Lamorinda Community Emergency Response Team Unit 7 - Psychology 01/03/2018 Lamorinda Community Emergency Response Team I’m Bruce Macler, your instructor I’m a public health toxicologist and risk communicator for USEPA, as well as the coordinator for its Water Emergency Team. A substantial part of my job involves working with upset people. However, I am not a psychologist or medical professional. Several of you are professionals. I would appreciate your participation and thoughts as they come to you. Unit 7: Disaster Psychology Released: 3 January 2018 Lamorinda CERT

Community Emergency Response Team Unit 7 - Psychology 01/03/2018 Community Emergency Response Team Personal health and safety is ALWAYS the number one priority Work as a team Wear personal protective equipment: gloves, helmet, goggles, N95 mask, and boots Take care of yourself while you are helping others The CERT goal is to do the Greatest Good for the Greatest Number Hope for the best but plan for the worst Personal health includes your emotional health as well People can get careless when upset Visual 7.1 Lamorinda CERT

Unit 7 - Psychology 01/03/2018 Disaster Psychology Many responders find their experiences exhilarating, meaningful and life- enhancing But for some, and for many victims, their experiences are stressful, traumatic or difficult, and may have long-term adverse consequences Who has been involved in an emergency or disaster response? Any thought to share with the group? We will cover these with a discussion of disaster trauma, stress and their effects, Elements of team and personal well-being, And a few “psychological 1st aid” ideas for supporting those that are having difficulties Visual 7.2 Lamorinda CERT

As a responder, you may face difficult or unpleasant situations Unit 7 - Psychology 01/03/2018 Disaster Psychology As a responder, you may face difficult or unpleasant situations During initial response During long-term recovery work You may be able to offer psychological first aid Not psychotherapy You also need to care for yourself Visual 7.3 Lamorinda CERT

Unit 7 - Psychology 01/03/2018 Unit Objectives Describe the disaster and post-disaster emotional environment for victims and emergency response volunteers Describe the steps that responders can take to provide psychological support to victim and to relieve their own stress We will cover these with a discussion of disaster trauma and effects, Elements of team and personal well-being, And a few ideas for supporting those that are having difficulties Visual 7.4 Lamorinda CERT

Psychological First Aid Unit 7 - Psychology 01/03/2018 Psychological First Aid Unit will cover Disaster trauma and effects Responder stress Elements of team and personal well- being Ways to support those having difficulties We will cover these with a discussion of disaster trauma and effects, Elements of team and personal well-being, And a few ideas for supporting those that are having difficulties Visual 7.5 Lamorinda CERT

The Nature of Disasters and Emergencies Unit 7 - Psychology 01/03/2018 The Nature of Disasters and Emergencies Can be completely disruptive of normal life Unexpected Lots of unusual things happening Lots of unknowns Events unfold unpredictably Often, limited specific preparation We will cover these with a discussion of disaster trauma and effects, Elements of team and personal well-being, And a few ideas for supporting those that are having difficulties Visual 7.6 Lamorinda CERT

Phases of a Crisis Impact phase Inventory phase Rescue phase Recovery Unit 7 - Psychology 01/03/2018 Phases of a Crisis Impact phase Survivors may not panic or show emotion, may be stunned Inventory phase Survivors assess damage They locate other survivors Rescue phase Survivors tend to cooperate with rescuers Recovery Survivors may show hostility toward rescuers In crisis or fear, survival behaviors dominate. May be inappropriate or odd, or may be very deliberate and useful. During 9/11, some folks ran away from the World Trade Center. Others ran towards it to help. As crisis or fear subsides, often get anger, hostility, resentment Some folks fall apart farther into the event. Visual 7.7 Lamorinda CERT

Responses to Risky Situations Unit 7 - Psychology 01/03/2018 Responses to Risky Situations People have different reactions to risky situations Fight versus flight Some don’t find it so dangerous Some are scared or panicked If it’s bad enough, nearly everyone is afraid Unpredictable Dire Catastrophic Unknown Visual 7.8 Lamorinda CERT

A Disaster Can Be Overwhelming Unit 7 - Psychology 01/03/2018 A Disaster Can Be Overwhelming Not necessarily trauma from awful situations Most CERTs will never experience these But the stress from being a responder can be significant When the “queso grande” event hits, you may be able to give aid for awhile Visual 7.9 Lamorinda CERT

What is Psychological Trauma? Unit 7 - Psychology 01/03/2018 What is Psychological Trauma? A response to a direct, personal experience of an event happening to you or someone else Actual or potential death Serious injury Actual or threatened violence Destruction of homes, neighborhood, or valued possessions Loss of contact with family or close relationships Trauma is different from stress Trauma involves shock from unexpected and unusual events and scenes Visual 7.10 Lamorinda CERT

