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.

The Canterbury earthquake and the effect it may have on families: Part two

Yesterday, I posted about some of the short-term effects that emergency events like earthquakes and the cumulative stress of aftershocks can have. Today, I’ll continue to describe some the medium to long-term effects, helpful things to do, and some indicators as to when you might need to find help.

Medium term effects

Some families cope well with the crisis and immediate aftermath. Changes which are not obviously related to the crisis may occur some weeks or months after the incident.

  • Routine and work patterns, ambition or motivation in the affected member or others in the family may change; work efficiency and concentration may be reduced.
  • Spouses/parents may be short tempered, irritable or intolerant, leading to friction in relationships and misunderstanding between themselves and their children.
  • Children or teenagers can be clingy, attention seeking or disobedient – this usually indicates they are anxious or fearful.
  • Teenagers may become more rebellious or demanding, or through other behaviour, demonstrate a need to have a sense of control over their lives.
  • Child or adult family members may be overly concerned to help. They may try hard not to do anything wrong and postpone their own needs to support the affected member.
  • Family members’ feelings for each other may change by becoming more detached, uninvolved or preoccupied with personal problems as each member tries to cope with their own reactions.
  • Spouses may experience changes in their sexual relationship.
  • Children and teenagers’ school performance and concentration may be lowered; they may lose former interests.
  • Family members may lose interest in leisure, recreation, sport or social activities.
  • Teenagers may turn outside the family for emotional support from peers or other adults.

Immediate post crisis responses may persist or sometimes begin to appear for the first time.

Long term effects

Sometimes problems become evident for the first time, months or years after the event.

  • The memories of the traumatic event may come back for family members involved in another crisis, although it was dealt with at the time.
  • Family members, including children, often need to go over the events again when they grow into new stages of maturity and develop a capacity for greater understanding.
  • People may find future crises harder to handle, particularly when similar feelings are aroused, even if for different reasons.
  • Family members may cover up or cope with difficult feelings until all the fuss is over and things have returned to normal, and only then show their distress.
  • Any of the immediate or medium term effects may occur as delayed reactions or may become habits.
  • Problems often appear in the form of everyday frustrations. Retracing the way they have developed and examining connections to the crisis often makes the cause clearer. It is wise to assume that a major change or problem in family members in the next few years has some relationship to the crisis.

These problems are all normal reactions to an abnormal event that has touched the lives of the whole family. It is important not to blame each other. Try to understand how members affect each other. It is part of a changed pattern of family life arising from the crisis.

Helpful things to do

A few simple things will help families recover from crisis.

  • Keep communicating: Talk about what is happening, how members feel, what they need from each other. This avoids feeling alone, isolated and not understood. Don’t leave communication to chance, make opportunities for it to happen.
  • Share information: Communicate with children, teenagers and toddlers. They know something is going on and a painful reality is easier to deal with than the unknown worry of fear.
  • Do things together: Ensure time is reserved for recreation, enjoyment and rewarding experiences. Shared pleasure carries a family through many difficulties.
  • Keep family roles clear: Don’t allow children to take too much responsibility for too long, even if they want to care for a distressed parent. Help members preserve their role and position in the family and support them. Don’t overprotect children or adults. Be understanding if a member cannot fulfil their role for a time and talk about how they will resume when they are ready and able.
  • Be active: Tackle problems, seek help, seek information and don’t let small issues build up. Whatever the cause, stress leads to further problems. Stress factors don’t add up, they multiply and make everything feel worse than it is.
  • Look back: From time to time take stock of how each member has changed since the crisis. Look for the ways the crisis has influenced everyone for better or worse.
  • Allow expressions of emotions: Support distressed family members and allow them time to find their way through their feelings. They may express distress many times before it diminishes. Suppressing emotions places them outside control and therefore outside recovery.
  • Use other people: Keep in contact with support groups, other family, friends, neighbours, and workmates. Make sure the family doesn’t become isolated and too involved with itself. Share the experience with those you trust. Most families have the ability to grow through crisis. But understanding its effects and actively dealing with them is necessary.


When to seek help

There are a number of signs that recovery may not be proceeding in a helpful way:

  • Communication in the family is breaking down
  • Parents do not understand their children’s (or each other’s) behaviour
  • Things are not improving over time in the family
  • There is evidence of deteriorating physical or emotional health in any family member
  • Family members are not able to enjoy being together.

If you are concerned about yourself, your spouse, children or parents do not hesitate to contact someone trained to assess the situation and advise you. A little early help from a trained person can avoid long-term difficulty and give family members back confidence in themselves and each other.

I have adapted this from information issued by Queensland Health: Fact Sheets for Psychosocial Disaster Management. I have also compiled a version that you can download here.

