Mass Casualty Disaster and the Mental Health of Personnel Involved in the Aftermath
Disasters are stated, defined or classified into: physical agents such as earthquake floods, fires, and explosions, physical impact on some environment such as land and water movement in earthquake, assessment of physical impacts, social disruption, social constructions of reality, Imbalance between demand and capability in crisis, and lastly, political definitions which are official disaster declarations that affect subsequent actions and assistance (Wee, 2004).
According to the Federal Response plan, which spells out the federal role in disaster, it will operate in the following assumptions, assumptions such as, a severe emergency will result to many injuries and fatalities, loss of property, and distraction of life’s normal systems of support, and will have an blow on the regional physical, economic, and social infrastructures; the casualties’ degree of damage will result to aspects which includes impact’s severity, time incidence, conditions of the weather, construction of the building, density of the population, and the probable activating of events such as flood and fire; heavy destruction to vital infrastructure and building, the high count of fatalities, and the disturbance of important ‘public-services’ will devastate the capacity of the its local and state government to suffice the situation’s need, ‘Federal agencies’ will be required to action on notice to give effective and timely assistance; and lastly, the federal involvement’s degree will be associated to the magnitude and severity of event as well as the local and state need for supports, and the most devastating disasters may require the full range of federal response and recovery assistance while less damaging disasters may require only partial federal response and recovery assistance.
Overview: Mass Casualty Management
‘Medical treatments’ of high counts of fatality is required only after specific type of disasters, and also most wound are obtained during impact, and, thus, the utmost need for emergency concern come about in the 1st few hours, and numerous lives are lost due to local resources haven’t been used quickly (PAN…, 2000). The load of delivering transportation, medical-care, first-aid, and supply drops on the country affected. Assistance from the int’l community is improbable to make difference on saving lives in the period of greatest necessitate, because of the ‘response-time’ needed. According to the PAN American Health Organization, in the ‘classic care approach’ utilized commonly in dealing with a high number of victims after the tragedy, first rescuers are taught to give victims with ‘basic triage’ and ‘field care’ before transferring them to the nearby available receiving ‘health care station’.
After great disaster, the necessity for rescue & search, and first-aid is great that ‘organized-relief-services’ wont able to meet the required, and also most urgent help come from survivors who are uninjured, and they will have to give whatsoever help possible (PAN…, 2000). Improvement in the quality and availability of immediate first aid services depends on increased training and preparation obtained through specialized agencies, for example, through courses taught to volunteers by fire brigades.
Normally, transport of wounded to the hospital must be ‘staggered’, and patients should have sufficient field treatment, making them to stand delay, however in actual fact, most wounded persons will congregate suddenly on health facility’s if they are at a sensible distance, using whatsoever transport is accessible, despite of the person’s operating status (PAN…, 20001). According to the PAN American Health Organization, other victims may not ask medical care, which makes ‘active case finding’ an essential piece of any fatality relief effort. This is enough explanation for making ‘mobile health care teams’ to be positioned to the ‘disaster site’ in addition to preset ‘first-aid station’. Giving adequate treatment to fatalities require that ‘health-service resources’ be transferred in this new-priority.
When the quantity and severity of injuries overwhelms the operative capacity of health facilities, a different approach to medical treatment must be adopted (PAN…, 2000). Triage composed of classifying the wounded on the basis of their survival rate and the severity of their injuries (PAN…, 2000). Higher priority is granted to victims whose immediate or long term prognosis can be dramatically affected by simple intensive care, and moribund patients who require great deal of attention (with questionable benefit) have the lowest priority. Triage must be carried-out at the ‘disaster-site’ to know transportation-priority and hospital admission where the patient’s priority and need for medical-care will be assessed. People with moderate or minor injuries must be taken care of near their homes as long as possible to avoid additional exhaust on resources of transferring them to main facilities and to avoid social dislocation (PAN…, 2000). Ideas and General and SpecificTechniques Employed in an Effort to Provide Mental Health Intervention following a Mass Casualty Disaster
Much of early intervention is really simple education giving survivors information intended to help them recover. Brief educational efforts are relatively non-stigmatizing, low cost forms of care deliverable via public health media communication, informal conversations with a range of helpers, or structured formal presentations (Ritchie, 2007). Simple education is surely effective in informing survivors about sources of mental health counseling, and in sometimes affecting some change in targeted behaviors, such as reducing alcohol consumption or using formal counseling services (Ritchie, 2007). According to Ritchie, this may be particularly true when the required change is easily within the repertoire of the survivor, as in the seeking of counseling. When desired behaviors required more complex social performances (e. g., seeking social support), simple instruction may be less effective, similarly, when they involve possible increases in negative emotion (e. g. talking about the experience of the trauma) or other disincentives, education may have limited impact. It was found that an educational self-help manual was ineffective in reducing PSTD symptoms, possibly because of difficulties in inducing self-managed exposure to feared situations, but currently, much of our post trauma care involves simple survivor education, often via pamphlets, self help materials, and informal discussions between trauma survivors and helpers (Ritchie, 2007). Little is currently known about the impact of such efforts, or of the more formal didactic educational presentations common in many post-trauma-related information.
