Monday, March 26, 2012

Responding to Disaster

Disasters and First Responders  

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.
First Responders

            Among those involved in rescue operations after a traumatic event are firefighters, paramedics, military and police personnel, medical doctors and nurses and specialists in the use of rescue equipment. They help the immediate victims and pick up the remains of those who died. In some situations, such as 9/11, because of the way the buildings collapsed, many rescuers became immediate victims.

            Although these workers have been trained to handle critical events, all can encounter horrendous situations that overwhelm their own defenses. Some events like 9/11 are so beyond ordinary human experience that almost anyone involved will suffer a traumatic response.

            Rescuers sometimes feel stressed because they have been involved in an operation where something went wrong or they thought they should have been able to do more. For example, they thought they should have been able to save someone they were not able to save.

            The dedication of the rescuers is intense. Many refuse to stop at the end of their work period. As bodies are uncovered of people who survived the initial destruction but died later, some rescuers will feel guilty because of a belief that they were responsible for the person’s death by not getting there in time.

            The following example given to me by one of my students in Criminal Justice illustrates the kind of situation that creates stress reactions in rescuers.

The life of a firefighter

Twenty minutes before the wake up call you are sound asleep in the bunk room, when the bells go off.  You rise to listen to the call.  The first thought that runs though your mind is, I sure hope it is a false alarm.  As the dispatcher calls out that there is a fire in the fourth quadrant. You run to the bay where you step into your boots.  You run toward the truck as you pull your pants up and slide your red suspenders over your shoulders.

Now that you are on the truck you begin to replay your training.  Do I need to get the hose?  Who am I going to work with?  Am I ready for this?  As you finish putting on your coat, gloves and stokes mask you slide your arms into the straps of your oxygen tank.  I sure hope I can get this tank to pop out of its holder.  Why does it have to be so secure?

As you pull up on the scene another fireman jumps off the truck to hook the hose up to the hydrant.  You jump off the truck and run down your gear.  Do I have everything? Is my oxygen tank on right?  As you put on your mask you take your last breath of fresh air and secure the seal.

One of the residents grabs your captain by the arm and is talking in hysterics.  You wonder, what is she saying?  Please don’t tell me there is still someone in there.  You look up at the burning house.  You tell yourself if there is someone still in there they don’t have much chance of survival.  Your captain comes over to tell you and your partner there is a five year old little boy still in there.   As he continues to talk you have blocked him out as you go off to think about your little girl at home.  What if she were in there?  What would she be thinking?  Where would she be within the house?

As you come back to the scene you are entering the front door.  You make a mental picture of your path as you can not see your own hand in front of your face.  You lead the way further into the fire as you work your way around the walls on your knees.  You have to continually tell yourself to breathe and to breathe slowly so you don’t use all of your oxygen before you are able to locate the child and exit and building.

As you enter another room you add it to your mental picture of the house.  You crawl over some items on the floor.  You instantly think we must be in a child’s bedroom, and we are crawling over their toys.  You yell out to the boy, and get no answer. You get that awful feeling in the bottom of your stomach.  You ask yourself, what if we are too late?  You press further into the room thinking where would a five-year old hide?  Staying in connection with the wall you and your partner work as a team to search the middle of the room.  I need to pay special attention to all hiding spots, you tell yourself.  As you feel under the bed you feel something that could possibly be the young child. You pull the lifeless body out from under the bed.  You think how could this happen?

Again you flash back to your little girl at home.  You know you must concentrate on the task at hand.  You think, what if we had moved through the house a little quicker?  Could we have found the boy in time?  With the feeling of failure you and your partner grab the child and proceed toward the exit.  As you get to the door of the bedroom you think of the mental picture you drew in your mind as you went in, allowing yourself the opportunity to quickly work your ay back to the front door.  On your way out of the burning house you think how am I going to tell this child’s mom he didn‘t make it?  How will I go home and hug my girl knowing this mother will never again be able to hug hers?

Back at the station you wash your gear, help refill the oxygen tanks, replenish equipment and clean the trucks.  You go through your routine very lifeless almost like a robot.  You continue to replay the days event, thinking what if we could have gotten out of the station quicker, drove faster, located the child in less time?  Could I have done anything different that would have saved the child’s life?  You can only come to one realization, that is, you will never know.

            The point is there are events that leave even the professional helper with a traumatic reaction. As a result, it has become standard practice in some places for the workers at disasters to receive critical incident stress debriefing after their tour of duty.

            Critical incident stress debriefing is a procedure developed years ago by paramedic Jeff Mitchell to prevent rescuers from developing post-traumatic-stress disorders. After such disasters as the Hyatt Regency collapse in Kansas City, it was discovered that if rescue workers were not debriefed, a significant percentage of them quit their jobs after the event. As a result, the American Red Cross sends disaster mental-health professionals to do critical incident stress debriefing with all its workers after a disaster.   Some recent research has suggested that debriefing is not of benefit to everyone and in some cases may make the situation worse.

