Component 2: Findings
Some participants reported being involved in CIs recently, while other CIs had occurred over a decade earlier. The participants unanimously recalled CIs involving serious human-related consequences, such as those resulting in fatalities or permanent disability, but acknowledged that CIs can inflict serious non-human consequences, such as damage to equipment and facilities. Examples of CIs discussed included accident-related deaths (e.g., due to falls and malfunctioning machinery) and sudden deaths relating to pre-existing health issues. Seven of the participants discussed suicide as a specific critical incident they had experienced. Although the participants were not prompted to recall a specific traumatic or significant event, the participants generally referenced events that significantly impacted themselves or their worksites, for which they were required to provide direct care and support to others. From the interview data, we were able to establish clear themes, which are presented, along with relevant quotes, in
Table 1,
Table 2,
Table 3,
Table 4,
Table 5 and
Table 6.
Table 1.
Individual factors in the pre-critical incident timeline.
Table 1.
Individual factors in the pre-critical incident timeline.
Timeline | Themes | Example Quote |
---|
Pre-critical incident factors | Impulsivity/risky behaviour | “You can think back on it from any which angle you want, and the guy wasn’t following the rules, did something stupid and that was an accident, but we all handled it as best we could.” (MIC11) |
Personal stressors | “When a guy loses the job and then things starts falling apart and then that’s, and this is what actually what happened with me, it was when I wasn’t working that I was close to suicide because I’d had a lot of things fall apart in my life … So, I would fall on these really hard times because I used to live it up. I used to go out and drink and all that kind of stuff, spend all my money and then all of a sudden, I’d lose my job on a day’s notice and I’m in a really bad position.” (MIC4) |
“… people who might suicide in construction, I think they already have a pre-existing condition not being able to deal with stress or high levels of stress or whatever that is. A common cause that I’ve seen in suicidal or people who go downhill, have been substance abuse, whether that’s party drugs and/or alcohol. Now, that is not the sole reason, but that’s been a very major contributor, and the four people been close to me who have suicided, the party drugs and alcohol have been heavily involved.” (MIC3) |
Much of the narrative regarding pre-event factors focused on individual worker characteristics, behaviours, and circumstances, which we labelled “impulsivity/risky behaviour”. For instance, human factors considered to precipitate a CI included impulsivity from young men, attention-seeking from colleagues and social media, and limited opportunity to reflect on a worker’s increasingly erratic behaviour. There were additional human-related factors recollected in the lead-up to a CI, including issues surrounding individual workers, such as relationship breakdowns, financial stress, mental health history, substance abuse, fatigue, and work–life balance, which we labelled “personal stressors”.
While there was a focus on the individual worker, there was also recognition of the influence of the context in shaping behaviours and the subsequent need for workplaces to assess the risk on site continually, reinforce the need to respect the level of risk involved, and consider the role of cultural norms in influencing risk behaviour. Additionally, the need to conduct training and rehearsals to develop processes and skills to respond effectively when CIs occur without warning was highlighted (Theme 2, “preparedness for CI response”). Importantly, although training to be prepared for future CIs matters, equally as important, according to our data, is the theme that the organisation must make sure that “training and policies for safe machine use” was a priority.
Table 2.
Team and organisational cultural factors in the pre-critical incident timeline.
Table 2.
Team and organisational cultural factors in the pre-critical incident timeline.
