Specialist teams of crisis support workers were last night helping the victims of the Dunblane massacre deal with the aftermath of the tragedy, as experts warned of the far-reaching effects on families and emergency workers.
Within hours of the shootings, major incident teams from Stirling - established after the Lockerbie disaster and comprising psychologists, social workers and psychiatric nurses - were on hand, and those in Edinburgh and Glasgow on stand-by.
Trauma experts acknowledge, however, that there is a limit to what they can do. "It is not a case of getting over it," said one. "People who live through that are always going to remember that it happened. They will still be talking about it when they are 90."
Dr James Thomson, senior lecturer in psychology at University College, London, and director of a trauma stress clinic, said they would be under intense pressure to deal with the "high levels of traumatisation among people in the school".
Marion Gibson, a social worker with more than 20 years' experience of the Irish Troubles, who trained some of the support workers now in Dunblane, described the "terrible uniqueness" of the shootings.
"This is the one we have all been dreading," she said last night. "It is a landmark tragedy. No amount of training can prepare for the death of so many very young children, for so much tragedy. You have to go back to the Aberfan tragedy in 1966 to find something similar."
Psychological "first aid" will be offered initially, said Mrs Gibson. "Love, comfort, and trust are the foundations for counselling for the future. The little children are vulnerable. They have no frame of reference, not even the language to describe what has happened."
Mrs Gibson also warned of the "ripple" effect of such a tragedy, which has serious consequences for those not directly touched by it and puts them at risk of post-traumatic stress syndrome. She joined other experts in urging that the school becomes the focus of community mourning.
Crisis support workers will be called on to help, according to Wendy Morris, founder of TACT (Trauma After Care Trust). "People are in shock. They won't be receptive to counselling when what they really need is comfort and answers to questions such as `where can I see my child's body?'."
The number of children involved presents special problems for support workers, Dr Dora Black, a consultant child and adolescent psychiatrist, and director of an NHS Traumatic Stress Clinic in London, said yesterday. "Very young children can be as traumatised as older ones. They have less cognitive understanding," she said.
However, Dr Black said psychiatrists would draw on the pioneering work of Professor Robert Pynoos, a Californian psychiatrist who studied an incident in a Los Angeles school when a sniper killed one teacher and injured pupils.
Preventive intervention - in which children are helped to process and understand what they have seen - is the key to limiting the destructive effects of trauma and should be available to all involved, she added. Of these, a proportion will need treatment - counselling or very rarely drugs.
Peter Hodgkinson, a director of the Centre for Crisis Psychology, whose team helped children cope with the impact of the M40 school mini-bus crash in 1993, which left 12 children and their teacher dead, said there would be a lot of "fear" among the children.
They may regress to early childhood fears of the dark or become clingy and not want to be left alone, he said. "It is going to be very much a test for the adults around them, the teachers and their families, to be able to deal with all this."Reuse content