1. Operations in Emergencies: Staff Care – Stress & Stress Management
Welcome to this introduction to staff care in emergencies.
The staff care presentations will give you an overview of challenges you and your staff may face in maintaining health and wellbeing during an emergency, along with guidance and best practices to help you address these challenges.
So, let’s begin…

2. Learning Objectives Part A: Part B:
Understanding the potential effects stress from humanitarian work may have on you & your colleagues
Managing stress on a personal level
Part B:
Adapting CP policies & procedures to support staff health & wellbeing
Staff care will be discussed in two separate presentations. In this first one, we’ll explore:
The potential effects stress from humanitarian work may have on you and your colleagues, some of which can be quite harmful.
We’ll then look at how to minimize these negative effects through stress management on a personal level.
The second staff care presentation will focus on how Country Programs may adapt policies & procedures at the organizational level, to support staff health and wellbeing during an emergency.

3. Emergency’s Effect on a Community
First, let’s look at the context you & your staff will be working in. Emergencies can be the result of many different kinds of events. Some are the result of natural disasters…. Where a storm, a flood or an earthquake devastates a community.
Typhoon Haiyan 2013
Image Credit: 
Jeff Schmaltz NASA Goddard/LANCE/EOSDIS MODIS Rapid Response

4. Emergency’s Effect on a Community
In this case, the actual event is limited – from a few minutes to a few days or weeks. It’s then over, and the community will start to deal with the impact. Typically, after an immediate negative reaction, a short honeymoon phase follows – when the community comes together and celebrates the victories – the little girl that survived the building collapse, & the heroism of the man who pulled a drowning victim out of the floodwaters.
The most difficult part comes after this, when the community realizes how much damage has been done and mourns their loss. This phase of working through grief may last quite a while – for major events, it will take years… and setbacks may occur along the way. But it’s generally a slow, upward recovery towards reconstruction and a new beginning.
Source: DTAC CCP training toolkit, Substance Abuse and Mental Health Services Administration (SAMHSA);

5. Emergency’s Effect on a Community
Other events like conflicts are more complicated. Instead of reaching a sustained recovery phase, communities may face on-going shocks and major setbacks…

6. Who are your Emergency Staff?
Current CP Staff
Volunteers
CRS TDYs
CRS Short Term Assignment
Consultants
New Recruits
The people involved in responding to an emergency will live in and work with these communities, which are under considerable strain.
Who are these people?
Usually, they will be a mix, with many different backgrounds… initially there will be current Country Program staff, along with local volunteers. They will be joined by CRS staff on temporary duty or short term assignments as well as external consultants. Eventually, you’ll probably be hiring new staff.
Some of these people will be from the areas that are being affected by the emergency, while others may be brand new to the country.

7. An Emergency’s Effect on your Staff
Some staff may be exposed to extreme deprivation, raw damage & loss of life; some may be experiencing personal loss of their belongings, of their home, or of loved ones.
Some staff may:
be exposed to extreme deprivation, raw damage & loss of life
experience personal loss of belongings, home, loved ones

8. An Emergency’s Effect on your Staff
And some staff may be far from home, away from friends & family; they may be learning & adjusting to a new location and new cultural norms
And some staff may:
be far from home, away from friends & family
be learning & adjusting to a new location and cultural norms

9. An Emergency’s Effect on your Staff
Many will be under pressure to provide urgent support while:
Working & living in difficult, volatile conditions
Often dealing with safety or security concerns, &
Having to make tough choices with limited information
Many will be under pressure to provide urgent support while:
working & living in difficult, volatile conditions
often dealing with safety or security concerns &
making tough choices with limited information

10. An Emergency’s Effect on your Staff
Staff will be at increased risk of suffering from traumatic stress
These are very unusual circumstances, and you and your emergency co-workers will be at increased risk of suffering from traumatic stress.