Education included in some early intervention attempts failed to prevent or reduce PSTD, although education has usually been delivered as part of control (comparison intervention (Ritchie, 2007). However it was demonstrated that simple education can produce some benefits for survivors. According to the International Society for Traumatic Stress Disorders it was concluded that “more complex interventions for those individuals at higher risk may be the best way to prevent the development of PSTD following trauma”. This conclusion agrees with current evidence and understanding of change of processes, and as noted, primary limitation of any brief educational approach is that a single episode of advice and group discussion will likely be limited in impact on the more complex actions important to recovery (Ritchie, 2007). However in moderate-intensity multisession interventions, key messages can be repeated; supportive relationships among members developed; skills instructed, practiced, and polished; recovery behaviors shaped and reinforced; myriad group helping processes extended in duration. According to Ritchie, multi contract interventions may enable applying some potentially powerful (and evidence consistent) helping methods: skills training, therapeutic repetitive exposure, and cognitive restructuring (cognitive therapy). Skills training technology (including skills instruction, practice, and coaching; demonstration of modeling of skills; self monitoring of key behaviors; and use of task assignments in the real world environment remains to be more effectively harnessed as a potential early intervention (Ritchie, 2007). According to Ritchie, teachable skills might include management, disclosure, social support seeking, support giving, and problem solving, and increased use of moderate intensity interventions may also help ensure that the survivor’s environment will facilitate recovery. Whereas many intervention approaches focus on intrapersonal processes and individual survivor behaviors/personnel, early intervention also needs to target a larger social environment, which can influence survivor/personnel behavior in various ways that negate or enhance the efforts of individual mental health providers (Ritchie, 2007). Also, according to Ritchie, interventions explicitly targeting social support processes require development, including efforts to build and maintain family support and to create support networks for those lacking it.
Early intervention services for personnel in mass casualty and survivors of mass trauma are increasingly available and, in many contexts, have become part of routine service provision. Current models have evolved to fit the survivor populations they serve and the contexts of care in which they operate, include many innovative elements, and target processes of change that generally match current theories and research evidence (Ritchie, 2007). As early interventions are increasingly based on systematic theory and subjected to empirical testing, surely some practices will be rejected, others maintained, and most modified to become more effective.
Education and Training of Disaster Mental Health Staff
Mental health professionals working in any field of trauma must have initial and ongoing specialized training. First, it is essential that graduates and professional schools of social work, psychiatry, psychology, and psychiatric nursing include coursework and supervised practice in the field of trauma assessment and treatment, and in addition, conferences, workshops, and other continuing education forums are necessary, both to maintain and update knowledge and skills, as well as to provide professional, college support (Wee, 2004). According to Wee, specialized training is essential, even for experienced trauma therapist, before working in the field of disaster mental health. Mental health professionals regularly presume that their experience clinical training is more than enough to allow them to adequately act during disaster; but unluckily, conventional ‘mental health training’ doesn’t tackle many issues seen in disaster-affected-populations. While ‘clinical-expertise’, particularly in the field of crisis-intervention is important, it is not sufficient, mental health personnel require to adopt latest techniques and in delivering highly focused disaster service (Wee, 2004). Training should be intended in preparing staff in the individuality of ‘disaster-mental-health-approaches’. Ideally, graduate and professional programs that train mental health professionals should include coursework specifically on disaster mental health.
Disaster Assignment Orientation
Before reporting for disaster orientation, every worker being assigned to disaster-impacted areas should have up-to-date immunizations for hepatitis and diphtheria/tetanus, and in addition to that, during the flu season in winter months (November to April), immunizations for influenza should be considered for all disaster workers because of the degree of public exposure they experience (Wee, 2004). According to Wee, for international disaster assignments, recommended immunizations for the country to be visited should be up-to-date. Staying healthy and energetic on the job will certainly help to minimize fatigue and burnout. Before deployment to the disaster assignment, personnel should be oriented and briefed as thoroughly as possible about what they will encounter in their disaster assignment location and role (Wee, 2004). This forewarning can help personnel to anticipate and to prepare emotionally for what they may experience in their assignment, and it also provides them with concrete information that will be essential to them in their work and crucial to their well-being and safety.
Strategies against Compassion Fatigue during Disaster
The strategies that can be taken by mental health agency, by supervisors, and by the disaster mental health workers themselves to prevent compassion fatigue during the actual mental health assignment includes briefing of disaster mental health staff before deployment; supervision of staff; consultation; continuing education and training; psychotherapy; organizational support and workplace strategies; defusing and debriefing; working as a team; mental health professional strategies; and mental health worker personal strategies (Wee, 2004).
During the immediate post-impact phase of disaster, workers respond with enthusiasm and often heroism to the immediate needs of the situation. It is rule rather than the exception that mental health staff, like other disaster responders tend to over extend themselves in their effort (Wee, 2004). According to Wee, disaster workers are usually not the best judges of their level of functioning, and usually underestimate the effects of stress and fatigue on their health and performance, thus, goo on-scene supervision is helpful.
