Trauma through Natural Disasters & Rescue Relief work

Traumatic Experiences are often associated with things such as childhood abuse, rape or sexual assault or being a victim of violent crime. However, one Traumatic Experience which can affect many people at the same time, is that of Trauma through Natural disaster eg: earthquakes, tornados or hurricanes, forest fires, floods, volcanic eruptions, landslides, or tsunamis. These types of experiences are particularly insidious because they tend to traumatize large populations of individuals at once, and can result in Survivor Guilt and other PTSD symptoms.

Trauma through Natural disaster, can be unforeseen, sudden and overwhelming. The most immediate and typical reaction to such a traumatic experience is shock, which at first may manifest as numbness or denial. Quickly—or eventually—shock can give way to an overemotional state that often includes high levels of anxiety, guilt or depression.

Natural disaster can leave people grieving the loss of their loved ones or their homes and communities. As a result, Survivors of natural disaster may feel helpless, they may have to live in temporary accommodation, camps or shelters without support from relatives or friends for extended time periods. However, living with other survivors can also be a time to reconnect, talk about the event with others, and help to reframe the event. Being able to help another survivor can reduce helplessness, and may start the healing process.

Natural disasters in particular can bring victims a feeling of being betrayed by "their god," which can result in a loss of faith.

The following are often feelings and signs of trauma through natural disaster:

Feelings become intense, and unpredictable. Irritability, mood swings, anxiety, and depression are common manifestations of this.
Flashbacks: repeated and vivid memories of the event that lead to physical reactions such as rapid heartbeat or sweating
Confusion or difficulty making decisions
Sleep or eating issues
Fear that the emotional event will be repeated
A change in interpersonal relationships skills, such as an increase in conflict or a more withdrawn and avoidant personality
Physical symptoms such as headaches, nausea, and chest pain

Some Survivors of Natural Disaster may be fine and overcome their experience with time, without developing PTSD, whilst others do go on to suffer the symptoms of trauma and develop PTSD as a result. It's hard to predict if or when PTSD may set in with a survivor of a traumatic natural disaster. Some victims seem at first perfectly (or even abnormally) fine, only to be beset with symptoms later on.

In general, survivors of natural disasters are recommended to seek professional guidance if they find themselves unable to regain control of their lives or if they continue to suffer from PTSD symptoms for more than a month.

It's very important with natural disaster trauma that the victim gives himself time to heal and pass through an appropriate mourning process. Only by processing the experience over a realistic period of time is healing possible.

During and after a disaster it is natural to experience a wide array of very differing and strong emotions. Connect with family, friends and others who were affected in your community. Take care of yourself and of each other, and know when and how to seek help. Coping with these feelings and getting help when you need it will help you, your family, and your community recover from a disaster.

An increasing number of relief, rescue and natural disaster workers are finding themselves unable to escape the horrors they have experienced, and are struggling with PTSD/C-PTSD. More awareness needs to be created about the effects on those who are often seen as hero's at a time of national disaster, and its important also for the organisations supplying workers, to seriously consider the factors affecting their project personnel. Someone must be able to spot the danger signals at an early stage, and help exposed individuals and those at risk of developing PTSD to manage and cope with their experiences.

Relief workers today are faced with situations which generate more stress than straightforward natural disasters. This happens in a context in which the usual support mechanisms of family, partner or close friends are absent. Furthermore, the culture in the humanitarian community which may be one of bravado and competition in emergency situations does often not allow the space for discussing issues such as psychological stress.

Despite mounting anecdotal evidence that stress and its consequences are key occupational health hazards, humanitarian agencies are under pressure to move quicker to help minimise the risks to the psychological well-being of their staff, whether they are expatriate or local.

Some common problems

Some of the common stress-related problems seen in relief workers include burnout, psychosomatic disorders, and risk-taking behaviour such as alcohol abuse and drug abuse. Unlike domestic rescue workers who are periodically exposed to short stressful events, relief workers may suffer exposure to chronic low levels of stress by, for example, residing in insecure environments for many years. It is in this setting that stress may be cumulative.

Burnout is probably the most commonly used lay term associated with cumulative stress. It is a process that is usually gradual in onset. Symptoms can be grouped into five categories:

physical: fatigue, emotional and physical exhaustion, sleep difficulties, and non-specific physical symptoms such as headaches and gastro-intestinal disturbances;

emotional: irritability, anxiety, depression, guilt, a sense of helplessness; iii. behavioural: aggression, callousness, cynicism and substance abuse;

work-related: tardiness, absenteeism, poor performance;

interpersonal: withdrawal, poor communication, distancing self from situation and beneficiaries.

Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are psychiatric diagnoses related to exposure to severe traumatic stressors such as a direct assault or abduction (primary traumatisation) or witnessing the death or abduction of a colleague (secondary traumatisation). The phenomenon of tertiary traumatisation is also increasingly recognised. Examples include being witness to mass violence or listening to first hand accounts of traumatised people.

ASD appears relatively quickly after exposure to a particular stressor and, by definition, resolves within a month. It includes a spectrum of emotional reactions, cognitive changes such as confusion, and symptoms of mental and physical hyperactivity. PTSD symptoms appear from one month to three months after a given event. Symptoms usually involve flashbacks to the events and a state of being hyper-alert. Symptoms may become chronic and extremely debilitating.

In their attempt to find a new internal equilibrium, relief workers may also respond to unresolved stress with more subtle behavioural changes. One such reaction has been termed 'enmeshment' and is akin to survivor guilt with an over identification with the beneficiary population. This reaction may be more common in the younger, more idealistic relief worker. By contrast, avoidance reactions of distancing, withdrawal and denial may be more common among experienced personnel. Finally, relief workers may exhibit self-destructive behaviours such as working to the point of exhaustion, consuming excessive amounts of alcohol, or engaging in unprotected sexual encounters. Psychiatrists term this a dissociative response; the individual feels distant from his/her previous self and environment in which he/she may have acted more cautiously.

Problems exacerbated by the humanitarian sector

Many of these problems may be exacerbated by factors particular to the humanitarian sector. For example, relief workers do not usually benefit from being in a well-trained, tightly knit unit with a clear command structure. In addition, training and briefing, particularly with regard to psychological issues, is generally inadequate. This is particularly pertinent for those organisations which deploy a high proportion of first assignment volunteers. Third, aid workers are often called upon to perform duties outside their realm of professional competency and experience. Finally, there is the pressure when the drive to ensure the visibility of their own organisation may over-ride questions of the appropriateness or quality of interventions.

Two other issues deserve mention because they are relatively modern sources of tension in the humanitarian sector. First is the pressure of discovering that one's internal mandate in terms of personal ethics and preferred approach does not match the mandate of a particular organisation. Second is the changing culture of humanitarian work. Organisations are more self-critical than previously and are increasingly putting resources towards evaluating their activities. Inevitably external criticism, even if constructive, leads to a re-assessment of an individuals perception of his/her own effectiveness. The latter is particularly true if individuals have an unrealistic expectation of what they may achieve under any given circumstance.

To improve things, an individual has three levels of resources personal, social and organisational at his/her disposal with which to tackle demands. Organisations should seek to strengthen these resources wherever possible.

Unfortunately, humanitarian emergencies are becoming more common. Concurrently the humanitarian sector is becoming larger and more professional, and we are seeing a new type of professional: the career relief worker. These environments, however, are not ordinary work places; they expose individuals and organisations to new dilemmas and new challenges. Staff turnover is high and burnout is common. Perhaps the crucial element in the achievement of the humanitarian goal today is the development of a stable and experienced workforce whose energies are effectively harnessed through more enlightened organisational policies. When seen in this light, the psychological support of relief workers is simply part of the employer's duty and responsibility. It is not an optional extra

Disaster Rescue and Response Workers - Bruce H. Young, LCSW, Julian D. Ford, PhD, and Patricia J. Watson, PhD

The terrorist attacks on New York and Washington are, together, the greatest man-made disaster in America since the Civil War. Lessons learned from natural and human-caused disasters can help us understand the unique stressors faced by rescue workers such as police and firefighters, National Guard members, emergency medical technicians, and volunteers. Past experience may also help us recognize how these stressors may affect response workers. Rescue workers face the danger of death or physical injury, the potential loss of their coworkers and friends, and devastating effects on their communities. In addition to physical danger, rescue workers are at risk for behavioral and emotional readjustment problems.

What psychological problems can result for rescue workers following disaster experiences?

The psychological problems for workers that may result from disaster experiences include:

Emotional reactions: temporary (i.e., for several days or a couple of weeks) feelings of shock, fear, grief, anger, resentment, guilt, shame, helplessness, hopelessness, or emotional numbness (difficulty feeling love and intimacy or difficulty taking interest and pleasure in day-to-day activities)

Cognitive reactions: confusion, disorientation, indecisiveness, worry, shortened attention span, difficulty concentrating, memory loss, unwanted memories, self-blame

Physical reactions: tension, fatigue, edginess, difficulty sleeping, bodily aches or pain, startling easily, racing heartbeat, nausea, change in appetite, change in sex drive

Interpersonal reactions in relationships at school, work, in friendships, in marriage, or as a parent: distrust; irritability; conflict; withdrawal; isolation; feeling rejected or abandoned; being distant, judgmental, or over-controlling

What severe stress symptoms can result for disaster workers?