11. Types of Stress Acute or Critical Incident Chronic or Cumulative
Source: Headington Institute
Types of Stress
Acute or Critical Incident
sudden onset
from experiencing a tragic, frightening or dangerous event, or
from witnessing the suffering of others
Chronic or Cumulative
from chronic stressors, which trigger enduring stress reactions that can build up & grow in intensity
may become problematic over time & eventually lead to “burnout”
What do we mean by traumatic stress? Well, there are two types of stress…
Acute or Critical Incident Stress, which usually comes on suddenly after experiencing a tragic, frightening or dangerous event. You can also experience it indirectly, from seeing or hearing about the suffering of others.
And then there’s Chronic or Cumulative Stress, which comes from the slow build-up of stress over time. Chronic stressors trigger enduring stress reactions that can grow in intensity and become problematic. It can eventually lead to “burnout”
When suffering from either of these types of stress, a person’s physical, emotional and social well-being are negatively impacted in significant ways…

12. The Body’s Reaction to Stress
Source: Headington Institute
The Body’s Reaction to Stress
heart rate goes up; blood redirects to your brain & muscles
blood sugar levels go up for more energy
clotting agents in blood increase
sensitivity to pain decreases
brain is stimulated to make vivid memories
Your body usually returns to normal quickly after the threat is over, but…
Immediate
Threat
Prepare
to Act
If you have continued exposure to threats or
thoughts of frightening past events,
your body will stay in action mode …
There are very specific changes that occur in the body due to both short and long-term stress.
In the short term, when you experience a dangerous or traumatic event, a series of approximately 1,500 biochemical reactions are triggered within your body. These reactions are designed to help you handle a threat by preparing you to act -- either to fight, run away or freeze…
The adrenaline and other hormones that are released into your body will:
Increase your heart rate and redirect blood-flow towards the brain and muscles. This helps you think more rapidly and prepares your muscles for action
Blood sugar levels will go up, giving you more energy
Clotting agents in the blood will increase, and
inflammation and sensitivity to pain will decrease… these reactions will help you in case you’re injured or hurt.
The hormones also stimulate the part of the brain responsible for converting sensory experience into enduring memory – creating very vivid memories of the event.
Our bodies have a feedback system, which will help to bring our stress hormone levels back to normal once the crisis has passed, but if you are experiencing continued exposure to threats – or thoughts of frightening past events – your body will continue to stay in action mode…

13. The Body’s Reaction to Stress
Source: Headington Institute
The Body’s Reaction to Stress
Long-term, elevated stress reactions can result in:
High blood pressure
Higher risk for stroke, heart attack
Less effective natural pain relief
Weakened immune system, with higher vulnerability to infections
Stomach & digestive issues
Recurring acute and chronic stress responses take a toll on your physical and psychological health over time, if these biological responses do not return to normal baseline levels fairly rapidly.
Some of the effects of a long-term elevated stress responses include:
High blood pressure;
Higher risk for stroke and heart attack;
Less effective natural pain relief;
A weakened immune system, with higher vulnerability to infections; and
Stomach & digestive issues.

14. The Body’s Reaction to Stress
Via: Headington Institute
The Body’s Reaction to Stress
Stress causes changes in brain cells
This means:
your brain’s ability to create & consolidate new memories may be compromised,
you may be sent into “high-alert” more easily, &
you may be less able to turn off the flight or flight reaction when it’s not needed
The good news is these negative effects are potentially reversible
Hippocampus &
Prefrontal Cortex Amygdala
Control
Chronic Stress
Having elevated stress responses over the long term can also affect how your brain functions.
Cells in the memory center of the brain, called the hippocampus, can shrink. The hippocampus is also the shut-off valve for the brain’s fight or flight response; when it shrinks, it is less effective in shutting off the stress response when it is not needed.
At the same time, cells in your amygdala can grow. The amygdala helps us process emotions and is responsible for our automatic responses when we’re in a frightening situation.
This means that, over the long term:
the brain’s ability to lay down and consolidate new memories may be compromised,
it may take less and less to send you into high-alert, and
you may be less able to turn off the fight or flight reaction when it’s not needed.
This can cause the feeling of being chronically alert and jumpy after exposure to trauma.
The good news is that these negative effects, especially those related to the hippocampus, are potentially reversible.
Source: Bruce McEwen, Rockefeller University

