RF_DM-2_DR-23_SUDHA.pdf
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S'(Helper)
is one who assi=>ts/aids
in some distress /
Carer
A helper who assists in disaster can become a hidden
misfortune.
victim.
Qualities of a helper:
1. Should be empathic
Should have the ability to cope with fear / stress
a
3. Should have the ability to handle their own emotions to
satisfactory extent
the
4. Should hve the confidence and the opt i m ism to face
consequences
5. Should have the ability to share and give
6. Should have the ability to maintain their edge
~7
Should have leadership ability and sometimes act 1 i k e a role
mod e1 .
Ro1e of a helper:
1
3
4
5
“?
S
Handling and treating the physically injured
Notification of death
Identification of bodies
Viewing of the dead
Inform about the circumstances of death
visiting the site of death
Conducting public memorial service
Providing psychosocial support
Stressors & Needs;
The helper is expected to know,, to do , to be in control,
to fix what has happened.
to be powerful and resourceful and
l
The stressors experienced by the helper
certain variables as outlined below.
will
depend
on
The helper came to their roles along and of different
He/she m,ay be the less severely affected among the
pathways.
to a voluntary
trained disaster worker/belong
v i c t i ms /
o rg an i z a t i on.
role
The role expectations of stressors associated with
role
of
performance,
could be high.
The uncertainty
expectation may itself produce stress.
Particular disasters may have comp 1ications in themselves
Certain personality pattern and previous experiences /
inner conflicts may have left him / her psychologically
vulnerab1e.
I
4
»
In recent years there has been1 an increasig awareness that
in a
a disaster <may" bring stressful effects for those involed
be
may
These stressors
vari ety of disaster and support roles.
severe and will be described in some detail below.
Encounter ^?ith death poses a few special problems:
The multiplicity of death, the shocking injuries they may
involve, deaths of the young, the unexpected nature of death may
all
reflect the special traumatic effect of confrontation wi th
human mor t a1i ty.
in which
to recover all body parts in situations
Failure
for
stress.
rare
also
can
be
a
major
cause
intact remains are
due to
In terms of consti11 at ion of symptoms experienced
above encounters the pattern are very much that of post traumatic
stress reactions with reports of bad drea, ms intrusive unpleasant
thoughts and sleep disturbance.
-AnQU-ish and suffering of -others:
Most helpers are likely to have contact with the d irectly
affected victims, sharing their suffering firsthand or hearing
from them about their experience.
Workers whose principal function is to offer emotional
support may feel great uncertainty and helplessness and this is
more likely to be associated with feelings of.deression.
The empathic response to the victims loss and grief and any
leave the helpers emotionally
uncertainty of role and training
vulnerab1e-
Ro 1 e stressor-s i
Helpers may be stressed due to the roles they are
to perform- These are:
expected
problems like
Not being able to accomplish due to practical
difficulties in communication, staff problems and inadequate ...
Exhaust ion
•7
Helplessness due ta overwhelming nature of disaster or lack
train ing
of
Interpersonal relationship with other relief organizations
Family interactions may become a source of strain.
This may be
due to family not being able to understand
and share
responsibility,
the helper being torn by his responsibility
towards v ict ims and fami1y.
FACTORS AFFECTING STRESS AMONG DISASTER WORKERS
Factors affecting
summa r i s ed as foilows:
stress among disaster
workers
may
be
Various factors may influence a disaster worker's stress
response to disaster.
Some of the factors re 1 ated
to the
individual which place him/her at an increased risk.
I - Factors related to the individual;
—
—
—
—
—
—
Poor health
Pre—existing stresses
Previous traumatic experience
Poor* coping skills
Prior disaster experience
High self expectations
II. In t a rge rson al f actors such as poor support system within the
family problems, high expectations from family members,
f am i 1 y,
separation from family members.
III. Aspects of the disaster like the unexpected nature of the
type of disaster <man—made disasters more stressful
disaster,
night,
natural
disasters),
disasters
occurring
at
than
disasters),
uncertainty of disaster, longer duration of the disaster and the
bigger scope of the disaster.
Sources of stress for disaster workers;
Three main sources of stress have been described.
Arising from the disaster itself
The
j—v j-t 4- m -i r-\ i > 4- .-n m
L- x-_/« I u i a (Jul v d i =>
toxic
are
stressors
of
d isaster
following
to the stress reaction of individuals.
When there is personal loss like a worker .being
substances or a team member dying.
