Understanding and Managing Trauma Impacts on Responders

1. The Psychological Impact of Trauma on Responders October 21, 2005 FEMA Crisis Counseling Program

2. Overview of Presentation • The Psychological Impact of Trauma • The short term and long term effects of stress • Family risk • Resilience and self-care • Resources

3. Importance of Psychological Responses • Affect our physiological responses • Overwhelming emotions can disrupt rational problem-solving • Promote adaptive and maladaptive individual and group behaviors

4. Effects on First RespondersNewOrleans, First Responders: • Dealt with angry people & were shot at. • Responders had to leave people without food or water • Saw people hurting and dying and could not help • Had to separate family members in order to save some • Are not used to limited success. • Were exposed to bacteria & chemicals in water.

5. Effects on Katrina RespondersResponding in later waves • Needs are overwhelming. • Had to deny aid in some cases • Began to close service centers, shelters • People living in tents – FEMA trailers • Physical Impact • Emotional Impact

6. PSYCHOLOGICAL CONSEQUENCES OF DISASTER AND TERORISM Distress Responses From IOM publication “Preparing for the Psychological Consequences of Terrorism” www.nap.edu NOTE: Indicative only; not to scale

7. Critical Stress Indicators • Threat to one’s life • Threat of harm to family • Destruction of home or community • Significant media attention • Witnessing others’ trauma • Being trapped or unable to evacuate

8. Physical Reactions • Fatigue, exhaustion • Gastrointestinal distress • Appetite change • Tightening in throat, chest, or stomach • Worsening of existing medical conditions • Somatic complaints

9. Emotional Reactions • Depression, sadness • Irritability, anger, resentment • Anxiety, fear • Despair, hopelessness • Guilt, self-doubt • Unpredictable mood swings • Feeling overwhelmed • Apathy

10. Cognitive Reactions • Confusion, disorientation • Recurring dreams or nightmares • Preoccupation with disaster • Trouble concentrating or remembering things • Difficulty making decisions • Questioning spiritual beliefs

11. Behavioral Reactions • Sleep problems • Crying easily • Avoiding reminders • Excessive activity level • Increased conflicts with family • Hyper-vigilance, startle reactions • Isolation or social withdrawal • Changes in appetite

12. Chronic Stressors • Family disruption • Work overload • Gender differences • Bureaucratic hassles • Financial constraints

13. Effects of Long-Term Stress • Anxiety and vigilance • Anger, resentment and conflict • Uncertainty about the future • Complicated grief reactions • Diminished problem-solving • Isolation and hopelessness • Health problems • Physical and mental exhaustion • Substance use or abuse • Lifestyle changes

14. Self Care and Stress Basics • Stress is: • Normal • Necessary • Productive and destructive • Acute and delayed • Cumulative • Identifiable • Preventable and manageable

15. Normal Reactions to a Disaster Event • No one who responds to a mass casualty event is untouched by it • Profound sadness, grief, and anger are normal reactions to an abnormal event • Wanting to remain on the scene until the work is finished • Overriding stress and fatigue with dedication and commitment • Denying the need for rest and recovery time

16. Difficulty communicating thoughts Difficulty remembering instructions Difficulty maintaining balance Uncharacteristically argumentative Difficulty making decisions Limited attention span Unnecessary risk-taking Tremors/headaches/nausea Tunnel vision/muffled vision Signs Stress Management Assistance is Needed

17. Disorientation or confusion Difficulty concentrating Loss of objectivity Easily frustrated Unable to engage in problem-solving Unable to let down when off duty Refusal to follow orders Refusal to leave the scene Increased use of drugs/alcohol Signs that Stress Management Assistance is Needed

18. Individual Approaches • Management of workload • Balanced lifestyle • Stress reduction strategies • Self-awareness

19. How is psychological impact different for first responders? • Chronic exposure to traumatic events • Fitness for duty issues • Culture of first responders • Pre-existing stressors • Family issues • Health status • Other losses • Mental health or alcohol/drug abuse issues

20. Good news….. • First responders generally resilient to “routine” trauma • Same protective factors as general public • Experience, gender and age • Least likely to have severe impairment as result of trauma • Professionalism and training increase resilience

21. Bad news….. • Greater risk and uncertainty • Secondary attacks on first responders • Higher rates of substance abuse, divorce, and suicide in first responder community, even greater post-event • Younger and less experienced at greatest risk

22. Unique Stressors and Risk Factors for First Responders • Stress of uncertainty, the unknown • Anticipatory stress • Chronic nature of stress • Personal Protective Technologies

23. Unique Stressors and Risk Factors for First Responders • Exposure to death • Identification with victims • Family risk • What am I bringing home? • Family coping behaviors? • Hours of work

24. “Even heroes need to talk.” One of the marketing slogans for Project Liberty, New York’s post-9/11 Crisis Counseling Program

25. Help-seeking barriers • Stigma • Access and cost • Timing • Fitness for duty • Masked as physical illness • Confidentiality • Media interest • Delayed response

26. Encourage Responders to: • Drink plenty of water and eat healthy snacks • Take frequent, brief breaks from the scene as practicable especially if they are coming home to work in a first responder capacity • Talk about their emotions to process what they have seen and done • Stay in touch with family and friends • Participate in memorials, rituals, and use of symbols as a way to express feelings • Pair up with another responder to monitor one another’s stress

27. Strategies in Response • Self-care • Peer Support • Humor • Decide to talk • Seek help from credible and trusted sources • Get extra rest • Use constructive coping strategies

28. Strategies in Recovery • Long term assessment for risk • Journaling • Practice “relapse prevention” • Lifestyle and health promotion • Role models/partnering/mentoring

29. Assignment and Supervision • Attachment and identification issues • Know risk factors and triggers, increase support as needed • Use risk communication skills • Monitor media attention to workers and hero identification • Provide family events, support groups, etc.

30. Access to Crisis Assistance and Mental Health Services • EAP • Peer support models • Health insurance mental health benefits • In-house mental health services • Volunteer organizations • Use of faith-based supportive counseling

31. Most effective if….. • Delivered by trusted individuals • Offered in non-traditional settings, • Can be arranged spontaneously • Handled informally • Not labeled as mental health • Culturally informed

32. Lynn CarterDepartment of Mental HealthPhone: 573-751-4970Email: lynn.carter@dmh.mo.govJenny WileyPhone: 573-751-4730Email: jenny.wiley@dmh.mo.gov