The major incident that occurred in the capital on July 7 2005 put many junior doctors on the front line, seeing badly injured and traumatised patients. Exposure to such horrific sights will make many health care workers vulnerable to post traumatic stress disorder (PTSD).¹

Following the major incident, occupational health staff sent relevant line managers information alerting them to the symptoms of PTSD. In accordance with current recommendations, formal counselling was not routinely offered to staff immediately after the event.² Evidence shows that it is not necessary for specific intervention until four to six weeks after the incident, when individuals have exhausted their normal coping mechanisms. It is difficult to achieve ‘watchful waiting’ in such a fluid environment as accident & emergency. In particular, four weeks after this major incident, the majority of the junior doctors moved on to other posts.

Four weeks after the event, we carried out a departmental survey based upon Chris Brewin’s Trauma Screening Questionnaire, in order to identify those more likely to be suffering from PTSD.³ The results showed that although no junior doctors were experiencing enough symptoms to suggest a greater risk of developing PTSD, only 50% knew where to access counselling despite detailed information available on the hospital’s intranet service.

We recommend that a senior staff member is responsible for informally following up junior doctors involved in a major incident. This should be four to six weeks after the event, potentially by postal questionnaire and should identify any on going problems. Posters advertising counselling should be clearly visible in communal staff areas and ultimately, every accident & emergency department should have a follow up plan for remote monitoring of staff that were involved. This should be the final chapter of the major incident plan for any department.