A Guide for Emergency Response Workers and their Managers

Although we are two weeks on from the triggering event, engaging in response efforts in the wake of a crisis event like the Canterbury earthquake and the aftershocks is inevitably stressful for those involved in the emergency response. While the work is personally rewarding and challenging, it also has the potential for affecting responders in harmful ways. The long hours, breadth of needs and demands, ambiguous roles, and exposure to human suffering can adversely affect even the most experienced professional. Too often, the stress experienced by responders is addressed as an afterthought. With a little effort, however, steps can be taken to minimise the effects of stress.

Stress prevention and management should be addressed in two critical contexts: the organisation and the individual. Adopting a preventive perspective allows both workers and organisations to anticipate stressors and shape responses, rather than simply reacting to a crisis when it occurs.
Organisational Approaches for Stress Prevention and Management

  1. Provide effective management structure and leadership. Elements include:
    • Clear chain of command and reporting relationships.
    • Available and accessible supervisors.
    • Disaster orientation for all workers.
    • Shifts of no longer than 12 hours, followed by 12 hours off.
    • Briefings at the beginning of shifts as workers enter the operation. Shifts should overlap so that outgoing workers brief incoming workers.
    • Necessary supplies (e.g., paper, forms, pens, educational materials).
    • Communication tools (e.g., mobile phones, radios).
  2. Define a clear purpose and goals.
  3. Define clear intervention goals and strategies appropriate to the assignment setting.
  4. Define roles by function.
  5. Orient and train staff with written role descriptions for each assignment setting. When a setting is under the jurisdiction of another agency, inform workers of each agency’s role, contact people, and expectations.
  6. Nurture team support.
  7. Consider creating a buddy system to support and monitor stress reactions. Promote a positive atmosphere of support and tolerance with frequent praise.
  8. Develop a plan for stress management. For example:
    • Assess workers’ functioning regularly.
    • Rotate workers among low-, mid-, and high-stress tasks.
    • Encourage breaks and time away from assignment.

I compiled this from information issued by http://www.samhsa.gov

You can also download the information from a fact-sheet I developed here.

Checklist: Common reactions, positive coping, and when to seek help

A new week is with us. So, here’s a heads-up.

Distress is an understandable and normal response to major disasters. Common causes of distress may be related to having been directly at risk from the earthquake and aftershocks, being concerned about family and friends who may be affected, witnessing injuries and distress to others, or being caught up in the panic and confusion that often follows. In addition, feelings and memories related to previous experiences of disasters or other grief and loss may also resurface. Most people experience acute stress during emergency events and most manage with courage and strength. However, sometimes it is only later when the distressing images are recalled that some of the stressful effects start to show.

While most people will manage with the support of family and friends, there are times when extra help and support may be needed. Those who have feared losing loved ones, have been seriously injured, or are highly distressed by the aftershocks, will often need particular support and care. Our communities have a history of coping with uncertain and troubled times with courage and strength.

There are three important things you need to know:

  • normal reactions to this type of emergency
  • positive ways of coping
  • when to get extra help.

Normal reactions to a disaster like this include:

  • shock and numbness, often fear at first
  • horror and grief when the extent of loss is realised
  • frustration, anger, helplessness and even sometimes despair when it all seems too much
  • sometimes fears or old worries may resurface.

These feelings usually settle over the early weeks.

Positive ways of coping may be:

  • supporting one another, especially in the family and in your community
  • providing emotional support – comforting each other
  • carrying out practical tasks – tackling the jobs that need to be done a bit at a time and counting each success
  • sharing your experience and feelings with others – a bit at a time when it is right for you
  • looking after your own and your family’s general health – rest, exercise, food and company all help (being careful not to drink too much alcohol).

Sometimes, post disaster stress can be ongoing and affect your physical and mental health and wellbeing.

It’s time to ask for help if:

  • your sleep is badly affected
  • you feel very distressed, irritable, on edge or agitated much of the time
  • you feel hopeless, despairing, miserable or that you can’t go on
  • you have trouble concentrating, are distracted and cannot do your usual tasks
  • you feel your health is not so good
  • you have recurrent nightmares or intrusive thoughts about the earthquake
  • you have new symptoms or old problems may seem to have returned, eg. breathing, heart and stomach problems.
  • For children, withdrawal, aggressive behaviours, difficulties at school, problems separating from parents or going to sleep may indicate the need for help.