Rescuer Psychological Trauma Unit 7 - Psychology 01/03/2018 Rescuer Psychological Trauma You can experience psychological trauma through Your own personal losses Working in your neighborhood Assisting neighbors, friends, or co-workers who have been hurt Not feeling safe and secure Take it personally…for your own sake, and for the sake of your CERT buddies and those you want to help Visual 7.11 Lamorinda CERT

Effects of Psychological Trauma Unit 7 - Psychology 01/03/2018 Effects of Psychological Trauma Psychological trauma may affect: Cognitive functioning – thinking, behavior Physical health Interpersonal relationships These effects may be immediate, gradual, or even much later. Visual 7.12 Lamorinda CERT

Possible Psychological Symptoms Unit 7 - Psychology 01/03/2018 Possible Psychological Symptoms Irritability, anger Self-blame, blaming others Isolation, withdrawal Fear of recurrence Feeling stunned, numb, or overwhelmed Feeling helpless Mood swings Sadness, depression, grief Denial You may wish it wasn’t so, but it is, and there isn’t much you can do about it… It hurts. That’s how it is. Visual 7.13 Lamorinda CERT

Possible Physiological Symptoms Unit 7 - Psychology 01/03/2018 Possible Physiological Symptoms Fatigue, low energy Loss of appetite Headaches, chest pains, weirdness Diarrhea, stomach pain, nausea Hyperactivity Increase in alcohol or drug consumption Chronic insomnia: inability to sleep, or broken sleep It hurts… Visual 7.14 Lamorinda CERT

Post-Traumatic Stress Visual 7.15 Lamorinda CERT

Stress and Anxiety from Disasters Unit 7 - Psychology 01/03/2018 Stress and Anxiety from Disasters Psychological trauma is often the result of overwhelming stress from events Less stressful situations can still be troublesome Disaster recovery may be extended Uncertainties can persist Long return to normal Visual 7.16 Lamorinda CERT

Prior experience with a similar event Intensity of disruption Unit 7 - Psychology 01/03/2018 Mediating Factors Prior experience with a similar event Intensity of disruption Individual feelings about event Emotional strength of individual Length of time since event Pre-event training and preparation Each of these can make things better Or can make things worse Visual 7.17 Lamorinda CERT

Unit 7 - Psychology 01/03/2018 The Road to Recovery Those survivors who could find something good that came out of the experience soon after it happened – "I realized how much I loved my family“ "I decided that life was too short not to follow my dreams" – had made a better recovery at the time of the follow-up interview Is the glass half-empty or half-full? Your view of life may make all the difference. “Wow, how lucky am I? I thought I was going to die, and now I’m standing on the wing of an airplane in the East River! Hi Mom!” Visual 7.18 Lamorinda CERT

Psychological 1st Aid: Taking Care of a Victim Unit 7 - Psychology 01/03/2018 Psychological 1st Aid: Taking Care of a Victim What is happening here? You would not be expected to provide detailed care- most of you are not medical or psychology professionals A touching hand may be the best that you can do Treat others the way you might want to be treated And for guys– don’t try to solve their problems… Visual 7.19 Lamorinda CERT

Unit 7 - Psychology 01/03/2018 Psychological Triage As part of triage, assess survivors for emotional state, as well as for injury and shock Red tarp Violent, suicidal, comatose Yellow tarp Traumatized, sad, anxious Green tarp At a loss, stunned Triage can include those in psychological shock. They can sit on the green tarp. For many people, giving them something useful to do helps their own anxieties. Red: professional help needed Yellow: suffering and too self-absorbed to function Green: Upset, need direction Visual 7.20 Lamorinda CERT

Psychological 1st Aid: Stabilizing a Victim Unit 7 - Psychology 01/03/2018 Psychological 1st Aid: Stabilizing a Victim Green tarp Get uninjured people involved in helping Yellow tarp Provide emotional support by Listening Empathizing Help survivors connect with their natural support systems Triage can include those in psychological shock. They can sit on the green tarp. For many people, giving them something useful to do helps their own anxieties Visual 7.21 Lamorinda CERT

How to Be an Empathetic Listener Unit 7 - Psychology 01/03/2018 How to Be an Empathetic Listener Recognize “mental noise” People who are upset have difficulty hearing and processing information Mental noise can reduce ability to process information by as much as 80% Avoid the negative People who are upset tend to think negatively Repetition of a negative reinforces this Avoid using negatives, such as NO, NOT, CAN’T, DON’T, NEVER, NOTHING, NONE Don’t expect folks to be rational or “with it.” They may be too distraught to be coherent or paying attention. Just be there and be patient. Visual 7.22 Lamorinda CERT

How to Be an Empathetic Listener Unit 7 - Psychology 01/03/2018 How to Be an Empathetic Listener Put yourself in the speaker’s shoes Listen for meaning, not just words Pay attention to nonverbal communication Paraphrase the speaker in their own words to show that you heard him / her Practice compassion Know when to back off. Some folks may not want to talk You might consider asking “how can I help?” especially if you are willing to deliver. Gauge the speaker’s interest and willingness to talk to you. Don’t be aggressive, but do give them the opportunity. Visual 7.23 Lamorinda CERT

