AFTERMATH OF DISASTER
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AFTERMATH OF DISASTER

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Short and Long-Term Effects of Disasters: An overview, impacts, related statistics, and a case presentation for Attorneys in MS and LA after Katrina and Rita

Short and Long-Term Effects of Disasters: An overview, impacts, related statistics, and a case presentation for Attorneys in MS and LA after Katrina and Rita

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    AFTERMATH OF DISASTER AFTERMATH OF DISASTER Presentation Transcript

    • AFTERMATH OFAFTERMATH OF DISASTERDISASTER Short and Long-Term Effects ofShort and Long-Term Effects of Disasters: An overview, impacts,Disasters: An overview, impacts, related statistics, and a caserelated statistics, and a case presentation for Attorneys in MS andpresentation for Attorneys in MS and LA after Katrina and RitaLA after Katrina and Rita Alexis Polles, MDAlexis Polles, MD
    • Outline for PresentationOutline for Presentation • Disasters -Causes of vulnerability • Psychological responses to traumatic stressors • Impacts on Attorneys • Statistics • Case Presentation • Closing Comments
    • BackgroundBackground Disaster: An event or occurrence- usually sudden and unexpected- that intensely alters the objects and localities under its influence. It results in loss of life and health in the local population, causes severe environmental damage and the destruction or loss of material goods resulting in a dramatic disruption of normal patterns of life. Such disruption…gives rise to the need for immediate intervention and humanitarian aid. Principles of Disaster Mitigation in Health Facilities
    • Involves response to (and preparedness for) natural or man- made events that affect an entire community or communities. (Usually) involve massive numbers of casualties and extensive property damage. Randal Beaton, PhD, EMT DISASTER RESPONSEDISASTER RESPONSE
    • Other Areas of VulnerabilityOther Areas of Vulnerability • Administrative/Organizational • Systemic • Individual
    • Psychological Responses toPsychological Responses to Traumatic StressorsTraumatic Stressors Traumatic Stressor: Any event which is outside of the realm of normal human experience and very distressing is a traumatic stressor or critical incident. 86% of individuals exposed (directly or indirectly) to a traumatic event or critical incident tend to have some kind of reaction within 24 hours of the incident but such reactions may be delayed for days to weeks. Stress Management and Disasters
    • MaslowMaslow’’s Hierarchy ofs Hierarchy of NeedsNeeds Self-Actualization Esteem Love/Belonging Safety Physiological
    • Prevalence of Adverse PsychologicalPrevalence of Adverse Psychological Effects Following DisasterEffects Following Disaster • 0-24 hours – 90%+ exhibit some untoward psychological effects • 12 weeks – 20-50%+ still show significant signs of distress • 1-2 years – 25%+ still show significant symptoms and others previously free of symptoms may first show a response Coping with Disasters; Ehrenreich, John October, 2001
    • Factors Affecting Vulnerability toFactors Affecting Vulnerability to Adverse Psychological EffectsAdverse Psychological Effects • Greater severity and terror = greater likelihood widespread and lasting negative effects. • Intentional > unintentional > natural • Mothers of children (5-10), people with prior mental illness, those with poor social adjustment, and those with prior personal experience of trauma Coping with Disasters; Ehrenreich, John October, 2001
    • Vulnerability factors cont.Vulnerability factors cont. • Specific disasters (e.g. witnessing death of loved one, losing a child, being entombed or trapped, serious injury from disaster, hospitalization as a result of the disaster) • Stigmatization of the victims (e.g. rape, in some cultures the victims are unable to tell the family or friends for fear of punishment or blame) • Lack of availability of social support networks. Coping with Disasters; Ehrenreich, John October, 2001
    • The more severe the disaster, the less the characteristics of individuals matter. In very severe disasters, virtually everybody shows adverse emotional responses. Coping with Disasters; Ehrenreich, John October, 2001
    • Katrina and RitaKatrina and Rita • Nationally – Top headline from NY Times and LA Times all but five days between 8/30/05 & 9/26/05 • Regionally – SouthCentral region had a much lower rate on a happiness index through the 2nd week of September – Income does have a noticeable relationship to happiness – Many people care about others but few are “Saints” • Locally “Unhappiness after Katrina”, Kimball, et al, March 2006
    • Potential Victims Of A TraumaticPotential Victims Of A Traumatic StressorStressor 1 Primary Victims Those individuals most directly affected by the event, e.g., the persons whose houses are blown down in a hurricane. 2 Secondary Victims Those individuals who in some way observe the consequences of the traumatic event on the primary victims, e.g., bystanders, rescuers, and emergency response personnel. 3 Tertiary Victims Those individuals who are indirectly affected by the traumatic event as a result of later exposure to the scene of the trauma or to the primary or secondary victims of the trauma, e.g., family members of primary or secondary victims or passers by. Stress Management and Disasters
