The Psychological Impact of Trauma on Responders

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The Psychological Impact of Trauma on Responders

• October 21, 2005
• FEMA Crisis Counseling Program

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Overview of Presentation

• The Psychological Impact of Trauma
• The short term and long term effects of stress
• Family risk
• Resilience and self-care
• Resources

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Importance of Psychological Responses

• Affect our physiological responses
• Overwhelming emotions can disrupt rational
  problem-solving
• Promote adaptive and maladaptive individual and
  group behaviors

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Effects on First RespondersNew Orleans, First
Responders

• Dealt with angry people were shot at.
• Responders had to leave people without food or
  water
• Saw people hurting and dying and could not help
• Had to separate family members in order to save
  some
• Are not used to limited success.
• Were exposed to bacteria chemicals in water.

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Effects on Katrina RespondersResponding in later
waves

• Needs are overwhelming.
• Had to deny aid in some cases
• Began to close service
• centers, shelters
• People living in tents FEMA trailers
• Physical Impact
• Emotional Impact

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PSYCHOLOGICAL CONSEQUENCES OF DISASTER AND
TERORISM
Distress Responses
From IOM publication Preparing for the
Psychological Consequences of Terrorism
www.nap.edu NOTE Indicative only not to scale
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Critical Stress Indicators

• Threat to ones life
• Threat of harm to family
• Destruction of home or community
• Significant media attention
• Witnessing others trauma
• Being trapped or unable to evacuate

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Physical Reactions

• Fatigue, exhaustion
• Gastrointestinal distress
• Appetite change
• Tightening in throat, chest, or stomach
• Worsening of existing medical conditions
• Somatic complaints

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Emotional Reactions

• Depression, sadness
• Irritability, anger, resentment
• Anxiety, fear
• Despair, hopelessness
• Guilt, self-doubt
• Unpredictable mood swings
• Feeling overwhelmed
• Apathy

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Cognitive Reactions

• Confusion, disorientation
• Recurring dreams or nightmares
• Preoccupation with disaster
• Trouble concentrating or remembering things
• Difficulty making decisions
• Questioning spiritual beliefs

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Behavioral Reactions

• Sleep problems
• Crying easily
• Avoiding reminders
• Excessive activity level
• Increased conflicts with family
• Hyper-vigilance, startle reactions
• Isolation or social withdrawal
• Changes in appetite

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Chronic Stressors

• Family disruption
• Work overload
• Gender differences
• Bureaucratic hassles
• Financial constraints

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Effects of Long-Term Stress

• Anxiety and vigilance
• Anger, resentment and conflict
• Uncertainty about the future
• Complicated grief reactions
• Diminished problem-solving
• Isolation and hopelessness
• Health problems
• Physical and mental exhaustion
• Substance use or abuse
• Lifestyle changes

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Self Care and Stress Basics

• Stress is
• Normal
• Necessary
• Productive and destructive
• Acute and delayed
• Cumulative
• Identifiable
• Preventable and manageable

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Normal Reactions to a Disaster Event

• No one who responds to a mass casualty event is
  untouched by it
• Profound sadness, grief, and anger are normal
  reactions to an abnormal event
• Wanting to remain on the scene until the work is
  finished
• Overriding stress and fatigue with dedication and
  commitment
• Denying the need for rest and recovery time

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Signs Stress Management Assistance is Needed

• Difficulty communicating thoughts
• Difficulty remembering instructions
• Difficulty maintaining balance
• Uncharacteristically argumentative
• Difficulty making decisions
• Limited attention span
• Unnecessary risk-taking
• Tremors/headaches/nausea
• Tunnel vision/muffled vision

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Signs that Stress Management Assistance is Needed

• Disorientation or confusion
• Difficulty concentrating
• Loss of objectivity
• Easily frustrated
• Unable to engage in problem-solving
• Unable to let down when off duty
• Refusal to follow orders
• Refusal to leave the scene
• Increased use of drugs/alcohol

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Individual Approaches

• Management of workload
• Balanced lifestyle
• Stress reduction strategies
• Self-awareness

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How is psychological impact different for first
responders?

• Chronic exposure to traumatic events
• Fitness for duty issues
• Culture of first responders
• Pre-existing stressors
• Family issues
• Health status
• Other losses
• Mental health or alcohol/drug abuse issues

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Good news..

• First responders generally resilient to routine
  trauma
• Same protective factors as general public
• Experience, gender and age
• Least likely to have severe impairment as result
  of trauma
• Professionalism and training increase resilience

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Bad news..

• Greater risk and uncertainty
• Secondary attacks on first responders
• Higher rates of substance abuse, divorce, and
  suicide in first responder community, even
  greater post-event
• Younger and less experienced at greatest risk

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Unique Stressors and Risk Factors for First
Responders

• Stress of uncertainty,
• the unknown
• Anticipatory stress
• Chronic nature of stress
• Personal Protective
• Technologies

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Unique Stressors and Risk Factors for First
Responders

• Exposure to death
• Identification with victims
• Family risk
• What am I bringing home?
• Family coping behaviors?
• Hours of work

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Even heroes need to talk.

• One of the marketing slogans for Project Liberty,
  New Yorks post-9/11 Crisis Counseling Program

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Help-seeking barriers

• Stigma
• Access and cost
• Timing
• Fitness for duty
• Masked as physical illness
• Confidentiality
• Media interest
• Delayed response

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Encourage Responders to

• Drink plenty of water and eat healthy snacks
• Take frequent, brief breaks from the scene as
  practicable especially if they are coming home to
  work in a first responder capacity
• Talk about their emotions to process what they
  have seen and done
• Stay in touch with family and friends
• Participate in memorials, rituals, and use of
  symbols as a way to express feelings
• Pair up with another responder to monitor one
  anothers stress

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Strategies in Response

• Self-care
• Peer Support
• Humor
• Decide to talk
• Seek help from credible and trusted sources
• Get extra rest
• Use constructive coping strategies

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Strategies in Recovery

• Long term assessment for risk
• Journaling
• Practice relapse prevention
• Lifestyle and health promotion
• Role models/partnering/mentoring

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Assignment and Supervision

• Attachment and identification issues
• Know risk factors and triggers, increase support
  as needed
• Use risk communication skills
• Monitor media attention to workers and hero
  identification
• Provide family events, support groups, etc.

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Access to Crisis Assistance and Mental Health
Services

• EAP
• Peer support models
• Health insurance mental health benefits
• In-house mental health services
• Volunteer organizations
• Use of faith-based supportive counseling

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Most effective if..

• Delivered by trusted individuals
• Offered in non-traditional settings,
• Can be arranged spontaneously
• Handled informally
• Not labeled as mental health
• Culturally informed

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Lynn CarterDepartment of Mental HealthPhone
573-751-4970Email lynn.carter_at_dmh.mo.govJenny
WileyPhone 573-751-4730Email
jenny.wiley_at_dmh.mo.gov