Avoid Saying … “I understand” “Don’t feel bad.” Unit 7 - Psychology 01/03/2018 Avoid Saying … “I understand” “Don’t feel bad.” “You’re strong, you’ll get through this” “Don’t cry” “It’s God’s will” “It could be worse” or “At least you still have...” “What you really must do...” These phrases discount the person’s feelings Visual 7.24 Lamorinda CERT

Can Say … “These are normal reactions to a disaster.” Unit 7 - Psychology 01/03/2018 Can Say … “These are normal reactions to a disaster.” “It’s understandable you could feel this way.” “As you connect with others who have been through this, you’ll find that they may have experienced the same things you are feeling.” “You can’t change what happened, but you can change what you do with this experience.” “Things may never be the same, but you may find some things from this experience that can help you help others.” Be careful and thoughtful with what you might say. Visual 7.25 Lamorinda CERT

Managing a Death Scene Move the body to temporary morgue Unit 7 - Psychology 01/03/2018 Managing a Death Scene Move the body to temporary morgue Cover the body; treat it with respect Have one family member look at the body and decide if the rest of the family should see it Allow family members to hold or spend time with the deceased Let the family grieve It is unlikely that you as a CERT volunteer would have to take charge of a death scene and address moving the body and informing the relatives Normally, a dead body should be covered and left for law enforcement and the coroner. However, a victim in your triage or medical area may die, or was brought in dead. Visual 7.26 Lamorinda CERT

Informing Family of a Death Separate the family members from others into a quiet, private place Have them sit down, if possible Make eye contact and use a calm, kind voice Use the following words to tell the family members about the death: “I’m sorry, but your family member has died. I am so sorry.” Visual 7.27 Lamorinda CERT

Taking Care of Your Team Unit 7 - Psychology 01/03/2018 Taking Care of Your Team CERT volunteers will experience a variety of feelings and emotions during their service These may be good- you are making a positive difference They may be bad- it’s not as pleasant as your drills They could be horrible- there could be some shocking, upsetting or otherwise depressing events and situations to face Preparation and self-care are important Visual 7.28 Lamorinda CERT

Emergency Response Realities Unit 7 - Psychology 01/03/2018 Emergency Response Realities You are not likely to be posted to tasks that would offer traumatic situations. More likely, you would be at an EOC or doing support field tasks. Never-the-less... Duty shifts are typically 12 on/ 12 off. That is usually 13 on/ 11 off when shift changes are counted. 14 on/ 10 off by the time you get to bed... Night shifts can be hard Mundane emergency response tasks are important, too. But life during ER is seldom normal After awhile, it gets to folks… EPA posts folks two weeks maximum before rotation Visual 7.29 Lamorinda CERT

Emergency Response Realities Unit 7 - Psychology 01/03/2018 Emergency Response Realities Usually, little slack time during duty. Go, go, go... Food may be sketchy Sleeping facilities may be unusual Field work may be hot, cold, rainy, or just miserable Hot showers? Peace and quiet? Dream on... Mundane emergency response tasks are important, too. But life during ER is seldom normal After awhile, it gets to folks… EPA posts folks two weeks maximum before rotation Visual 7.30 Lamorinda CERT

Leadership Support for Volunteer Well-being CERT team leaders or response staff should: Brief personnel before assignment Personal preparations and supplies Expected situation Insist that all group leaders pay attention to volunteer emotional status Provide for proper nutrition and rest Rotate team members and duties Have an “escape plan” for demobilizing stressed-out volunteers Conduct a hot wash at end of event to discuss issues Visual 7.31 Lamorinda CERT

Unit 7 - Psychology 01/03/2018 Take Care of Yourself Prepare for extended time away and under uncomfortable conditions Try to address home/ work issues first Bring personal supplies For sleeping For comfort Clothes Food Phone/ charger Keep that go-bag ready… Visual 7.32 Lamorinda CERT

Unit 7 - Psychology 01/03/2018 Take Care of Yourself Be aware that trauma / stress can result from disaster work Explain to family members and friends how they can support you Listen to you when you need to talk Understand that you may not want to talk Allow yourself to receive, as well as give Connect with others Use spiritual resources Some folks just get cranky when tired. Visual 7.33 Lamorinda CERT

Returning to Normal For most responders, it all goes away post- deployment A normal routine helps Can make for good stories, team building and camaraderie later on For some, the experience may leave bad memories If these are problems, consider professional help Visual 7.34 Lamorinda CERT

Unit Summary Disaster situations can be traumatic and stressful Help survivors as best you can Remember what you can and cannot say Manage a death scene with care and compassion Take care of your team Take care of yourself Visual 7.35 Lamorinda CERT