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.

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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.

Recognising and dealing with cumulative stress after the earthquake

A few days ago, I wrote about how we can sometimes put ourselves into an ’emergency state’ when we try deal with problems and cope with fear after an emergency events like the Canterbury earthquake and subsequent aftershocks.

This short article describes the sorts of signs of stress you may be able to identify in yourself or others if you’ve been in this state of emergency stress for too long, and what you can do about it.

Common stress symptoms

Thinking

  • trouble thinking clearly
  • planning
  • making decisions
  • can’t concentrate or remember details
  • low attention span
  • can’t stop thinking about the issues all the time
  • keep thinking about bad times in the past
  • not speaking clearly, slurring words, forgetting names.

Physical

  • bodily tension, stress and tightness in muscles
  • weak feelings, tiredness, loss of energy and enthusiasm
  • headaches, trembling, sweating, nausea, aches and pains
  • lack of appetite, increased desire for stimulants, sugar, alcohol, tobacco or coffee
  • feeling tired but cannot sleep, disturbed sleep, dreams and nightmares.


Feelings

  • feel detached from things
  • don’t care any more
  • irritable, bad-tempered, impatient and restless
  • unable to relax or keep still
  • feeling overwhelmed
  • everything seems too hard or difficult
  • tearful for no reason
  • easily upset or hurt
  • oversensitive to what others do and say
  • insecure – wanting to stay in familiar places with routines
  • feeling very emotional
  • experience waves of anger or worry that are not reasonable.


Relationships

  • feel others are to blame for stress
  • tendency to get things all out of proportion
  • can’t feel happiness enjoyment or affection for loved ones
  • moody and gloomy
  • feeling sad and hopeless as though the emergency will never end
  • changed relationships with those close to you
  • don’t want to be with family or friends or always need them around
  • have to talk about the emergency all the time
  • feel others don’t understand or don’t seem to care.

Cumulative stress

The same effects can occur if the emergency is not dramatic, but a series of smaller problems that go on for a long time. If it is not possible to unwind and relax between the problems stress builds up. This might apply especially in this case where we can expect the aftershocks to the earthquakes to be going on for some time.

The stress cycle

If stress has been ongoing, a pattern of stress may form. As a result, stress reactions cause more problems and this causes more stress. This is called the stress cycle. Once established, stress can become a lifestyle. Long term stress will undermine health and may cause illnesses. Getting over stress means breaking the stress cycle.

Breaking the stress cycle
Step 1. Recognise you are stressed
People often don’t recognise their own stress because they are too focused on the problems. Listen to others who may see you more clearly than you see yourself.

Step 2. Get to know your stress cycle

Try to see how the stress symptoms cause more stress and put you in the stress cycle.

Step 3. Make a decision to break the stress cycle
Although there are lots of things about your life you cannot change there a real ways some that you can, but you have to decide to do it.

Step 4. Reduce stress activities
Check your routines and life style to see where you can reduce the stress. Where possible stop doing things that keep stress high.

Step 5. Increase relaxation and positive activities
Build activities into the daily routine which break the stress cycle and give you a reward or good feeling, even if only a small one. Put a little effort in to enjoying yourself.

Looking after yourself

There are plenty of things that anyone can do which will help to break the stress cycle and reduce tension. Many simple pleasures will make a big difference to stress. Enjoyment is the best antidote to stress.

Physical

  • Do regular rhythmic physical exercise such as walking, swimming, cycling
  • Make an effort to reduce or at least not to increase your intake of stimulants such as alcohol, tobacco and sugar as they keep the stress cycle going
  • Eat regular, well-balanced meals even if they are small.


Relationships

  • Keep regular contact with people you like to be with
  • Ask for help when you need it, many people enjoy giving help
  • Make time to be with your family or friends
  • Talk to people you trust about yourself and what is happening so you can get it into perspective.

Relaxation

  • Do regular relaxation exercises such as deep breathing, listening to quiet music, meditation
  • Do something about bodily tension such as massage or exercises
  • Rest regularly, even if you can only do it for a short time
  • Try to find something that will make you laugh sometimes.

Attitudes

  • Accept that it will take time to get out of the stress cycle and keep trying
  • Be careful of accidents – concentration and judgement may be impaired under stress
  • Try to be organised and efficient so you have some time to yourself.

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.