Timeline | Themes | Example Quote |
---|
Pre-critical incident factors | Training and policies for safe machine use | “…critical incidents is an area where you can never probably plan enough… you may only use it once every few years, but when you do kick in the more you plan for it the more you understand it, the better the outcome.” (MIC1) |
“… no matter how messed up or how ugly it is, you know if you can massage the heart and if you can put breath in the body you can sustain life… the ambos said oh, mate we’ll take over from here… and with all their gear and stuff, and they had a look at the wounds and mate they put a sheet on him within, I wouldn’t have thought more than 10 s, 15 s… I was indirectly involved, I suppose, in an incident that resulted in a very serious injury to a guy. He got backed over by a piece of machinery. We weren’t all trained in how to deal with it. There was no incident investigation. He just got struck by a piece of machinery, but now, we ask a lot more questions of people and therefore, we know a lot more about our fellow workers and co-workers. A lot of that’s good, but I think a lot of that we have to be very gentle with it.” (MIC5) |
“Technical training in the construction industry is very, very good where you train to look at all the technical aspects of how something works or how it’s stopped working or risk management processes, but when it comes to human element, there should be some training structure in human element.” (MIC5) |
Preparedness for CI response | “… it’s one thing to have like a crisis centre set up at a corporate level, but at the remote level beyond head office it’s almost a separate team and response that could, certainly from my business we do need improvement.” (MIC1) |
“I’ve done a lot of safety in my life. I’m qualified in ICAMs and investigations and incident causation, but I’m not really trained in what to do afterwards… look, they might mention it. It might be something that’s mentioned, it’s briefly discussed, but really it all focuses on why the incident happened and what was the events leading up to it?” (MIC4) |
The way participants reported experiencing the event and its immediate aftermath, and the roles they themselves undertook during the event, demonstrate the ways in which immediate responses can influence the long-term impacts of the event for the workers and their workplaces. Many of the participants indicated they held critical response roles in relation to the CIs they described. Some participants were present on site when the CI occurred, while others arrived within a few hours of the event. Those who were off site were generally made aware of the event via a phone call and then were required to travel to the site and navigate the emergency response. Participants could recall these events clearly because of the heightened physiological response to the situation that propelled them into action. The initial critical response required when attending an incident, including ensuring policy and procedures are followed, made it difficult to pause and process what psychological trauma was occurring. In this way, the emergent theme of “narrow focus (autopilot)” became clear as the participants discussed how they managed the intersection between the practical and emotional needs of themselves and others by focusing on the critical practical needs of the situation and shutting down emotional needs. When recalling an event, one participant described feeling both “numb” and “hypervigilant” when explaining their experience of heightened physical arousal.
Table 3.
Individual factors in the critical incident timeline.
Table 3.
Individual factors in the critical incident timeline.
Timeline | Themes | Example Quote |
---|
Factors during the event | Narrow focus (auto-pilot) | “It’s really challenging… but… you go into autopilot… and literally you’re breaking down, unfortunately, it probably starts off a bit unemotional… where you’re actually just going in very direct conversations with people: do this, I need that sorted, get the lawyers here, notify the unions, notify the regulators, and you go into autopilot mode of response… That, I find, takes probably an hour to get initial responses up and running, in which case your brain then flicks into standing back away from everything and stepping away from the direct mode into bringing the emotional capacity now of how is everybody doing, and the welfare is now forefront of my mind.” (MIC1) |
Role conflict | “I can see as clearly as I’m looking at you now, workers running, just running and screaming, you better get up there… you know. I see this avalanche of people running away and in that time you’re sort of like thinking oh well that’s not going to be real pretty by the time you get up there but how bad can it be? Well it was fairly ordinary. But after that, you know you’ll be concentrating on your job and you know there was stuff that was happening around me at that particular time, which was like, I should never have put myself in that situation. The load wasn’t secured still, it was whipping around like a snake’s tongue, and there’s like 8 or 10 tonnes laying over your head while you’re trying to drag this body out to actually perform CPR.” (MIC12) |
Provide referrals | “In terms of how I reacted, it was personally get the workforce together, announce what has occurred in as plain language and directly as possible, here’s the support available to you, but go home and be with your loved ones essentially.” (MIC1) |
“He did say, ‘hey, look we have counsellors available, these are their numbers’, kind of thing.” (MIC4) |
“Role conflict” became a theme where the tension between practical and emotional needs was revealed as the participants spoke about how they managed the competing needs of securing a site, engaging with the investigative response, and supporting as many people as possible. The participants spoke about the tension between the practicalities of the immediate response and the emotional needs of workers in contexts that are often chaotic, suggesting that responding to the moment of crisis needs to be instinctive but must also consider the physical and psychological safety of all workers, including managers and first responders when securing the site. Related to this tension between practicalities and emotional needs, the participants spoke of the need to be wary of dealing with the immediate needs at the time, not assessing what caused the event, nor what will be needed to prevent the event from occurring again in the future.
