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SHEFFIELD, England - From March 17 to 20 - less than a week before the massacre of Dunblane schoolchildren - 300 delegates from 30 countries gathered in Sheffield for the First European Conference on Traumatic Stress in Emergency Services, Peacekeeping Operations and Humanitarian Aid Organizations.

This watershed conference for the field of psychotraumatology, jointly sponsored by the European Society for Traumatic Stress Studies and the Emergency Planning Department of Trent NHS Executive in Sheffield, was the first regional meeting to focus specifically on the needs of responders. More than 100 presentations addressed risks, needs and care programs.

As pointed out by Berthold Gersons, M.D. (The Netherlands), the challenge presented to individuals, professions and organizations is to maintain goal-directed action in spite of complications arising from ambiguities of needs and role conflicts. These all too often engender a sense of uncertainty, and their combined effects for psychotraumatology in Europe has been to limit options for change. We may have had our backs turned to the future for too long and the costs to responders are manifest in compassion fatigue (C. Figley, Ph.D., USA) and a vast array of somatic syndromes (W.S. de Loos, M.D., The Netherlands).

The conference bolstered the impression that Europe is reclaiming and reasserting its own heritage with respect to conceptualizations of traumatic stress, its sequelae and care provision for its victims. The days of uninformed "product promotion" are numbered (J. Mitchell, Ph.D., USA). A previous focus on techniques for intervention is being replaced by growing appreciation of the value of process factors in critical incident stress management (A. Dyregrov, Ph.D., Norway). Another point of regional divergence may be the extent of reliance on professional staff groups for provision responder support. This may prove to have been an impediment to defining specific standards for training and quality of service provision (Dr. J. Kenardy, Australia).

Evidence was presented that education and realistic exercises that correctly anticipate future incident scenarios are a powerful protector for responders (L. Weisaeth, M.D., Norway). With respect to strengthening social support resources and responder family networks, the challenge is to establish user-friendly information systems backed by policies to minimize the effects of traumatic stress in the workplace (Lt. Col. R. McLellan, Canada). Evidence suggests using systematically gathered data to screen and select staff for particular duties (Col. M.W. de Swart, The Netherlands).

While every responder's experience is invariably deeply personal and idiosyncratic (Lt. Col. I. Palmer, U.K.), a prerequisite for truly turning our backs to the past and achieving an enlightened future is the use of objective evidence as the tool of our trade. In this respect humanitarian aid organizations appear to lag behind other responder groups featured in the conference program. Ultimately, all groups that respond to traumatic stress are developing a keen recognition that interventions at an organizational level promise considerable longer-term rewards (Dr. A. Ager, Scotland). All the more reason for all practice to be informed by evidence (S. Turner, MRCP, U.K.).