Unit Objectives: Disaster Psychology Describe the emotional environment in a disaster and post-disaster situation. Explain the difference between stress and burnout. Describe the steps that rescuers can take to relieve their own stress and the stress of disaster survivors. Differentiate between healthy and unhealthy responses to stress. List the five stages of grief.

A critical incident is a specific situation that: causes an emergency worker to experience unusually strong emotional reactions and interferes with his or her ability to function immediately or in the future.

Critical Incident What makes an incident “critical” will be different for everyone. For example, an EMT with children might respond more strongly to a call involving the death of a child. What sorts of emergencies do you anticipate would most affect you?

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

Vicarious Trauma The process of changes in the rescuer resulting from empathic engagement with survivors. Common in the helping professions Makes it hard to “turn off” work at the end of the day Some situations affect you more than others

Phases of a Crisis Impact Inventory Rescue Recovery

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

Possible Psychological Symptoms Irritability, anger. Self-blame, blaming others. Isolation, withdrawal. Fear of recurrence. Feeling stunned, numb, or overwhelmed.

Possible Psychological Symptoms Feeling helpless. Mood swings. Sadness, depression, grief. Denial. Concentration, memory problems. Relationship conflicts/marital discord.

Possible Physical Symptoms Loss of appetite. Headaches, chest pain. Diarrhea, stomach pain, nausea. Hyperactivity.

Possible Physical Symptoms Increase in alcohol or drug use. Nightmares. Inability to sleep or sleeping more than usual. Fatigue, low energy.

Balance work, play, and rest. Reducing Stress Get enough sleep. Exercise. Eat a balanced diet. Balance work, play, and rest.

Use spiritual resources. Reducing Stress 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.

Stress Reactions are Personal Mediating Factors: Prior experience with a similar event. The intensity of the disruption in the survivors’ lives. The emotional strength of the individual. The length of time that has elapsed between the event occurrence and the present. Immediate support system of the individual.

Provide pre-disaster stress management training. Team Well-Being 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 Team Well-Being Team leaders should: Provide for proper nutrition Rotate Phase out workers gradually Conduct a brief discussion Arrange for a post-event debriefing

Helping the Survivors Assess the survivors for injury and shock. Get uninjured people involved in helping—this will help them feel more in control. Provide support by: Listening Empathizing Help survivors connect with natural support systems.

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 . . .”

Managing the Death Scene The body should be covered; treat it with respect. One family member should look at the body and decide if the rest of the family should see it. Family members may wish to hold or spend time with the deceased. Let the family grieve; everyone will express their grief differently.

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.” Avoid euphemisms such as “passed away” or “passed on.”

Critical Incident Stress Debriefing (CISD) Debriefing process is conducted by a team of peer counselors and mental health professionals. Meeting is held within 24-72 hours after the incident Hold a group discussion

Phases of CISD Meeting 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

CISD Meeting Everyone who was involved in the incident should be invited to the meeting—police, fire, first responders, CERT team members, EMS, dispatchers, and emergency department personnel.

CISD—does it make a difference? Helps people work through their emotional responses more quickly than they may be able to on their own Accelerates the normal recovery process after experiencing a critical incident

Grief or Bereavement

Elizabeth Kubler-Ross Stages of Grief Elizabeth Kubler-Ross Acronym-DABDA Denial Anger Bargaining Depression Acceptance

Do not agree with patients who are in denial “Not me.” People deny the facts even in the face of overwhelming evidence. Do not agree with patients who are in denial Be honest and straightforward

Anger “Why me?” People respond with anger when confronted with death. Do not take anger or insults personally. Be tolerant and patient and do not become defensive. Answer all questions honestly. Do not make false reassurances such as “everything will be all right.”

Bargaining “OK, but first let me….” Patients will often try to bargain for more time May try to bargain with doctors, themselves, or their God

Depression “OK, but I haven’t…” Sadness and despair May begin to retreat and become withdrawn Be supportive and honest with these patients

Acceptance “OK, I’m no longer afraid….” Patient has made peace with dying Family member may require more support at this stage

Stages of Grief Stages experienced by patient and families. Remember that not everyone moves through these stages in order or in the same time frame. Some people may move back and forth between stages or skip a stage. May depend on patient age, and if death is expected or sudden.

In conclusion….. Can you…… Name three healthy ways to deal with stress in your life? Explain how CISD works? Describe the five stages of grief?