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Actions can be taken before, during, and after an incident to help manage emotional impact of disaster response work

Knowing possible psychological and physiological symptoms of disaster trauma helps manage impact

Learn to manage stress

CERT members for themselves

CERT leaders during response

Why is team well being so important?

About 50% of disaster workers likely to develop significant distress (Myers and Wee, 2005, Dis. Men. Health)

PTSD prevalence: 10-15% of Law Enforcement Personnel (Everly and Mitchell, 1999)

PTSD Prevalence: 10-30% of those in fire suppression (Everly and Mitchell, 1999)

PTSD Prevalence: 16% of Vietnam veterans (Everly and Mitchell, 1999)

Phases of a Crisis

Impact

Inventory

Rescue

Recovery

 In the impact phase, survivors generally do not panic and may, in fact, show no emotion.

In the inventory phase, which immediately follows the event, survivors assess damage and try to locate other survivors. During this phase, routine social ties tend to be discarded in favor of the more functional relationships required for initial response activities (e.g., search and rescue).

In the rescue phase, as emergency services personnel (including CERTs) respond, survivors are willing to take direction from these groups without protest. This is why CERT identification (helmets, vests, etc.) is important.

Survivors are likely to be very helpful and compliant during the rescue phase.

In the recovery phase, the survivors appear to pull together against their rescuers, the emergency services personnel.

• Survivors may express anger or blame to the rescuers as they transition to the recovery phase.

If a person becomes agitated he or she may:

  • Challenge or Question Authority: Answer their question or restate the direction calmly
  • Refuse to Follow Directions: Do not assert control, Offer choices by setting limits, Remain professional, Give the person time to consider your request.
  • Become Verbally Aggressive: Stay calm, remove audience if possible, get assistance, allow them to vent
  • Become Threatening: Seek assistance and take seriously

Effects of Traumatic Stress

Cognitive functioning

Physical health

Interpersonal relationships

Mediating Factors:

Prior experience with a similar event

Prior trauma exposure

Intensity of disruption

Individual feelings about event

Emotional strength of individual

Length of time since event

Team Well Being

How do we get a debriefing for our team or for someone else?

Ask your team leader to contact: Tracy King at FMRS: 304-256-7100 to arrange for Debriefing.

Critical Incident Stress Debriefing

CISD is not Group Therapy. It is a form of crisis intervention with the goal of stabilization, symptom reduction, return to adaptive functioning and facilitation to continued care as needed.

  • Occurs within 24 hours of the event and no longer than a week outside of the event.
  • CISD is a structured team guided discussion that lasts between 1 to 3 hours.

1. Introductions and description

2. Review of factual material

3. Sharing of initial thoughts and feelings

4. Sharing of emotional reactions to incident

5. Instruction about normal stress reactions

6. Review of symptoms

7. Closing and further needs assessment

How Team Leaders Reduce Stress

How You Reduce Stress

Brief CERT personnel beforehand

Remember CERT is a team

Rest and regroup

Take breaks away

Eat properly, stay hydrated

Arrange for debriefing

Rotate teams and duties

Phase out workers gradually

Take Care of Yourself

Get enough sleep

Exercise regularly

Eat a balanced diet and drink water

Balance work, play, and rest; pace yourself.

Allow yourself to receive as well as give

Connect with others, take time off to relax.

Use spiritual resources such as meditation and prayer.

Avoid excessive amounts of caffeine and alcohol.

Do not use tobacco or illegal drugs.

Be aware of trauma that can follow a disaster

Explain to family members and friends what you need:

  • Listen when you want to talk
  • Don’t force you to talk

Have a plan to manage tasks: do important things first. Avoid making life changing decisions.

Know that feeling stressed, depressed, guilty, or angry is common after a traumatic event.

Physiological Symptoms of Trauma

Disaster Trauma

Loss of appetite or eating too much

Headaches or chest pain

Diarrhea, stomach pain, or nausea

Hyperactivity

Increase in drug and/or alcohol consumption

Nightmares

Insomnia

Fatigue

Tremors, muscle twitches

Easily startled

Sweating or having chills

Intervening with Survivors

Risk Factors for Trauma

It is an individual’s experience of the event, not necessarily the event itself that is traumatizing.