3
weighty
exposed
to
— Traumatic stimuli which might trigger off stress reactions are
death of a child the same as one's own, loss of
life following
prolonged
expenditure of energy, victims being known to the
helper, baby child dying, hostage situations which presents
physical or psychologica: threats to the worker.
Failure due to human error like a situation which have been
prevented, civilian
c i v i1i an dues due to collision with an emergency
vehicle.
Occupational stressors
The nature of the disaster work like weighty pressures at
work,
time pressures, work overload,
responsibi1ity overload.
These put increased physical, mental and emotional demands on the
individual.
The work environment such as the work area
, poor
weather conditions,
amount of contact with death,
poor living
conditions, lack of human resources, frustrations and presence of
bystanders.
Organisational stressors
Nature of the organisation itself may be stressful
volunteer
organisations have
less training,
size
of
organisct ion,
reward systems,
confusion
sonfus i on as regards
ambiguity of roles, poor deligation of responsibi1ities.
like
the
to
The following section discusses the effect of stress on
d i s as t e r wo r -k e r s.
It is important to understand that
(1 ) no one
who sees a disaster is untouched by it and (2) stress reactions
are a normal
response to an abnormal situationThese are
described as :
Stress response during disaster
WORKERS SO THROUGH THE FOLLOWING PHASES:
* Alarm and mobilisation phase
* Action phase
* Let down phase
I.
Alarm
and Mobilisation phase:
Th i s
involves
phase
comp rehend ing
the news of the disaster and coord inating pIans.
There may be several reactions like
<1 )
Physiological
pressure.
(2)
Coqn i tive : — Disorientation, difficulty in concnentration
Increased
4
pulse,
respiration .
blood
(3)
Emotional
Shock, anxiety. fear, decreased efficiency.
II. Action Phase:- This may vary in length from days to weeks.
In this phase a high level of activity and a high level of stress
concurs.
It would be timely to stress that experiencing a few of
problem.
however
the
listed symptoms does not constitute
a problem,
several symptoms may diminish the worker s raspers i bi1ity-
The p h ys i c a1 s ymptoms described are increased heart beat,
tremors,
nausea, diarrhoea, sweating, clammy skin,
resp iration,
1ow back pain. fatigue, appetite change.
The cognitive changes are the next to set in.
There may be
memory problems, disorientation, poor concentration,
difficulty
calculating, making poor judgements and loss of objectivity.
anxi ety,
The psycholocical reactions which may occur are
anger,
event,
guilt, recurrent dreams of the
fear, depnersia,
blaming. diminished interest, numbness.
The behav ioural symptoms whi c h may occ u r are
hyperactivity, social withdrawal. inability to rest.
crying,
lli. Stress Responses after Disaster (Let down phase):
very
Workers experiences may be positive and in
m addition
is
disaster
.
painful.
There may be mixed reaction after a disaster.
It
it
helpful
to understand the transition and transformation
can
There
entails the workers to go through after the disaster,
The posi t i ve
be positive and negative consequences of disaster,
aspects of the disaster experience are
1.
2.
3.
4.
Opportunity to use creativity and leadership potential
New relationship
Feeling of accomplishment, helpfulness
Feeling of excitement, self confidence and a sense of courage
The negative aspects are outlined above.
The ending of disaster will be the let down phase there may be
Hence
A. Factors related to giving up their roles.
1.
2.
3.
4.
5.
6.
Difficulty in letting go
Sadness, depression
A desire to maintain contact with disaster workers. victims.
Anger if no recognition is given for performance
Conflict and feeling of estrangement from-peers and workers
at office who were not included in the disaster operationsConflict and estrangement with family members.
5
B. Reactions related to the disaster
1.
2.
3.
4.
5.
6.
7.
might include
Feeling of numbness
Sadness, Srief
Avoidance of activities wh ich arouse
recoilectiOn
traumatic event
A need to talk about the event
Fear of recurrence of event
Withdrawal, and unwillingness to talk- about the event.
irrelevant thoughts of the event can recur.
of
T iming of -otre^s reactions can be at any time during
the
above
phases.
A debriefing should be conducted at anv time such
a
reaction occurs.
How to know when stress reactions become a problem:
1.
3.
When duration lasts longer than 6 weeks
Any symptoms that seem acutely intense
Any symptoms that seriously interfere with
functioning
an
indiv iduals
These are some ^ofjnh guidelines t be fallowed by admistraiors
in helping carers to cope with disaster.
however,
these are
covered in much detail elsewhere.
Disaster Planning;
Normal precautions against physical
injuries and
their
treatment are considered to be covered by the use of
protective clothes.
