1. 11:20 am - You are contacted about a school bus which has rolled off the road on I-80 east of Buford, WY and landed upside down, trapping all passengers inside. Passengers are 50 teenagers and two adults. What actions do you take?
2. You are on duty at the hospital when the call comes about the bus accident. The bus was headed toward Laramie. The call comes in that you will be receiving casualties and a disaster alert is sent throughout the hospital. Develop a disaster plan of action for physicians, nurses, and mental health teams.
3. Casualties begin arriving and only then do you realize how serious the accident has been. The teenagers are members of the school choir at Central Nebraska High School. They had been heading for a weekend with their counterparts in Laramie. Their trip terminated about 15 miles short of its destination, with 28 people dead and 24 critically injured.

• Someone will have to identify the accident victims. None of them are able to speak and not everyone has identification on their person.

• Where do families go to obtain information about the condition of family members, since victims were distributed to three hospitals and a morgue? Who will inform the parents of their child's condition? Who will help the family begin to make plans for the immediate future?

• There is a need for shelter and food for the families if they stay overnight.

• Emotional support for family members is needed. Someone will have to be with the family when they are told of the condition of their child, for it will be a time of extreme anxiety and grief.

• Acute crisis intervention is needed to manage shock and grief reactions.

Since all persons involved are either dead or in critical condition, none of the families will be receiving "good news". It is anticipated that 50 to 100 family members will be arriving in Laramie shortly and they will be asking, "How is my child?" "Where is my child?"

1. You receive word that families are being directed to a central disaster area located in Laramie where all information regarding the whereabouts and condition of their children is being centralized. Two Disaster Mental Health Professionals have gone to the disaster center to evaluate what arrangements have been made and what assistance the rest of our mental health personnel can provide. Several nurses from the county health department, clergymen, and many Red Cross workers have volunteered to assist families at the center. However, more manpower is needed so that each family member can have, if at all possible, at least one mental health professional to meet and stay with them throughout the ordeal, or at least until each family is settled for the night. What actions do you take to accomplish this?
2. When the families arrive at the disaster center, they register at the door giving their name, address, phone number, religious preference, name of their child, and whether they will require housing for the night. At this point, a mental health professional and/or clergyman introduces him/herself and remains with them.

The family is told by the deputy coroner if their child is dead or in the hospital. If the child is alive, the family is sent on to the appropriate hospital. Mental health professionals escort such families to the hospital where another mental health team is waiting to provide help.

Those families whose child - in one case children - is/are dead have to go through the painful process of answering questions, making funeral arrangements, and, in some instances, viewing the body and gathering their child's personal belongings. How do you help families get through this process?

3. The feelings of pain and grief are intense at the center. Local families offer their homes to the stricken families for the night, and bring homemade food for them and the volunteers. Telephones are installed to enable families to call relatives and friends.

Amidst the physical activity in the disaster center, the grief work for the families begins. Families arrive after driving 200 miles to the disaster center hoping that their child is alive, but with a gnawing fear that their child is one of the 28 dead. They answer questions, their body postures tense, eyes red from crying, and then they usually whisper "Is she…, is he…dead? And the answer is, all too often, "Your son…, your daughter is dead." Then the shock and pain.

Most people cry, holding each other as the anguish and realization goes deeper into their being. A few cry out in grief and begin to run until embraced and held tightly by their spouse or a friend or worker.

The mental health team works with the families, encouraging them to cry, to express the depth of their pain. Places are found for family members to sit together so that they can share their grief and support and lean on each other. Mental health professionals hold and touch grievers, which helps them. This simple gesture frees the family members who usually play a supportive role to cry and find comfort for themselves.

You listen to families talk of their dead children over and over again. They keep repeating comments such as "I just saw her this morning?" "We were saving our money to go skiing together." :"She was so good; she went to church every week." :He was going to be a lawyer." "I'll never see her again." How do you respond? How do you deal with this for yourself? How do you help your fellow workers deal with this?

4. In the midst of their shock and distress, the families have to answer questions for the coroner's office and make preliminary funeral arrangements. How do you help the families answer questions and guide them through various activities?
5. Families ask "Did he suffer?" "Is her face smashed?" It is important to answer these questions when they arise. Some parents may not be ready to deal with issues such as funeral arrangements and viewing the body. How do you intervene to assist the family with this?
6. Although the bodies have already been identified by the choir director, the families are asked if they want to view their child's body. Some families are reluctant to do so, being afraid that the body is marred. Some say that they want to remember their child as he/she was last seen. When this happens, how do you respond? How do you assess the situation?
7. One family refuses to see their daughter's body. One mental health professional then tells the family that she is worried that they would later wonder if their child was really dead. The family agrees that this could happen. What do you as a mental health professional do next?
8. You assess the grief reactions of the families for potential complications. In some families there may be a single family member who shows little emotion. The danger for such a person is a delayed or repressed grief reaction which might later express itself through psychosomatic disease or depression. What do you do to help stimulate discussion by these families in order to encourage an accompanying emotional response?
9. You are concerned about those people who do not express grief directly, but spend time and energy helping others. A possibility is that these people are doing for others what they want done for themselves, and by focusing on others, they are not experiencing their own grief. What are some of the dangers in this reaction? How do you handle this with them?
10. Another reaction which concerns you is an extreme and profound expression of guilt. "I killed her - if I hadn't been gone, she would be alive! She wouldn't have been in the choir if I hadn't left. I killed her - it's all my fault." How would you intervene to deal with this?
11. Follow-up is provided for those families who appear to be at high risk in terms of having difficulty beginning grief work. How do you accomplish this?
12. Because of the tragic nature of the accident and the intensity of emotion involved, the staff at the disaster center has to deal with their own reactions as well. These reactions parallel those of the families, although they may be less intense. At times, staff had tears streaming down their faces as they comforted family members. Staff began comforting one another with a hand on a shoulder or an embrace. Most talk of feeling numb and describe feeling like a sponge that soaked up the pain and grief of others until a saturation was reached. How do you debrief the staff and help them deal with their feelings?
13. For the next couple of days, several staff members experience dreams and vivid visual images of the day's experiences. The staff are aware of feelings of inadequacy and helplessness. They find themselves thinking of their own children and loved ones. No one remains untouched. What follow-up do you provide for staff? How do you deal with your own personal reactions and feelings?
14. What do you do to respond to ongoing concerns over the ensuing months and even years following this tragedy? What about anniversaries?