The Human Dimension: Identifying and Treating Disaster-Related Stress

After a disaster, emergency managers – along with other federal, state, tribal, and local leaders – begin rebuilding the communities struck, whether by natural or human-induced incidents. The recovery process calls out for the best of leadership and partnership in the region. Debris removal, the re-opening of schools and businesses, and routine recovery work all begin as soon as possible.

At the same time, experience has taught responders that stress caused by loss and/or traumatic experiences can catch people off guard and create intense feelings of fear, shock, anger, helplessness, and hopelessness. Disasters affect human lives like no other phenomena. For those affected directly, disasters generate a sense of anxiety that can destroy an individual’s peace of mind. Frequently, such anxiety is not recognized for weeks or even months. It is therefore important that the individual’s family and friends are sensitive to this danger and take remedial action, if possible. It is normal to feel great angst after a disaster. The difference is that help may be needed if the reaction is not only sustained but also dangerously deep and debilitating.

Among the numerous and best known indications of stress are difficulties in communicating, sleeping, maintaining regular activities and/or work routines, a lack of concentration, the use of drugs and/or alcohol, the fear of leaving home, the presence of crowds, and the onslaught of such physical and emotional symptoms as mood swings, crying, stomach pains, guilt feelings, headaches, depression and confusion, colds, and even the loss of hearing. The willingness to accept help from others is a healthy sign, and should be emphasized over and over. Planning to deal with these and other symptoms is important both for the individual and for the community, state, and nation to which he or she belongs.

FEMA Grants, Crisis Counseling, and a Grim Reminder

For the last fifteen years or so, the Federal Emergency Management Agency (FEMA) has been increasingly generous in providing grants for crisis counseling services, usually provided by counselors available through FEMA and/or state disaster centers.

The 1995 Oklahoma City Bombing saw the first widespread use of the crisis counseling available from FEMA and proved to be significantly helpful to responders and rescuers as well as to disaster survivors and the families of those killed or seriously injured by the bombing. Regrettably, one Oklahoma City police officer – who did not accept counseling – later suffered immensely and eventually committed suicide. His death served as a grim reminder to all emergency managers to be keenly aware that even highly trained and physically fit professionals see sights, and experience feelings, during a major disaster that are so removed from the everyday norm of human experience that they may need special care – even when they themselves may not recognize how seriously they have been affected, both mentally and emotionally.

The emergency responders and managers who worked at the Pentagon crash site on 11 September 2001 and the days following had never before seen anything like the massive damage and the number of casualties they were dealing with – all of which was magnified exponentially because of the intent behind the devastation. Fortunately, Arlington County (Va.) emergency responders had been well rehearsed to cope with both the stress and the emotional toll caused by that horrific event. In the more than seven years that have passed since that new “date that will live in infamy” the county has continued to refine its Critical Incident Stress Management (CISM) program, and all members of the county’s fire department now go through a comprehensive training program, augmented by numerous drills and exercises designed to help them cope in the future with similar incidents of such magnitude. Having such a program in place well beforehand makes a major difference when an incident occurs, and the aftermath of the terrorist attack on the Pentagon provided a vivid real-life example of how the system should work.

Trust and Respect: The Arlington Example

The partnerships that firefighters, and their fellow professionals in other responder communities, build among themselves as they face a common danger are a key component of their professionalism – along with a high level of trust and respect, of course, neither of which can be built during a disaster or on the fly. Current Arlington Fire Chief Jim Schwartz, as well as former Chief Ed Plaugher, are and have been leaders in building ways to cope with disaster-related stress among responders.

Following are some, but by no means all, of the more significant steps that both FEMA and SAMHSA – the Substance Abuse and Mental Health Services Administration – recommend to help both individuals and groups cope with the stress caused by sudden disasters:

• Talking to someone else about the deep feelings of anger or sorrow usually experienced;
• Seeking help from professional counselors experienced in post-disaster treatment;
• Resisting the temptation to hold themselves personally responsible for the emergency or disaster;
• Promoting physical and emotional healing by healthy eating, resting, and exercising;
• Maintaining as normal a routine as possible;
• Spending as much time as possible with family and friends, having fun;
• Joining and participating in support groups; and
• Spending additional time working to prepare for future disasters (taking such positive action is often therapeutic).

There is an abundance of additional information on the internet related to dealing with trauma, disaster-related stress, and mental-health problems. One such “best practice” example is a site called RESPONSE, which provides a long list of resources available from various other sites and organizations – including references to national organizations, as well as to local resources with helpful information specific to numerous types of incidents. One excellent resource is the New River Valley, Virginia, website http://www.nrvcs.org/response/default.html, which was designed to be a one-stop shop for information and is regularly updated. Another best-practice website is one created by Virginia Tech (https://web.archive.org/web/20160729095653/http://www.recovery.vt.edu:80/), which includes a section specifically devoted to: (a) the counseling resources available to Virginia Tech students; (b) the counseling resources available to the university’s staff and faculty; (c) the university’s Campus and Workplace Violence Prevention Policy; (d) Responding to Disruptive or Threatening Student Behavior: A Guide for Faculty (PDF); and (e) Identifying and Referring the Distressed Student: a Faculty/Staff Guide.

Interestingly, specially trained dogs are now frequently being used to provide emotional therapy for rescuers as well as for victims and survivors. There is a robust organization and effort in the Commonwealth of Virginia, for example, as well as in many other states and commonwealths throughout the nation. Since 1980, when Therapy Dogs International was founded, the use of dogs to help humans cope with stressful situations has broadened significantly, and now provides therapy for disaster rescuers, victims, and survivors.

In short, the handling of disaster-related stress requires long-term planning, an ongoing training program, robust collaboration, joint exercises, and trusting partnerships at all levels of the emergency-management community, including offices and agencies in the public, private, and nonprofit sectors.