Ground-breaking study unearths forgotten victims
THE Cowper bus crash killed 21 people but there were far more victims to the tragedy.
The impacts were not limited to those on the bus, or even those on the scene.
Australia's worst road disaster, when a semi-trailer collided head-on with a coach would go on to play on the minds of countless men and women.
For some, it would become a ripple in a pond that seemed to constantly have another trauma thrown in. For others, it would make a wave so great, it could feel like drowning in its all-consuming horror.
The men and women responsible for saving lives in the hospital or at the scene plus those who dealt with the dead and had the excruciating task of piecing families back together and telling loved ones the devastating news. These are the people who often become the forgotten wounded.
Southern Cross University professor Jean Griffiths conducted a study into the impact of the Cowper and Clybucca bus crashes after Australia's two worst road disasters forever changed tight-knit communities along Australia's east coast.
Listen to Dr Jean Griffiths in Episode 3 of Cowper:
The Cowper bus crash on October 20, 1989 was the most visceral smash local emergency services had ever seen, and one they could not prepare for.
Two months later, a two-bus collision near Kempsey killed even more - 35 people on December 22.
In their study, The Kempsey and Grafton Bus Crashes: The Aftermath Professor Griffiths and co-author Rodney Watts delved into the horror the tragedies left behind for those involved, and callous industries unequipped to deal with it.
Dr Griffiths said the two crashes came at a time when the potentially life-long impacts of life on the frontline, including depression and post-traumatic stress disorder, were just starting to be understood.
"There was starting to be some significance in understanding that first responders can have quite severe effects," she said.
"Not everyone does, but some do. And for those who do, it can be quite debilitating."
The myriad support services made available to present day first responders weren't the norm in the 1980s.
In the '80s and through the 1990s, mandatory debriefings in emergency and medical services were at the height of popularity.
Despite a lack of evidence backing up the meetings held at the end of major events which usually involved some kind of group counselling or re-working a traumatic experience, they were used ubiquitously throughout NSW.
Despite the intention to lessen distress, Dr Griffiths said debriefings slathered on extra pressure for first responders to talk to a room of friends and colleagues.
An intrinsic shame of the effects of the gruesome and scarring scenes they had witnessed kept some workers from talking to anyone they thought might not understand.
One-on-one counselling wasn't made easily accessible to employees who were at times told by their superiors to simply toughen up and move on.
"There's no one size fits all," Dr Griffiths said.
"For some people it was good, but for other people it was not so good, because they may not have had effects but if you're sitting listening to everyone else saying that they were feeling a bit upset about it, then you think 'What's wrong with me'?"
"There was a contamination effect in partaking a debriefing."
"It's no longer mandatory for a number of reasons and our study overall found that debriefing was not as effective as had previously been thought."
That sense of shame was bolstered for many by not wanting to appear weak.
"In those days if you showed any sign of weakness it was well known that could and would be used against you in your performance, your future jobs application, whether you got promoted or any of those things," Dr Griffiths said.
"So you put up and shut up, basically."
Paramedic Robin Smith said Ambulance NSW management at the time acted as though employees "should be tough enough" to get through the horror scenes they witnessed.
"It's a little bit different living life in Grafton than it is in Sydney. There is a degree of anonymity in Sydney, there's not in Grafton," Dr Griffiths said.
"There was not a real good awareness of those local, cultural things. So not always appropriate the response."
Following the Cowper crash, chaplains and counsellors were flown into Grafton from Sydney to provide support to first responders, victims and their families.
The Clarence Valley - the geographic and local government area encompassing Grafton and several townships and villages along the Clarence River and beyond - is now home to 50,000 people. And 30 years ago, these tight-knit communities were even more closely bound than they are today.
Everyone knows everyone, and news travels fast - even if you don't want it to.
"People were not willing to have it out there that they were seeing somebody, because they were having difficulty coping - that was seen as a sign of weakness," Dr Griffiths said.
For everyone involved in that crash from those first on the scene to the cleaners at the hospitals unprepared for what they would see, it seemed everything was working against them.
In the country towns, mental health support services in the '80s were hard to come by and despite an influx of help, being one to put up your hand and accept help from a counsellor took courage for many.
For paramedic Mr Smith, and others who were on the scene of the Cowper bus crash, local ministers became a saving grace, often calling in for a cup of tea to provide a shoulder to lean on and much-needed company.
According to Dr Griffiths, this self-appointing of quasi-counsellors wasn't uncommon.
"We were always concerned about the people who were at the roadside, but not necessarily about people doing other jobs," she said.
"The person that was the greatest amount of follow-up long term was a dermatologist. Skin conditions can be a by-product of stress, and so these people presented to the dermatologist, and he was doing a lot of work with the trauma aspect of the response that people had."
"Sometimes we cannot prescribe who talks to whom, we need to facilitate it and let people talk when they want to, to people of their choosing, not necessarily who we think they should talk to."
"Being at the roadside wasn't always a determinant of whether you were affected or not," Dr Griffiths said.
"People working in some roles at the hospital were really quite distressed by it, because it wasn't what they would've expected."
When the crash happened in the early hours of Friday morning, the phones started ringing off the hook at the small country hospitals.
"Journalists from all over Australia and overseas, ringing these country towns in the middle of the night," Dr Griffiths said.
"People didn't know what to do or how to respond or what to say. And they found that quite distressing. We're always concerned about the people who were at the roadside, but not necessarily about people doing other jobs."
The Cowper and Clybucca bus crashes remain Australia's worst road accidents.
And five days after the two-bus collision at Clybucca, Newcastle 280km south was devastated by an earthquake that killed 13, injured hundreds and did billions of dollars in damage.
"For people who have got PTSD I look at it and say, it's on a continuum. There's those who have a little effect at one end, who go - just like anyone would - 'That was really an awful thing to go through'," Dr Griffiths said.
"And there's those at the other end who've got full-blown PTSD, and there's a whole range on that continuum in between that vary in accordance with the individual's own life experience."
Dr Griffiths said the three major events now etched in Australia's history were catalysts for change in understanding that while one first responder may walk through life with little to no side effects, their colleague may never forget it.
"There was a question we asked people and it was quite a significant determinant of whether or not people were affected. The question we asked was, 'Is this the most distressing experience of your life'?"
"If people said 'Yes' then they were more likely to have side effects than those who didn't."
"There is a degree of what we now call stress inoculation. If people have been through bad experiences before then they could get some side effects to their experience."
For some, the assistance provided in the aftermath of the Cowper bus crash was adequate, it helped them move past the trauma and on to the next event in their lives. For many others, it was simply dismal.
According to a 2018 report from Beyond Blue, about 40per cent of emergency workers in Australia have been diagnosed with a mental health condition.
More unsettling was the finding of a direct link between suicidal thoughts and traumatic experiences at work.
Employees who had the chance to take time off after trauma, or worked in a supportive environment had a higher chance of returning to work with a healthier mental state.
SES says its workers now have a comprehensive mental health strategy plan and access to a peer support program, chaplaincy program and 24/7 phone line.
These have become expectations across emergency services as mental health is increasingly widely discussed.
However, the Beyond Blue report found of emergency workers who used the services available, 40per cent needed further support.