Assisting Rescue Workers Assisting Rescue Workers During and After During and After

a Disastera Disaster

Patricia Rowell, PhD, RN, Patricia Rowell, PhD, RN, CNS, BCCNS, BC

A Disaster is:A Disaster is:

‘‘a grave occurrence having ruinous a grave occurrence having ruinous results’results’

Webster’ II New Riverside Webster’ II New Riverside Dictionary, Dictionary, 198.198.

‘‘an occurrence inflicting widespread an occurrence inflicting widespread destruction and distress’destruction and distress’

The American The American

Heritage Dictionary, Heritage Dictionary,

p. 374p. 374

Disaster (continued)Disaster (continued)

‘‘A grave or total misfortune’A grave or total misfortune’

American Heritage American Heritage Dictionary,374Dictionary,374

Disaster? Clarify Yourself!Disaster? Clarify Yourself!

Brush or forest firesBrush or forest fires EarthquakesEarthquakes House/apartment firesHouse/apartment fires Avalanches/mud slides/hurricanesAvalanches/mud slides/hurricanes RiotsRiots ShootingsShootings Explosions of any typeExplosions of any type Highway pile upsHighway pile ups ETC.ETC.

The Disaster EnvironmentThe Disaster Environment

ChaosChaos ‘‘Potentially’ unfamiliar with the Potentially’ unfamiliar with the

physical site.physical site. High emotions everywhere.High emotions everywhere. Death or, possibly, gruesome injuries. Death or, possibly, gruesome injuries. Panic among the people in the disaster Panic among the people in the disaster

area.area. Potentially demolished infrastructure, Potentially demolished infrastructure,

therefore, shortages of necessities.therefore, shortages of necessities.

Everything Seems BackwardEverything Seems Backward

n a bird cage!n a bird cage!

Immediate reaction to disasterImmediate reaction to disaster Normal adaptive biophysio-psyhological reaction Normal adaptive biophysio-psyhological reaction

to stress (>HR, >RR (>adrenalin flow), perspiring, to stress (>HR, >RR (>adrenalin flow), perspiring, visual fields narrowed, > auditory acuity, etc.visual fields narrowed, > auditory acuity, etc.

……useful, life-saving, focuses attention, mobilizes useful, life-saving, focuses attention, mobilizes mental and physiological capacities and prompts mental and physiological capacities and prompts decision making.decision making.

If too long or intense, energy reserves are If too long or intense, energy reserves are exhausted and stress becomes overwhelming - exhausted and stress becomes overwhelming - stuporus inhibition, uncontrolled agitation, panic stuporus inhibition, uncontrolled agitation, panic flight, automatic behavior without recall.flight, automatic behavior without recall.(Crocq, L. 2002. (Crocq, L. 2002. World PsychiatryWorld Psychiatry 1(3): 154). 1(3): 154).

People are still people even if they People are still people even if they are rescue workers!are rescue workers!

The chaos, unfamiliar environment,The chaos, unfamiliar environment,

gruesome injuries, panic among the gruesome injuries, panic among the people in the disaster area, and thepeople in the disaster area, and the

shortage of necessities to provide care shortage of necessities to provide care to many people, producesto many people, produces

– ANXIETY and FEAR among all people ANXIETY and FEAR among all people at the site, even the rescue workers!at the site, even the rescue workers!

Mobilizing for SurvivalMobilizing for Survival

We all do We all do

what we needwhat we need

to do to to do to

survive!survive!

Everyone is an individual,Everyone is an individual, therefore, it is imperative that the mental health therefore, it is imperative that the mental health

rescue worker follow the verbal lead of the victim rescue worker follow the verbal lead of the victim or rescue worker with whom they are intervening.or rescue worker with whom they are intervening.

If a rescue worker is immobilized, lead him/her If a rescue worker is immobilized, lead him/her away to a safe place and provide water, rest and away to a safe place and provide water, rest and food. A worker in such a condition can not decide food. A worker in such a condition can not decide on their own what to do so you must initiate the on their own what to do so you must initiate the intervention.intervention.

Do not pressure the victim or worker to talk about Do not pressure the victim or worker to talk about her/his emotions. The individual will decide when her/his emotions. The individual will decide when it is the right time for her/him to explore her/his it is the right time for her/him to explore her/his emotions.emotions.

Remember that the care provided Remember that the care provided is not therapy!is not therapy!

The mental health professional, as well as, The mental health professional, as well as, other health care professionals and people other health care professionals and people who can and are willing to listen have a who can and are willing to listen have a commitment limited to the disaster time or commitment limited to the disaster time or part of it.part of it.

If an individual appears to need mental If an individual appears to need mental health emergency care, they must be health emergency care, they must be moved to a hospital for care.moved to a hospital for care.

Rescue WorkersRescue Workers

By nature of education and training, By nature of education and training, rescue workers try to control their rescue workers try to control their emotions so they can help others.emotions so they can help others.

Rescue workers have emotions common to Rescue workers have emotions common to all people in disaster environments but all people in disaster environments but they “tuck them away” until their jobs are they “tuck them away” until their jobs are done.done.

