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)
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)
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.
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