The Psychological Impact Of Disaster On Emergency Response


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The Psychological Impact Of Disaster On Emergency Response

  1. 1. The Psychological Impact of Disaster on Emergency Response Workers, Victims and Communities
  2. 2. Deborah Renholm RN MS
  3. 3. <ul><li>Disasters take many forms and demand quick responses from emergency response workers. </li></ul><ul><li>Disasters may be natural such as earthquakes, hurricanes, or floods, or they may be manmade such as mass violence or terrorist attacks. </li></ul>
  4. 4. <ul><li>It is a recent phenomenon that attention has been focused on the mental health impact of disasters (Politin et al, 2005). </li></ul><ul><li>Efforts are more commonly directed toward the immediate physical health and community infrastructure risks in the aftermath of disasters. </li></ul>
  5. 5. <ul><li>This focus overshadows the short and long term mental health consequences of disasters and the extent to which mental health plays a role in the impact of a disaster. </li></ul>
  6. 6. <ul><li>For emergency response workers, there can be serious physical and psychological consequences prior to, during, and after a disaster. </li></ul>
  7. 7. Oklahoma City Federal Building Bombing April 19, 1998
  8. 8. <ul><li>Mass violence or disaster exposes victims, emergency response workers, and communities to physical and mental trauma that may result from exposure to severely injured children, adults, dead bodies or body parts, or the loss of colleagues. </li></ul>
  9. 9. <ul><li>Emergency responders must be educated and supported in order to deal with their own vulnerabilities and fears, and must not become victims themselves (Briggs, & Twomey, 2003). </li></ul><ul><li>Mental health concerns exist in most aspects of preparedness, response, and recovery (CDC, 2005). </li></ul>
  10. 10. <ul><li>Stress and grief reactions are normal responses to an abnormal situation (APA, 2004, p.15; Briggs, & Twomey, 2003, p. 33; CDC, 2005). </li></ul><ul><li>Traumatic incidents can produce unusually strong emotional reactions that may interfere with the ability of emergency response workers to function at the disaster scene or later. </li></ul>
  11. 11. Some Symptoms of Stress Experienced During or After a Traumatic Incident Table 1 <ul><li>Physical </li></ul><ul><li>Chest Pain </li></ul><ul><li>Difficulty Breathing </li></ul><ul><li>Shock symptoms </li></ul><ul><li>Fatigue </li></ul><ul><li>Nausea/vomiting </li></ul><ul><li>Dizziness </li></ul><ul><li>Profuse sweating </li></ul><ul><li>Rapid heart rate </li></ul><ul><li>Thirst </li></ul><ul><li>Headaches </li></ul><ul><li>Visual Difficulties </li></ul><ul><li>Clenching of jaw </li></ul><ul><li>Nonspecific aches and pains </li></ul><ul><li>Cognitive </li></ul><ul><li>Confusion </li></ul><ul><li>Nightmares </li></ul><ul><li>Disorientation </li></ul><ul><li>Heightened or lowered alertness </li></ul><ul><li>Poor concentration </li></ul><ul><li>Memory problems </li></ul><ul><li>Poor problem solving </li></ul><ul><li>Difficulty identifying familiar objects or people </li></ul><ul><li>Source for table 1:NIOSH, 2002 </li></ul>
  12. 12. Table 1 continued <ul><li>Emotional </li></ul><ul><li>Anxiety </li></ul><ul><li>Guilt </li></ul><ul><li>Denial </li></ul><ul><li>Severe panic (rare) </li></ul><ul><li>Fear </li></ul><ul><li>Irritability </li></ul><ul><li>Loss of emotional control </li></ul><ul><li>Depression </li></ul><ul><li>Sense of failure </li></ul><ul><li>Feeling overwhelmed </li></ul><ul><li>Blaming others or self </li></ul><ul><li>Behavior </li></ul><ul><li>Intense anger </li></ul><ul><li>Withdrawal </li></ul><ul><li>Emotional outburst </li></ul><ul><li>Temporary loss or increase in appetite </li></ul><ul><li>Excessive alcohol consumption, inability to rest, pacing, change in sexual functioning </li></ul>
  13. 13. <ul><li>Some emergency response workers may even experience some form of post-traumatic stress disorder by the end of the first month following disaster. (APA, 2004). </li></ul>
  14. 14. September 11, 2001
  15. 15. <ul><li>Most emergency workers only experience mild, normal stress reactions, and disaster experiences may even promote personal growth and strengthen relationships. </li></ul><ul><li>However, 1 out of 3 rescue workers may experience severe stress symptoms that leads to lasting Post Traumatic Stress Disorder (PTSD), anxiety disorders, or depression. </li></ul>
  16. 16. <ul><li>Emergency response workers environment often involves physical hardship, unclear roles and responsibilities, limited resources, rapidly changing priorities, intrusive media attention, and long work hours. </li></ul>
  17. 17. <ul><li>Natural and man-made disasters not only affect first responders, they also affect individuals, families, and communities. </li></ul><ul><li>Emergency workers are concerned about their own families too. </li></ul><ul><li>When a community mitigates a disaster, they become safer, and the loss of property and life is reduced (Ivanov, & Blue, 2008, p.627). </li></ul>
  18. 18. (CDC, 2005)
  19. 19. <ul><li>Emergency responses can be more effective in the community and human suffering reduced when there is advance warning and preparation for a disaster. </li></ul>
  20. 20. <ul><li>Survivors respond when rescue workers display interest and concern. Rescue workers can offer survivors a listening ear, encouragement, reassurance, and comforting measures (APA, 2004; CDC, 2005; DHHS, 2005, p.2). </li></ul>