This is just the brief version. If you want more detail about specific topics, check out the other posts on this blog. The home page will have a list of recent posts in the right-hand column. Or you can click here for the fact-sheets at the Ministry of Health. I compiled these too.

Helping adolescents through the Canterbury earthquake and aftershocks: Part One

One week on from the initial earthquake, and hundreds of aftershocks later, it is the weekend. A chance to take stock of what will be remembered as an unforgettable week for a generation of New Zealanders, with considerable uncertainty about what may be yet to come.

But much of the Christchurch CBD is accessible again. All over the region, people will be out and around, surveying their surroundings. Some will take the opportunity to re-connect with others, while others will perhaps take a moment to consider their journey so far, and what they might do next.

One group that can often suffer a little from the lock-down that tends to happen during emergency events are adolescents. All sorts of stuff going on in the life of a modern adolescent – family competes for attention with peer groups, cellphones, games consoles, and generally being out and around and exploring the world. However, under the threat of earthquakes and the aftershocks, people are sometimes enforced to spend a lot of time indoors and in cramped spaces. This weekend might provide a bit of release.

Adolescents involved in crisis and emergency events, may not always show their distress outwardly. As a result, adults may misunderstand their needs or find them unwilling to accept help. Adolescents frequently lose the self-assurance they had when younger, but often gain other types of confidence and abilities. Parents, and adolescents themselves, are confused by their inconsistent behaviour. They can think rationally, but have unstable emotions and may not apply logical thinking to real situations. They need support and independence to learn this. They want to be both close to others and time to be alone as they find new ways of relating to people. To communicate with adolescents, these contradictions have to be understood. Moodiness, depression and insecurity commonly alternate with excitement, happiness and adventurousness.

Whereas children are dependent on parents and live within the family, adolescents are usually proud that they could survive on their own. School, peers, other adults and social or sporting groups are a large part of their support network. They often do not feel the family is the life support system it was in childhood. Parents may feel sidelined, but their importance is no less than before, just different.

Adolescents usually don’t understand these changes although they feel the frustration of them. They need their family to be a trusted home base for their adjustment to painful events, but how much they rely on their family to come to grips with what has happened varies greatly from one person to another.

Adolescents are often more involved in doing things than understanding emotions and may lack words to express important feelings. They handle painful events by distracting themselves. They may be immersed in their own feelings and point of view and not recognize adults’ reactions. They may feel threatened when adults try to be logical about painful experiences and not fully understand what is said until later. But their behaviour often shows they have taken notice even when they don’t acknowledge it. It is important to allow time for them to work things out and not demand immediate feedback. Parents’ own anxiety may make adolescents confused and guilty or cause them to reject the parent’s emotions to protect themselves.

Jump down to Part Two of Helping Adolescents for more.

Prime Minister John Key gives good counsel

I think Prime Minister John Key made some very helpful statements yesterday regarding how some people are reacting to the earthquake and subsequent aftershocks and how they might get help. Here is some of the quote:

Prime Minister John Key is calling on those still residing in Canterbury to consider seeking counselling to deal with the stress of the earthquake and continuing aftershocks.

Speaking to RadioLIVE’s Marcus Lush this morning Mr Key said that the “compounding increase in anxiety that is taking place because of the aftershocks” only became clear to him upon visiting the region to assess the fallout of Saturday’s quake.

“People are living in slightly damaged houses, so they’re thinking ‘I’m living in a damaged structure, I’m fearful of another earthquake’ and of course they’re getting really upset, and that’s really one of the reasons why we’re asking people to reach out and get some counselling,” said Mr Key.

Do you notice how he doesn’t talk about trauma?

He talks about anxiety and getting really upset.

Mr Key is getting good advice (or he knows this himself, possibly).

Talking about trauma is not very helpful, and it is not true for the majority of people either. In this post, I point out how research predicts that most people who are living through this unfolding event will be OK. They may have some ups and downs and some wobbles along the way, the dominant story is resilience for the majority, particularly if they have supportive friends, families, clubs , societies, church groups, and voluntary or government-sponsored groups standing strong beside them. Trauma symptoms affect the minority but we of course need to ensure that we can identify and help these people early on in the piece.

Mr Key gets this.

Talking about trauma turns people off from looking for help. However, anxiety and uncertainty will be all too common. This is just a normal reaction to a highly unusual and sometimes frightening set of events. Getting good information about why people are feeling, thinking and behaving like they are, that they are not alone in experiencing this, and that there are concrete things that can be done, along with caring, compassionate people (sometime professionals) around to help them work through what they need to do – this is what Mr Key is getting at.

