The Psychological Impact of The Psychological Impact of Disaster on Emergency Disaster on Emergency

Response Workers, Victims and Response Workers, Victims and CommunitiesCommunities

Deborah Renholm RN MSDeborah Renholm RN MS

Disasters take many forms and Disasters take many forms and demand quick responses from demand quick responses from emergency response workers.emergency response workers.

Disasters may be natural such as Disasters may be natural such as earthquakes, hurricanes, or floods, or earthquakes, hurricanes, or floods, or they may be manmade such as mass they may be manmade such as mass violence or terrorist attacks.violence or terrorist attacks.

It is a recent phenomenon that It is a recent phenomenon that attention has been focused on the attention has been focused on the mental health impact of disasters mental health impact of disasters (Politin et al, 2005). (Politin et al, 2005).

Efforts are more commonly directed Efforts are more commonly directed toward the immediate physical toward the immediate physical health and community infrastructure health and community infrastructure risks in the aftermath of disasters. risks in the aftermath of disasters.

This focus overshadows the short This focus overshadows the short and long term mental health and long term mental health consequences of disasters and the consequences of disasters and the extent to which mental health plays extent to which mental health plays a role in the impact of a disaster.a role in the impact of a disaster.

For emergency response workers, For emergency response workers, there can be serious physical and there can be serious physical and psychological consequences prior to, psychological consequences prior to, during, and after a disaster.during, and after a disaster.

Oklahoma City Federal Building Oklahoma City Federal Building Bombing April 19, 1998Bombing April 19, 1998

Mass violence or disaster exposes Mass violence or disaster exposes victims, emergency response victims, emergency response workers, and communities to workers, and communities to physical and mental trauma that may physical and mental trauma that may result from exposure to severely result from exposure to severely injured children, adults, dead bodies injured children, adults, dead bodies or body parts, or the loss of or body parts, or the loss of colleagues. colleagues.

Emergency responders must be Emergency responders must be educated and supported in order to educated and supported in order to deal with their own vulnerabilities and deal with their own vulnerabilities and fears, and must not become victims fears, and must not become victims themselves (Briggs, & Twomey, 2003).themselves (Briggs, & Twomey, 2003).

Mental health concerns exist in most Mental health concerns exist in most aspects of preparedness, response, aspects of preparedness, response, and recovery (CDC, 2005). and recovery (CDC, 2005).

Stress and grief reactions are normal Stress and grief reactions are normal responses to an abnormal situation (APA, responses to an abnormal situation (APA, 2004, p.15; Briggs, & Twomey, 2003, p. 2004, p.15; Briggs, & Twomey, 2003, p. 33; CDC, 2005).33; CDC, 2005).

Traumatic incidents can produce unusually Traumatic incidents can produce unusually strong emotional reactions that may strong emotional reactions that may interfere with the ability of emergency interfere with the ability of emergency response workers to function at the response workers to function at the disaster scene or later.disaster scene or later.

Some Symptoms of Stress Some Symptoms of Stress Experienced During or After a Experienced During or After a

Traumatic Incident Table 1Traumatic Incident Table 1PhysicalPhysical Chest PainChest Pain Difficulty BreathingDifficulty Breathing Shock symptomsShock symptoms FatigueFatigue Nausea/vomitingNausea/vomiting Dizziness Dizziness Profuse sweatingProfuse sweating Rapid heart rateRapid heart rate ThirstThirst HeadachesHeadaches Visual DifficultiesVisual Difficulties Clenching of jawClenching of jaw Nonspecific aches and painsNonspecific aches and pains

CognitiveCognitive ConfusionConfusion NightmaresNightmares DisorientationDisorientation Heightened or lowered Heightened or lowered

alertnessalertness Poor concentrationPoor concentration Memory problemsMemory problems Poor problem solvingPoor problem solving Difficulty identifying familiar Difficulty identifying familiar

objects or peopleobjects or people

Source for table 1:NIOSH, Source for table 1:NIOSH, 20022002

Table 1 continuedTable 1 continued

EmotionalEmotional AnxietyAnxiety GuiltGuilt DenialDenial Severe panic (rare)Severe panic (rare) FearFear IrritabilityIrritability Loss of emotional controlLoss of emotional control DepressionDepression Sense of failureSense of failure Feeling overwhelmedFeeling overwhelmed Blaming others or selfBlaming others or self

