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Common stresses experienced by everyone can sometimes trigger emotional memories of stressful events, including all of the accompanying physiological responses 



Common stresses experienced by everyone can sometimes trigger 
emotional memories of stressful events, including all of the accompanying physiological 
responses. Prolonged stress (e.g. divorce, the end of a relationship, a hostile workplace, 
death of a loved one) can trigger elements of PTSD.

Consider the following scenario. You awaken refreshed and happy. You relax over coffee 
and breakfast while reading the morning paper. As a bright sun lights up your kitchen, you 
feel happy and secure. You leave for work. Your workplace is a hostile environment. 
Day after day your boss disparages you inappropriately. Your job is in jeopardy because 
of downsizing. There is an  inadequate infrastructure to support your productivity. Physical 
surroundings are noisy and cramped. You are not valued for your full worth. Your mood 
gradually deteriorates as you drive closer to your office. You become increasingly more 
tense the closer you get. You experience a rush of  anxiety as you enter the parking lot. 
You feel mildly flushed and your heart rate increases. On top of all this, there are no parking 
spots because the company policy reserves spots only for those of higher rank. However, you 
park there anyway, knowing that when you return at the end of the day there will be a parking 
ticket on your windshield. As you leave your car and  walk towards the office, you feel anxious, 
angry. demoralized and you dread the start of the work day.

Another example might be one in which you work on a  job you love. You work in a clean,
airy office with supportive co-workers and boss, enthusiastic management which values its 
workers. However, home life is falling apart. You are in the middle of a nasty divorce from
a controlling spouse, someone who has emotionally or physically abused you during
the marriage. For months, day after day, your soon-to-be ex-spouse's attorney who is 
kown as a pitbull divorce attorney, a basher who takes pride in destroying lives rather than
salvaging what may be left of the family's spirit, uses grinding tactics to wear you down. He
uses repeated  questions designed to trap you and to set you up against  yourself. He waits 
a few days, then escalates the legal demands, threatening subpoena and depositions. His 
threats come in waves. As soon as you regain some balance, he hits you again. As a result, 
you feel like one of those inflatable, plastic punching toys that is slapped down the moment 
it pops up again. The threat this attorney is using to try to break your spirit is loss of 
custody of your children. As the target of these attacks, you might experience flushing, 
palpitations, an urgency to defecate every time the phone rings or when a letter is delivered 
to your door. You might have repeated nightmares about losing your children, searching for 
them and not finding them. You might wake up in a cold sweat and even continue to 
experience such physical symptoms and anxiety long after the divorce is over and a 
settlement reached.

These are some of the elements of PTSD which you might experience. The trigger for such 
symptoms doesn't have to be very complex, especially if the initial event was severe enough. 
A single visual element can sometimes expose a piece of memory which evokes a physiological 
response. Something as innocent as a lawn marker for a house address (e.g. a gray stone with 
the address  painted on it) may, following the death of a loved one, remind one of a grave 
stone. For a few transient seconds it brings on a rush of hormones and despondent feelings 
experienced when the loved one died.

Situations do not have to entail the risk of life to be real and potent stressors. Conversely, 
an incident that involves risk of life may not necessarily be perceived by everyone as a 
major stress. Within hours of the Northridge, California earthquake immune and hormone 
responses were measured in people who had been at the earthquake epicenter. While 
some individuals seemed to respond with high stress and low immune responses, others 
did not.

Stress can cause sickness because hormones and nerve pathways which are activated by the 
stress change the way the immune system responds. It becomes less able to fight off invaders. 
Genetics and perceptions of the event also play important roles. Some people are high stress 
responders and others are low. We do have control over how we perceive events. We can 
learn how to tone down physiological responses to stress. By doing so, we can minimize the 
effects of stress on disease. Memories of what was or what should have been play an additional 
role along with learning.

In addition to the above stressful situations, there is another element that contributes to 
perceived stress. Interpersonal relationships in some cases contribute to job stress and in 
others may buffer us from it. These relationships can be the most powerful stressors most 
people encounter in their working lives.

Coping With Stress – Guidelines For Workers

One of the most important keys to managing stress in yourself is by first deciding if you want to be a "sprinter" where you work very hard for a short period of time and then burn out, or a long distance runner". In order to be able to work effectively and stay healthy on disaster assignments, you must develop good stress management skills. Don’t think, "I should manage my stress," and then ignore the signals as they appear. You must learn to take conscious steps to manage stress on the job in order to remain an effective member of the disaster response team.

How do you know when you or others are stressed? What suggestions do you have to help workers deal with stress? The following are some examples:

 

 

  • Watch workers functioning; the person watching can be the worker himself, a mental health professional, a peer working in a buddy system, or a supervisor.

  • Breaks should be scheduled regularly when possible, or when function is impaired.

  • Breaks should be taken away from the area so the worker is not reminded of the scene and is not interacting with the victims.

  • Sleep breaks must be scheduled; otherwise they may not be taken.

  • Workers should talk and share experiences with friends and colleagues as a way to let off steam. Included in this is "disaster humor".