The participants noted that all people on site were affected, although there were varying degrees to which individuals were impacted; thus, the support provided must be individually based and driven by the needs of employees. Furthermore, it was recognised that it is unlikely that any response during the event will sufficiently deal with all workers’ needs, and additional onsite and off-site support is likely needed, including our third theme, “providing referrals”. One complication associated with this need for individualised support is that it relies on understanding the workers themselves, which is challenging because of the aspects of construction work. For instance, a clear tension in the interviews was the casualisation of the workforce, with managers not knowing their workers to the same depth as they may have in the past. Also, many workers operating across multiple sites or on rosters results in a network of connected people. Thus, when an event occurs on one site, it is likely to have an impact on workers across multiple sites, requiring a response across several sites.
When considering themes related to the team or organisational culture, some participants discussed the disconnect they experienced between what they had been taught in response training and the reality of the event. This “uncertainty (training–reality gaps)” means that given that the seriousness of the events experienced by the participants could be graphic, confronting, and leave lasting images, the need for training to provide realistic preparation for responses was raised as vitally important. A related point is the gap between the reality of the event and the fundamental assumption most workers hold, being the expectation of going to work and returning home safely, which can impact workers’ sense of reality when experiencing the event.
Table 4.
Team and organisational cultural factors during the critical incident timeline.
Table 4.
Team and organisational cultural factors during the critical incident timeline.
Timeline | Themes | Example Quote |
---|
Factors during the event | Emotional demands | “I guess a lot of people ring me going, ‘are you all right?’ but I’d say once again, I wasn’t worried about me, I put me in the background and I was just worried about the individuals that were there and made sure everyone else was okay and did the whole site thing and meeting and do that. I haven’t really dealt with it in that sense.” (MIC9) |
“You wouldn’t go on the cusp of how it’s happened at that point in time because it’s only just happened. You’re more looking at the welfare of the individuals that are on the job at the time, making sure they’re okay.” (MIC9) |
Uncertainty (training-reality gaps) | “The guy was a mate of mine and I was the first aider, so I was actually there trying to save his life, which was quite impossible, but I didn’t know that at the time … it goes back to your foundations of training that you learn… and then you know when the ambos got there and with all their gear and stuff, and they had a look at the wounds and mate they put a sheet on him within, I wouldn’t have thought more than 10 s, 15 s.” (MIC12) |
A clear theme that emerged from the data is the potential for events to have long-lasting impacts on workers, meaning that ongoing trauma is a serious concern, thus highlighting the need for support options that focus on the potential long-term impacts of a CI experience. Several participants suggested that post-event support appeared to be time-limited or insufficiently prioritised in comparison with the need to return to “business as usual”.
These quotes illustrate that support options may appear time-limited, particularly when there is a perceived pressure to return to business as usual. Although the participants expressed an understanding amongst workers of the financial imperative to return to work, the sense that the job was more important than the lives lost, or the injuries endured, impacted workers’ ongoing experiences of the event. Related to this point is when there is a perception of greater value placed on learning from the incident to prevent further damage to machinery and equipment rather than emphasising the human-related impacts of the event. Although uncommon, when it occurred, the participants noted that being reminded that people were more valuable than equipment allowed for a more supportive environment for discussing the incident.
Table 5.
Individual factors in the post-critical incident timeline.
Table 5.
Individual factors in the post-critical incident timeline.