BehaviorBehavior Intense angerIntense anger WithdrawalWithdrawal Emotional outburstEmotional outburst Temporary loss or Temporary loss or

increase in appetiteincrease in appetite Excessive alcohol Excessive alcohol

consumption, inability consumption, inability to rest, pacing, change to rest, pacing, change in sexual functioningin sexual functioning

Some emergency response workers Some emergency response workers may even experience some form of may even experience some form of post-traumatic stress disorder by the post-traumatic stress disorder by the end of the first month following end of the first month following disaster. (APA, 2004).disaster. (APA, 2004).

September 11, 2001September 11, 2001

Most emergency workers only experience Most emergency workers only experience mild, normal stress reactions, and disaster mild, normal stress reactions, and disaster experiences may even promote personal experiences may even promote personal growth and strengthen relationships. growth and strengthen relationships.

However, 1 out of 3 rescue workers may However, 1 out of 3 rescue workers may experience severe stress symptoms that experience severe stress symptoms that leads to lasting Post Traumatic Stress leads to lasting Post Traumatic Stress Disorder (PTSD), anxiety disorders, or Disorder (PTSD), anxiety disorders, or depression.depression.

Emergency response workers Emergency response workers environment often involves physical environment often involves physical hardship, unclear roles and hardship, unclear roles and responsibilities, limited resources, responsibilities, limited resources, rapidly changing priorities, intrusive rapidly changing priorities, intrusive media attention, and long work media attention, and long work hours.hours.

Natural and man-made disasters not only Natural and man-made disasters not only affect first responders, they also affect affect first responders, they also affect individuals, families, and communities.individuals, families, and communities.

Emergency workers are concerned about Emergency workers are concerned about their own families too.their own families too.

When a community mitigates a disaster, When a community mitigates a disaster, they become safer, and the loss of they become safer, and the loss of property and life is reduced (Ivanov, & property and life is reduced (Ivanov, & Blue, 2008, p.627).Blue, 2008, p.627).

(CDC, 2005)(CDC, 2005)

Emergency responses can be more Emergency responses can be more effective in the community and effective in the community and human suffering reduced when there human suffering reduced when there is advance warning and preparation is advance warning and preparation for a disaster.for a disaster.

Survivors respond when rescue Survivors respond when rescue workers display interest and concern. workers display interest and concern. Rescue workers can offer survivors a Rescue workers can offer survivors a listening ear, encouragement, listening ear, encouragement, reassurance, and comforting reassurance, and comforting measures (APA, 2004; CDC, 2005; measures (APA, 2004; CDC, 2005; DHHS, 2005, p.2).DHHS, 2005, p.2).

Through helping with practical tasks Through helping with practical tasks rescue workers often earn survivors rescue workers often earn survivors trust, and the privilege to support trust, and the privilege to support them when they express their pain, them when they express their pain, fear, sorrow, and anger (DHHS, 2005, fear, sorrow, and anger (DHHS, 2005, p.6).p.6).

Man-made disasters and acts of Man-made disasters and acts of terrorism are planned and carried out terrorism are planned and carried out to instill fear, terror, and suffering in to instill fear, terror, and suffering in their victims. Those confronted with life their victims. Those confronted with life threat, mass casualties, overwhelming threat, mass casualties, overwhelming terror, and human suffering may terror, and human suffering may experience severe psychological stress experience severe psychological stress and trauma (DHHS, 2005, p.24).and trauma (DHHS, 2005, p.24).

Emergency WorkersEmergency Workers

When rescue and recovery efforts When rescue and recovery efforts continue over a period of time, continue over a period of time, disaster victims become uncertain of disaster victims become uncertain of an ongoing threat or another attack in an ongoing threat or another attack in the future.the future.

This increases anxiety and This increases anxiety and vulnerabilities. Traumatic realities of a vulnerabilities. Traumatic realities of a disaster impact the whole community.disaster impact the whole community.

Stable social systems are important Stable social systems are important in improving the lives of disaster in improving the lives of disaster victims. The five essential elements victims. The five essential elements of trauma interventions are to of trauma interventions are to promote safety, calmness, efficacy, promote safety, calmness, efficacy, hope, and connectedness (Norris, & hope, and connectedness (Norris, & Stevens, 2007, p. 321).Stevens, 2007, p. 321).