  • Recreational and leisure activities should be encouraged away from the disaster area to avoid constant reminders of the event.

 

Workers who are away from their home area or who will not be able to return home for an extended period of time, should be encouraged to bring personal items from home with them, and to call home often.

 

INTERVENTIONS DURING A DISASTER

Team Managers

The following are suggestions for team managers:

  • During the Alarm Phase, provide workers with as much factual information as possible about what they will find at the scene. Provide this information via radio communications or in the form of a quick briefing as new personnel arrive at the scene. This forewarning can help personnel gear up emotionally for what they may find.

  • Try to get information for workers about the location and well-being of their family members.

  • Remember that early identification and intervention of stress reactions is the key in preventing worker burnout. Review lists of stress symptoms. Remember that multiple symptoms in each category indicate that worker effectiveness is diminishing.

  • Use mental health assistance in field operations if plans have been made to do so. Mental health staff can observe workers’ functioning, support workers, and give advice to command officers about workers’ fatigue levels, stress, reactions, and need for breaks.

  • Check in with workers by asking, "How are you doing?" Assess whether verbal response and worker’s appearance and level of functioning jibe. For example, workers may say they are doing "fine", but may be exhibiting multiple stress symptoms.

  • Try to rotate workers among low-stress assignments (such as staging areas), moderate-stress assignments, and high-stress tasks.

  • Limit workers’ time in high-stress assignments (such as triage or morgue) to an hour or so at a time, if at all possible. Provide breaks, rotation to less stressful assignments, and personal support.

  • Ask workers to take breaks if effectiveness is diminishing. Order them to do so if necessary. Point out that the worker’s ability to function is diminishing due to fatigue, and that you need him/her functioning at full potential to assist with the operation. Allow worker to return to the scene if he/she rests and functioning improves.

  • On breaks, try to provide workers with the following:

§ Bathroom facilities

  • A place to sit or lie down away from the scene with quiet time alone

  • Food and beverages

  • Shelter from weather, dry clothes. Etc.

  • An opportunity to talk about their feelings – coworkers, chaplains, or mental health staff can assist

Workers

The following are suggestions for workers for management of stress during a disaster operation:

  • Develop a "buddy" system with a co-worker. Agree to keep an eye on each other's functioning, fatigue levelm and stress symptoms. Tell the buddy how to know when you are getting stressed. For example: "If I start doing so-and-so, tell me to take a break."

Make a pact with the buddy to take a break when he/she suggests it, if the situation and command officers allow.

  • Encourage and support co-workers. Listen to each other's feelings. Don't take anger too personally. Hold criticism unless it's essential. Tell each other "You're doing great" and "good job". Give each other a touch or pat on the back. Bring each other a snack or something to drink.

  • Try to get some activity and exercise.

  • Try to eat frequently, in small quantities.

  • Humor can break the tension and provide relief. Use it with care, however. People are highly susceptible in disaster situations. Victims or co-workers can take things personally and be hurt if they are the brunt of "disaster humor".

  • Use positive "self-talk", such as "I'm doing fine" and "I'm using the skills I've been trained to use."

  • Take deep breaths, hold them, then blow out forcefully.

  • Take breaks if effectiveness is diminishing, or if asked to do so by commanding officer or supervisor.

  • On long assignments away from home, remember the following:

» Try to make your living accommodations as personal, comfortable, and homey as

possible. Unpack bags and pull out pictures of loved ones.

» Make new friends. Let off steam with co-workers.

» Get enough sleep.

» Enjoy some recreation away from the disaster scene.

» Remember things that were relaxing at home and try to do them now. Take a hot

bath or shower, if possible. Read a good book. Go for a run. Listen to music.

» Stay in touch with people at home. Write or call often. Send pictures. Have family

visit if at all possible and appropriate.

» Avoid excessive use of alcohol.

» Keep a journal. This will make a great story for grandchildren.

 

INTERVENTIONS FOLLOWING A DISASTER

Team Leaders

The following are some things for team leaders to consider following a disaster:

  • Arrange a debriefing for all workers involved in the disaster.

  • Line personnel should have an opportunity to participate in a critique of the event. Often, a critique is limited to officers and supervisors. However, line staff participation can assure that workers are recognized for their contribution to the operation. Additionally, their viewpoints are valid and valuable input toward improving operations the next time around.

  • Formal recognition by the organization of a worker's participation in a disaster operation can mean a lot. A letter in the individual's personnel file, or a certificate of appreciation for contribution to an unusual and important job, lets the worker know that his/her participation meant something. Workers who remained at the office or station "minding the store" during the disaster should also receive recognition. Their contribution was also essential.

  • Managers and supervisors should plan for the letdown their staff may experience. Discuss stress reactions in a staff meeting and emphasize that they do not imply weakness or incompetence. It is similar to being wounded in action.

 

  • If workers' reactions are severe or last longer than 6 weeks, encourage them to use professional assistance. Again, this does not imply weakness. It simply means that the event was so traumatic that it has had a profound effect on the individual.

 

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