Timeline | Themes | Example Quote |
---|
Factors following the critical incident | Emotional surge | “I felt shitty for a while. I felt really bad for the guy’s family, I felt really bad for some of his close workmates so yes, there was a definite effect for a period of time, yes.” (MIC10) |
“This dread sort of like hits you and all this what else could you have done hits you, you know, you’re talking about all the things you should be doing, could’ve done, and it floods you. It’s really fucking overwhelming.” (MIC12) |
Continuation of heightened emotional response | “… the whole philosophy that Mates in Construction… use [is] looking out for your mates and that kind of thing but when you [are] busy that tends to fall away and no one on a construction site’s primary role is as the site psychologist… (but) this particular incident was that it brought back memories and things for other people of… other trauma that they’ve had in their life” (MIC10) |
“It was probably that night when I was down there in the room on my own, stepping back feeling really drained, because it obviously ends up being a big day, really emotionally drained… I probably… it hit home firstly there. Secondly probably two to three weeks later, when a lot of the operational elements are done, the emotion floods through and it’s almost you’re starting to really process what has occurred, in an emotive way, the adrenaline is wearing off, and you’re now actually thinking about everything you’ve had to deal with, what you’ve seen, what you’ve done.” (MIC1) |
Empowering individual support decision | “Training and resources that provide multiple opportunities for engagement—peer to peer support, team support, EAP and MIC all working together to acknowledge the needs of people.” (MIC3) |
“It’s a tough one ‘cause from my experience it’s really hard, I’m trying to have some engaging and deep conversations with men on the jobsite and there are a lot of walls. So, if someone isn’t processing something like that very well, to give them the space to talk and open up.” (MIC4) |
“I remember [NAME] taking me home, taking me back to his place and we had a couple of beers. We didn’t talk about the incident, didn’t talk about it. He was just with me, he just stayed with me and he phoned my wife and let [NAME] know that [NAME] has been involved in a very nasty incident, he’s okay but you know he’s the guy that was trying to preserve life, so you know he’s going to be a bit upset or agitated or whatever happens during that time. But I never was, I was more, you just keep flicking over in your head what else could you have done, what else, what else, what else?” (MIC12) |
Preoccupation with assigning responsibility | “… You just keep flicking over in your head what else could you have done, what else, what else, what else?” (MIC12) |
“… then we got a bit of blame for moving him onto a roster and FIFO at his request. One of his mates said, ‘If he stayed up here, I could have looked after him’. So, yeah, you sometimes second guess or doubt yourself, did we do the right thing or not.” (MIC3) |
“By the time I got down those conversations had been had, but it was all with our management team and our supervisory staff where again we facilitated a similar discussion just… with our team… Because obviously they’re going through some trauma themselves, because they feel they’ve contributed one way or another indirectly.” (MIC1) |
Similarly, the participants spoke about how the emotional impact or significance of an event can be undermined by information-gathering activities perceived to be focused on assigning blame for the incident. The participants reported that discussions about what had occurred and who or what was to blame often happened after an event. The insinuation of blame and questioning from others produced a sense of exhaustion, failure, and self-doubt at the individual level and a corrosive culture of a “preoccupation with assigning responsibility” at a team and/or organizational level.
The design of jobs, roster, and organisational culture can also limit access to support options for employees exposed to CIs. For example, access to appropriate support at times they are available was important in an industry that works beyond the general 9 to 5 workday. The participants suggested that to allow people the capacity to recover, they need to be able to access services within usual work hours, even when this means taking time out from their onsite work. These points illustrate ways in which the work environment influences workers’ ongoing experiences of the event itself and their capacities to recover and access ongoing support.
Table 6.
Team and organisational cultural factors in the post-critical incident timeline.
Table 6.
Team and organisational cultural factors in the post-critical incident timeline.