Safety regulation in policies and instructions
and first aid and procedures.
in
Mental
trauma has rrecently been gien attention to
result from service at
- J a dis as ter site.
response
that
may
What
is of
immediate concern to administration
is the
development of mechanisms that will enhance the workers
ab i1i ty
to perform at the disaster site and facilitate optimal
coping
with the event.
This can be subdividprt
subdivided as below:
Pre-disaster stress Management:
In te rv en t ions aimed at reducing the negative consequenc es
of trauma resulting from exposure to a disaster event should be
devised before such an event occurs,
Some techniques
to
accomplish this areas follows:
Et?e--b inoculation and Stress auditing:
— Programmes and courses focusing on disaster are
if not nonexistent.
infrequent
Training curriculum can however incorporate the results of
a
stress
audit
which
includes detailed analysis
of
the
information
concerning the physical and psychological
i mp ac t
of disasters and other catastrophic situations.
— Stress inoculation training basically consist of the
inservice
programmes,
range of tasks and information covered
in such
programmes for protective service and rescue personnel.
Since
catastrophic event is likely to be rare, most of the trainino
programmes have spent less time on the possible mental sequelae
of d isaste r work«
Howe ver,
if
included
in a programme
information
on
potential mental problems it would be both timely and extremely
helpful to the worker and the organization.
Train!ng should be
information
covering research
psychclogical
trauma associated with disaster and evaluation
the effectiveness of the current intervention.
on
4—% -r-
U I
Gu i d e 1 i n e-s to be followed:
1.
Look at
the various duties to be oerformed
in
situations
and provide guidelines for time
for
assigned to particularly stressful tasks.
2=
Disaster workers report many strong feelings of
fear.
anger
hatred.
and hatred.
Social support and group cohesion can be bui 11
into the procedural response to disaster by paying particular
attention to these responses.
3.
Al though common sense wou
would
1d
indicate the advantages of
rotating workers offsite on
a regular b as i s to combat
f at igue,
preliminary research suggests that
better to
al low workers to stay on the job as long as possible,
preferably until the relief operations come to an end thereby
"7
di fferent
□ersonne1
giving a sense of completion.
4.
Loss of control and feelings of vulnerability have been
reported by.disaster workers,. Any adjustment that allows for
the maintenance of a sense iof control may prevent / relieve
mental trauma.
5.
and
Workers
to be briefed about
various
physical
psychological emerge cies to be expected and the app ropr i ate
plan of action and management.
6.
Less stressful methods for accomp1ishing specific tasks to
looked into.
be
POST-DISASTER MANAGEMENT
a
a disaster
A relatively new procedure following
of
types
structured
debriefing.
Two distincts
formally
the other
protocols have emerged, on educational approach and
addressing psychological functioning-
Debr i ef inq:
A debriefing is an organised approach to the management
stress response following a critical incident-
of
Debriefing aims at working through the feelings experienced
by the disaster worker.
It should aim to
- Examine the carer's role
- Examine the problems encountered and solutions found
- Help the expression of feelings
- Recognize those at risk
- Explain how to cope with stress in a more adaptive manner
in
(5-7)
- Recognize gains'— Debriefing should be conducted
sessions -
Educational debriefing:
Centres on an informational experience, generally providing
participants
with
facts about what
is
known
concerning
psychological
and behavkoural reactions of others in similar
situations and professions.
Acquaints disaster workers with possible personal reactions.
To minimize the
reactions of any ensuing problems
by
acknowledging that expressing symptoms can be quite normal,
thus leading the way to therapeytic intervention.
8
i
I
The debriefing session commences with the introduction of a
two person team compared of a mental health professional
and a
member of the protective service profession.
By presenting the
experiences of other protective service workers in similar
situations,
the session leaders acquaint participants with the
physical and psychological effects of disaster relief operations.
The symptoms are described as transient, their normal
duration
being 6 months or less.
It is stressed that symptoms normally
resolve themselves without psychosocial intervention,
is
intervention. or it
not uncommon for some symptoms to last longer, to recur following
subsequent traumatic
experiences.
or to be
exacerbated bv
normal stressors.
Discussion of treatment of such symptoms by a mental health
professional
including counselling within
the
context
of
treatment of other duty incurred injuries creates the
impression
that mental symptoms and treatment are not unusual or indicative
of psychological weakness.
P sychoIoq ica1 debrief ing has two cofljpanents:
Ventilation of feelings about the event
— Discussions of the signs and symptoms of a stress response
Di=briefing involves going through in details the
of events as experienced by each participant.
sequence
The briefing session should also encourage the expression
of positive aspects,
The rescuers should share
their thoughts
and feelings during and after the disaster.
