No one likes to imagine the worst case scenarios in work injury: the fatalities, the permanent disabilities, the trauma. Yet for Return to Work professionals, knowing how to handle cases of catastrophic injury can drastically improve outcomes for the injured person.

Catastrophic injuries include brain injuries, spinal injuries, amputations and other severe, long-term conditions. In cases of permanent impairment, a lump sum payment is made by the authority when the injuries have stabilised. However, not all permanent impairments lead to permanent unemployment – just see our inspiring case study of Mario, who returned to work with quadriplegia.

The scale of catastrophic injuries, mixed with complex legal, social and emotional factors, frequently leave managers feeling helpless.

Here are 9 tips for dealing with the most severe injuries:

1. Be available

Perhaps the most important thing a Return to Work manager can do is visit the worker in hospital, when medically appropriate. This gesture may seem small but can set a positive tone for the entire compensation process. It tells the worker they are cared for as part of the team.

As time goes on, be available if the person needs to speak with you. People who have been through trauma often seek to make sense of what happened. Giving the employee information can help them come to terms with their injury.

The person may want to talk about what happened with someone from the organisation. Let the employee express themselves, without shutting them down or pushing them on topics they are reluctant to discuss.

Similarly, encourage the employee to ask questions to set their mind at ease (“Will I still have a job if I never walk again?”). Even if you have no definitive answer, be honest and open (“I don’t know at this stage but we’ll work with you and your doctors to help you back to an appropriate job”). It’s often less about a yes/no answer than letting the patient know other people are on their side.

The employee’s family and loved ones also need support. Encourage them to speak to you freely and provide information when you can, within the bounds of employee confidentiality.

2. Understand the psychology of trauma

Traumatic events affect every person differently. Some common reactions include sleep disturbances, immense tiredness, feeling numb or frequent crying.

Victims may find it difficult to concentrate or to focus on anything except the accident. Some people may not remember what happened or not want to talk about it.

On average, it takes people 4 to 6 weeks to recover psychologically from trauma. Some may require counselling to help them through the process.

Depending on the circumstances of the accident, the person may be harbouring anger towards the company. As a Return to Work manager, your role is not to get involved with questions of blame. The most effective response to anger is compassion.

After trauma, some people develop post-traumatic stress disorder. Common symptoms include flashbacks or nightmares, anger, increased startle response and avoidance behaviours such as not talking about the accident. PTSD can be difficult to identify as many sufferers become wary and withdrawn. Be alert for signs of PTSD and if you identify them, encourage your employee to seek counselling.

3. Be conscious of your communication

The best of intentions are worthless if they are badly communicated. This does not mean you can only communicate in politically-correct language sanitised of all meaning. It means remembering to treat the injured person with respect. Talk to the worker like an adult, not a child, even if their condition requires speaking slowly and repeating yourself.

Studies have identified that hope helps people overcome catastrophic injuries. Theo Feldbrugge, an expert in injury recovery through training and personal experience, believes optimism can help motivate people to recover.

According to Feldbrugge, optimism is a learned behaviour whereby people choose to believe that bad events are temporary flukes without universal effect. He encourages return to work professionals to model optimism to their clients and call out pessimistic behaviours. Describing negative situations with universal words like “always, never, everywhere or forever” suggests a person is thinking pessimistically.

4. Patience, patience

Catastrophic injury claims can be drawn-out and messy. The employee may require a series of operations. Each time, they face post-operative pain and long rehabilitation. Complications may arise, such as delayed healing of fractures, month-long infections and coordinating different referrals and treatments.

It may take over two years for a patient’s condition to stabilise to the point where a long term assessment of their capabilities can be made.

Given the seriousness of the damage, the incident may attract an investigation by the regulatory body or the police. Lawyers are also frequently involved in such high stakes claims.

The Return to Work professional may feel discouraged when the claim remains unresolved for a long period of time. Understanding from the start that such claims are complex may help keep the manager focused and engaged.

