Crisis Intervention in Response to Disasters

1. Crisis Intervention in Response to Disasters The Right Communication at the Right Time can Make all the Difference

2. Understand Physiological and Psychological Responses to Traumatic Incidents (TI) • Understand how Large Group Communications can Reduce Chaos, Enhance Credibility, and Engender Cohesion • Understand how Small Group Debriefings can Mitigate Stress, Facilitate Normalization, and set appropriate expectations for Recovery Session Objectives

3. Section 1Psycho/Physiological Responses to Traumatic Incidents (TI) What the Body and Brain do and Why They do it

6. Different people have different reactions to the same incident • Reactions can be immediate, or delayed • Reactions can be intense, or almost non-existent • Reactions may last hours, weeks and, in some cases, years Common TI Reactions

7. 86% of persons involved in TI’s typically have transitory reactions • 33% will be expected to have moderate to severe reactions • Up to 5% of persons will have long-term disruptive reactions Common TI Reactions

8. Immediate Reactions • Short- Term Reactions • Delayed Reactions • Long-Term Reactions Stages Of Reactions

9. Almost always Automatic and are Beyond our Control Immediate Reactions

10. Shock/disbelief that this is happening • Distortions of time, space and speed Immediate Reactions

13. Shock/disbelief that this is happening • Distortions of time, space and speed • Tunnel vision • Detachment: As if viewing the incident from the outside • Adrenaline rush; Heightened sensory awareness • Memory gaps and distortions • Nausea or vomiting • Crying and despair • Denial Immediate Reactions

14. May last from several days to many weeks. Typical categories of reactions: • Hyper arousal • Re-experiencing • Avoidance Short-Term Reactions

15. Strong emotions such as depression and impotent rage may persist • Individuals may experience anxiety, nightmares and sleep disturbance • Individuals may become withdrawn • Individuals may still experience some of the Immediate Reactions listed earlier Short-Term Reactions

16. Immediate Reactions • Short- Term Reactions • Delayed Reactions • Long-Term Reactions Are Strong Indicators of Potential Difficulties and a Referral is STRONGLY RECOMMENDED! Stages Of Reactions

17. The body channels resources for strength and speed BRAIN: Sense of pain is dulled. Thinking & memory improve. EYES: Pupils dilate for better vision. LUNGS: More oxygen is taken in. LIVER: Sugar stored as glycogen is converted to glucose. Immediate Physiological Response HAIR: Hairs stand to look puffed up – bigger & stronger. continued

18. The body channels resources for strength and speed HEART: Bloodstream brings extra oxygen & glucose (fuel for power). Heart rate & BP rise. ADRENAL GLANDS: Medulla secretes fight-or-flight hormone epinephrine (adrenaline). INTESTINES: Digestion halts, allowing energy to be directed to muscles. Immediate Physiological Response SPLEEN: Extra red blood cells flow giving increased oxygen to muscles.

19. The body changes to stabilize shortly after fight-or-flight BRAIN: Hippocampus (memory and learning) activated. IMMUNE SYSTEM: Infection fighting lessens, increasing available energy. LIVER: Fat (stored energy) is converted into usable fuel. Delayed Physiological Response ADRENAL GLANDS: Cortex secretes cortisol (regulates metabolism & immunity. But toxic over time).

20. Frequent stress response may harm the immune system, brain, & heart BRAIN: Cortisol becomes toxic to brain cells, damaging cognition. Fatigue, anger and depression increase. IMMUNE SYSTEM: Repeated suppression of disease-fighting cells ultimately weakens resistance to infection INTESTINES: Decreases in blood flow leave mucous lining vulnerable to ulcers. Chronic Physiological Response CIRCULATORY SYSTEM: Elevated BP & heart rate Damage elasticity of blood vessels

21. Traumatic Incidents are Toxic

22. A calm reassuring approach is an antidote for anxiety • Structure is an antidote for chaos • Thinking is an antidote for dysfunctional emotions • Catharsis is an antidote for psychological tension and frustration • Information is an antidote for loss of control • Acceptance and social support are antidotes for alienation • Action is an antidote for helplessness Most Toxins Have an Antidote

23. Assimilation Five Early-Intervention Principles

24. Reduces biological aspects of traumatic stress reactions • Positively affects thoughts that inhibit recovery 1 - Promote Sense of Safety

25. Reduces anxiety, high arousal, numbing, or strong emotions • Supports better: • Sleep • Eating • Decision-making • Performance of life tasks • May reduce the probability of long-term psychological difficulties 2 - Promote Calming