This helps to
achieve a mastery over the unpleasant feelings and features of
disaster work.
Some rough guidelines are given below:
I.When should a debriefing be held and how long it should take
— The best time to hold a debriefing is about
the incident.
- It should last for (2—4) hours
(24-48) hours after
II. Who should attend;
Everyone who participated should attendtoo big,
should be split into smaller groups.
If the group
Who conductsa the debriefing:
Conducted by an experienced mental health facilitator.
9
is
HOW HELPERS CAN COPE
This section will discuss approaches that
’
may be helpful to
workers in dealing with disaster-re1ated stress,
.. it will suggest
interventions
that may be helpfull before, during, and
after a
* disaster.
suggestions presented are guide lines.
The
No
single
suggestion will work for all people at all times.
However, these
ideas,
in addition to those identified by course part ic ipants
earlier in the training, are based on a wealth of experience and
wisdom from disaster workers.
Predrssster interventions:
Preven t ion
Some of the most important stress management
interventions
for disaster workers take place predisaster?
These activities
are
important
in preparing workers for what
they will
likely
encounter
in
the disaster situation. Preparation by both
the
indi v idual
worker and the organization can help minimize the
effects of stress when it occurs, and can help
ind i v iduals and
the organization cope with stress in a more efficient manner.
The following are some useful predisaster interventions.
Predisaster personal emergency prpeparedness plans;
Having
a personal
and family emergency plan
p 1 an will help
indi viduaIs to cope with whatever emergencies may occur while
they are at horne.
Every emergency worker should be familiar with
hazards
and potential
emergencies inherent
in
the
local
geograpnic area, and should have contingency plans for self and
family,
but also to the availability of the worker for disaster
assignment. The more *quickly things can be taken care of at home,
the more quickly the worker can report to work relatively free of
Similarly,
ramily worries.
if the worker is at work when a
peace
of mind and concentration will be enhanced
disaster occurs,
if the person s family is prepared and able to cooe.
Every family emergency plan should include the following:
~ A home inspection to identify hazards and eliminate them
- A plan for different types of emergencies that might occur
in
the area, such as tornado, hurricane, earthquake, or hazardous
materials spill, training for what to do before,
during,
and
after each emergency.
- A home fire safety plan,
including smoke detectors,
f i re
extinguishers, and preplanned escape routes
- An evacuation plan:
what to take, w.jere to go, where to meet or
reunite
—A plan to icare for children, individuals needing
assistance
(the ill or1 those with disabilities) and pets
- Training of
every capable family member in how to turn off
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utilities and in first aid
- Prominent posting of emergency phone numbers
Emergency supplies and equipment should include the following:
Food and water for 72 hours; include spec i a1 diets.
infant
formula, and pet food
Portable radio, flashlight, and batteries
An adequate supply of prescription medications,
prescript ion
glasses, extra batteries for hearing aid, etc.
First aid kit
Blankets or sleeping bags
Sanitation supplies
Fire e x t i ngu ishe r
S an i t a t ion and p e rson al hyg i en e supplies
Alternate lighting; camping lantern, candles, matches
Safety equipment: hose for firefighting ,
h e a v y s h o r e s and
gloves, work clothes
Tools
Cooking supplies:
charcoal, sterno, camp stove.
It
is a good idea to establish a mutual aid system within
the neighbourhood. With a bit of prpep1anning,
neighbours can
arrange
to look out for and assist one another
in
times> of
emergencu,
pooling
supplies
as well
as
skills.
i Many
neighbourhoods develop emergency preparedness plans as part of
the neighbourhood crime alert network.
Such a mutual
aid
arrangement can give emergency workers increased peace of imind
about their families' welfare.
In addition, every worker who is likely to be called out on
emergency assignment on short notice is wise to have an emergency
bag prepacked.
Supplies should be tailored to the nature of the
worker's usual type of assignment. If the assignment is likely to
away from home, the bag should
entail any length of time awav
include
the following:
- Clothes,
including sturdy shoes and clothes for
inclement
weather
- Glasses and medications (including
over-the-counter
remed i es
for personal stress reactions
antacids, aspirin.
ant idiarrhe a
medicine, etc)
- Personal hygiene supplies
- Paper and pens
- Forms or supplies necessary to the worker's disaster assignment
- Sleeping bag
- Cash
and
important identification,
including
official
identification to allow access into restricted areas
- Change for pay phones (these circuits usually work when other
phone lines are out of service)
- A picture of one's family and at least one comforting ob .ject
from home
- A good book. a deck of cards, crossword puzzles
11
Interventions during the disaster
The following are suggestions for
stress during a disaster operation:
management
of
worker
Suggestions for line workers:
A.