15. Signs of Stress Impairment
Source: Headington Institute
Signs of Stress Impairment
Physical
Mental
Emotional
Spiritual
Behavioral
poor sleep, fatigue
changes in appetite
upset stomach
back, neck, headaches
tension
inability to relax
easily startled
poor concentration
forgetfulness
easily confused
difficulty making decisions
intrusive thoughts
nightmares or dreams
irritability
anger
anxiety
paranoia
depression or numbness
mood-swings
doubt
loss of meaning, purpose or hope
loss of connection
feeling discouraged or empty
cynicism
listlessness
risk-taking
over or under eating
increased smoking, alcohol and/or drug use
hyper- alertness
aggression
Stress at low does can be helpful to us – it motivates us to get things done!
But, acute or chronic stress can start to affect us negatively on many levels. We’ve already touched on a few of the physical & mental effects… in general on the physical side, you may experience difficulty sleeping and fatigue, as well as various physical ailments such as stomach issues, back or neck pain, or headaches. You may also be tense, unable to relax or easily startled.
On the mental side, you may start to experience poor concentration and forgetfulness. This can be associated with confusion and difficulty making decisions. You may also have thoughts or dreams that you cannot seem to stop.
Trauma and stress can also have emotional consequences. We all have basic psychological needs. These include the need to feel relatively safe, the need to trust and feel close to other people, and the need to feel that we have some control over our lives. These can be eroded by a trauma, and you may experience irritability or anger, anxiety, paranoia or depression. You may also experience rapid mood swings.
On a spiritual level, you may feel doubt about things you were once sure of. This can lead to a loss of meaning and purpose, hope or connection to others. This can leave you with a sense of emptiness and feelings of cynicism.
All of these many issues may manifest themselves in your behavior. Some people may become listless or withdrawn. Others might engage in risk-taking behavior or begin to self-medicate with things like food, alcohol or drugs. And some may begin to be hyper-alert or aggressive.

16. Risk Factors for Stress
Source: Headington Institute
Risk Factors for Stress
The nature and intensity of:
any traumatic events experienced in the past
the traumatic or stressful events triggering the current reactions
The number of stressors
The length of exposure to stressful situations
Organizational factors
Lack of social support
Pronounced introversion
Negativity and pessimism
History of previous psychiatric illness
There are several risk factors for experiencing stress reactions… these include external factors such as:
The nature and intensity of any traumatic events experienced in the past, as well as those triggering the current reactions
The number of stressors
The length of exposure to stressful situations
Organizational factors
Lack of social support
Certain personal characteristics can also elevate someone’s risk for stress. These include having:
a very introverted personality - this is not problematic in and of itself, if the person maintains a good balance between the alone-time they need and social interaction; the problem comes if they start to become withdrawn and isolate themselves…
a generally negative and pessimistic outlook on life, and
a history of previous psychiatric illness.

17. multiple chronic stressors better predictor of higher stress levels
Source: Headington Institute
Risk Factors for Stress
The presence of
multiple chronic stressors
is often a
better predictor of higher stress levels
than the occurrence of an
occasional critical incident
It’s important to note that the presence of multiple chronic stressors is often a better predictor of higher stress levels than the occurrence of the occasional critical incident. This means that a sequence of relatively mild stressful events can ultimately create high stress levels if they are not dealt with effectively on an ongoing basis.

18. Stress & Human Functioning
Source: Headington Institute
Stress & Human Functioning
Stress becomes distress if:
- it lasts too long,
- occurs too often, or
- is too severe
Remember that stress is the result of a demand or change that a person must meet and respond to. Stress is a part of normal life. Without physical and emotional challenges, life would be boring. However, stress becomes distress when it lasts too long, occurs too often, or is too severe.