There is nothing wrong with controlling There is nothing wrong with controlling one’s emotions until a later time, however,one’s emotions until a later time, however,

After the Disaster,After the Disaster,

the bottled-up emotions must eventuallythe bottled-up emotions must eventually be dealt with because:be dealt with because:

Failure to recognize and work through the resulting Failure to recognize and work through the resulting emotions one has can result in being & feeling emotions one has can result in being & feeling isolated, re-experiencing the event, being isolated, re-experiencing the event, being anxious, being hypervigilant, having insomnia, & anxious, being hypervigilant, having insomnia, & avoidance of anything related to the event.avoidance of anything related to the event.

Post Disaster StressPost Disaster Stress Most persons involved in a disaster will suffer some degree Most persons involved in a disaster will suffer some degree

of acute stress disorder (ASD).of acute stress disorder (ASD). A relatively small percent of those with ASD will develop A relatively small percent of those with ASD will develop

post-traumatic stress disorder (PTSD), either acute or post-traumatic stress disorder (PTSD), either acute or chronic.chronic.

All rescue workers must proactively be taught about the All rescue workers must proactively be taught about the emotional impact they may experience during and after emotional impact they may experience during and after disaster work.disaster work.

They must also be taught what symptoms They must also be taught what symptoms should signal them to seek needed help should signal them to seek needed help and where to go for it.and where to go for it.

And they need to be taught about self care during the And they need to be taught about self care during the disaster work time.disaster work time.

They should also be told that experiencing stress is not They should also be told that experiencing stress is not wrong or a weakness. It is normal!wrong or a weakness. It is normal!

What is disaster self care?What is disaster self care?

Eat.Eat. Rest, even if only for a few minutes.Rest, even if only for a few minutes. Talk with colleagues about Talk with colleagues about

something other than the disaster something other than the disaster even if for only a few minutes.even if for only a few minutes.

Talk with significant others Talk with significant others (telephone, e-mail, etc.), if possible.(telephone, e-mail, etc.), if possible.

Attend to personal hygiene, Attend to personal hygiene, if possible.if possible.

Self Care (continued)Self Care (continued)

Think about something you enjoy or Think about something you enjoy or a place of peace (visual imagery).a place of peace (visual imagery).

Teaching about self careTeaching about self care

Teaching rescue workers about Teaching rescue workers about psychological self care both before and psychological self care both before and during the disaster is critical.during the disaster is critical.

Simple self care actions can be forgotten Simple self care actions can be forgotten or ignored due to the many needs being or ignored due to the many needs being thrust upon each worker.thrust upon each worker.

Don’t let it happen or the rescue workers Don’t let it happen or the rescue workers will become less able to do their job well will become less able to do their job well and, thus, less effective.and, thus, less effective.

Offer a place for the workers to Offer a place for the workers to get together.get together.

Even during the disaster, a place for Even during the disaster, a place for workers to congregate during their workers to congregate during their breaks allows them to support each breaks allows them to support each other.other.

The presence of a mental health The presence of a mental health professional on the scene, assigned professional on the scene, assigned to care for the rescue workers, is to care for the rescue workers, is essential.essential.

A Place to GatherA Place to Gather

Try to provide a place where the workers Try to provide a place where the workers can sit down.can sit down.

Provide liquids and food so they can Provide liquids and food so they can rehydrate and eat.rehydrate and eat.

Try to keep the disruptions to a minimum Try to keep the disruptions to a minimum in this area.in this area.

If possible, have cots and appropriate If possible, have cots and appropriate coverings (blankets, etc.) so they can coverings (blankets, etc.) so they can catch a few ‘ZZZZZZZ’.catch a few ‘ZZZZZZZ’.

Inattention to the rescue workers Inattention to the rescue workers is inexcusable and counter- is inexcusable and counter-

productive.productive.

For efficiency, effectiveness and safety, For efficiency, effectiveness and safety, workers need to get some rest, sleep workers need to get some rest, sleep preferably.preferably.

They need to eat for energy and the They need to eat for energy and the strength to do the work being asked of strength to do the work being asked of them.them.

They are the same as the human beings They are the same as the human beings they are helping. They all have needs.they are helping. They all have needs.

Plan Ahead for Worker CarePlan Ahead for Worker Care

Part of any disaster relief plan must Part of any disaster relief plan must be a plan for caring for the people be a plan for caring for the people who will be the rescue workers.who will be the rescue workers.

Make it clear to all rescue workers Make it clear to all rescue workers they will be expected to take breaks they will be expected to take breaks at a set interval (i.e., every 2 hours). at a set interval (i.e., every 2 hours). Enforce the rule!Enforce the rule!

Support workers as they reach out Support workers as they reach out to each otherto each other

Disaster CounselingDisaster Counseling

Counseling during a disaster is:Counseling during a disaster is: a process of triaging rescuers with a process of triaging rescuers with

significant mental health problems and significant mental health problems and sending them to the hospital;sending them to the hospital;

Being available to rescue workers to talk Being available to rescue workers to talk with them on an informal basis;with them on an informal basis;

Recommending to those in need Recommending to those in need community resources for ongoing help; community resources for ongoing help; and and

Applying the same rules of self care to Applying the same rules of self care to yourself that apply to other rescue yourself that apply to other rescue workers.workers.