    • Responses To A Traumatic SituationResponses To A Traumatic Situation 1 No Reaction 2 Normal Stress Response 3 Psychological and Behavioral Syndrome 4 Psychological Disorders Stress Management and Disasters
    • PRE-IMPACTPRE-IMPACT PHASE:PHASE: The majority of persons make some effort to prepareThe majority of persons make some effort to prepare for the potential impact of a disaster. Others becomefor the potential impact of a disaster. Others become indifferent and deny that there is any impendingindifferent and deny that there is any impending danger and still others become anxious and somewhatdanger and still others become anxious and somewhat disorganized. A few persons remain quite calm anddisorganized. A few persons remain quite calm and focused.focused. WARNINGWARNING PHASE:PHASE: During this phase a greater proportion of persons tendDuring this phase a greater proportion of persons tend to become agitated and over-react but a few continueto become agitated and over-react but a few continue to remain calm and purposeful.to remain calm and purposeful. Persons tend to be fearful and they attempt to cope byPersons tend to be fearful and they attempt to cope by either giving up, running away, or rescuing others.either giving up, running away, or rescuing others. HEROISMHEROISM PHASE:PHASE: During this phase, efforts are made to survive andDuring this phase, efforts are made to survive and recover property. This is a time of great altruism andrecover property. This is a time of great altruism and overwork with possible irritability and exhaustionoverwork with possible irritability and exhaustion HONEYMOONHONEYMOON PHASE:PHASE: Persons tend to share their experiences. GoodPersons tend to share their experiences. Good outcomes are anticipated and hope and elationoutcomes are anticipated and hope and elation prevails.prevails. DISILLUSIONMENTDISILLUSIONMENT PHASE:PHASE: Disappointment occurs when aid is not as readilyDisappointment occurs when aid is not as readily forthcoming as was anticipated and some people areforthcoming as was anticipated and some people are seen as less fortunate than others. Depression oftenseen as less fortunate than others. Depression often follows.follows. REBUILDINGREBUILDING PHASE:PHASE: People need to accept that they must depend onPeople need to accept that they must depend on themselves if they are going to move on and rebuildthemselves if they are going to move on and rebuild their lives. Failure to do this leads to bitterness andtheir lives. Failure to do this leads to bitterness and animosity.animosity. PRE-INCIDENT (ifappropriate)IMPACT PHASE POST-INCIDENT Stress Management and Disasters
    • NURSESNURSES’’ RESPONSERESPONSE • n=443 inpatient nurses in Kobe, Japan following devastating earthquake • 80% (335) completed general health questionnaire at 1 & 8 months after the quake. Compared to their usual state pre-earthquake, nurses showed considerably increased total scores on psychiatric symptoms; especially somatic symptoms, sleep disturbance, anxiety and social dysfunction. BMJ 1996; 313:1144 (2 November)
    • Phases of DisasterPhases of Disaster HONEYMOON (COMMUNITY COHESION) HEROIC PREDISASTER DISILLUSIONMENT RECONSTRUCTION A NEW BEGINNING Warning Threat Impact Inventory (C om ing to Term s) W O R KING TH R O U G H G R IEF Trigger Events and Anniversary Reactions --1 to 3 DAYS –Time------------------------------------1 to 3 YEARS --------------------------------
    • Reflection QuestionsReflection Questions Where do you think you are on this graph? What is one issue of concern you have for yourself, (one for) your family, your work, your community? What is one way (smaller is better) you can take care of yourself this week?
    • Common Reactions of NormalCommon Reactions of Normal People to an Abnormal SituationPeople to an Abnormal SituationNumberofpeopleaffected Many Few Examples of moderate reactions: •Persistent Insomnia •Anxiety Examples of severe reactions: •PTSD •Depression Examples of mild reactions: •Insomnia •Worry •Feeling upset Mild/Few Severe/Many Severity or number of symptoms
    • Common Immediate ReactionsCommon Immediate Reactions • Denial/Indifference/Avoidance • Refusal to evacuate • Self-destructive “coping skills”, especially excessive alcohol and substance use, excessive work, etc. • Despair • Panic- Fight/Flight/Freeze • Survival Guilt • Destruction of personal illusion of invincibility DANGER Adrenaline Storm Ahead
    • •Decision making is influenced by personalDecision making is influenced by personal psychological factors and cultural factors.psychological factors and cultural factors. •Many professionals have an authoritarianMany professionals have an authoritarian style with rigidity, inflexibility, and need forstyle with rigidity, inflexibility, and need for highly predictable environment.highly predictable environment. •There is a strong drive for achievement and aThere is a strong drive for achievement and a fear of failure.fear of failure. •They may respond with an attempt to regainThey may respond with an attempt to regain control, though by outwardly behaving as thoughcontrol, though by outwardly behaving as though everything is normal.everything is normal.