Develop a “buddy" system with a coworker.
Agree to keep an
eye on each
e ac h others' functioning,
fatigue
level,
and stress
fat igue
symptoms.
Tell
the buddy how to know when you are getting
(If I start doing so-and-so, tell me to take a break).
stressed
pact
Make a
with the buddy to take a break when he or she
suggests it, if the situation and command officers allow.
B.
Enc ou r ag e an d support cowc r k e rs.
Listen tc eachi otheirs'
Don
't
feelings.
Don't
take anger tco personally,
Hold cr i t ic ism
unless it's essential.
Tell each other "you're doing great'
and
'Good
jcb'Give each other
othe r a touch or pat on the back.
Br ^.ng
each other a snack or something to drink.
C. Try to get some activity and exercise
D. Try to eat frequen11y, in small quantities.
E. Humour can b re a k the tension and provide relief,
Use
it
with care, however;
people are highly suggestible
in dis as ter
situations,
and victims or coworkers can take things personally
and be hurt if they are the brunt of 'disaster humor'.
Use positive 'self—talk' as I'm doing fine, and
the skills I've been trained to use ' .
"I 'm
U.
Take deep breaths,
hold them,
breaths,
(Mitchell, unpublished paper).
forcefully
then
b low
out
using
H. Take breaks if effectiveness is diminishing, or if asked to do
sc by commanding officer or supervisor.
I. On long assignments away from home, remember the following:
1»
Try to
make uour
comfortab1a,
and homey
pictures of loved ones.
2. Make new friends,
1983)
living accommodations
as
personal,
as passible. Unpack bags and put out
Let off steam with
coworkers
(0'Callahan
3. Get enough sleep
4. Enjoy some recreaion away from the disaste
scene
(O'Callahan
1983?
5. Remember things that were relaxing at home and try to do them
now:
take a hot bath cr shower, if possible;
read a good book;
12
go for a run ;
listen to music.
6. Stay in touch with people at home. Write or call often .
Send
pictures. Have family visit if at ail possible and appropriate.
7. Avoid e xce = = ive use of alcohol.
S.
Keep
a
grandchi idren.
journal»
this
will
make
a
great
story
for
interventions after the d isaster:
The fell■_wing suggestions may be usefu 1
in the first hours.
d ays, and weeks following a disaster.
Suggestion for line workers
A. ’’Defusing” „
This may happen quite sjp on taneous1y, or may be
■ an
organ i zed staff meeting immediately followinc
j
an
inc
ident
or
operation.
It is an informal debriefing in
which
personnel
1can
□egin
to tai k about their thoughts and
feelings about the
incident. It may happen over coffee or
cleaning
of equipment. The
s to keep the tone positive
key iis
and supportive,
No one should
Oe criticized
for how they feel or how they
functioned
.
Team
members and leaders should check
on ech other's well
b
e
ing
and
provide support
support to
to those who seem to be hardest hit by
the
incident (Mitchell 1983a).
B.
Attend a debriefing
if one is offer'ed:
try to get
organized if it is not offered
(Mitchell, unpublished paper)
C. ? a 1 k ab ci! t feelings as they arise.
and listen to each
fee 1ings
on e
others'
D«
when
1isten ing,
try to keep war stories to
It
doesn ' t really help to hear that once-upon-a-time a minimum,
someone
went
through something worse
(Mitchell,
unpublished paper);
it
doesn ' t help
to hear
it could have been worse.
so
quit
your
complaining" .
E. Don't take anger too personally
(Mitchel 1, unpublished paper).
Anger is a normal
feeling after ■3. traumatic
event,
and
it
sometimes get vented at- c owo rk e rs inadvertently.
Recognition
is important;
coworkers
should
appreciaition and positive feedback for a job we11 done.
6.
Eat well and try to get adequate sleep
m the days
the event.
rece i ve
f ol lowing
H. Relaxation and stress management techniques
are helpful.
IMaingaininc
a normal routine and "taking care of business ii
help maintain a sense of order and accomplishment.
13
J. The transition back into home and family life can be difficult
after a disaster or critical incident, workers should
tell
the
family the story of what happened, including what the worker saw
and did. Shwoinq pictures, videorapes, or newspaper articles of
the event can help. Workers should also encourage their families
to tell what
it was like for them in the worker's absence;
families need to tell their story, too.
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