In addition to supervision and training, personal psychotherapy can be important to preventing compassion fatigue and intervening with STS in disaster mental health staff (Wee, 2004). It is said that trauma workers with personal histories of traumatization are likely require deliberate personal attention to their own healing process in order to manage effectively the difficult task of coping with their own STS reactions. It is also pointed out that, among other things, it provides a regular opportunity to focus on oneself, one’s own needs, and origins of one’s response to the work. Individual expressive therapy such as music, art, or movement can help therapist to become and retain centered and to reclaim their emotional lives in the chaotic post disaster environment (Wee, 2004). According to Wee, group therapy and support groups can also be of help to disaster mental health workers, providing a safe space for healing and for exploring the interaction of therapist’s past with his or her current work with survivor clients. Also, group therapy and support groups for disaster mental health workers are particularly effective in dealing with the unique aspects of disaster work, which other trauma therapist have mot encountered and may have a hard time understanding.
Organizational Support and Workplace Strategies
The importance of creating an atmosphere of respect for both clients and employees is emphasized. This essential in the early phases of disaster, where mental health staff may be working with survivors in chaotic, field-based situations, as well as long-term recovery work, where staff may work with clients in both field and office setting (Wee, 2004). Respect and organizational support is conveyed to staff by providing assistance with concrete disaster needs; adequate briefing of workers; work related supplies; well designed procedures for management of telephone calls; official identification; paperwork; communication; food and housing on disaster assignment; transportation; policies regarding maximum duration of shifts (no longer than 12 hr maximum) and frequency of breaks (every 2 to four hour); excellent supervision, training, support, consultation, and recognition of staff efforts.
Critical Incident Stress Management
Critical incident stress management is an integrated, comprehensive multi component crisis intervention system which is designed to support personnel through traumatic events that have been potential to disrupt coping, disrupt homeostasis, and produce distress of functional impairment (Wee, 2004).
Building a team approach to disaster mental health work can provide both active intervention and prevention. Social support is a known source of significant psychological benefit for trauma survivors but a strong team approach can provide the same social support for trauma mental health professionals. Stress management training materials for disaster workers have long emphasized the importance of working in a “buddy system’ in disaster, using teams of at least two workers to ensure the staff can serve a check-and-balance for each other and monitor each other’s stress level while providing support and encouragement.
Disaster mental health workers need to have balance in both the quantity and quality of task in their work life, paying close attention to the proportion of their work that involves direct trauma treatment, and balancing it with other professional responsibilities (Wee, 2004). Finding a satisfactory and healthy balance between professional and personal life is important, and setting time boundaries, professional boundaries, and personal boundaries are essential. Studies continuously find that many mental health staff hold the irrational belief that’s they must operate at peak efficiency and competence at all times with all people which can be a key contributing factor for STS in disaster mental health workers.
Personal Strategies of Mental Health Worker
Personal strategies include lifestyle choices such as healthy diet, exercise and a balance between play, work, and rest, and also, creative expression, spiritual replenishment and meditation, humor and self awareness. Other informal strategies such as maintaining strong personal support networks of family and friends, limiting trauma exposure and media coverage of the disaster outside work hours, developing diverse interests, and seeking positive experiences outside of work can be helpful. Other activities that contribute to disaster mental health worker self-care and health promotion include being willing to talk about events and feelings; practicing yoga and meditation; deep breathing practicing and other relaxation-techniques; prayer; using self talk and positive self-encouragement; maintaining meaningful practices and rituals; reading; keeping a journal; creative pursuits such as writing and art; music; dancing; getting a massage; taking a warm bath or shower; attending theater movies; going out to dinner; spending time with children, family, & friends, pets, nature; traveling; and pursuing hobbies.
There is a certain amount of work to be done in ending what has been a long-term time-limited disaster mental health program. Staff should receive consultation and training and hold planning sessions about how they will end the program (Wee, 2004). According to Wee, whether staff was involved for short term or long term, they usually experience a mixture of emotions at the end of the end of the work: relief that it is over, and sadness and guilt at leaving it behind. In addition, there is often a sense of letdown and some difficulty in transitioning back into regular job and family responsibilities. Mental health personnel working in disaster can be helped to anticipate these mixed emotions through education and training about common reactions and coping strategies that can help with the changes (Wee, 2004).
Studies of emergency service workers, disaster workers, and disaster mental workers have identified stress reactions to the disaster work that can result in pattern of mental and physical distress (Wee, 2004). Traumatologists’ experiences of working with disasters and violence in the community sensitize them to the experiences, pain, challenges and success on the community on its road to recovery.
Englehardt, H. T., & Spicker, H. F. (1978). Mental Health: Philosophical Perspective. New York: Springer.
Keyes, D. C. (2004). Medical Response to Terrorism. New York: Lippincott Williams & Wilkins.
Pan American Health Organization. (2000). Natural Disasters: Protecting the Publics Health. New York: Pan American Health Org.
Ritchie, E. C., Watson, P. J. & Friedmann, M J. (2007). Interventions Following Mass Violence and Disasters. New York: Transactions Publishers.
Wee, D. F. (2004). Disaster Mental Health Services: A Premier for Practitioners. New York: Psychology Press.