    • Personality TraitsPersonality Traits • Type A behaviors – driven – competitive – individualistic – perfectionist – compulsive
    • Common BehaviorsCommon Behaviors • Inappropriate anger or resentment • Inappropriate words or actions directed towards another person • Inappropriate response to patient needs or staff requests
    • Inappropriate Words/ActionsInappropriate Words/Actions Directed Toward AnotherDirected Toward Another • Sexual comments/harassment • Seductive, aggressive or assaultive behaviors • Racial, ethnic, or socioeconomic bias • Lack of regard for others’ comfort/dignity
    • Inappropriate Responses toInappropriate Responses to Clients/StaffClients/Staff • Being uncooperative, defiant, rigid when dealing with problems or responding to requests for help • Being avoidant or unreliable • Unprofessional demeanor • Recurrent conflict with others • Difficulty with authority • Belittling remarks near clients/families/staff
    • Review of Impacts ofReview of Impacts of Katrina/RitaKatrina/Rita • Acutely Traumatized Population • Over-Burdened Professionals • Disrupted Social and Economic Infrastructure – Family dysfunction – Migration and displacement – Loss of tax base and social services – “Getting on with life” leading to shift of priorities away from problems of evacuees after the acute crisis has settled James Griffith, MD Pine Grove Katrina Workshop November, 2005
    • Bringing it HomeBringing it Home • Cultural and Psychological Issues in Attorneys
    • Failure = Lack of effortFailure = Lack of effort Inability to ask for or receive helpInability to ask for or receive help
    • Depression in AttorneysDepression in Attorneys • 10% prevalence of Major Depression > twice that of the general population • Applicants = general population • End of first year, 32% depressed • End of third year, 40% depressed • Two years of practice, 17% -20% depressed, 12% problem drinkers, 6% both • 33% in practice in Washington with depression, problem drinking, or cocaine abuse
    • Prevalence of Alcohol ProblemsPrevalence of Alcohol Problems • < 20 years practice = 18% prevalence • > 20 years practice = 25% prevalence
    • Indicators of Problems inIndicators of Problems in LawyersLawyers • Being late for court • Failing to file legal notifications • Poor records • Misappropriating funds • Delays in taking care of mail • Missing deadlines • Failing to return calls • Intentionally failing to pursue lawful objectives
    • Less Specific IndicatorsLess Specific Indicators • Irritability, moodiness, verbal abuse • Complaints from clients or staff • Changes in schedule or absences • Decline in quality of work • Family problems • Financial difficulties • Isolation • Physical deterioration • Somatic Complaints
    • Indicators Specific toIndicators Specific to AddictionsAddictions • Long lunch hours • Long sleeves • Bathroom use • Breath • Coming in late and leaving early • Overt intoxication
    • STATISTICSSTATISTICS There are 374 attorneys that were living in Louisiana prior to Hurricane Katrina who are now living out of state.
    • GULFPORT, MSGULFPORT, MS • 1st Weekend in June 2006 – Total of 8 “911” calls for suicide attempts • In the year since Katrina – The number of completed suicides has quadrupled – The number of suicide attempts has increased by 30% WLOX News Broadcast 6/16/06
    • John BarristerJohn Barrister • 45 year old general practice attorney from a small town • Married with no children • Family History: Drug addiction in a younger sibling. Workaholism and perfectionism in his father. Chronic health problems in his mother.
    • CopingCoping
    • ResilienceResilience • The capacity to emerge from adversity stronger and more capable: – Best regarded as “something one does,” rather than “something one is” – Can refer to competencies of a person, a family, or a culture in responding to adversity – Strengthened by identifying strengths, skills, competencies, resources, personal wisdom from lived experience, with which adversity can be countered James Griffith, MD Pine Grove Katrina Workshop November, 2005
    • • What is a competency you have noticed in yourself, another person, your family, and your culture?
    • Closing CommentsClosing Comments • Traumatic events are frequently a source of energy for new ideas, discoveries, and growth.