Processing tragedy: the aftermath of the Grenfell Tower fire

The shocking tower block fire in London may have long-term effects for those who were there. As nurses, firefighters, police and residents struggle to come to terms with the events of that night, expert advice can help.

Palliative care nurse Simone Williams was woken by sirens on the night of the fire at nearby Grenfell Tower and rushed out to see what was happening. She helped look after those who had escaped from the burning building and knocked on doors appealing for blankets for them. 

The University College London Hospitals NHS Foundation Trust nurse says, while this was traumatic, at that point she and others assumed the people still inside the tower block would get out. 

It was only the next day that the true horror of the fire started to sink in. An estimated 79 people are dead, or missing presumed dead, after the fire, which broke out in the early hours of 14 June and spread rapidly through the 24-storey building. At the time of writing a total of 18 people remain in hospital, some critically ill.

Belief system

Ms Williams has been signed off work by her GP and referred to occupational health by her supportive employers as she tries to process the tragedy that happened on her doorstep.

‘Someone said to me you should be used to this because you are a palliative care nurse, but with that there is a process and a journey,’ she says. ‘These people went to bed with the belief that they would wake in the morning, as everyone does. I went to work and I couldn’t do it, I cannot face the patients.’

The local community in north Kensington cannot escape the sight of the giant blackened tower, she adds. ‘It is a constant reminder. The train I catch to work is next to the building. If I drive or go for a jog I see it. My leisure centre is where we were taking patients and they were keeping bodies there.’ 

‘It is about giving people information to normalise their reactions after an unusual and extreme experience, and supporting them coping. We see people as fundamentally resilient’

Sarah Davidson

For local healthcare services and charities, the challenge now is helping those directly affected, including residents, emergency workers and healthcare teams, to cope with what they experienced and witnessed. 

A 24-hour community assistance centre near the tower is staffed by the British Red Cross and other agencies, including the local mental health trust. It offers basics such as food, toiletries and clothes, but there are also volunteers and staff offering psychosocial support to anyone who needs help.

Sarah Davidson, head of the psychosocial support team at the British Red Cross, says volunteers are providing outreach services for people in hospital and those who may not want to visit the community centre. 

Psychological first aid

‘We are not providing counselling, more psychological first aid,’ Dr Davidson says. ‘It is not going into details about the event, or taking long histories, it is much more about giving people information to normalise the understandably concerning reactions they are having after going through an unusual and extreme experience, and supporting them coping. We see people as fundamentally resilient.’
 
The British Red Cross, the local mental health trust and social services are also working with local schools to ensure that the children and staff have the support they need in the short and long term.

Central and North West London NHS Foundation Trust has a phone line to enable people to access mental health support services, as well as information and advice 24 hours a day (0800 0234 650).

The trust's chief psychologist John Green says it is getting in touch with those affected by the fire. He says all those involved lost their homes, and many speak languages other than English, making it more complicated, but there is a well-organised plan in place.

‘Nurses don’t need to do anything special, but should familiarise themselves with what happens to people who are traumatised and use their nursing skills to support them’ 

John Green

Dr Green urges nurses to read up about the signs and symptoms in people affected by trauma. ‘Nurses are often in the front line and meeting people in traumatic situations, and having someone sympathetic to listen to and support them is really important,’ he says.

‘Nurses don’t need to do anything special, but should familiarise themselves with what happens to people who are traumatised and use their nursing skills to support them.’ 

The mental health trust is using a ‘screen and treat’ model to identify those at risk of post-traumatic stress disorder (PTSD), in which people are assessed at least a month after the event to see if they need further intervention.

The approach was used after the 7 July 2005 terrorist attacks on London’s transport network and is advocated in the National Institute for Health and Care Excellence’s PTSD guidance.

Risks of debriefing

Nurse Suzanna Rose, a cognitive behavioural psychotherapist and visiting professor at the University of Reading’s school of psychology and clinical language sciences, and professor of nursing at the University of West London, agrees with this approach. She led a Cochrane review of healthcare and policy in 2002, which found no evidence that single-session individual psychological intervention, or ‘debriefing’, was useful in the prevention of PTSD, and could worsen it.

One study found a significantly higher risk of PTSD for those who had gone through a debrief after a major trauma.

‘We support people at the outset but don’t make them talk about the event if they don’t want to,’ Professor Rose says. ‘It’s about providing support and watchful waiting. Most people faced with these awful experiences will process the event and carry on with their lives. Only an important minority cannot do so.’