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Emergency Preparedness

Guide Book

HELPING THE HELPERS IN A DISASTER

     Heavy workloads, long hours and the pressure to accomplish difficult tasks quickly are inherent in emergency and disaster work. Occupational stressors can arise from:

• Time pressures – especially in rescue and emergency medical situations in which a time limit exists on the victim’s chance for survival, time pressures may be great;
• Responsibility overload – especially for those with supervisory or command responsibility, a multitude of tasks, all with high priority, may need to be done simultaneously with no one to whom they can be delegated;
• Physical demands – rescue work requires physical exertion, strength, stamina and endurance where hours are long and work conditions adverse;
• Mental demands – the work requires good judgment, clarity of thinking, and the ability to make accurate calculation, set priorities, and make decisions in chaotic situations;
• Emotional demands – workers are exposed to traumatic stimuli and victims under stress.  They must keep their emotions under control in order to function.  They must make painful, life-or-death decisions and work in the presence of anger or fear;
• Work area – this can range from low-pressure, such as a staging area, to high-pressure, such as a triage area or morgue;
• Limited resources – lack of personnel, equipment, funding;
• High expectation – from the public and from rescue response personnel themselves.

Minimizing Stress Effects During a Disaster

     The following guidelines are suggested for minimizing stress effects among emergency response workers and maximizing performance during a disaster operation:

• Staff Rotation – Limit workers’ time in high-stress assignments such as body removal or morgue work to two hours at a time.  Psychosocial workers involved in providing grief support to loved ones at a morgue or hospital or who are assigned to telephone help lines should be limited to four hours of work at a time.
• Rest Periods – Provide 15 – 30 minute rest periods every 2 hours.  Breaks from the action will help decrease the possibility of injury, fatigue, and emotional strain.
• Comfort and Care – On breaks, try to provide workers with the following: a place to sit or lie down away from the scene; warm food, high protein snacks and beverages, preferably juice; shelter from weather, dry clothes; an opportunity to talk about their feelings with co-workers or a chaplain.

Critical Incident Stress Debriefing

     Dr. Jeffery Mitchell of the University of Maryland, a disaster psychologist, defines Critical Incident Stress as: “Any situation faced by emergency service personnel that causes them to experience unusually strong emotional reactions which have the potential to interfere with their ability at the scene or later … all that is necessary is that the incident, regardless of type, generates unusually strong feelings in the emergency service worker.”

     A Critical Incident Stress Debriefing (CISD) is a structured meeting of emergency response personnel involved in a critical incident and facilitated by a trained CISD team.  The purpose of the debriefing is it:

• Lessen the impact of major events on emergency service personnel;
• Accelerate normal recovery in normal people who are experiencing normal stress after experiencing highly abnormal events or incidents.

     The CIDS meetings are not “gripe” sessions; nor are they a critique of what happened.  The format for the meetings, in general, deals with what happened to the individuals during the event; how they felt at the scene and what their reactions were afterwards.

     In addition to providing a supportive environment that allows emergency workers to deal with stress reactions, the debriefing provides education about acute stress and its normal effects.  The participants learn specific stress management techniques for coping with their responses.

     CISD meetings should optimally occur within 72 hours of the incident but can be done any time after the event. 

     However, the greater the delay between the incident and the debriefing, the greater the likelihood of delayed or prolonged stress reactions.