1. 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 Workshop Washington, DC April 18, 2006

2. 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

3. 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.

4. 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

5. 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.

6. 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

7. 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.

8. Psychological Response Stages 1. Shock and disbelief 2. Strong emotional response 3. Acceptance 4. Recovery

9. Short term Psychological Symptoms Numbness Denial Avoidance Difficulty concentrating Withdrawal Relationship problems Depression Feeling overwhelmed Anger Increased alcohol consumption Change in sexual functioning Change in eating habits

10. 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

11. 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

12. 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

13. 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.

14. 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 questions First Reactions, First Decisions, Information, Recommendations

15. 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.

16. 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

17. Training Knowledge is Power “Instinctive” behavior is a result of training. Adult Learning is Active and Problem-centered. Training together builds trust.

18. 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..

19. 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

20. 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