 Positive Self Talk

The Rescuers: Talking ones self through a crisis.

What follows are two scripts prepared by students in my Crisis Intervention class for the Criminal Justice Masters Program.  These illustrate the principles of self talk as way of preparing for a crisis and for working ones way though it.

 A major automobile accident

            You have been called to the scene of an accident where you expect to find a dead body.  You need to remember there is nothing you can do physically to help that person right now.  The best thing you can do to help that person and his family is to discover the cause of the accident, arrest the responsible party or simply report the accident for review by the Highway Patrol and future road planners.

            You reach the scene of the accident.  You have some duties and some concerns to take care of before you approach the vehicle.  You need to be sure you are going to as safe as you exist your vehicle. You make sure there are no traffic hazards or life threatening objects that could hurt you.  You need to be sure there are no life threatening injuries while you are here on the scene because you are going home tonight, unlike the unfortunate person involved in the accident.

            You make sure traffic is blocked off and you do all that you can to be sure that there are no gawkers or rubber neckers.  You then go to the vehicles involved in the accident and determine if there is any life inside either car.  If there is you will do your best sustain that life and to try and relieve the victims fears and concerns about what is taking place.

            As soon as the medical personnel arrive you detach yourself from the care of the victims and turn your attention to the investigation of the accident. You need to remember that you can only help and injured person within your capability.  Your cannot help a person who has injuries beyond your capabilities without medical personnel.  If a death occurs you need to remember it was not your fault.  You did not cause the accident and you were not driving the vehicle.  You will remember that accidents happen and that ultimately if a passenger in a car dies there was nothing you could have done to prevent it.

            You will proceed to investigate the accident to the best of your ability, using all the resources you have available to you, including experts.  You will reassure yourself that no one you know was involved in the accident and that your family and friends are all safe at home. 

            You will most likely be called to aid the medical examiner in collecting the bodies.  This task may be difficult.  It is, however, important to the family of the victim that all of the pieces are collected.  It is also important for you to remove any signs of the accident so that when family come, as some do, to that location, that there is no indication that their loved one suffered.

            If there are pieces of the victim to pick up you will remind yourself that this isn’t enjoyable but that is part of the job you love.  This does not have the excitement of arresting a bad guy, but it is also part of the job.  You can reassure yourself that they are not your family and that you had very little attachment to the person in the vehicle.

            You will remind yourself that it is OK to feel sorry for the victim.  If you feel like joking about the accident outside of the earshot of the family that will be all right if that if one of your ways of dealing with stress.

            Later you will seek another officer out who has had previous experience to speak with about the incident.  By speaking with another officer, even if it is to tell then about the crash, the information is no longer held within you and it is out in the open.  You will not have to carry the sights you saw all by yourself. 

The following scenario was worked out by a student who worked in the State Court’s Judicial Education Building.

 Tornado Warning

            The small brick office building houses staff offices on the upper level and classrooms on the lower.  There are entry points on both levels, but no stairs as the floors are connected by an elevator. 

Crisis Scenario: A tornado warning is issued for our area.  A tornado had been sighted on the ground just as few west of the building.  At the time of the warning, the staff members are in their offices on the upper level while two classes are being held on the lower level.  It is storming outside and you notice that the wind speed is increasing.  Small items including leaves and small pieces of trash can be seen blowing across the parking lot.

My Script: You hear the tornado warning begin to wail.  Your heart begins to pound as you immediately think of the classrooms full of people on the lower level, and the staff members on the upper level. You think about what you need to do.  You know the classroom of attendees were told at beginning of class where they were supposed to assemble in the event of a tornado, and where they needed assemble if they had to evacuate the building. You are unsure of whether the other program administrator’s class was also informed.  You are concerned that in the excitement of the situation, some of the participants and staff members may take inappropriate actions and you know it is your duty to insure their safety.

            You tell yourself to stay calm and that you know what to do.  You call the lower-level reception desk where your secretary is working and tell her you need her to go to both classrooms and tell the participants to assemble in the restrooms because of the possible tornado. You plan to gather the staff members on the upper level and ensure they join the class participants downstairs.  You take them on the elevator to the lower level.  You think to yourself, “Once again, it sure would have been nice to have had stairs, but taking the elevator is safer than sending everyone outside where they could be hit by flying debris.”

            On the lower level you direct the staff to join the class participants in the restrooms that considered the optimum safety locations should the tornado hit the building.  You check the building to be sure everyone is in the safe area.  You are aware your heart is racing and your muscles tightening up.  You recognize these as signs of sensory arousal and tell yourself you have planned well and have done everything you have been taught to do in this type of emergency.  You take a couple of deep breaths.

            You join the others in the restroom and comfort those who are stressed by leading them in some controlled breathing exercises.  You commend everyone for cooperating.

            When you hear the all-clear signal you instruct everyone to return to their offices/classrooms thankful that everyone is safe and that a potentially chaotic situation was handled well.  You tell yourself, “I handled that one pretty well!”

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