Contra Costa County CERT Program Unit 7 – Disaster Psychology

1. Contra Costa County CERT ProgramUnit 7 – Disaster Psychology Released: 18 August 2011

2. Community Emergency Response Team • Personal safety is ALWAYS the number one priority • Work as a team • Wear personal protective equipment…gloves, helmet, goggles, N95 mask and boots • The CERT goal is to do the Greatest Good for the Greatest Number • Hope for the best but plan for the worst

3. Unit Objectives • Describe the disaster and post-disaster emotional environment for victims and rescuers • Describe the steps that rescuers can take to relieve their own stress and that of disaster survivors

4. Vicarious Trauma The process of changes in the rescuer resulting from empathic engagement with survivors

5. Disturbing legacy of rescues: Suicide • Bob Long, a surveyor credited with finding the nine trapped coal miners in Pennsylvania, killed himself the following June. • Terry Yeakey, an Oklahoma City police sergeant who rescued four bombing victims in 1995, committed suicide the following year. • Robert O'Donnell, a paramedic who played a crucial role in saving baby Jessica McClure from a Texas well shaft in 1987, took his life nearly eight years later.

6. September 11th Aftermath • Long after 9/11, survivors were still emerging: • Nine months later, Fire Department of New York paramedicDaniel Stewart, 27, hanged himself in the basement of his Long Island home. In his suicide note, Stewart wrote of the horrors of excavating bodies from the wreckage of the World Trade Center. • James Kay Jr., an emergency medical technician, shot himself in early 2002. • Gary Celentani, 33, a strapping firefighter who followed two brothers into the New York City Fire Department, was at home Sept. 25, 2002, when he shot himself to death with a rifle.

7. Oklahoma City Bombing • Since the bombing, Oklahoma City police have counted at least six suicides of people directly involved in the disaster -- including a bombing survivor, two police officers and a Denver federal prosecutor who participated in the Timothy McVeigh investigation.

8. Rescuer Psychological Trauma • Your own personal losses • Working in your neighborhood • Assisting neighbors, friends, co-workers who have also been injured • Not feeling safe and secure

9. Possible Psychological Symptoms • Irritability, anger • Self-blame, blaming others • Isolation, withdrawal • Fear of recurrence • Feeling stunned, numb, or overwhelmed • Feeling helpless • Mood swings • Sadness, depression, grief • Denial • Concentration, memory problems • Relationship conflicts / marital discord

10. Possible Physiological Symptoms • Loss of appetite • Headaches, chest pain • Diarrhea, stomach pain, nausea • Hyperactivity • Increase in alcohol or drug consumption • Nightmares • Inability to sleep • Fatigue, low energy

11. Team Well-Being CERT team leaders should: • Provide pre-disaster stress management training • Brief personnel before response • Emphasize teamwork • Encourage breaks • Provide for proper nutrition • Rotate • Phase out workers gradually • Conduct a brief discussion • Arrange for a post-event debriefing

12. Reducing Stress • Get enough sleep • Exercise • Eat a balanced diet • Balance work, play, and rest • Allow yourself to receive as well as give • Remember that your identify is broader than that of a helper • Connect with others • Use spiritual resources

13. Formal Debriefing • Gather 1-3 days after the event to discuss in depth: • What was encountered • Reactions to what was encountered • Feelings about the event • Consider having a mental health professional conduct a Critical Incident Stress Debriefing (CISD)

14. Critical Incident Stress Debriefing Debriefing phases: • Introduction and a description • Review of the factual material • Sharing of initial thoughts / feelings • Sharing of emotional reactions to the incident • Review of the symptoms • Instruction about normal stress reactions • Closing and further needs assessment

15. Take Care of Yourself • Be aware that disaster-worker trauma/stress can follow disaster work • Explain to family member and friends how they can support you • Listen to you when you need to talk • Understand that you may not want to talk

16. Post-traumatic Stress Disorder

17. Six Criteria For PTSD • A horrific, horrible, grotesque, disgusting or frightening event • Intrusive images - seeing the event again, hearing it, smelling it, tasting it; seeing the face of an injured child floating in a bowl of soup or hearing a person's voice screaming for help • Avoidance - avoiding places, conversations, people or experiences that even remotely remind them of an experience • Arousal - having a hard time shutting down after emergency calls; constantly feeling on edge; looking over one's shoulder and expecting something to happen • Symptoms that last longer than 30 days • Significant disruption in normal life pursuits

18. Traumatic Stress Traumatic stress may affect: • Cognitive functioning • Physical health • Interpersonal reactions

19. Traumatic Crisis An event in which people experience or witness: • Actual or potential death or injury to self or others • Serious injury • Destruction of homes, neighborhood, or valued possessions • Loss of contact with family / close relationships

20. Phases of a Crisis • Impact • May show no emotion • Inventory • Assess damage • Locate other survivors • Rescue • Survivors tend to cooperate with rescuers • Recovery • Survivors may show hostility toward rescuers

21. Mediating Factors • Prior experience with a similar event • Intensity of disruption • Individual feelings about event • Emotional strength of individual • Length of time since event

22. The Road to Recovery Those survivors who could find something good that came out of the experience soon after it happened – "I realized how much I loved my family," for example, or "I decided that life was too short not to follow my dreams" –had made a better recovery at the time of the follow-up interview.

23. Stabilizing Individual • Assess the survivors for injury and shock • Get uninjured people involved in helping • Provide support by: • Listening • Empathizing • Help survivors connect with natural support systems

24. How to Be an Empathetic Listener • Put yourself in the speaker’s shoes • Listen for meaning, not just words • Pay attention to nonverbal communication • Paraphrase the speaker

25. Avoid Saying . . . • “I understand.” • “Don’t feel bad.” • “You’re strong/You’ll get through this.” • “Don’t cry.” • “It’s God’s will.” • “It could be worse” or “At least you still have . . . (Discounts person, not understood, more alone)

26. Can Say . . . • “These are normal reactions to a disaster.” • “It’s understandable you feel this way.” • “As you connect with others who have been through this, you’ll find that they may have experienced the same things you are feeling.” • “It wasn’t your fault, you did the best you could.” • “Things may never be the same, but you may find some things from this experience that can help you help others.”

27. Managing the Death Scene • Move the body to temporary morgue • Cover the body; treat it with respect • Have one family member look at the body and decide if the rest of the family should see it • Allow family members to hold or spend time with the deceased • Let the family grieve

28. Informing Family of a Death • Separate the family members from others in a quiet, private place • Have the person(s) sit down, if possible • Make eye contact and use a calm, kind voice • Use the following words to tell the family members about the death: “I’m sorry, but your family member has died. I am so sorry.”

29. Unit Summary • Disaster psychology • Caring for yourself, your buddy and survivors