Timeline | Themes | Example Quote |
---|
Factors following the critical incident | Close knowledge gaps (training) | “I would love to see MATES in the future working in that, like having another safety net or a support for those people who have lost their job and just checking in with them and helping them cause I think that’s a real, it’s a red zone. It’s a real slippery area where lives, if they fall into that and then drugs and alcohol or whatever, and a fight with the missus and it can really take off from there.” (MIC4) |
“I actually got the defibrillator out after this event and actually showed all the staff how to use it because it was a bit of a complicated process with somebody talking in a, I think it was probably in America or maybe a similar accent to your own, so that actual, in relation to this specific critical incident the equipment used, i.e., the defibrillator, the application of the defibrillator definitely could have been more widely understood throughout the site.” (MIC10) |
“Anybody in a managerial role, because we deal with humans all the time, one of the things that we should understand is the basic elements of human behaviour, whether that be understanding body language or understanding how we present ourselves or how we should approach people. There could be training in that area.” (MIC5) |
Time limited support | “ … it was like, ‘well, you guys, you know, we still need to pull this thing tomorrow so we’re got to get moving boys kind of thing’. So, it was definitely more so the, like well what I felt was that the job was more important than these lives.” (MIC4) |
Interviewer: “So do you think there were people there that may have needed that extra support but didn’t really get it or put their hand up?” MIC10: “Yes, I’d say there probably were, yes.” |
Return to work pressures | “… the focus was, okay, yes, this bad thing happened but, I always hate when someone says but because it really just means that they’re kind of saying, let’s get back to work.” (MIC4) |
“We had the union come out and it might have been like we got together in the smoko shed and it might have been like a 5 or 10 min talk and then basically, cause it wasn’t in my direct area, it wasn’t in our direct crew, it was like, ‘well, you guys, you know, we still need to pull this thing tomorrow so we’re got to get moving boys kind of thing’. So, it was definitely more so the, like well what I felt was that the job was more important than these lives.” (MIC4) |
Preoccupation with assigning responsibility | “Some people don’t want to be followed up, like I know some people were just like, yes, it’s happened, done, okay, let’s move on and scratching the scab for them was maybe quite painful and maybe not really wanting to go back over it. I for one didn’t want to continually go back over it, I got sick of answering questions about it from management whereas some people would have talked about it every day of the week… So, every different level of management wanted to hear the full story, wanted to know how you felt, blah blah, yes.” (MIC10) |
“Nowadays, every time there’s a near miss or there’s an incident, there’s a need to understand what happened and you can’t really understand what happened unless you start asking questions and sometimes, I even find that asking questions can be traumatic to people. The whole thing surrounding incidents and, as I said, they don’t have to be serious incidents, it’s depending on the situation, near miss or minor incident, is becoming a very, very delicate subject.” (MIC4) |
Barriers to seeking help (stigma, work hours) | “Going back some years ago, people were more linear, I suppose. They either said, ‘Yes, I want some help’ or ‘No’ they didn’t and if they didn’t want help, are probably okay. If they wanted help, they wanted help. But nowadays, I think, there’s a lot more forces at play in the every day of people now. It’s a lot more complicated.” (MIC5) |
Support may be time-limited and not sufficient for the ongoing trauma experienced by workers | “I had a number of people associated with the business reach out to me personally going, how you doing?… There was initial on the day and the next day, really quick, hey, I understand what you’re dealing with, let me know if I can help in any way… But within two weeks that pretty much disappeared, and it was more, what’s happening with the investigation, what can we learn from it, that was more where the questions turned to.” (MIC1) |
“I didn’t use the EAP support and I’m not, I think the people who used it were a little bit, I’m not sure about was that good or not. I don’t believe that there was too much follow-up so I think the support that was offered and the support was provided varied in its effectiveness.” (MIC10) |
Perceived pressure to return to work | “You didn’t really have time to dwell on anything. It’s an issue. It happened. Close it out. Move on. So, you don’t have time to dwell on critical incidents, if you want to call them that.” (MIC3) |
Culture affects recovery and people seeking help | “If [support] was there and it was during worktime because you’ve just gone through a fatality or something, I reckon people would have more interest in it because I guess in—I’ll say using my own brain, but I’ve just gone to a traumatic event that’s a part of my job, I then am going to now take time off out of my time, I’m not going to get paid, so I never did it. I just went there and did what I had to do as what I was employed to do. Now I’m going to suffer the consequences. I’m going to lose out on something I had nothing to do with. Whereas if you turn that around and go we’ll pay you and you find them and we’ll pay you to go there and it’s half day on a Friday.” (MIC9) |