19. Stress & Human Functioning
Source: Headington Institute
Stress & Human Functioning
Intended performance
Fatigue point X
Performance
Actual performance
Exhaustion
If we look at the effects of stress on how humans function, it should be noted that a low level of stress is useful – it can help motivate us to get things done! The goal is to stay within this optimal zone, where the demands on you help to increase your performance.
If you go too far, however, stress will start to affect you negatively. Additional demands will start to decrease rather than increase your productivity -- though you may not realize it at first.
If you continue to push, you will start to become exhausted and eventually, you will start to become sick. If this path isn’t reversed, you may eventually break down…
The further you go along the negative portion of this spectrum, the longer it will take you to recover!
Potential Exercise:
Put an x along this curve based on where you think you are along the continuum.
Challenge of self-assessment
Goal is to operate in the optimal zone.
Healthy tension
Ill health
Breakdown point
Demands/Stress

20. Promoting Personal Resilience
Source: Headington Institute
Promoting Personal Resilience
Be Aware of what’s getting to you & how those issues are affecting you
Seek Balance among:
work, rest & play
time alone & time with others
giving & receiving
Connect with people (friends, family, co-workers) you trust, respect, care about
So what can you do to prevent this?
There are steps you can take to manage your stress and increase your resilience – which is your ability to withstand and rebound from challenging events or circumstances.
The first, is to be aware of the things that may be causing you stress and how you’re reacting to them. What signs of stress are you feeling and where are you on the stress graph?
The next is to seek balance… between work, rest & play; time alone & time with others; giving and receiving.
And finally Connect with people (friends, family, co-workers) you trust, respect and care about.

21. Promoting Personal Resilience
Source: Headington Institute
Promoting Personal Resilience
Physical:
Exercise, Sleep, Hydration, Healthy Diet
Emotional:
Personal space,
Social support
Mental: Develop job competencies, Positive attitude
Spiritual:
Find meaning & purpose, Practice gratitude
We can look at the different ways in which stress affects you and how you can combat each.
Physically – it’s good to exercise! For your body, this mimics what you would do in a fight or flight situation and helps to bring the hormones released by stress back to normal levels. You should also take care of yourself. Get enough sleep, stay hydrated and eat a healthy diet.
On the mental side – one of the major stressors people face is that circumstances are so different from what they are used to, and they’re not sure what to do… this undermines their confidence. A way to combat this is to be open to learning and developing your competencies in your job. When you’re not sure what to do, ask your supervisor or colleagues with more experience for advice. Having this sense of being part of a team can also assist in developing and maintaining a positive attitude.
On the emotional side – people differ quite a bit on whether they get more energy from “alone time” or from interactions with others. Try to find your balance… Connect with people that can help you process what you’re going through on a daily basis, as well as take a break from it entirely – to think about other things and let go of the thoughts that may be stressing you, even if just temporarily.
And on the spiritual side, it will help to find the meaning and purpose in what you are doing and be grateful for the things that are going well, no matter how small.
All of this can be very difficult to do in an emergency response –but you can’t forget to take care of yourself & support your co-workers in doing the same…
If you don’t, it will eventually take a toll on you personally, your team, and the work you are trying to carry out.

22. RED FLAG Critical Stress Reactions
Source: Headington Institute
RED FLAG Critical Stress Reactions
In some circumstances, a person’s resilience will be overwhelmed… they’ll begin to approach a breaking point.