26. Encourages affected individuals to play an active role in their own recovery • Increases peoples’ beliefs about their capability • Increases self-control of thoughts, emotions, and behavior 3 - Promote Self-Efficacy

27. Related to better emotional well-being and recovery • Provides opportunities for: • Information about resources • Practical problem-solving • Emotional understanding • Sharing of experiences • Normalization of reactions and experiences • Sharing ways of coping 4 - Promote Connectedness

28. Favorable outcomes are associated with: • Optimism • Positive expectations • A feeling of confidence in life and self • Strong faith-based beliefs 5 - Instill Hope

29. Section 2Large Group Communications Reduce Chaos and Enhance Credibility

30. Usually, a one-time, large–group information process for emergency services, military, or other operations staff who have been exposed to a significant traumatic event such as a disaster or terrorist event. Demobilization

31. Immediately after a unit completes its first shift (on-going events) or assignment (termination of emergency response) at disaster site, and…. • Before that unit is released to go home or assigned to non-disaster duties. When to Conduct a Demobilization

32. Provide practical information (presentation in structured demobilization with handouts) • Provide a rest break after disaster work and before returning to home or non-disaster related duties • Opportunity for assessment of personnel to see who might need additional support Main Function of a Demobilization

33. A ten minute informational session on operation, as well as information on stress and stress management • A twenty minute rest period with food and fluids • A very brief period of instruction from unit leaders on either a return to non-disaster duties or release to home • THIS IS A PASSIVE PROCESS; no participant has to speak Parts of the Demobilization

34. Structured large group community / organizational “town meetings” designed to provide information about the incident, control rumors, educate about symptoms of distress, inform about basic stress management, and identify resources available for continued support, if desired. May be especially useful in response to community violence / terrorism. Crisis Management Briefings

35. May be utilized with a traumatic event of any size that impacts a large number of people • Applicable to school, business, church, industrial, organizational and community based populations • Has military and emergency services application as well Crisis Management Briefings

36. NOT a press conference • NOT psychotherapy • NOT a CISD • NOT a substitute for psychotherapy • NOT a focus group • NOT a solution for ongoing problems in organizations and communities Crisis Management Briefing is

37. 45 - 75 minutes Depending on the circumstances and the needs of the large group Average Time To Provide A CMB

38. Provide information • Provide a sense of leadership • Reduce sense of chaos • Enhance credibility • Rumor control CMB Goals

39. Provide coping resources • Engender cohesion, morale • Re - establish a sense of community CMB Goals

40. ASSEMBLE groups • Credible representative of the community or specific organization presents FACTS of the situation • Team member reviews psychological impact of event and TYPICAL SYMPTOMS • Suggestions are provided for coping and STRESS MANAGEMENT, and RESOURCES for follow-up are reviewed • Opportunity for questions and answers Phases of the CMB

41. Identify group needs • Let the group know that more information and other resources will be offered as they become available • Offer understanding, sympathy, concern and hope • Let the group know that other CMB sessions or other types of interventions will be made available as the situation evolves Wrapping up the CMB

42. Never allow a CMB to degenerate into name calling, accusations, and/or a general forum for organization or leadership bashing. Caution:

43. Section 3Small Group Debriefings Mitigate Negative Effects of Stress and Enhance Normalization

44. A structured crisis intervention process led by a trained/certified debriefer(s) • A CISD is not… • Psychotherapy or counseling • Treatment for PTSD • A critique or investigation of the traumatic event • Part of any problem-solving process for administrative problems Critical Incident Stress Debriefing

45. Usually conducted 1-10 days post event or 3-4 weeks post disaster • Typically lasts 1-2 hours • The room should be private, comfortably accommodate the participants, and, when possible, not in close proximity to the location of the traumatic event • Notes are not allowed and participants are urged not to discuss what was said outside of the meeting • Participants may speak as much or as little as they desire Critical Incident Stress Debriefing

46. Encourages participants to discuss the facts of the incident. • Invites description of thoughts, reactions and feelings about the event. • Educates about crisis reactions and adaptive coping skills. Role of the Facilitator

47. Introduce the Purpose and Proceedings of the CISD • Describe the Incident Debriefing Stages

49. Introduce the Purpose and Proceedings of the CISD • Describe the Incident • Focus on Thoughts and Feelings • Psycho-education on Post-Critical Incident Reactions & Coping • Wrap Up Debriefing Stages

50. Emotional Trauma is likehaving the Flu