  21. 21. <ul><li>Through helping with practical tasks rescue workers often earn survivors trust, and the privilege to support them when they express their pain, fear, sorrow, and anger (DHHS, 2005, p.6). </li></ul>
  22. 22. <ul><li>Man-made disasters and acts of terrorism are planned and carried out to instill fear, terror, and suffering in their victims. Those confronted with life threat, mass casualties, overwhelming terror, and human suffering may experience severe psychological stress and trauma (DHHS, 2005, p.24). </li></ul>
  23. 23. Emergency Workers
  24. 24. <ul><li>When rescue and recovery efforts continue over a period of time, disaster victims become uncertain of an ongoing threat or another attack in the future. </li></ul><ul><li>This increases anxiety and vulnerabilities. Traumatic realities of a disaster impact the whole community. </li></ul>
  25. 25. <ul><li>Stable social systems are important in improving the lives of disaster victims. The five essential elements of trauma interventions are to promote safety, calmness, efficacy, hope, and connectedness (Norris, & Stevens, 2007, p. 321). </li></ul>
  26. 26. <ul><li>Communities must offer victims the resources they need to get their lives back in order. Dysfunction is followed by a return to predisaster levels of functioning, and interventions must work to normalize and validate victims’ emotional reactions (Norris, & Stevens, 2007, p. 322). </li></ul>
  27. 27. (CDC, 2005)
  28. 28. <ul><li>Appropriate interventions will promote better outcomes of resiliency and recovery among victims after a disaster. Flexibility and local control is needed when planning disaster interventions. Communities can take charge of local recovery efforts. Individuals can regain their sense of collective and self-efficacy that may have been injured by the trauma and ensuing adversities (Norris, & Stevens, 2007, p. 324). </li></ul>
  29. 29. <ul><li>Simple concrete tasks can be given and rescue workers can help survivors focus and take a more active role in coping. Being reliable and following up, even when there is nothing to report, helps survivors gain control (DHHS, 2005, p.14). People can be empowered to solve their own problems. </li></ul>
  30. 30. Severity of Psychological Reaction After a Traumatic Event (CDC, 2005)
  31. 31. <ul><li>First responders should monitor victims for the following behaviors and symptoms, consult with their supervisor, and refer for more specialized treatment: disorientation, severe anxiety, depression, mental illness, inability to care for self, suicidal or homicidal thoughts or plans, problematic use of alcohol or drugs, domestic violence, child abuse, or elder abuse (DHHS, 2005, p. 15-16). </li></ul>
  32. 32. <ul><li>Individuals at risk, such as the seriously injured and those suffering from pre-disaster mental health problems, should be monitored closely at the disaster healthcare site. If their conditions worsen, these clients should be sent to nearby hospitals for appropriate care, treatment and follow-up discharge planning (APA, 2004, p.13). </li></ul>
  33. 33. Drill NYC May 19, 2009
  34. 34. Drill NYC
  35. 35. Conclusion <ul><li>Remember that anyone experiencing a disaster is affected by it. It is important to implement psychological first aid with medical evaluations during recovery efforts. Psychological first aid is a practical effort by meeting victims’ basic needs for food, comfort, and safety. Connectedness at the disaster site offers victims supportive activities and opportunities for appropriate treatment in the community. </li></ul>
  36. 36. <ul><li>Appropriate interventions during disasters promote resiliency and recovery. When communities take charge of recovery efforts, individuals can regain their sense of control and well being. Victims and communities can successfully move on with their lives after the experience of a disaster. </li></ul>
  37. 37. Poster
  38. 38. References <ul><li>American Psychiatric Association (APA), (2004), Disaster psychiatry handbook. </li></ul><ul><li>Retrieved March 4, 2010, from: </li></ul><ul><li> </li></ul><ul><li>Briggs, S.M., Twomey, J.C. (2003). Basic Disaster Awareness for Healthcare Providers, Boston Public Health Commission, Boston Emergency Medical Services, and Delvalle Institute for Emergency Preparedness, Boston, Mass. </li></ul><ul><li>Centers for Disease Control and Prevention (CDC). (2005). Disaster mental health primer: Key principles, issues and questions. Retrieved February 27, 2010, from </li></ul><ul><li>Ivonov, L.L., & Blue, C.L. (2008). Public Health Nursing: Leadership, policy & practice. Clifton Park, N. Y.: Delmar Cengage Learning. </li></ul><ul><li>National Center for PTSD (2007). Disaster Rescue and Response Workers. Retrieved May 28, 2010 from: </li></ul>
  39. 39. <ul><li>National Institute for Occupational Safety and Health (NIOSH) (2002). Traumatic Incident Stress: Information for Emergency Response Workers DHHS (NIOSH) Publication Number 2002-107. </li></ul><ul><li>Norris, F.H., & Stevens, S.P. (2007). Community resilience and the principles of mass trauma intervention. Psychiatry , 70 (4), 320-328. </li></ul><ul><li>Polatin P.B., Young, M., Mayer, M., & Gatchel, R. (2005). Bioterrorism, stress and pain: The importance of an anticipatory community preparedness intervention. Journal of Psychosmatic Research. 58(4):311-6. </li></ul><ul><li>U.S. Department of Health and Human Services. (2005). Mental health response to mass violence and terrorism: A field guide. DHHS Pub. No. SMA 4025. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Administration. </li></ul>