Sunday, March 25, 2012

Disasters: The Immediate Victims


Early in my working with trauma I became aware that there was a difference in how people responded depending on what their connection with the crisis event was.  There are four groups of people who suffer the greatest impact and in many cases, their lives may never be the same after the critical incident.

Who are these major victims?

            In any disaster or critical event, there are four groups of survivors. Although individuals in all these groups are likely to have traumatic stress reactions, there are important differences between them. The groups are:

  • Immediate victims of a disaster.
  • Rescuers on the scene — this would include paramedics, law-enforcement officers, firefighters and other first responders.
  • Relatives and friends of those killed or severely injured in a disaster.
  • Doctors, counselors and therapists who work with the first three groups of victims after a crisis.
The immediate victims

            Initially our crisis intervention training was directed at helping individuals who had experienced a life-threatening situation, whether they were physically injured or not, who were showing post-traumatic stress reactions.  Much of what I have discussed to this point has been focused on these immediate victims.

            Though symptoms will vary with the individual depending upon his or her background, they usually include nightmares, flashbacks or the vivid reliving of the event, increased sensitivity to sound and sight and highly generalized anxiety. Many victims will have physical symptoms such as sleeplessness, stomach upset, muscle tension and headaches.  As I have stressed it is normal for anyone who was in a situation where he or she could have been severely injured or killed to show these types of symptoms for a period of time after the event.

            If these victims receive no treatment, many will go on to develop a post-traumatic-stress disorder. The symptoms become chronic and interfere with the individual’s ability to live a normal life. Efforts to avoid thoughts associated with the trauma lead to overuse of alcohol or drugs, avoidance of anything that reminds them of the event and a feeling of detachment from others.

            The person’s experiences during the disaster will influence the strength and number of symptoms: How long they were in the life-threatening situation, the severity of their injuries, how prepared they were for the event, effectiveness of rescue efforts and whether the disaster was man-made or natural.  Man make disasters such as terrorists’ attacks may have more potential to create post traumatic stress reactions as there is usually no preparation for the impact, and they are highly life-threatening.  Earthquakes are similar in lack of preparation for impact. All of this suggests the post-traumatic reactions are likely to be widespread and intense.

            A natural disaster that builds more slowly where its effects can be anticipated such as floods result in many fewer cases of post-traumatic-stress.  I was allowed to examine the interview data on individuals who had experienced the Midwest flood of 1993 that resulted in the loss of much property and found that the number of post-traumatic stress reactions was not much larger than the expected base rate among people who have not been exposed to the disaster.  That is there very few new cases. I suspect a flash flood would be more like a tornado or a hurricane in its negative effects. 

            Some personality factors that influence the response are previous experience in coping with danger, the number of other life pressures, age and religious beliefs.

            After a crisis, the world is no longer a safe place for the traumatized person. It will not be safe until some understanding and predictability can be restored to his or her worldview. For many people, the world will never seem safe again.

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