Assisting Rescue Workers During and After a Disaster

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Assisting Rescue Workers During and After a
Disaster

• Patricia Rowell, PhD, RN, CNS, BC

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A Disaster is

• a grave occurrence having ruinous results
• Webster II New Riverside Dictionary, 198.
• an occurrence inflicting widespread destruction
  and distress
• The American
• Heritage Dictionary,
• p. 374

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Disaster (continued)

• A grave or total misfortune
• American Heritage Dictionary,374

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Disaster? Clarify Yourself!

• Brush or forest fires
• Earthquakes
• House/apartment fires
• Avalanches/mud slides/hurricanes
• Riots
• Shootings
• Explosions of any type
• Highway pile ups
• ETC.

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The Disaster Environment

• Chaos
• Potentially unfamiliar with the
• physical site.
• High emotions everywhere.
• Death or, possibly, gruesome injuries.
• Panic among the people in the disaster area.
• Potentially demolished infrastructure, therefore,
  shortages of necessities.

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Everything Seems Backward

• n a bird cage!

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Immediate reaction to disaster

• Normal adaptive biophysio-psyhological reaction
  to stress (gtHR, gtRR (gtadrenalin flow),
  perspiring, visual fields narrowed, gt auditory
  acuity, etc.
• useful, life-saving, focuses attention,
  mobilizes mental and physiological capacities and
  prompts decision making.
• If too long or intense, energy reserves are
  exhausted and stress becomes overwhelming -
  stuporus inhibition, uncontrolled agitation,
  panic flight, automatic behavior without recall.
• (Crocq, L. 2002. World Psychiatry 1(3) 154).

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People are still people even if they are rescue
workers!

• The chaos, unfamiliar environment,
• gruesome injuries, panic among the people in the
  disaster area, and the
• shortage of necessities to provide care to many
  people, produces
• ANXIETY and FEAR among all people at the site,
  even the rescue workers!

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Mobilizing for Survival

• We all do
• what we need
• to do to
• survive!

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Everyone is an individual,

• therefore, it is imperative that the mental
  health rescue worker follow the verbal lead of
  the victim or rescue worker with whom they are
  intervening.
• If a rescue worker is immobilized, lead him/her
  away to a safe place and provide water, rest and
  food. A worker in such a condition can not decide
  on their own what to do so you must initiate the
  intervention.
• Do not pressure the victim or worker to talk
  about her/his emotions. The individual will
  decide when it is the right time for her/him to
  explore her/his emotions.

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Remember that the care provided is not therapy!

• The mental health professional, as well as, other
  health care professionals and people who can and
  are willing to listen have a commitment limited
  to the disaster time or part of it.
• If an individual appears to need mental health
  emergency care, they must be moved to a hospital
  for care.

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Rescue Workers

• By nature of education and training, rescue
  workers try to control their emotions so they can
  help others.
• Rescue workers have emotions common to all people
  in disaster environments but they tuck them
  away until their jobs are done.
• There is nothing wrong with controlling ones
  emotions until a later time, however,

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After the Disaster,

• the bottled-up emotions must eventually
• be dealt with because
• Failure to recognize and work through the
  resulting emotions one has can result in being
  feeling isolated, re-experiencing the event,
  being anxious, being hypervigilant, having
  insomnia, avoidance of anything related to the
  event.

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Post Disaster Stress

• Most persons involved in a disaster will suffer
  some degree of acute stress disorder (ASD).
• A relatively small percent of those with ASD will
  develop post-traumatic stress disorder (PTSD),
  either acute or chronic.
• All rescue workers must proactively be taught
  about the emotional impact they may experience
  during and after disaster work.
• They must also be taught what symptoms
• should signal them to seek needed help
• and where to go for it.
• And they need to be taught about self care during
  the disaster work time.
• They should also be told that experiencing stress
  is not wrong or a weakness. It is normal!

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What is disaster self care?

• Eat.
• Rest, even if only for a few minutes.
• Talk with colleagues about something other than
  the disaster even if for only a few minutes.
• Talk with significant others (telephone, e-mail,
  etc.), if possible.
• Attend to personal hygiene,
• if possible.

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Self Care (continued)

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

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Teaching about self care

• Teaching rescue workers about psychological self
  care both before and during the disaster is
  critical.
• Simple self care actions can be forgotten or
  ignored due to the many needs being thrust upon
  each worker.
• Dont let it happen or the rescue workers will
  become less able to do their job well and, thus,
  less effective.

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Offer a place for the workers to get together.

• Even during the disaster, a place for workers to
  congregate during their breaks allows them to
  support each other.
• The presence of a mental health professional on
  the scene, assigned to care for the rescue
  workers, is essential.

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A Place to Gather

• Try to provide a place where the workers can sit
  down.
• Provide liquids and food so they can rehydrate
  and eat.
• Try to keep the disruptions to a minimum in this
  area.
• If possible, have cots and appropriate coverings
  (blankets, etc.) so they can catch a few
  ZZZZZZZ.

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

• For efficiency, effectiveness and safety, workers
  need to get some rest, sleep preferably.
• They need to eat for energy and the strength to
  do the work being asked of them.
• They are the same as the human beings they are
  helping. They all have needs.

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Plan Ahead for Worker Care

• Part of any disaster relief plan must be a plan
  for caring for the people who will be the rescue
  workers.
• Make it clear to all rescue workers they will be
  expected to take breaks at a set interval (i.e.,
  every 2 hours). Enforce the rule!

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Support workers as they reach out to each other
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Disaster Counseling

• Counseling during a disaster is
• a process of triaging rescuers with significant
  mental health problems and sending them to the
  hospital
• Being available to rescue workers to talk with
  them on an informal basis
• Recommending to those in need community resources
  for ongoing help and
• Applying the same rules of self care to yourself
  that apply to other rescue workers.

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