Stabilizing Victims

Your own personal losses

Working in your neighborhood

Assisting neighbors, friends, coworkers who have also been injured

Not feeling safe and secure

Assess survivors for injury or shock

Get uninjured people to help

Provide support by:

Listening

Empathizing

Help survivors connect with natural support systems

Provide comfort (drink, blanket, food...)

Provide a distraction

Ask them to take deep breathes

Take them for a walk

Keep groups calm, remove upset individuals

Give information and find answers to their questions

Encourage people to follow directions of first responders

Encourage those that can to help others by giving tasks

Shield children from the scene

Stay with children and assist with finding family

Explain multiple times what you need them to do (children and elderly)

Provide stuffed animals to children for comfort

Give older children and the elderly tasks to stay busy that they can handle.

Help elderly to physically get around

Encourage to leave their homes if in danger.

How to be an Empathic Listener

What is Trauma? "an emotional shock that creates significant and lasting damage to a person’s mental, physical and emotional growth.”

Traumatic experiences can significantly alter a person’s perception of themselves, their environment, and the people around them. In effect, trauma changes the way people view themselves, others and their world.

Can impact safety, well-being, permanence.

Give the person your full attention

Make eye contact

Have an open posture and get on their level

Listen for "feelings"

Paraphrase what the person is telling you

Clarify that you are understanding their message

Summarize

Be Non-Judgemental

Watch para verbal and nonverbal communication (i.e. tone/volume/cadence, eye rolling)

What not to say!

"I understand”

“Don’t feel bad”

“You’re strong” or “You’ll get through this”

“Don’t cry”

“It’s God’s will”

“It could be worse”

“At least you still have…”

“Everything will be okay”

"If I were you I would....."

start 33:29 stop 41:15

What is Traumatic Crisis?:

Actual or potential death

Serious injury

Destruction

Loss of contact with family or close friends

Disaster Psychology

Managing a Death

first 7 min.

Psychological Symptoms of Trauma

Cover the body; treat it with respect

Move the body to temporary morgue

Follow local laws and protocols

Talk with local authorities, (if this is a crime scene must get approval from authorities before intervening)

Inform family/friends of their loved one's death:

  • Separate the family member(s) or friend(s)
  • Have the person(s) sit down
  • Make eye contact
  • “I’m sorry, but your family member has died. I am so sorry.”
  • Let the family and friends grieve

Irritability or anger

Self-blame or blaming others

Isolation and withdrawal

Fear of recurrence

Feeling stunned, numb, overwhelmed

Feeling helpless

Mood swings

Feeling heroic, euphoric or invulnerable

Sadness, depression, grief, frequent crying

Denial

Concentration and memory problems, feeling confused and difficulty making decisions

Relationship problems/marital discord

Summary

Rescues may be unpleasant or uncomfortable

Psychological and physiological symptoms of trauma

Take steps to reduce stress

CISD is one intervention

Four emotional phases of a disaster

Stress affects cognition, health, and interactions

Stabilize individuals

Be an empathetic listener

People can recover and become more empowered with the right supports and interventions.

References

Emergency Management Institute (U.S.) United States Fire Administration. United States. Federal Emergency Management Agency. United States. Department of Homeland Security. Human Technology, Inc. Citizen Corps (USA Freedom Corps) (2003). Community emergency response team. Washington, D.C.?: FEMA.

Mitchell, J. T. (2006). Critical incident stress management (CISM): Group crisis intervention. Ellicot City, MD: International Critical Incident Stress Foundation.

National Child Traumatic Stress Network (2008). Child welfare trauma training toolkit: Trainr's guide. Los Angeles, CA: NCTSN, National Center for Child Traumatic Stess.

Tips fo survivors of truamatic event managing your stress (NMH05-0209R). (2007). US Department of Health and Human Services Substance Abuse and Mental Health Services Administration Center for Mental Health Services.

Training Video: Psychological First Aid Basics [Video file]. (n.d.). Retrieved from

United States. Substance Abuse and Mental Health Services Administration (2005). Psychological first aid: A guide for emergency and disaster response workers. Rockville, MD: Substance Abuse and Mental Health Services Administration, U.S. Dept. of Health and Human Services.

For the

Community Emergency Response Team

Learning Objectives

  • Describe disaster and post-disaster environment for victims and rescuers
  • Describe steps rescuers can take to relieve their own stress and that of survivors

Thank You for your participation and interest in serving your community!

Presented by: Tracy King, MSW LCSW

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