When someone you know has been through a traumatic experience

So far in this blog, I’ve mainly written about those people  – the majority of people – who will be upset and distressed by their experience through the earthquake and aftershocks. However, I thought it would be worth putting up a post that focuses upon those who are, or may be, more profoundly affected in a negative way.

The  Canterbury earthquake was certainly distressing and threatening, and may have been experienced as so intense that it can temporarily disrupt a person’s ability to come to terms with it. Thinking you might die, seeing others injured (or killed – but thankfully not in this case), intense fear, abuse or being forced to do things out of your control are all traumatic experiences. While traumas occur all the time, they only affect to a few people. The reactions of those affected often cause those close to them to be confused and unsure about what to expect or how to help. People who have been traumatised can respond in ways that may seem unusual, make things worse for them or they may be concerned about things that seem unreasonable.

The effects of trauma

A traumatic experience can temporarily shatter basic assumptions about life or other people such as trust, safety, predictability. The feelings caused may be so intense that unlike normal distress, they do not fade with time, but either continue the same or get worse after a while.

People affected by trauma may feel fear even when it is quite safe. They may be constantly on edge and not respond to normal reassurance or opportunities to relax. Their tiredness may continue on for much longer than seems reasonable. They may have periods of appearing numb or detached and not wanting contact. This may be followed later by over-excited behaviour and a need to cling to family or familiar things. They may feel they failed or did the wrong thing at the time (even if this is not true). Usually they remember a combination of very intense fragments of the event that do not go away, combined with important gaps that make them feel uncertain about what really happened.

Recovery from trauma

Most people recover from traumatic experiences, but it usually takes them longer than would be expected for non-traumatic crises. It is common for there to be an initial period of several days with strong emotions of fear or distress, and a constant preoccupation with the events. Many people then feel a need to get back to normal and put it out of their minds. Although this can often be beneficial in the short-term and help recovery from normal crises, it often only postpones problems for people who have been through traumas. Sometimes they can maintain normal routines for some time (although those around them often see that all is not well) and eventually something happens that brings it to the surface again. This can happen months after the event.

The important thing about recovery from trauma is to go back over what happened so the feelings fade and the person can come to terms with the event, realise it is in the past and how they can be safe again. But this has to happen at a time and rate that is comfortable for the individual. Other people are the most valuable support for recovery, but it is often difficult for them to be confident about what to do. Uncertainty and the wish to avoid distress can make those close to the affected person keep away from the experience or from them. It is usually best to ask how you can help and to let them know they can talk if they want to.

Helping someone who has been through trauma

  1. Spend time with the stressed person, without judging or demanding, their recovery will occur in its own time.
  2. Offer support and a listening ear: talking is one of the best things they can do to work things out; but they may need to go over things many more times than you expect. Try to be interested in what they want to say; avoid giving advice or trying to solve the problems. The talking itself is important and helps to make it fade. Remember though, this is likely to happen at their pace, not yours.
  3. Help with practical tasks and chores as this enables more of their energy and time to be given to the recovery process.
  4. Give them time, space and patience: don’t take it personally if at times they are irritable, bad tempered or want to be alone. These are a natural part of the stress response and will pass as they recover.
  5. Don’t try to talk them out of their reactions, minimise the event or say things like “you’re lucky it wasn’t worse,” or “pull yourself together,” or try to get them to look on the bright side; stressed people need to concentrate on themselves at first; they will feel supported if you let them know you are concerned, want to help and are trying to understand. They will see your viewpoint as they recover.


When to seek additional help

Sometimes it is important for people to know when their own recovery activity requires additional help. Personal recovery may need to be supported by specialist knowledge to ensure stress does not linger unnecessarily or lead to later health problems. Stress problems respond rapidly with professional advice and information.

Indications for this are:

  • if recovery has stalled or does not seem to be proceeding
  • if physical or other symptoms are causing concern
  • if there is no one to talk to or relationships are being affected by the stress
  • if there is continuing emotional numbness, depression or anxiety
  • if there is continued disturbed sleep and nightmares
  • if they are unable to handle the intense feelings or physical sensations
  • if they are becoming accident prone or increasing use of drugs and alcohol.

Looking after yourself

Don’t forget that to have a loved one, friend or colleague go through a trauma can be very stressful for you as well and you may find that you have strong reactions of anger that it happened, sadness for them, fear for yourself, changes in how you see life and the world, nightmares or general moodiness. Often the best thing may be to seek support from others for yourself so you can be more available to your loved one for the time it takes them to get over it.

Information and counseling

Counseling with someone trained in trauma is often helpful not only to talk about the trauma, but to give a better understanding about what is happening and how to get over it. Sometimes the person who has had the trauma may not be willing to seek help for a time. In this case it may be beneficial for those close to them to seek professional advice and this often helps them take the step themselves.

I have adapted from information issued by Queensland Health: Fact Sheets for Psychosocial Disaster Management. I have also compiled a version that you can download here.