Most disaster rescue workers only experience mild, normal stress reactions, and disaster experiences may even promote personal growth and strengthen relationships. However, as many as one out of every three rescue workers experience some or all of the following severe stress symptoms, which may lead to lasting Posttraumatic Stress Disorder (PTSD), anxiety disorders, or depression:

Dissociation (feeling completely unreal or outside yourself, like in a dream; having "blank" periods of time you cannot remember)
Intrusive reexperiencing (terrifying memories, nightmares, or flashbacks)
Extreme attempts to avoid disturbing memories (such as through substance use)
Extreme emotional numbing (completely unable to feel emotion, as if empty)
Hyperarousal (panic attacks, rage, extreme irritability, intense agitation)
Severe anxiety (paralyzing worry, extreme helplessness, compulsions, or obsessions)
Severe depression (complete loss of hope, self-worth, motivation, or purpose in life)
Who is at greatest risk for severe stress symptoms?

Rescue workers who directly experience or witness any of the following during or after the disaster are at greatest risk for severe stress symptoms and lasting readjustment problems

Life threatening danger or physical harm (especially to children)
Exposure to gruesome death, bodily injury, or dead or maimed bodies
Extreme environmental or human violence or destruction
Loss of home, valued possessions, neighborhood, or community
Loss of communication with or support from close relations
Intense emotional demands (such as searching for possibly dying survivors or interacting with bereaved family members)
Extreme fatigue, weather exposure, hunger, or sleep deprivation
Extended exposure to danger, loss, emotional/physical strain
Exposure to toxic contamination (such as gas or fumes, chemicals, radioactivity)
Studies also show that some individuals are at a higher than typical risk for severe stress symptoms and lasting PTSD if they have a history of:
Exposure to other traumas (such as severe accidents, abuse, assault, combat, rescue work)
Chronic medical illness or psychological disorders
Chronic poverty, homelessness, unemployment, or discrimination
Recent or subsequent major life stressors or emotional strain (such as single parenting)
Disaster stress may revive memories of prior trauma and may intensify preexisting social, economic, spiritual, psychological, or medical problems.

How can you manage stress during a disaster operation?

Here are some ways to manage stress during a disaster operation:
Develop a "buddy" system with a coworker.
Encourage and support your coworkers.
Take care of yourself physically by exercising regularly and eating small quantities of food frequently.
Take a break when you feel your stamina, coordination, or tolerance for irritation diminishing.
Stay in touch with family and friends.
Defuse briefly whenever you experience troubling incidents and after each work shift.
How can you manage stress after the disaster?

After the disaster:
Attend a debriefing if one is offered, or try to get one organized two to five days after leaving the scene.
Talk about feelings as they arise, and be a good listener to your coworkers.
Don't take anger too personally - it's often an expression of frustration, guilt, or worry.
Give your coworkers recognition and appreciation for a job well done.
Eat well and try to get adequate sleep in the days following the event.
Maintain as normal a routine as possible, but take several days to "decompress" gradually.
How can you manage stress after returning home?

After returning home:
Catch up on your rest (this may take several days).
Slow down. Get back to a normal pace in your daily life.
Understand that it's perfectly normal to want to talk about the disaster and equally normal not to want to talk about it; but remember that those who haven't been through it might not be interested in hearing all about it - they might find it frightening or simply be satisfied that you returned safely.

Expect disappointment, frustration, and conflict - sometimes coming home doesn't live up to what you imagined it would be - but keep recalling what's really important in your life and relationships so that small stressors don't lead to major conflicts. Don't be surprised if you experience mood swings; they will diminish with time. Don't overwhelm children with your experiences; be sure to talk about what happened in their lives while you were gone. If talking doesn't feel natural, other forms of expression or stress relief such as journal writing, hobbies, and exercise are recommended. Taking each day one at a time is essential in disaster's wake. Each day provides a new opportunity to FILL-UP:

Focus Inwardly on what's most important to you and your family today.
Look and Listen to learn what you and your significant others are experiencing, so you'll remember what is important and let go of what's not.
Understand Personally what these experiences mean to you, so that you will feel able to go on with your life and even grow personally.

https://www.ptsd.va.gov/professional/treatment/early/disaster-rescue-response.asp