Israel still held some open forums. “We felt it was important to communicate the message that not everybody is done with this and we still care about you,” she says.

If employees continue to have significant problems more than a month after the event — trouble sleeping or concentrating, or other symptoms that interfere with daily life, they are advised to seek professional help, says Lee. The Employee Assistance Program can provide a link to counseling.

‘Things happen every day’

The Boston Marathon bombing is a unique event, and in some ways, the support for staff was also unique. Hollywood celebrities and politicians visited the hospital and personally thanked health care workers.

There was a community outpouring, a sense of pride and unity in Boston that flowed into the hospitals where some bombing victims remained hospitalized for weeks. Donated tickets allowed hospital staff to go to Red Sox games or attend special events. The social work staff received a free Duck Boat tour. Cards and letters poured in from church and school groups.

Outside experts also bolstered Beth Israel’s efforts. A team from the Israeli Trauma Coalition shared their advice. The U.S. Department of Health and Human Services sent mental health experts.

Yet the framework for emotionally supporting health care workers applies in many cases and for hospitals around the country, says Lee.

There could be an adverse event that led to an unexpected patient death. Or a sudden death of an employee on a unit. Or a more localized disaster that nonetheless is traumatic. Those are all opportunities for “facilitated conversations” to help people cope, Lee says.

“I urge people to remember that things happen every day that impact people,” she says.