Psychological and Training Aspects

Kathleen M. Kowalski-Trakofler, Ph.D.Research Psychologist, PRL

Mental Health Advisor NIOSH Office for Emergency Preparedness

Mine Escape Planning and Emergency Sheltering WorkshopWashington, DC April 18, 2006

Acknowledgements

• Charles Vaught, Ph.D., CMSP, Sociologist• Launa Mallett, Ph.D., Sociologist• Michael J. Brnich, Jr., CMSP, Mining Engineer• William J. Wiehagen, CMSP, Industrial Engineer• Robert Peters, Social Scientist• Edward A. Barrett, CMSP, Mining Engineer (ret)• Jacqueline H. Jansky, Physical Scientist• G. Michael Meighen, General Manager Wabash Mine

• The findings and conclusions in this presentation have not been formally disseminated by the National Institute for Occupational Safety and Health and should not be constituted to represent any agency determination or policy

History of Disaster Psychology

• Impact of human behavior in disasters has been referenced throughout history.

• Studies of military experiences, police, emergency medical services, and general human response in disasters have contributed to knowledge in this area.

• The Vietnam War brought attention to the psychological issues with the medical diagnosis of PTSD.

History of Disaster Psychology

• Since 9/11 research on the psychological aspects of traumatic incidents has increased exponentially.

FDNY fire fighters at the World Trade Center

Psychological Aspects

• What do we mean when we discuss psychological aspects of escape and sheltering?

• What we DO NOT mean is counseling, psychotherapy, or pathology. Escapees and responders are normal people responding to an abnormal situation.

• Understanding the natural, normal, human response to danger provides the escapees, the command center leadership, and the mine rescue team responders with an ability to be more resilient in an emergency situation.

Psychological Aspects

• An individual during escape is likely experiencing the normal symptoms associated with the fight or flight response. This is an innate response that prepares an individual to fight or run from danger.

• There are psychological, physical, behavioral, and cognitive components to the response:– Increase in heart rate, muscle tension, perspiration– Hyperventilation – rapid heart beat, shortness of breath, nausea– Dilation of the pupils; dry mouth; numbness of hands or feet– Fatigue– Confusion; fear

Psychological Phases of Disaster

• 1. Initial impact phase• 2. Heroic phase• 3. Honeymoon phase• 4. Disillusionment phase• 5. Reconstruction phase

It has been suggested that the most emotionally vulnerable time is from 6 months to one year after the event. There is increased fear of rages, self-destructive behavior, and even suicide.

Psychological Response Stages

• 1. Shock and disbelief

• 2. Strong emotional response

• 3. Acceptance

• 4. Recovery

shock

Short term Psychological Symptoms

NumbnessDenialAvoidanceDifficulty concentratingWithdrawalRelationship problemsDepressionFeeling overwhelmedAngerIncreased alcohol consumptionChange in sexual functioningChange in eating habits

Long Term Psychological Symptoms

Fearfulness

Sleep disturbance

Flashbacks

Feelings of guilt

High anxiety

Irritability

Exaggerated startle responses

May lead to a diagnosis of Post Traumatic Stress Disorder

Post-traumatic Stress Disorder

• PTSD is a medical psychiatric diagnosis based on some or all of the following:

– A traumatic event– Re-experiencing the traumatic event– Numbness and avoidance– Hyper-arousal symptoms– Duration– Severity– Impaired functioning

RAND/NIOSH Report

The RAND/NIOSH Report issued after 9/11 addressed the psychological aspects of responders. Mine rescue personnel need to be taken into consideration.

• Stress affects responders’ judgment about their own health and safety. Personal and professional bonds led to greater risk taking at WTC and the Pentagon.

• Many bodies horribly mangled; mostly body parts

Psychological Aspects

• Of the five senses, smell lasts the longest in memory.

• Thus, even many years after a mine disaster, a smell can trigger a flashback.

• The visual sense is next and can also

trigger a flashback.

2005 NIOSH Study (on-going)

• What happens in the initial moments of an emergency response? What are the communication issues?

• Method– Focus Groups and Interviews with subjects at underground

mines in the US– Subjects were selected for their experiences in disaster

response and disaster management. To date, a total of 7 focus groups and 11 individuals have been interviewed

– Open-ended questionsFirst Reactions, First Decisions, Information, Recommendations

2005 NIOSH Study (on-going)

• Judgment and Decision-making considerations:

– Information must be accurate – The source affects decision-making– Stress and fatigue lead to poor decisions

• Trust– Trust is more important than protocol– Trust is built through working

together and training together.

Key Factors

• Psychologically, PREPARATION is the most important activity in which to engage after a disaster. What can we do to prevent or mitigate such an event?

• INFORMATION lowers anxiety

• PLANNING quiets fears

Training

Training Training Training

Knowledge is Power

“Instinctive” behavior is a result of training.Adult Learning is Active and Problem-centered.

Training together builds trust.

Recommendations

• Include community mental health professionals trained in disaster mental health in mine disaster planning. (i.e. American Red Cross) Develop those relationships.

• Develop a curriculum and train mine personnel:– human stress response– judgment decision-making skills – normal group escape behavior – leadership in mine escape

• Study psychological aspects of sheltering. Develop expectations training.

Thank you for your attention.

Kathleen M. Kowalski-Trakofler, Ph.D., Research Psychologist

NIOSH Pittsburgh Research Laboratory

Mental Health Advisor NIOSH Office for Emergency Preparedness

kkowalski@cdc.gov

Selected NIOSH Published Research

• Judgment and Decision-making Under Stress: An Overview for Emergency Managers

• Critical Incident Stress Debriefing: A Missing Component in Your Emergency Plans

• Behavioral and Organizational Dimensions of Underground Mine Fires

• The Emergency Communication Triangle

• MERITS mine emergency response simulation

www.cdc.gov/niosh