“… to take time out, or expect someone to make a proactive appointment with their GP (General Practitioner), was not always part of the culture.” (MIC6) |
“I think for any high stress level job it should be mandatory to go see whether they pay for a psychologist twice a year or a psychiatrist or whatever you need to see or just a counsellor, that should be mandatory because at the end of the day, if you don’t want to do something, and it has proved back that if you don’t want to do it you’ll find any excuse under the sun not to do it.” (MIC9) |
Ongoing support varies on an individual basis | “Maybe the theoretical answer goes back to which box everybody sits in psychologically and how they’re wired and how they deal with stress. I think that the people who were closely involved in this, well the guy that was most closely involved in the incident, the first guy that did CPR, the first responder, our project safety officer, he seemed to deal with it the best and didn’t want any EAP assistance and we have a quick chat about it but he was an older guy and he just moved on with what he needed to do. Whereas other guys that were in the second responder or helped out a little bit later on category, they were the guys that had other issues that doubled up in their lived about their parents and whatever else came out in the slightly longer term. I think if your personal life, home life, wife, kids, partners, dog, if everything is going well in your life, it’s quite, it’s easier to process and event like this and from personal experience if all that other stuff’s, even in the absence of a critical incident like this, if the other stuff in your life, if you’ve got a couple issues going on the background, then it’s much harder to focus and an incident like this probably does make you think its all doom and gloom possible.” (MIC10) |
Focus on people over equipment | “[the Managing Director passed on this message]: ‘We can get another truck, we can’t get another you. Don’t dwell on it. We’ll look after you.’ That’s about all it took, but those sort of situations are rare.” (MIC9) |
Support options should recognise that living through and responding to events will have different meanings and varying levels of significance for workers depending on their own history of mental health and trauma, current personal circumstances, and existing support networks, and while services, such as EAPs, were viewed as being person-centred, they were not uniformly suitable for all people. The participants noted that individuals should not be required to access a particular form of support; rather, individuals need to be given space to talk and open up. Peer-based support that is simultaneously directive and supportive, driven by the individuals themselves, allows the incident and its impact to be acknowledged while also allowing individuals to express their needs in a safe environment.
As reported earlier, although all the participants had experienced CIs, a smaller proportion of the participants had specifically experienced a suicide-related CI. Six of the participants discussed either their own suicide attempts or the bereavement of a worker they had known who died by suicide. It was significantly more difficult to elicit information regarding suicide-related pre-event factors, the event itself, or post-event factors. The difficulty discussing the topic of suicide in the interviews is reflected in the broader construction work environment, where the topics of mental health and suicide are often regarded as taboo. Suicide is not viewed as a “one-off” situation unrelated to work but is viewed as being inherently related to construction work-specific challenges, with the link between suicide, financial strain, and employment uncertainty expressed by the participants. While there are some obvious risk factors that precede a death by suicide, many are unexpected and “left-of-field”. The participants, for instance, noted that training and support for suicide responses needed nuance as, for some deaths by suicide, there were no obvious early indicators to observe. There was a sense that many of those who died by suicide appeared strong and resilient on the outside, so it was difficult to know what was going on internally. All workers, irrespective of their organisational levels, may be vulnerable. The participants noted that suicidal thoughts and behaviours impacted the workplace and, importantly, the safety and morale of the workplace. The participants noted that a lot of the workplace training was focused on physical safety, while little was focused on psychological safety or mental health. The participants spoke about the dual responsibilities of training people and supporting the workplace, along with the challenges of learning to engage with others to be able to provide support within construction. The participants also noted the need for appropriate, integrated, and ongoing support, for example, in the form of a peer-support network, which would provide a safety net, capturing those who really need it.
Additionally, the participants spoke about the need for continual invitations to speak about all aspects of life and that for some, dwelling on trauma or the negative aspects of the workplace was not always conducive to connecting with others, while also being a time when communication about difficult events can occur. Mental health challenges related to exposure to CIs and chronic conditions are challenging to deal with in the context of construction work. Symptoms such as manic and risky behaviours and insomnia make it difficult to complete work tasks. Compounding this issue is that prescription medications offered as a treatment for some symptoms have side effects that impact a worker’s capacity to work; for example, medications that may cause drowsiness cannot be used when operating machinery.