Employees may need varying levels of support during this period. One employee may start off coping well, only to become discouraged as the reality of their situation sets in. Another may cope well until a particularly difficult period, such as the anniversary of their injury. And another still may be distressed from the start and continue needing high levels of support

5. Support your employee to get good medical care.

Choosing the right medical care is vital for long-term injury patients. You can assist your employees by ensuring they have all the information they need to make an informed choice.

Initially, many employees with substantial injuries are taken by ambulance to a public hospital. In the early stages, this system may serve the employee well.

However, employees should be aware that they will be expected to attend the outpatient department for their follow up care. In the outpatient department, they are more likely to be seen by a different doctor at each visit, many of whom are fairly junior.

Changing doctors means medical practitioners do not get to follow the employee’s progress. This can result in delays in addressing any complications. It also makes it difficult for the employee to develop confidence in their doctor.

For some employees, the public system will perfectly suit their needs. For others, the private system will provide the assurance of having a single specialist dealing with their case.

As a return to work professional, you can let employees know they have the option of private and public care and the opportunity to change doctors. You can also assist them in seeking out a specialist who will accept compensation cases. The employee may also wish to discuss this with their general practitioner who can make an appropriate referral.

The key is that the employee is happy with their care and understands their options.

6. Get advice

Catastrophic injuries are thankfully rare. As a result, however, this area is uncharted territory for most Return to work professionals.

If any questions arise about what to do, remember it’s okay to ask. Encourage lawyers and doctors to continue explaining issues to you until you fully understand. Getting the facts straight is far more important than appearing knowledgeable.

It’s also okay to ask the patient how they would like to be treated. “Would you like me to help you when X happens?” “How do you feel about people saying Y?” This allows the patient to decide what their boundaries are. To someone who has had to radically adjust their lifestyle, this level of control often feels empowering.

7. Finances

Although compensation systems aim to ease the financial burden on people with catastrophic injuries, the financial impact can still be significant. At appropriate times, provide the employee with information about their financial options. Human Resources can frequently help in this regard.

Permanent impairments may attract a lump sum settlement, after which compensation payments may cease. The employee might have a common law claim, income protection or another source of potential funding. Help the employee identify what options are available and who they need to contact.

8. Home assistance

A significant injury can cause massive upheaval to an employee’s everyday activities at home.

To provide appropriate assistance, it is necessary to fully understand the employee’s living situation. Who else lives with them? Who in their family could provide support? How much mobility will they have? How accessible is their home to someone on crutches or in a wheelchair? Will they be able to shop or mow the lawn or vacuum the stairs?

Ensure any issues are addressed and aids and necessary appliances are supplied. A home visit by an occupational therapist may be needed to fully understand the person’s needs.

The employee’s needs may also change in the short, medium and long term. Discuss potential requirements, with the input of the occupational therapist and the employee, for each of these scenarios.

Being active at home is an important component of rehabilitation. Work with the employee and their treaters to devise a plan that maximises the employee’s abilities.

An example may be an employee that requires home assistance for three months when first released from hospital. As they begin their exercise program, they could start to take on some of the house work. After a year, the employee may do most of the everyday tasks, but continue getting assistance with tasks requiring a ladder.

9. Care for others in the workplace too

A traumatic injury has ripple effects to people throughout the organisation. Direct witnesses to the incident, those with a history of trauma or people particularly close to the injured person may be particularly vulnerable.

Keep staff in the loop with the person’s condition, encouraging them to visit the injured person or send cards. Keep lines of communication open so that staff know they can speak to you about their reactions and feelings.

While some staff may need time off, keeping busy and involved with the workplace is often the best way to help people move on.

A person with a catastrophic injury may be overwhelmed with all the issues they need to deal with.

Providing sensitive, proactive support helps the person get through a difficult time. At RTW Matters, we have heard a number of affected employees describe how post-injury support had a major impact on their recovery.