Communities must offer victims the Communities must offer victims the resources they need to get their lives resources they need to get their lives back in order. Dysfunction is followed back in order. Dysfunction is followed by a return to predisaster levels of by a return to predisaster levels of functioning, and interventions must functioning, and interventions must work to normalize and validate work to normalize and validate victims’ emotional reactions (Norris, victims’ emotional reactions (Norris, & Stevens, 2007, p. 322).& Stevens, 2007, p. 322).

(CDC, 2005)(CDC, 2005)

Appropriate interventions will promote Appropriate interventions will promote better outcomes of resiliency and recovery better outcomes of resiliency and recovery among victims after a disaster. Flexibility among victims after a disaster. Flexibility and local control is needed when planning and local control is needed when planning disaster interventions. Communities can disaster interventions. Communities can take charge of local recovery efforts. take charge of local recovery efforts. Individuals can regain their sense of Individuals can regain their sense of collective and self-efficacy that may have collective and self-efficacy that may have been injured by the trauma and ensuing been injured by the trauma and ensuing adversities (Norris, & Stevens, 2007, p. adversities (Norris, & Stevens, 2007, p. 324).324).

Simple concrete tasks can be given Simple concrete tasks can be given and rescue workers can help survivors and rescue workers can help survivors focus and take a more active role in focus and take a more active role in coping. Being reliable and following up, coping. Being reliable and following up, even when there is nothing to report, even when there is nothing to report, helps survivors gain control (DHHS, helps survivors gain control (DHHS, 2005, p.14). People can be empowered 2005, p.14). People can be empowered to solve their own problems.to solve their own problems.

Severity of Psychological Severity of Psychological Reaction After a Traumatic Reaction After a Traumatic

EventEvent(CDC, 2005)(CDC, 2005)

First responders should monitor victims for First responders should monitor victims for the following behaviors and symptoms, the following behaviors and symptoms, consult with their supervisor, and refer for consult with their supervisor, and refer for more specialized treatment: disorientation, more specialized treatment: disorientation, severe anxiety, depression, mental illness, severe anxiety, depression, mental illness, inability to care for self, suicidal or inability to care for self, suicidal or homicidal thoughts or plans, problematic homicidal thoughts or plans, problematic use of alcohol or drugs, domestic violence, use of alcohol or drugs, domestic violence, child abuse, or elder abuse (DHHS, 2005, p. child abuse, or elder abuse (DHHS, 2005, p. 15-16).15-16).

Individuals at risk, such as the seriously Individuals at risk, such as the seriously injured and those suffering from pre-injured and those suffering from pre-disaster mental health problems, disaster mental health problems, should be monitored closely at the should be monitored closely at the disaster healthcare site. If their disaster healthcare site. If their conditions worsen, these clients should conditions worsen, these clients should be sent to nearby hospitals for be sent to nearby hospitals for appropriate care, treatment and follow-appropriate care, treatment and follow-up discharge planning (APA, 2004, up discharge planning (APA, 2004, p.13).p.13).

Drill NYC May 19, 2009Drill NYC May 19, 2009

Drill NYCDrill NYC

ConclusionConclusion

Remember that anyone experiencing a Remember that anyone experiencing a disaster is affected by it. It is important to disaster is affected by it. It is important to implement psychological first aid with implement psychological first aid with medical evaluations during recovery efforts. medical evaluations during recovery efforts. Psychological first aid is a practical effort by Psychological first aid is a practical effort by meeting victims’ basic needs for food, meeting victims’ basic needs for food, comfort, and safety. Connectedness at the comfort, and safety. Connectedness at the disaster site offers victims supportive disaster site offers victims supportive activities and opportunities for appropriate activities and opportunities for appropriate treatment in the community.treatment in the community.

Appropriate interventions during Appropriate interventions during disasters promote resiliency and disasters promote resiliency and recovery. When communities take recovery. When communities take charge of recovery efforts, individuals charge of recovery efforts, individuals can regain their sense of control and can regain their sense of control and well being. Victims and communities well being. Victims and communities can successfully move on with their can successfully move on with their lives after the experience of a disaster.lives after the experience of a disaster.

PosterPoster

ReferencesReferences

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