People to hear their story, when they’re ready.

At their own pace.

Those people are around – you might already know them.

Just don’t let anyone rush you.

Common reactions to an earthquake (and aftershocks)

Most people involved in a very stressful incident experience some kind of emotional reaction. Although each person’s experience is different, there are a number of common responses that are experienced by the majority of those involved. It is reassuring to know that, even though these feelings can be very unpleasant, they are NORMAL reactions in a normal person to an ABNORMAL event. You are not losing your mind or going crazy if you have these feelings. It is often difficult for those who were not involved to understand what the survivor is going through; you may wish to show this information to friends and relatives, and perhaps discuss your reactions with them.

Outlined below are some of the normal reactions to crisis events:

Emotional

Shock
disbelief at what happened
feeling numb, as if things are unreal
Fear
of a recurrence
for the safety of oneself or one’s family
apparently unrelated fears
Anger
at who caused it or “allowed it to happen”
at the injustice and senselessness of it all
generalised anger and irritability
Sadness
about the losses, both human and material
about the loss of feelings of safety and security
feeling depressed for no reason
Shame
for having appeared helpless or emotional
for not behaving as you would have liked

Physical

Sleep
difficulty getting off because of intrusive thoughts
restless and disturbed sleep
feeling tired and fatigued
Physical Problems
easily startled by noises
general agitation and muscle tension
palpitations, trembling or sweating
breathing difficulties
nausea, diarrhoea or constipation
many other physical signs and symptoms

Thinking

Memories
frequent thoughts or images of the incident
thoughts or images of other frightening events
flashbacks or a feeling of “reliving” the experience
attempts to shut out the painful memories
pictures of what happened jumping into your head
dreams and nightmares about what happened
unpleasant dreams of other frightening things
difficulty making simple decisions
inability to concentrate and memory problems

Behaviour

Social
withdrawal from others and a need to be alone
easily irritated by other people
feelings of detachment from others
loss of interest in normal activities and hobbies
Work
not wanting to go to work, poor motivation
poor concentration and attention
Habits
increased use of alcohol, cigarettes or other drugs
loss of appetite or increased eating
loss of interest in enjoyable activities
loss of sexual interest

Remember that all responses are NORMAL to an ABNORMAL situation.

It will take time before you start to feel better. You may have strong feelings right away. Or you may not notice a change until much later, after the crisis is over. Stress can change how you act with your friends and family. It will take time for you to feel better and for your life to return to normal. Give yourself time to heal.

Tomorrow, I’ll write more about practical steps you can take, but take a look at this post for now.

Videos explaining psychosocial support now on blog

These videos explain some of the concepts of psychosocial support, some the experiences you might be going through, and what you can do to help yourselves and others.

You can watch them by clicking on the videos on the right hand side of the home page on this site.

Psychosocial support after the Canterbury quake – Advice blog

In the hours, days and weeks ahead you may come across instances where people are worried, anxious, frightened, or just uncertain about their experiences and futures. You may be feeling like this yourself. Some will have experienced damage to their property which means that they cannot live where they normally live. Others may have experienced injury – whether to themselves, or their loved ones. And this injury could be physical or non-physical, visible or non-visible. What we know from the research is that most people will be ok, especially if they have their usual resources to draw upon – especially their social networks and experience with coping with adversity successfully before in their lives. Others will need more support.

This site provides information to help you to help yourself and others.

This blog started after doing some work over the first couple of days after the initial earthquake, having been quoted in a NZ Herald article here on helping children after the event (also also in the Star Canterbury and another article here, and here), and a Radio NZ National radio interview on Nine to Noon with Kathryn Ryan too. I also made a post on Nigel Latta’s Facebook page after being prodded by a friend on looking after children after the earthquake.

As a result of the work that I have done to develop the NZ Government’s psychosocial support response in emergency events, I’ve been inspired to set up this new blog on support after the quake – please check in regularly for bite-sized advice and tips to help you recognise some of the new and unsettling thoughts, feelings and behaviours that you and others around you might be seeing or going through, and how to help yourself and others.

I’m happy for you to share this information with whoever you think might find it useful. Just check with me through the comments function if it will be used for press or media purposes. Always happy to receive feedback too. Thanks.