23. RED FLAG Critical Stress Reactions
Source: Headington Institute
RED FLAG Critical Stress Reactions
Statements indicating possible self-harm, suicide or harm to others
Threatening or violent behavior
Angry outbursts
Increase in substance abuse
Increase in reckless behavior (thrill-seeking)
Inability or refusal to speak
Frequent weeping
Substantial loss of weight
Dramatic increase in fatigue/falling asleep at work
Dramatic decrease in productivity or competence
Pronounced indecisiveness
The most common signs of someone experiencing critical-level reactions to stress are:
Statements indicating possible self-harm, suicide or harm to others;
Threatening or violent behavior;
Angry outbursts;
Increases in substance abuse – such as drugs, alcohol or food;
Increases in reckless behavior, such as disregarding security protocols and basic safety precautions or gambling;
An inability or refusal to speak;
Frequent weeping;
A substantial loss of weight;
Dramatic increases in fatigue or falling asleep at work;
Dramatic decreases in productivity or competence; and
Pronounced indecisiveness

24. RED FLAG Critical Stress Reactions
Source: Headington Institute
RED FLAG Critical Stress Reactions
Someone exhibiting these reactions
needs additional help
immediately
Someone exhibiting any of these reactions will need additional help immediately!! They should be assisted in obtaining the support they need…

25. Addressing Critical Stress Reactions
For Yourself:
Be aware of your stress levels & know if nearing critical stress
Seek psycho-social support (PSS)
friends & family
Headington Institute or local counseling options
Remove yourself from the context causing elevated stress
short term: short assignment elsewhere, take some leave
long term: permanent reassignment
Share issues with senior management, if stress is due to organizational factors
For yourself --
be aware of your stress levels; know what gets to you, and when you are nearing critical stress
If you feel this is beginning to happen, seek psycho-social support – either from friends and family, or from professional counseling services. Headington Institute is contracted by CRS headquarters to provide psycho-social support to staff, and is available either by telephone or online at any time. Local counselling options are also often available in country; country program management should be able to support you in accessing these services.
You may need to remove yourself from the context that is causing your elevated stress. A short break might be enough – in this case, you might request a temporary assignment to another office, project or department, or take some of your leave. In an emergency, the Country Program will often have special R&R or compensation time policies in place, to give staff time to rest and recharge. You might find, however, that you cannot return to this situation after a short break… in this case, you should work with your supervisor to look at longer-term options, such as reassignment. If necessary, also look into getting more intensive psycho-social support.
And finally, share issues with senior management if your stress was primarily due to organizational factors. This may help management identify and address problem areas, which in turn will reduce stress for you and your colleagues. If you don’t feel comfortable talking to your supervisor, you can reach out to other members of the senior management team.

26. Addressing Critical Stress Reactions
For Your Colleagues:
If you see something, say something
If you see early signs & symptoms of stress, encourage the person to:
give themselves a break from the situation &
seek psycho-social support
If you see critical stress reactions in a colleague, let a manager know of your concerns immediately
If a colleague or coworker is exhibiting stress reactions, remember: if you see something, say something. If you see symptoms of stress relatively early, before they reach a critical level, you might want to approach the person directly…. If you don’t know them that well, you might want to ask one of their friends or close colleagues to talk to them instead. If your country program has anyone trained in psychological first aid, they would also be a good resource.
If you’re engaging directly with the person, mention your concerns and listen to what they say. Encourage them to take a break from the situation and to reach out for psycho-social support.
If your colleague starts to exhibit critical stress reactions, their wellbeing as well as the wellbeing of others may be at stake. Let someone more senior – a supervisor or manager – know your concerns about your colleague immediately.
The second presentation on staff care will discuss what CRS can do, on an organizational level, to help support staff in managing stress and assisting people experiencing burnout or critical stress reactions.

27. Resources Headington Institute CRS Safe & Sound Manual
CRS Safe & Sound Manual
Emergency Field Operations Manual
- EROS
- HR section
The Headington Institute website is an excellent resource on stress and personal resilience, while the CRS Safe & Sound Manual and Human Resources section of the Emergency Field Operations Manual can provide additional information on staff safety and wellbeing.
And if you need more guidance or support, please don’t hesitate to reach out to the HRD!

28. With thanks to the Headington Institute
Acknowledgements
With thanks to the Headington Institute
for providing information & graphics on stress, stress management and resilience
And we’d like to end with grateful acknowledgement to Headington Institute, for providing the information and graphics concerning stress, stress management and resilience, used in these staff care presentations.