Disaster Psychology Disaster Medical Operations

1. Welcome Disaster PsychologyDisaster Medical Operations CERT Basic Course Day 2 Cpt. Joe Kanzler (Ret)/County EMS Victor Kline/LWR CERT Mysh Bilous/LWR CERT

2. Questions?

3. Unit 7 Disaster Psychology Capt. Joe Kanzler (Retired) Manatee County EMS

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

5. Warning – Some of the following slides may be graphic and disturbing.

6. Disasters come in many forms:

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

8. Critical Incident Stress • A disruption of the coping mechanisms due to becoming involved in a traumatic event. • Becoming affected by what one sees, hears, touches, or smells.

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 identity is broader than that of a helper. • Connect with others. • Use spiritual resources.

13. Take a Break

14. Most Important • Do Not Experience What is Not Required

15. Critical Incident Stress Management • Provides Several Functions • Demobilizations • Defusings • Debriefings • Others

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

17. But What About the Victims? • How do they deal with their trauma? • They will have similar responses • Generally in four phases

18. Phases of a Crisis • Impact • Inventory • Rescue • Recovery

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

21. Contributing Factors • Prior experience with a similar event • The intensity of the disruption in the survivors’ lives • Individual feelings that there is no escape, which sets the stage for panic • The emotional strength of the individual • The length of time that has elapsed between the event occurrence and the present

22. 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. • Provide Confidentiality

23. 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 . . .”

24. Managing the Death Scene • 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.

25. 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.”

26. Disaster Psychology • You are one of our most vital resources • Know what you are getting into • Do not witness horrific scenes without need • Remember that victims may act a bit strange • Be emphatic and respectful • Most important, take care of yourself:

27. Take Advantage of Other Volunteers

28. Smile • There is always a bright spot

29. Disaster Medical Operations — Part 1 CERT Basic Training Unit 3 Victor Kline/Lakewood Ranch CERT Mysh Bilous/Lakewood Ranch CERT

30. Assumptions • Need for CERT members to learn disaster medical operations is based on two assumptions: • Number of victims could exceed local capacity for treatment • Survivors will assist others • They will do whatever they know how to do • They need to know lifesaving first aid or post- disaster survival techniques CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

31. Importance of Quick Action • Phase 1: Death within minutes, result of severe trauma • Phase 2: Death within several hours, result of excessive bleeding • Phase 3: Death in several days or weeks, result of infection CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

32. CERT Training • Treatment for life-threatening conditions • Airway obstruction, bleeding, shock • Treatment for other, less urgent conditions Provide greatest good for greatest number by conducting simple triage and rapid treatment CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

33. START • STart = Simple Triage • Victims sorted based on priority of treatment • stART = And Rapid Treatment • Rapid treatment of injuries assessed and prioritized in first phase CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

34. Unit Objectives • Identify “killers” • Apply techniques for opening airway, controlling bleeding, and treating for shock • Conduct triage under simulated disaster conditions CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

35. Treating life threatening injuries Triage Unit Topics CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

36. Three “Killers” • Emergency medicine “killers” • Airway obstruction • Bleeding • Shock • First priority of medical operations: • Open airway • Control excessive bleeding • Treat for shock CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

37. How to Approach a Victim • Be sure victim can see you • Identify yourself • Your name and name of your organization • Request permission to treat, if possible • Respect cultural differences CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

38. Open the Airway CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

39. Open vs. Obstructed Airway CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

40. Head-Tilt/Chin-Lift Method CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

41. Types of Bleeding - 1 • Arterial bleeding • Bleeding from artery spurts • Venous bleeding • Bleeding from vein flows • Capillary bleeding • Bleeding from capillaries oozes CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

42. Types of Bleeding - 2 CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

43. 3 main methods for controlling bleeding: Direct pressure Elevation Pressure points Control Bleeding CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

44. Pressure Points CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

45. Result of ineffective circulation of blood Remaining in shock will lead to death of: Cells Tissues Entire organs Shock CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

46. Recognizing Shock • Main signs of shock • Rapid and shallow breathing • Capillary refill of greater than 2 seconds • Failure to follow simple commands, such as “Squeeze my hand” • Symptoms of shock are easily missed… pay careful attention to your patient! CERT Basic Training Unit 3 Disaster Medical Operations — Part 1

47. Have a plan Follow that plan Document your actions throughout Responding to Mass Casualty Event CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

48. Gather Facts Assess Damage Consider Probabilities Assess Your Situation Establish Priorities Make Decisions Develop Plan of Action Take Action Evaluate Progress REMEMBER: CERT SIZEUP IS A CONTINUAL PROCESS CERT Sizeup CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

49. What Is Triage? • Process for managing mass casualty event • Victims are evaluated • Victims are sorted by urgency of treatment needed • Victims are set up for immediate or delayed treatment CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

50. Triage • Immediate (I): Victim has life-threatening injuries (airway, bleeding, or shock) • Delayed (D): Injuries do not jeopardize victim’s life; treatment can be delayed • Minor (M): Walking wounded and generally ambulatory • Dead (DEAD): No respiration after two attempts to open airway CERT Basic Training Unit 3: Disaster Medical Operations — Part 1